Skip to main content

Full text of "California and western medicine"

See other formats 


\ 


Digitized  by  the  Internet  Archive 
in  2017  with  funding  from 

The  National  Endowment  for  the  Humanities  and  the  Arcadia  Fund 


https://archive.org/details/californiawester32unse 


Annual  Session  California  Medical  Association,  Del  Monte,  April  28-May  1,  1930 
Annual  Session  American  Medical  Association,  Detroit,  Michigan,  June  23-27,  1930 


L5' 

& 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and  Published  l Monthly  by  the  California  ^Medical  (^Association 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUME  XXXII 
NUMBER  1 


JANUARY  . 1930 


50  CENTS  A COPY 
S5.00  A YEAR 


CONTENTS  AND  SUBJECT  INDEX 


SPECIAL  ARTICLES: 

Intestinal  Obstruction.  By  V.  R.  Mason, 

Los  Angeles 1 

Discussion  by  Charles  D.  Lockwood,  Pasa- 
dena; William  J.  Kerr,  San  Francisco;  Lovell 
Langstroth,  San  Francisco. 

Medical  Care  of  Peptic  Ulcer.  By 

Howard  R.  Hartman,  Rochester, 
Minnesota  5 

Pulmonary  Tuberculosis.  By  F.  M. 

Pottenger,  Monrovia 9 

Discussion  by  Philip  H.  Pierson,  San  Fran- 
cisco; William  C.  Voorsanger,  San  Francisco; 

A.  L.  Bramkamp,  Banning. 

The  Teaching  of  Perineal  Prostatec- 
tomy. By  Frank  Hinman,  San  Fran- 
cisco   13 

Discussion  by  Ralph  Williams,  Los  Angeles ; 

R.  L.  Rigdon*  San  Francisco;  Robert  V.  Day, 

Los  Angeles. 

The  Child  Who  Will  Not  Eat.  By 

Henry  E.  Stafford,  Oakland 18 

Discussion  by  C.  F.  Gelston,  San  Francisco ; 
William  W.  Belford,  San  Diego. 

Blood  Sedimentation  Test.  By  Donald 
G.  Tollefson,  Los  Angeles 20 

Discussion  by  Donovan  Johnson,  Los  Angeles; 
Alice  F.  Maxwell,  San  Francisco. 

Kahn  Precipitation  Test  for  Syphilis. 

By  Newton  Evans,  Los  Angeles 24 

Discussion  by  Gertrude  Moore,  Oakland ; 

W.  T.  Cummins,  San  Francisco;  Zera  E. 
Bolin,  San  Francisco. 

Scabies  and  Its  Complications.  By 
Thomas  J.  Clark  and  Frank  H. 
Stibbens,  Oakland 26 

Discussion  by  George  D.  Culver,  San  Fran- 
cisco ; Robert  T.  Legge,  Berkeley ; C.  Ray 
Lounsberry,  San  Diego. 

The  Diagnosis  and  Treatment  of  Lung 
Abscess.  By  Frank  S.  Dolley,  Los 
Angeles  .. 28 

Discussion  by  Philip  H.  Pierson,  San  Fran- 
cisco; Harold  Brunn,  San  Francisco;  F.  M. 
Pottenger,  Monrovia. 

Carcinoma  of  the  Cervix — Its  Surgical 
Treatment.  By  Hans  von  Geldern, 

San  Francisco — 32 

Discussion  by  William  H.  Gilbert,  Los  An- 
geles; Emil  G.  Beck,  Chicago;  C.  G.  Toland, 

Los  Angeles. 

A Note  on  the  Medical  Books  of 
Famous  Printers  (Part  I) — The  Lure 
of  Medical  History.  By  Chauncey  D. 
Leake,  San  Francisco 36 


CLINICAL  NOTES  AND  CASE  REPORTS: 
Extensive  Fracture  of  Skull.  By  S. 
Nicholas  Jacobs  and  Lawrence  M. 

Trauner,  San  Francisco 40 

Self-Retaining  Intra-Uterine  Pessary. 

By  Olga  McNeile,  Los  Angeles 41 

Surgical  Catastrophes  Following  Over- 
looked Stone.  By  Stanley  H.  Mentzer, 

San  Francisco 42 

BEDSIDE  MEDICINE: 

The  Causes  of  Angina  Pectoris 43 


Discussion  by  Robert  William  Langley,  Los 
Angeles;  Joseph  M.  King,  Los  Angeles;  Harry 
Spiro,  San  Francisco;  J.  Marion  Read,  San 
Francisco ; William  Dock,  San  Francisco. 

EDITORIALS: 

The  C.  M.  A.  and  the  Years  1929  and 

1930  47 

New  County  Society  Officers — Some  of 

Their  Prdblems  49 

Individualism  and  the  Group  Spirit  in 

the  Practice  of  Medicine 51 

Mary  Baker  Eddy — A Letter  and  a 

* Book  Review 52 

MEDICINE  TODAY: 

Chronic  Dacryocystitis.  By  M.  F.  Weymann, 

Los  Angeles 53 

The  Present  Status  of  Liver  Function  Tests. 

By  T.  L.  Althausen,  San  Francisco 53 

Recognition  of  Infected  Tonsils.  By  Benj'amin 

Katz,  Los  Angeles 54 

The  Stramonium  Treatment  of  Chronic  En- 
cephalitis. By  Garnett  Cheney 54 

STATE  MEDICAL  ASSOCIATIONS: 

California  Medical  Association 56 

Nevada  State  Medical  Association 63 

Utah  State  Medical  Association 64 

MISCELLANY: 

News  66 

Medical  Economics 67 

Correspondence  68 

Twenty-Five  Years  Ago 69 

Department  of  Public  Health 70 

California  Board  of  Medical  Examiners  71 
Directory  of  Officers,  Sections,  and 
County  Units  of  the  California  Medi- 
cal Association Advertising  page  2 

Book  Reviews Advertising  page  11 

Books  Received  Advertising  page  12 

Truth  About  Medicines 

Advertising  page  19 

ADVERTISEMENTS— INDEX: 

Advertising  page  8 


S3 


S3 


S3 


S3 


S3 


£3 


£2 


Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


Resident  Staff 

Aaron  S.  Green , M.  D. 
Louis  D.  Green,  M.  D. 
Martin  D.  Icove,  M.  D. 
Einar  V.  Blak,  M.  D. 


THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in  the  A.  M.  A. 
Facilities  are  especially  designed  for  Ophthalmology  and  include  X-Ray, 
Radium,  Physio-Therapy  and  Clinical  Laboratories. 

A private  out  patient  department  is  conducted  daily  between  the  hours  of 
g A.  m.  and  5 p.m,  A report  of  findings  and  recommendations  for  treatment 
are  returned  with  the  patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for  patients  of  limited 
income.  Examination  fees  in  the  clinic  are  $2.50  for  the  first  visit  and 
$1.50  for  subsequent  visits.  Moderate  fees  for  drugs,  laboratory  work, 
X-Rays.  Operating  fees  are  arranged  according  to  the  circumstances  of 
each  individual. 


Bush  at  Octavia  Street  • Telephone  WEst  4300  • San  Francisco,  California 


EYE  HOS  PITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


Patronize  Your  Home  Firm 


Because  We  Are  Progressive 


Z 1 2 Zoalite 

Infra  Red  Generator 


Burdick  Portable  Air-Cooled  Quartz  Lamp 
FOR  ULTRA  VIOLET  RADIATION 

These  lamps  may  be 
obtained  upon  rental. 
Information  upon 
request 

BUSH  ELECTRIC 

334  Sutter  Street 


San  Francisco,  Calif. 
SUtter  6088 


Los  Angeles,  Calif. 
MUtual  6324 


it  s Ij 


CORPORATION 

1207  West  Sixth  Street 


Produces  heat  deep  in  the  tissues  for  Local  or 
General  application.  Infra  Red  Radiation  is 
Decongestive,  Analgesic  and  Sedative 


2 


Officers  of  the  California  Medical  Association 


General  Officers 


President — Morton  R.  Gibbons,  515  Union 
Square  Building,  350  Post  Street,  San 
Francisco. 

President-Elect — Lyell  C.  Kinney,  510  Med- 
ico-Dental Building,  233  A Street,  San 
Diego. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

Vice-Speaker  of  House  of  Delegates — John 


H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw  Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 


Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 


Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  5th  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam Duffield  (1930),  516  Auditorium 

Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1930),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Cruz. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Junius  B.  Harris  (1930), 
Medico-Dental  Building,  1127  Eleventh 
Street,  Sacramento. 


Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 
lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1930),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large — T.  Henshaw  Kelly  (1930),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Robert  A.  Peers  (1931),  Colfax. 


Standing  Committees 


Executive  Committee  Committee  on  Membership  and  Organization 


The  President,  the  President-Elect,  the  Speaker  of  the  House  Harlan  Shoemaker,  Los  Angeles 1932 

of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair-  LeRoy  Brooks,  San  Francisco 1931 

man  of  the  Auditing  Committee.  (Committee  Chairman,  T.  Jesse  W.  Barnes,  Stockton - 1930 

Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.)  The  Secretary Ex-officio 


Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego 1932 

William  Bowman,  Los  Angeles 1931 

George  H.  Kress,  San  Francisco  1930 

Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego .1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach .1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 


Committee  on  History  and  Obituaries 

Charles  D.  Ball,  Santa  Ana 

Percy  T.  Phillips,  Santa  Cruz 

Emmet  Rixford,  San  Francisco 

The  Secretary 

The  Editor 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 

Percy  T.  Magan,  Los  Angeles 

Frederick  F.  Gundrum,  Sacramento 

The  Secretary - 

The  Editor 


1932 

1931 

1930 

Ex-officio 

Ex-officio 


1932 

1931 

1930 

Ex-officio 

Ex-officio 


Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 

William  Duffield,  Los  Angeles 

Joseph  Catton,  San  Francisco 

The  President - 

The  President-Elect 


1932 

1931 

1930 

Ex-officio 

Ex-officio 


Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Gayle  G.  Moseley,  Redlands 1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco 1932 

William  T.  McArthur,  Los  Angeles .1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education  and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 

Committee  on  Medical  Defense 

George  G.  Reinle,  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Mott  H.  Arnold,  San  Diego 1930 


Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco ..... 

Karl  Schaupp,  San  Francisco 

Lemuel  P.  Adams,  Oakland 

Robert  V.  Day,  Los  Angeles - 

Ernest  H.  Falconer,  Sec’y  Sect.  Med.,  San  Francisco 
Sumner  Everingham,  Sec’y  Sect.  Surg.,  Oakland 


1932 

.1931 

1930 

.1930 

1930 


Committee  on  Arrangements 


1930  Annual  Session — Del  Monte,  April  28  to  May  1,  1930 


T.  Henshaw  Kelly  (Chairman),  San  Francisco. 
Joseph  Catton,  San  Francisco. 

Martin  McAulay,  Monterey. 

Garth  Parker,  Salinas. 

William  H.  Bingaman,  Salinas. 

Alfred  Phillips,  Santa  Cruz. 

The  Secretary 


Ex-officio 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland 

Albert  Soiland,  Los  Angeles 

Fitch  C.  E.  Mattison,  Pasadena 

Victor  Vecki,  San  Francisco 

Percy  T.  Magan,  Los  Angeles.. 
Junius  B.  Harris,  Sacramento.. 


(1930-1931) 

(1930-1931) 

(1930-1931) 

(1929-1930) 

(1929-1930) 

(1929-1930) 


ALTERNATES 

Joseph  Catton,  San  Francisco 

William  H.  Gilbert,  Los  Angeles 

James  F.  Percy,  Los  Angeles 

William  E.  Stevens,  San  Francisco 

Charles  D.  Lockwood,  Pasadena 

John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


SPECIAL  MOTORCYCLE  SERVICE 

Phones:  GArfield  4417-4418-4419 

HOURS:  WEEK  DAYS,  8 A.  M.  TO  9 P.  M.;  SUNDAYS,  9-1,  6-8 

Insulin  Squibb,  like  other  Squibb  products,  has 
the  merited  approval  and  confidence  of  physi- 
cians everywhere.  It  is  prepared  under  license 
from  the  University  of  Toronto  and  conforms 
to  the  standards  established  and  maintained  by 
the  Insulin  Committee. 


lin  ScH 

If,  S.  Pa*- 
3 Oct.  1023.  IKWS" 

~20 

» * u.’ider  Ltcensej 
!!  Ifoivetsity  of  TO 

* Phvsic.i  .n’s 
****  Enclosed  C‘rr 


*&&  & SoS^f 

$®fr<ories,  NeW. 


SERUMS 


Insulin  Squibb  is  accurately  standardized,  uni- 
formly potent,  highly  stable.  It  has  a particu- 
larly low  nitrogen  content  and  is  remarkably 
free  from  reaction-producing  proteins. 

Insulin  Squjbb  of  10,  20  and  40  units  per  cc. 
strength  is  distributed  in  5 and  10  cc.  vials. 
Insulin  Squibb,  80  units  per  cc.,  is  distributed 
in  10  cc.  vials  only. 

Available  at 

BROEMMEL’S 

PRESCRIPTION 

PHARMACY 


FITZHUGH  BUILDING 
Rooms  201-202-203 


VACCINES 

Free  Delivery 


ANTITOXINS 


Post  and  Powell  Streets 
San  Francisco,  Calif. 


Radium  and  Oncologic  Institute 

1052  West  Sixth  Street,  Los  Angeles 


An  institution  providing  adequate  facilities  for  the  scientific  study,  diagnosis, 
and  treatment  of  cancer  and  other  neoplastic  diseases. 

Recognized  therapeutic  measures  for  the  treatment  of  cancer  are  radium, 
high  voltage  x-ray  and  surgery. 

Results  in  cancer  therapy  are  entirely  dependent  upon  early  diagnosis, 
thorough  study  and  proper  application  of  such  of  the  above  methods  of 
treatment,  either  alone  or  in  combination,  as  each  case  may  indicate. 

We  desire  to  confer  and  cooperate  with  the  medical  profession  in  the 
diagnosis  and  treatment  of  cancer  and  other  neoplastic  diseases. 

DR.  REX  DUNCAN  DR.  H.  H.  HATTERY 

AND  STAFF 

Office  Hours:  10  a.m.  to  4 p.m.  TRinity  3683 
1052  West  Sixth  Street  Los  Angeles 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  Lorruli  A.  Rethwilm,  2217  Web- 
ster Street,  San  Francisco. 

Secretary,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 

Chairman  of  Section  Program  Committee 
Q.  O.  Gilbert,  301  Medical  Building,  1904 
Franklin  Street,  Oakland. 

Pathology  and  Bacteriology 

Chairman,  W.  T.  Cummins,  Southern  Pacific 
Hospital,  San  Francisco. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
H.  A.  Thompson,  907  Medico-Dental 
Building,  233  A Street,  San  Diego. 

General  Surgery 

Chairman,  Clarence  G.  Toland,  902  Wilshire 
Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Secretary,  Northern  Division,  Sumner  Ever- 
ingham,  400  29th  St.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Dermatology  and  Syphilology 
Chairman,  Samuel  Ayres,  Jr.,  517  Westlake 
Professional  Building,  2007  Wilshire 
Boulevard,  Los  Angeles. 

Vice-Chairman,  Stuart  C.  Way,  320  Medioo- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  George  F.  Koetter,  812  Medical 
Office  Bldg.,  1136  W.  6th  St.,  Los  Angeles. 
Vice-Secretary,  Merlin  T.  Maynard,  408 
Medico-Dental  Building,  San  Jose. 

Pediatrics 

Chairman,  Guy  L.  Bliss,  1723  East  First 
Street,  Long  Beach. 

Secretary,  Donald  K.  Woods,  5th  and 
Laurel  Streets,  San  Diego. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Industrial  Medicine  and  Surgery 
Chairman,  Charles  A.  Dukes,  601  Wakefield 
Building,  426  17th  Street,  Oakland. 
Secretary,  Edmund  J.  Morrissey,  201  Med- 
ical Bldg.,  909  Hyde  St.,  San  Francisco. 
Chairman  of  Program  Committee,  Arthur  L. 
Fisher,  212  Medical  Building,  909  Hyde 
Street,  San  Francisco. 

Eye,  Ear,  Nose  and  Throat 
Chairman,  Barton  J.  Powell,  510  Medico- 
Dental  Building,  Stockton. 

Vice-Chairman,  Frederick  C.  Cordes,  817 
Fitzhugh  Building,  384  Post  Street,  San 
Francisco. 

Secretary,  Andrew  B.  Wessels,  1305  Medico- 
Dental  Building,  233  A Street,  San  Diego. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Irving  S.  Ingber,  321  Medico- 
Dental  Building,  490  Post  Street,  San 
Francisco. 

Secretary,  William  H.  Sargent,  Franklin 
Building,  1624  Franklin  Street,  Oakland. 
Chairman  of  Section  Program  Committee, 
W.  E.  Chamberlain,  Stanford  Hospital, 
San  Francisco. 

N europsychiatry 

Chairman,  Thomas  G.  Inman,  2000  Van  Ness 
Avenue,  San  Francisco. 

Secretary,  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

General  Medicine 

Chairman,  Walter  P.  Bliss,  407  Professional 
Bldg.,  65  North  Madison  Ave.,  Pasadena. 
Secretary,  Ernest  H.  Falconer,  316  Fitzhugh 
Building,  384  Post  Street,  San  Francisco. 

Obstetrics  and  Gynecology 
Chairman,  Karl  L.  Schaupp,  835  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  Clarence  A.  De  Puy,  Strad  Build- 
ing, 230  Grand  Avenue,  Oakland.  . 

Urology 

Chairman,  Charles  P.  Mathe,  Room  1831, 
450  Sutter  Street,  San  Francisco. 

Secretary,  Harry  W.  Martin,  1010  Quinby 
Building,  650  S.  Grand  Ave.,  Los  Angeles 

Officers  of  County  Medical  Associations 

Alameda  County  Medical  Association 

2404  Broadway,  Oakland 

President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Monterey  County  Medical  Society 
President,  William  H.  Bingaman,  Mercan- 
tile Building,  Salinas. 

Secretary,  H.  J.  Koenecke,  246  Main  Street, 
Salinas. 

San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Santa  Barbara  County  Medical  Society 
President,  Nathaniel  Brush,  108  E.  Michel- 
torena  Street,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment, Santa  Barbara. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Secretary,  J.  O.  Chiapella,  Chiapella  Build- 
1 ing,  Chico. 

Orange  County  Medical  Society 
President,  F.  H.  Gobar,  361  Commonwealth 
Avenue,  Fullerton. 

Secretary,  Merrill  W.  Hollingsworth,  409 
First  National  Bank  Building.  Santa  Ana. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building,  San  Jose. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 

Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary,  C.  J.  Durand.  Colfax. 

Santa  Cruz  Countv  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldg.,  Santa  Cruz. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son Building,  Fresno. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block. 
Riverside. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Glenn  County  Medical  Society 
President,  Etta  S.  Lund,  143  North  Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Sacramento  Society  for  Medical 
Improvement 

President,  Wm.  H.  Pope,  503  California 
State  Life  Building,  Sacramento. 

Secretary,  Hans  F.  Schluter,  516  Medico- 
Dental  Building,  1127  Eleventh  Street, 
Sacramento. 

Siskiyou  County  Medical  Society 
President, 

Secretary.  Ruth  C.  Hart,  Fort  Jones. 

Humboldt  County  Medical  Society 
President,  Charies  C.  Falk,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street, 
Vallejo. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol. 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

Kern  County  Medical  Society 

President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Eytinge,  47  East  Vine 
Street,  Redlands. 

Stanislaus  County  Medical  Society 
President,  Francis  Petr,  Berg  Blk.,  Turlock. 
Secretary,  R.  S.  Hiatt,  Ceres. 

Lassen-Plumas  County  Medical  Society 
President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

San  Diego  County  Medical  Society 
Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 

President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey,  Red  Bluff. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 

1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 
Street,  Los  Angeles. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

San  Francisco  County  Medical  Society 
2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street.  San  Francisco. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary,  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  G.  C.  Coffey,  First  National 
Bank  Building,  Ventura. 

Secretary,  Wilfred  S.  Clark,  422  California 
Street,  Ventura. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary,  L.  L.  Robinson,  Larkspur. 

San  Joaquin  County  Medical  Societv 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Mendocino  County  Medical  Society 

President,  L.  K.  Van  Allen,  Ukiah. 

Secretary.  Paul  J.  Bowman,  Fort  Bragg. 

Yolo-Colusa  County  Medical  Society 
President,  Ney  M.  Salter,  Williams. 
Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Merced  County  Medical  Society 

President,  H.  Kylberg,  O and  G Building, 
Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building. 
Merced. 

San  Luis  Obispo  County  Medical  Society 
President,  Gifford  L.  Sobey,  214  Bank  of 
Italy  Building,  Paso  Robles. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 

Yuba-Sutter  County  Medical  Society 
President,  Philip  Hoffman,  404  D Street, 
Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 


LAS  ENCINAS  - - - PASADENA,  CALIF. 

A Sanitarium  for  the  Treatment  of  General  and  Nervous  Diseases 

BOARD  OF  DIRECTORS:  George  Dock,  M.D.,  Pres.;  H.  G.  Brainerd,  M.D.,  Vice-Pres. ; W.  Jarvis  Barlow,  M.D. ; 

Stephen  Smith,  M.D.;  F.  C.  E.  Mattison,  M.D. 

BEAUTIFULLY  located  in  the  country,  two  miles  from  Pasadena.  Grounds  comprising  natural  live- 
oak  grove  of  20  acres,  with  lawns  and  gardens,  ideally  adapted  to  rest  and  enjoyment.  Large  central 
building  and  cottages  all  modernly  equipped,  homelike  and  comfortable.  Light,  airy  rooms  with  or 
without  private  bath  and  sleeping-porch.  Physicians  and  nurses  in  constant  attendance.  Hydrotherapy, 
Electrotherapy,  Occupational  Therapy,  Massage  and  the  most  approved  modern  medical  and  hygienic 
methods  employed.  Careful  individualization  of  treatment.  Patients  educated  to  correct  physical  and 
mental  habits.  Rigid  dietetic  supervision  and  unexcelled  table.  Adequate  dairy  and  poultry  plant  No 
tuberculosis,  epilepsy  or  insanity  received. 


Address , Stephen  Smith,  Medical  Director,  or  E.  D.  Kremers,  Associate  Medical  Director,  Pasadena,  California 


“TRADE  IN  SACRAMENTO” 

WITH 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 


Surgeons’  Instruments  i Physicians’  and  Hospital  Supplies 


SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY 

Manufacturers  and  Fitters  of  Orthopedic  and  Surgical  Appliances 


Blades,  $1.50  dozen;  10  per  cent  off 
In  Gross  Lots 


SACRO-ILIAC,  SURGICAL,  MATERNITY  AND  POST-OPERATIVE  BELTS 
TRUSSES,  ELASTIC  HOSIERY,  ARCH  SUPPORTS 


6 


Miscellaneous  California  Medical  Organizations 


State  Board  of  Health 
San  Francisco,  337  State  Building 
Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.  Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 


State  Board  of  Medical  Examiners 
San  Francisco,  623  State  Building 
Los  Angeles,  931  Associated  Realty  Building, 
510  West  Sixth  Street 
Sacramento,  908  Forum  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 


Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 


Southern  California  MedicalAssociation 
President,  Paul  E.  Simonds,  Riverside. 
Secretary.  Carl  R.  Howson,  711  Merritt 
Building,  307  West  8th  Street,  Los 
Angeles. 


California  Northern  District  Medical  Society 
President,  J.  D.  Lawson,  Woodland  Clinic, 
Woodland. 

Vice-President,  Dan  H.  Moulton,  Chico. 


Secretary,  Albert  K.  Dunlap,  Sacramento 
Hospital,  Sacramento. 

Treasurer,  Walter  E.  Bates,  Davis. 

Better  Health  Foundation 
President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 


Nevada  State  Medical  Association 


W.  A.  SHAW,  Elko President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 


HORACE  J.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 

Place  of  next  meeting Reno,  September  26-27,  1930 


Utah  State  Medical  Association 


H.  P.  KIRTLEY,  Salt  Lake  City President  J.  U.  GIESY,  701  Medical  Arts  Building, 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect  Salt  Lake  City... Associate  Editor  for  Utah 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary  Place  of  next  meeting Salt  Lake  City,  September  9-11,  1930 


Hospitals  and  Sanatoriums 

The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 

Belmont,  Calif. 

FRANKLIN  HOSPITAL 

Limited  General  Hospital 
Fourteenth  and  Noe  Streets,  San  Francisco 

SAN  FRANCISCO  HOME  FOR 
INCURABLES,  AGED  AND  SICK 

2750  Geary  Street,  San  Francisco 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 

San  Jose,  California 

GREENS*  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  of 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

ANDERSON  SANATORIUM 

Mental  and  Nervous  Diseases 

2535  Twenty-fourth  Avenue 

Oakland,  Calif. 

JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

JOSLIN’S  SANATORIUM 

Nervous  and  Mental 

Lincoln,  Calif. 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

BANNING  SANATORIUM 

Treatment  of  Tuberculosis  and  Throat 
Diseases 

Banning,  Calif. 

ENCINAS  SANITARIUM 

Nervous  and  General  Diseases 

Las  Encinas,  Pasadena,  Calif. 

ST.  FRANCIS  HOSPITAL 

Limited  General  Hospital 

Bush  and  Hyde  Streets,  San  Francisco 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Belmont,  San  Mateo  County,  Calif. 

LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 

ST.  JOSEPH’S  HOSPITAL 

Limited  General  Hospital 

Buena  Vista  and  Park  Hill  Avenues 

San  Francisco,  Calif. 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 

ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 

27th  and  Valencia  Streets,  Sa'n  Francisco 

CHILDREN’S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Los  Gatos,  Calif. 

ST.  MARY’S  HOSPITAL 

General  Hospital 

2200  Hayes  Street,  San  Francisco,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

POTTENGER  SANATORIUM 

AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

DANTE  SANATORIUM 

Limited  General  Hospital 

Van  Ness  and  Broadway,  San  Francisco 

RADIUM  AND  ONCOLOGIC 
INSTITUTE 

Diagnosis  and  Treatment  of  Neoplastic 
Diseases 

1052  West  Sixth  Street,  Los  Angeles,  Calif. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


Illustrating  "Jfine  Tefl”  method  of  standardizing  Vitamin  D content. 
At  left,  the  leg  hone  of  a rachitic  rat  showing  induced  decalcification 
area{X}.  At  right,  healing  has  begun,  as  evidenced 
by  initiation  of  recalcification  at  dark  line  (Y). 


BOTH 

Vitamins 
Definitely 
Measured 

How  can  vitamins 
be  “measured?”  What  is 
meant  by  “standardized” 
when  applied  to  Cod-liver 
Oil?  Here,  briefly,  is  the 
method  followed  in  determ- 
ining the  vitamin  content 
of  Parke-Davis  Standardized  Cod-liver  Oil: 

To  test  for  vitamin  A potency  the  oil  is  given 
orally  to  young  albino  rats  which  have  been  fed 
on  a diet  free  from  vitamin  A.  We  ascertain 
how  much  oil  is  needed  daily  to  correct  the 
induced  typical  eye  condition  (xerophthalmia) 
and  to  institute  a specified  rate  of  growth.  The 
daily  minimum  amount  of  oil  required 
to  bring  about  this  change  constitutes 
one  vitamin  A unit. 

Every  lot  of  Parke-Davis  Standard- 
ized Cod-liver  Oil  must  contain  not  less 
than  13,500  units  of  vitamin  A in  each 
fluid  ounce. 

In  determining  vitamin  D potency  we 
use  our  quantitative  adaptation  of  the 
“line  test”  technique  of  McCollum, 
Simmonds,  Shipley,  and  Park.  The 
oil  is  fed  to  young  rats  in  which  rickets 
has  been  induced.  We  measure  the 
minimum  amount  of  oil  required  per  day  over  a 
period  of  ten  days  to  initiate  recalcification  in 
the  leg  bones.  This  amount  represents  one 
vitamin  D unit.  Each  fluid  ounce  of  Parke- 
Davis  Standardized  Cod-liver  Oil  contains  not 
less  than  3000  vitamin  D units. 


Parke,  Davis  & Company  was  the  first 
commercial  laboratory  to  assay  Cod-liver  Oil 
for  both  vitamins  A and  D.  Parke-Davis 
Standardized  Cod-liver  Oil  is  backed  by  years 
of  research  work  in  various  phases  of  nutrition 
chemistry.  Quite  aside  from  its  vitamin 
richness,  this  product  has  other  dis- 
tinguishing features  which  will  appeal 
to  you.  It  is  clear,  bland,  and  as  nearly 
tasteless  and  odorless  as  a pure  Cod- 
liver  Oil  can  be.  May  we  suggest  that 
in  prescribing  Cod-liver  Oil  for  your 
patients  you  specify  the  Parke-Davis 
product? 

Send  for  stock  package 

To  any  physician  who  is  personally  unacquainted 
with  Parke-Davis  Standardized  Cod-liver  Oil  we 
will  gladly  send  a 4-ounce  bottle  for  free  trial. 


PARKE,  DAVIS  & COMPANY 

DETROIT,  MICHIGAN 

NEW  YORK  KANSAS  CITY  CHICAGO  BALTIMORE  NEW  ORLEANS 
ST.  LOUIS  MINNEAPOLIS  SEATTLE 

In  Canada:  walkerville  Montreal  Winnipeg 


PARK!  - DAVIS 
standardized 
COO-LIVER  OIL 


iaaaaEsaacES 


PARKE-DAVIS  STANDARDIZED 

COD-LIVER  OIL 


8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 


Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 


*e» 


N* 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

American  College  of  Physicians..  58 

American  Laundry  Mach.  Co 29 

American  X-Ray  Corp 52 

Anderson  Sanatorium,  The 59 

Approved  Clinical  Laboratories..  57 

Banning  Sanatorium  44 

Bard-Parker  Co 28 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  & Rackerby 5 

Benjamin,  M.  J 33 

Bischoff’s  Surgical  House 48 

Bittleston’s  56 

Brady  & Co.,  George  W 39 

Broemmel’s  Prescription  Phar- 
macy   3 

Brown  Press  48 

Bush  Electric  Corporation 1 

Butler  Building  16 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co 41 

Camp  & Co.,  S.  H 30 

Canyon  Sanatorium  23 

Certified  Laboratory  Products....  38 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 

Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co 36 

Dante  Sanatorium  4 Cover 

Dewar  & Hare 46 

Doctors’  Business  Bureau 19 

Doniger  & Co.,  Inc.,  S 62 

Dry  Milk  Co.,  The 47 

Four  Fifty  Sutter 61 

Franklin  Hospital  43 

Frazier,  Delmer  J 53 

Furscott,  Hazel  E 24 

Golden  State  Milk  Products  Co.  30 
Graduate  School  of  Medicine, 
Tulane  University  of  La 14 


Page 


Greens’  Eye  Hospital 2 Cover 

Gunn,  Herbert,  Stool  Examina- 
tion Laboratory  24 

Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Haley  M-O  Company.. 61 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H 10 

Hoffmann-La  Roche,  Inc 13 

Holland-Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning....  11 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic  40 

Joslin’s  Sanatorium  55 

Kenilworth  Sanitarium  59 

Keniston-Root  Corporation  41 

Knox  Gelatin  Laboratories 25 

Laboratory  Products  Co 3 Cover 

Las  Encinas  Sanitarium 5 

La  Vida  Mineral  Water  Co.  60 

Lederle  Antitoxin  Laboratories..  37 

Lengfeld’s  Pharmacy  53 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 14 

Livermore  Sanitarium  44 

Maltine  Company,  The 35 

Mead  Johnson  & Co 21 

Medical  Protective  Co 15 

Medical-Surgical  Institute  of 

Southern  California 46 

Medico-Dental  Finance  Co 40 

Mellin’s  Food  Co 16 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc 42 

Monrovia  Clinic  43 

National  Ice  Cream  and  Cold 

Storage  Co.  12 

Nestle’s  Food  Co 60 

New  York  Polyclinic  Medical 

School  and  Hospital 9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital 12 

Nichols  Nasal  Syphon 14 

Nonspi  Company 41 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 

cal  Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 

O’Keeffe  & Co 16 


Page 


Park  Sanitarium  24 

Parke,  Davis  & Co 7 

Petrolagar  Laboratories 18 

Podesta  and  Baldocchi 38 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 48 

Radium  and  Oncologic  Institute  3 

Rainier  Brewing  Co 36 

Reid  Bros 37 

Richter  & Druhe 56 

Riggs  Optical  Company 31 

San  Francisco  Home  for  Incur- 
ables, Aged,  and  Sick 46 

Santa  Barbara  Clinic,  The 51 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  53 

Sharp  & Dohme 34 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription 

Pharmacies  24 

Soiland  (Albert,  Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stark,  Dr.  Morris,  State  Board 

Review  38 

St.  Francis  Hospital 26 

St.  Joseph’s  Hospital 43 

St.  Luke’s  Hospital 23 

St.  Mary’s  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugarman  Clinical  Laboratory.  ..  56 
Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies 37 

Towns  Hospital,  Charles  B. 39 

Trainer-Parsons  Optical  Co 26 

Travers’  Surgical  Co , 33 

Troy  Laundry  Machinery  Co 20 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Victor  X-Ray  Corporation 45 

Vitalait  Laboratory  64 

Wallace,  Sidney  J 55 

Walters  Surgical  Company 61 

Wedekind,  Frank  F 39 

White,  Arthur  H.,  Quiz  Course..  24 


mm 1X7^90 —ISM 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


0 


The  Oaks  Sanitarium  Los  (jatos , California 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 


WILLIAM  C.  VOORSANGER,  M.  D.  PAUL  C.  ALEXANDER,  M.  D. 

Medical  Director  Asst.  Medical  Director 

San  Francisco  Office  490  Post  Street 


Ten  Acres  of  Beautiful  Grounds 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 
COMPTON,  CALIF. 

30  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  bed  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 
P.  J.  Cunnane,  M.  D.  J.  F.  Vavasour,  M.  D. 
Office:  1052  West  6th  St.,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

(Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 

PROCTOLOGY,  GASTRO-ENTEROLOGYand  ALLIED  SUBJECTS 

For  information  address  MEDICAL  EXECUTIVE  OFFICER:  345  W.  50th  St.,  New  York  City 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


For  1930 

WE  WISH  YOU  MOST  WARMLY 
ALL  THE  HAPPINESS  AND  PROS- 
PERITY THE  WORLD  AFFORDS 


In  1930 

WE  RESOLVE  TO  CONTINUE  TO 
IMPROVE  AND  ENLARGE  OUR 
SERVICE  THAT  WE  MAY  MORE 
FULLY  DESERVE  YOUR  CONFI- 
DENCE AND  GOOD  WILL. 


C.  H.  H1TTEN BERGER  CO. 

1115  Market  Street  460  Post  Street 

Market  4244 

ORTHOPEDIC  BRACES,  SURGICAL  BELTS 
AND  APPLIANCES 


VACCINES 

are  of  value  and  are  used  extensively  in  the 
prophylaxis  and  treatment  of  Colds,  Influenza  and 
Pneumonia. 

REFERENCES 

(1)  New  England  Journal  of  Medicine,  200:  853- 
857,  April  25,  1929. 

(2)  From  the  Transactions  of  the  Association  of 
American  Physicians,  1926. 

(3)  Archives  of  Internal  Medicine,  April,  1929. 

(4)  The  Lancet,  October  12,  1918. 

(5)  Illinois  Medical  Journal,  April,  1928. 

(6)  Quoted  Sutton;  ibid. 

Order  a vial  now.  It  will  come  in  handy  for  the 
winter  months. 

C.  CCDCLDIi  GUTH 

BIOLOGICS  &.  THERAPEUTIC  SPECIALTIES 
WILLIAM  H.  BANKS,  M.  D.,  Medical  Director 

Phone  KEarny  3644 

811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

Frates  a Lovotti,  Professional  Pharmacists 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less ; 
additional  words  5 cents  each. 


FOR  SALE  IN  CENTRAL  SOUTHERN  CALIFORNIA— 

General  medical  and  surgical  practice.  Thirty  thousand  yearly 
collections.  Fine  opportunity  for  making  money  from  the  start. 
Price  $6,000  with  equipment.  Will  introduce.  Address  Box  1110, 
California  and  Western  Medicine. 


SITUATIONS  WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 


FOR  SALE — TONSILLECTOMY,  NASAL  AND  SINUS  In- 
struments at  one-third  Standard  Instrument  Company’s  price 
list.  Instruments  have  been  used  but  are  in  perfect  condition.  Sold 
in  sets  only — for  cash.  Prices  and  descriptive  lists  on  application. 
Address  Box  100,  California  and  Western  Medicine. 


UNUSUAL  OPPORTUNITY  FOR  A QUALIFIED  EYE, 

Ear,  Nose  and  Throat  Specialist  with  recognized  group.  No 
investment  necessary.  Communicate  with  Dr.  Burns  R.  Eastman, 
1275  East  Green  Street,  Pasadena,  California. 


AVAILABLE  FOR  ASSIGNMENT— PHYSICIANS,  SUR- 

geons.  Pediatricians,  Tuberculosis  Specialists,  X-Ray  Laboratory 
Technicians,  Dietitians,  Occupational  and  Physical  Therapy  Aides 
of  ability.  A capable  nurse,  ten  years’  superintendency,  first-class 
tuberculosis  hospital,  desires  position  commensurate  with  her  abil- 
ity. Professional  Efficiency  and  Placement  Association,  Ray  Build- 
ing, Oakland,  California;  Phone  HOlliday  5295. 


DOCTOR’S  OUTFIT  — WHITE  ENAMEL  FURNITURE, 

lamps,  diathermy  machine,  microscope,  instruments,  etc.,  like 
new;  for  sale  complete  or  in  part;  reasonably  priced.  Room  216, 
391  Sutter  Street,  San  Francisco. 


FOR  SALE— DUE  TO  ILLNESS— $12,000  GENERAL  PRAC- 

tice  established  18  years.  Town  of  1000,  gives  service  in  seven 
adjacent  towns  to  3000  persons.  Will  sell  office  furnishings  of  five 
rooms,  all  equipment  including  instruments.  X-ray,  therapy  lights 
and  drugs.  Rent  or  sell  office  and  home.  Lodge,  insurance  and 
Southern  Pacific  appointments  transferable.  For  cash,  or  will  take 
monthly  payments  from  man  with  high  recommendations.  Address 
Box  110,  California  and  Western  Medicine. 


EXCHANGE  PRACTICE— FULLY  EQUIPPED  MODERN 

home  and^  small  hospital  accepting  selected  cases.  Good  operat- 
ing room,  X-ray,  etc.  In  best  valley  in  Nevada,  forty  miles  from 
Reno,  on  state  highway,  all  paved.  Will  exchange  for  practice 
and  equipment  on  Pacific  Coast.  Purchase  of  real  estate  mutually 
optional.  Address  Box  120,  California  and  Western  Medicine. 


THE  PROFESSIONAL  EFFICIENCY  AND  PLACEMENT 

Association  interests  heads  of  hospitals,  clinics  and  offices.  Call 
on  us  to  assist  you  in  securing  efficient  physicians,  nurses,  aides, 
dietitians,  technicians  and  others.  The  Professional  Efficiency  and 
Placement  Association,  Inc.,  1924  Broadway,  Oakland,  Califor- 
nia, Phone  HOlliday  5295. 


FOR  SALE  AT  CARMEL-BY-THE-SEA— LARGE  HOUSE 

successfully  operated  as  rest  home  by  graduate  nurse  for  past 
nine  years,  now  wishes  to  retire.  Property  close  to  ocean.  Modern 
in  every  detail.  Six  bedrooms  and  four  bathrooms.  Excellent 
clientele.  Good  terms  arranged  responsible  party.  Write  Parrott  & 
Jones,  Carmel,  California. 


Fewer  Children  in  California’s  Institutions  for  De- 
pendent Children. — California  believes  in  home  care 
for  children.  A decided  decrease  since  1913  in  the 
population  of  institutions  for  dependent  children  has 
been  brought  about  by  the  increased  use  of  financial 
aid  to  children  in  their  own  homes,  foster-home  care, 
and  adoption,  according  to  the  first  biennial  report 
of  the  department  of  social  welfare  of  the  state. 
About  seven-eighths  of  the  children  now  in  the  insti- 
tutions have  one  or  both  parents  living;  most  of  the 
orphans  have  been  placed  for  adoption.  The  hope  in 
the  case  of  children  with  one  or  more  parents  is,  of 
course,  that  the  family  life  may  be  reestablished. — 
United  States  Department  of  Labor  Children’s  Bureau, 
Washington. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


// 


BOOK  REVIEWS 


Mrs.  Eddy. — The  Biography  of  a Virginal  Mind.  By  Edwin 
Franden  Dakin.  Charles  Scribner’s  Sons,  New  York. 
1929.  Price,  $5. 

Uncolored  by  tints  of  acquired  divinity,  undistorted  by 
the  high  heat  of  controversy,  illumined  on  all  sides  by 
the  light  of  truth  and  understanding,  the  figure  of  Mrs. 
Eddy  emerges  from  the  pages  of  this  book  set  high  upon 
a broad  base  of  facts  gathered  and  articulated  by  Mr. 
Dakin  in  his  years  of  study  of  the  life  of  the  founder  of 
Christian  Science. 

Mr.  Dakin  has  said  that  he  began  this  study  in  an  effort 
to  acquaint  himself  with  the  environmental  and  personal 
problems  of  this  founder  of  the  latest  religious-philosoph- 
ical sect.  He  had  previously  and  similarly  studied  the 
creators  and  doctrines  of  other  sects  and  systems,  en- 
deavoring to  find  for  himself  a satisfying  belief,  but  when 
he  came  to  elicit  the  facts  of  Mrs.  Eddy’s  life  and  devel- 
opment he  found  this  no  simple  task — the  available  works 
were  so  definitely  biased  by  the  writers’  belief  or  non- 
belief in  Christian  Science  that  no  clear  picture  of  the 
woman  herself  could  be  drawn  from  out  the  welter  of 
words. 

So  the  inquirer  set  himself  the  task  of  sifting  fact  from 
fancy  and  truth  from  fiction  and  by  painstaking  research 
and  intensive  study  he  accumulated  the  mass  of  knowl- 
edge from  which  he  made  his  book. 

And  what  a book  it  is!  As  chapter  follows  chapter, 
there  is  unrolled  to  the  readers’  eyes,  if  not  blinded  by 
unreasoning  adherence  or  opposition  to  the  doctrines  pro- 
mulgated by  its  subject,  a fascinating  panorama  of  a life 
which  attained  the  external  manifestations  of  power, 
prominence  and  even  quasi-divinity  in  the  eyes  of  many, 
but  which  ended  still  constricted  and  limited  by  the  same 
inner  deficiencies  with  which  it  began. 

In  his  foreword  to  the  book  Mr.  Dakin  says,  “Now  it 
is  because  Mary  Baker  Eddy  was  a woman  with  an  im- 
passioned urge  for  life  and  self  expression  throbbing  in 
her  veins,  and  not  a passive  figure,  that  she  has  any 
possible  human  significance.  It  is  because  of  this  that 
hers  was  a gorgeous  adventure — gorgeous  no  matter  what 
the  beginning  and  what  the  end.  What  if  indeed  she  was 
a soul  obsessed?  Few  who  have  become  instruments  for 
great  ideas  were  ever  less.  What  if  she  was  indeed  ignor- 
ant, distraught,  fearful — lustful  of  power  and  glory — 
tortured  by  self  and  the  universe — eager  for  wealth  and 
grandeur?  What  if  she  made  mad  mystery  out  of  ignor- 
ance, inspiration  out  of  dread? 

“The  streets  of  the  whole  world  are  thronged  by  those 
who  are  her  kin. 

“In  these  pages  then  will  be  found  no  fumbling  apologia 
for  Mary  Baker  Eddy,  and  no  effort  to  fit  her  into  the 
image  of  a saint  on  calloused  knees.  Any  attempt  to 
understand  reality  must  at  least  be  a braver  human 
tribute  than  any  feeble  effort  to  extenuate.  When  she 
said  that  her  course  was  'impelled  by  a power  not  one’s 
own,’  it  would  not  matter  if  she  erred.  For  at  least  she 
was  impelled.  This  is  enough.  The  force  in  her  of  that 
great  inner  Will  which  in  every  being  creates  its  own 
fulfillment — compensate  how  it  must — needs  no  justifica- 
tion. It  is  beyond  the  little  human  labels  of  ‘good’  and 
‘evil.’  Such  a force  in  all  things,  in  all  men,  is  that 
which  is.” 

So  he  tells  the  story  of  this  “gorgeous  adventure” — this 
inner  impulsion  that  drove  her  on,  despite  the  limitation 
of  her  environment,  education  and  temperament,  the  pov- 
erty and  struggles  of  her  middle  life  and  the  sorrow  of  her 
marriages,  to  the  leadership  of  the  sect  which  she  had 
founded  and  that  great  house  at  Chestnut  Hill  where  she 
died,  still  the  victim  of  those  fears  to  which  the  tenets  of 
her  own  church  denied  real  existence. 

The  troubled  evolution  of  Christian  Science  is  neces- 
sarily told  coincidentally  because  Mrs.  Eddy  could  not  be 
understood  without  knowledge  of  that  contribution  of 
hers  to  the  distortion  of  reality  which  makes  life  endur- 
able to  her  followers.  However,  the  book  is  not  a tract 
about  Christian  Science — it  is  the  epic  of  Mary  Baker 
Eddy. 

The  story  is  carefully  annotated  with  the  sources  and 
authority  for  all  of  the  statements  contained  within  it 
and  the  reader  feels  always  the  understanding  sympathy 
which  the  author  brought  to  his  task. 

Mr.  Dakin’s  narrative  will  not  be  abstracted  here — it 
is  too  worthy  of  reading  in  its  entirety  to  be  shredded 
in  a review.  Get  the  book  and  read  it;  and  if  you  cannot 
obtain  it  from  your  local  booksellers  who  may  have  re- 
fused to  deal  in  “error,”  you  can  obtain  it  by  a letter  and 
its  price  ($5)  sent  to  Charles  Scribner’s  Sons,  New  York, 
N.  Y.  T.  H.  K. 


Surgical  and  Medical  Gynecologic  Technic.  By  Thomas 
H.  Cherry.  Pp.  678.  Illustrated.  Philadelphia:  F.  A. 
Davis  Company.  1929. 

This  book  gives  an  excellent  description  of  the  modern 
methods  of  therapy  and  diagnosis  of  gynecological  dis- 
eases. As  the  author  states,  it  is  not  intended  to  be  used 
as  a textbook  for  the  undergraduate  student,  but  as  a 
handy  reference  for  the  practitioner.  The  physiology  and 
symptomatology  are  purposely  omitted. 

The  various  conditions  are  discussed  in  a simple  and 
orderly  manner.  Only  one  operation  for  each  condition 
(Continued  on  Next  Page) 


As  a General  Antiseptic 

in  place  of 

TINCTURE  OF  IODINE 
Try 

Mercurochrome-220  Soluble 

( Dibrom-oxytnercuri- fluorescein.) 

2%  Solution 

It  stains,  it  penetrates,  and  it 
furnishes  a deposit  of  the  germ- 
icidal agent  in  the  desired  field. 

It  does  not  burn,  irritate  or  injure 
tissue  in  any  way. 

Hynson,  Westcott  & Dunning 

Baltimore,  Maryland 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


New  York  Post-Graduate  Medical  School  and  Hospital 

Offers  Courses  in  PEDIATRICS  including: 

Physical  Diagnosis,  Practical  Pediatrics,  Infant  Feeding,  Communicable  Diseases,  Gastro-Intestinal  Disorders  of  Childhood, 

Malnutrition,  Bedside  Rounds  and  Allied  Subjects 

These  courses  are  suitable  for  the  needs  of  the  general  practitioner  as  well  as  the  pediatrician.  Physicians  from  approved 
medical  colleges  are  admitted.  Courses  are  of  one,  three  and  six  months’  duration  and  are  continuous  throughout  the  year. 

For  descriptive  booklet  and  further  information  address 

THE  DEAN  i 313  East  Twentieth  Street  i New  York  City 


BOOK  REVIEWS 

(Continued  from  Preceding  Page) 
is  discussed  in  detail.  A few  of  the  other  operations  for 
the  same  conditions  are  only  briefly  mentioned.  How- 
ever, the  technique  for  the  operations  discussed  is  based 
on  sound  surgical  principles,  namely,  anatomy  and  pa- 
thology. The  various  steps  for  each  operation  are  clearly 
described  and  are  freely  illustrated  by  simple,  plain 
drawings  which  demonstrate  the  anatomy  and  pathology 
very  well. 

This  book  should  meet  with  the  approval  of  the  busy 
practitioner.  C.  L.  C. 


Your  Nose,  Throat  and  Ears — Their  Health  and  Care. 

By  L.  W.  Oaks  and  H.  G.  Merrill.  Pp.  167.  Illus- 
trated. New  York  and  London:  D.  Appleton.  1929. 
Price,  $1.50. 

A manual  for  the  layman,  purported  to  set  forth  the 
simple  hygienic  measures  that  everyone  should  take  for 
promoting  the  health  of  these  important  sense  organs. 

The  manual  plainly  shows  itself  to  be  the  result  of  an 
earnest  and  honest  endeavor  on  the  part  of  the  author 
to  remove  from  the  class  of  mysteries  the  somewhat 
intricate  physiology  and  anatomy  of  these  special  sense 
organs,  and  put  the  explanations  and  expositions  in  such 
language  that  the  facts  may  be  assimilated  by  the  lay- 
man. Others  have  endeavored  to  do  this  and  failed. 
Although  this  manual  is  a step  in  advance  in  the  proper 
direction,  it,  too,  cannot  be  wholly  recommended.  The 
language  and  terminology  are  such  that  the  individual 
only  equipped  with  high  school  education  would  not 
understand  it  if  one  could  induce  him  to  read  it.  The 
layman  of  higher  educational  assets  would  either  seek  a 
more  scientific  volume,  or,  as  should  be,  seek  the  advice 
of  his  family  physician  or  specialist.  L.  F.  M. 


Diseases  of  the  Thyroid  Gland.  By  Arthur  E.  Hertzler, 
with  a chapter  on  hospital  management  of  goiter 
patients  by  Victor  E.  Chesky.  Second  edition.  Pp.  286. 
Illustrated.  St.  Louis:  The  C.  V.  Mosby  Company. 
1929.  Price,  $7.50. 

For  thirty  years  in  his  hospital  at  Halslead,  Kansas, 
Doctor  Hertzler  has  been  studying  the  problem  of  goiter 
as  it  presents  itself  in  a nonendemic  goiter  area.  This 
rewritten,  second  edition  of  his  book  presents  the  results 
of  his  study  which  possess  a peculiar  value.  The  author 
recognizes  this  fact  for  he  states  in  his  preface,  “What- 
ever merit  it  may  contain  must  rest  in  the  fact  that, 
because  of  my  isolation,  it  has  been  possible  to  work 
untrammeled  by  the  opinions  of  others.” 

Doctor  Hertzler  contends  that  time  is  an  essential  ele- 
ment in  the  study  of  goiter.  This  requires  that  the  phy- 
sician know  the  life  history  of  his  patient.  The  goiterous 
disease  is  not  chronic  in  most  cases,”  which  reminds 
me  that  Hertzler  once  said  (though  I did  not  find  the 
statement  in  his  book)  that  the  clinical  history  of  a goiter 
patient  ends  only  with  the  patient’s  death. 

The  seventy-six  page  chapter  on  pathological  anatomy 
is  the  best  part  of  the  book,  especially  those  pages  which 
deal  with  “bosselated”  goiters.  When  the  author  con- 
fines himself  to  the  fields  of  surgery  and  pathology  he  is 
sound,  but  his  comments  upon  the  cardiac  and  other 
complications  of  toxic  goiter  are  less  appealing  He 
differs  from  most  workers  in  this  field  of  accepting  the 
adrenalin  test  of  Goetsch  and  in  making  a diagnosis  of 
toxicity  without  elevated  basal  metabolic  rate.  I do  not 
opine  that  most  goiter  surgeons  would  agree  with  him, 
either,  in  the  use  of  adrenalin-novocain  anesthesia  for 
toxic  goiter  operations. 

The  book  is  well  illustrated  and  fairly  completely  in- 
dexed, but  could  have  been  more  carefully  proof  read. 

A twenty-page  chapter  on  the  hospital  management  of 
goiter  patients  by  Victor  E.  Chesky  is  included.  The 
book  concludes  with  chapters  on  topographic  anatomy 
and  operative  technique.  j.  m.  R. 


The  Treatment  of  Varicose  Veins  of  the  Lower  Ex 
tremities  by  Injection.  By  T.  Henry  Treves-Rarher 
M .D.,  B.  Sc.  Cloth.  Pp.  120.  Price,  $2.25  net  New  York 
William  Wood  & Company,  1929. 


Annua!  Report  of  the  Board  of  Regents  of  the  Smith 
soman  Institution.  Showing  the  operations,  expenditure* 
and  condition  of  the  institution  for  the  year  endin; 


June  30,  1928.  Cloth.  Pp.  763,  illustrated.  United  States 
Government  Printing  Office,  Washington.  1929. 


Hemorrhoids,  The  Injection  Treatment  and  Pruritus 
Ani.  By  Lawrence  Goldbacher,  M.  D.,  Philadelphia. 
Cloth.  Pp.  205,  illustrated  with  thirty-one  halftone  and 
line  engravings,  some  in  colors.  Price,  $3.50  net.  Phila- 
delphia: F.  A.  Davis  Company,  1930. 


Pettibone’s  Textbook  of  Physiological  Chemistry.  With 
Experiments.  By  J.  F.  McClendon,  Ph.  D.,  Professor  of 
Physiological  Chemistry,  Medical  School,  University  of 
Minnesota,  Minneapolis.  Fourth  edition,  revised  and  re- 
written. Cloth.  Pp.  368.  Price,  $3.75.  St.  Louis:  The 
C.  V.  Mosby  Company,  1929. 


The  Science  of  Nutrition  Simplified.  A Popular  Intro- 
duction to  dietetics.  By  D.  D.  Rosewarne,  M.  R.  C.  S., 
late  Honorary  Actinotherapeutist  and  Assistant  Phy- 
sician, City  of  London  and  East  London  Dispensary. 
Cloth.  Pp.  314,  illustrated.  Price,  $3.50.  St.  Louis:  The 
C.  V.  Mosby  Company,  1929. 


Stone  and  Calculous  Disease  of  the  Urinary  Organs. 

By  J.  Swift  Joly,  M.  D.  (Dub.),  F.  R.  C.  S.  (Eng.),  Sur- 
geon to  St.  Peter's  Hospital  for  Stone;  Consulting  Urolo- 
gist to  St.  James’  Hospital  Wandsworth.  Cloth.  Pp.  568, 
with  189  illustrations  in  the  text  and  four  colored  plates. 
Price,  $16.  St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


An  Introduction  to  the  Study  of  the  Nervous  System. 

By  E.  E.  Hewer,  D.  Sc.  (Lond.),  Lecturer  in  Histology 
and  Assistant  Lecturer  in  Physiology  at  the  London 
(Royal  Free  Hospital)  School  of  Medicine  for  Women, 
(Continued  on  Page  14) 

TmnroTnnnroTnnmnnnr^ 


For  Medicinal,  Industrial  and  Drinking  Purposes 


rMiifioii  uniiifftunni  i ami 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


13 


^iakerr  of  Medicines  ofQiare  Quality 

NUTLEY  NEW  JERSEY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 
Telephone  Main  7676 

Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


Graduate  School  of  Medicine 

The  Tulane  University  of  Louisiana 

Approved  by  the  Council  on  Medical  Education 
of  the  A.  M.  A. 

Post-graduate  instruction  offered  in  all  branches  of 
medicine.  Courses  leading  to  a higher  degree  have 
also  been  instituted. 

For  bulletin  furnishing  detailed  information 
apply  to  the 

DEAN 

Graduate  School  of  Medicine 
1551  Canal  Street  New  Orleans,  La. 


ELASTIC  HOSIERY 

Seamed  or  Seamless 

Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 

Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  , TRUSSES  , ELASTIC  WEAR 

Clark-Gandion  Co.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
522  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


*°<<2 
¥ 


^/isters 

CAS  e IM  —PAL  M NUT 


Dietetic  Flour 

Starch-free  Diabetic  Foods  that  are  ap- 
petizing are  easily  made  in  the  patient’s 
home  from  Listers  Flour.  It  is  self-rising. 
Ask  for  nearest  depot  or  order  direct. 

LISTER  BROS. Inc.,  41  East  42nd  St.,  NEW  YORK 


BOOKS  RECEIVED 


(Continued  from  Page  12) 

and  G.  M.  Sandes,  M.  B.,  B.  S.  (Lond.),  Demonstrator 
in  Anatomy  at  the  above  school.  Cloth.  Pp.  104.  Price, 
$6.50.  St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


Clinical  Obstetrics.  By  Paul  T.  Harper,  Ph.  B.,  M.  D., 
Sc.  D.,  P.  A.  C.  S.,  Fellow  of  the  American  Association, 
of  Obstetricians,  Gynecologists  and  Abdominal  Surgeons 
and  of  the  New  York  Obstetrical  Society.  Cloth.  Pp.  627, 
illustrated  with  eighty-four  plates  of  engravings  (250' 
figures)  with  legends  and  charts.  Price,  $8  net.  Phila- 
delphia: F.  A.  Davis  Company,  1930. 


Krankheiten  und  Hygiene  der  Warmen  Lander.  Ein 

Lehrbuch  fur  die  Praxis.  Von  Prof.  Dr.  Reinhold  Ruge, 
Marinegeneralstabsarzt  A.  D.  in  Klotzsche  Bei  Dresden; 
Prof.  Dr.  Peter  Muhlens,  Marinegeneralarzt  A.  D.  und 
Vorsteher  der  Klinischen  Abteilung  am  Tropeninstitut 
in  Hamburg:  Prof.  Dr.  Max  Zur  Verth,  Marinegeneral- 
oberarzt  A.  D.  und  Oberregierungs-Medizinalrat  in  Ham- 
burg. 3.,  Vollstandig  Umgearbeitete  Auflage.  Mit  6 Far- 
bigen  und  1 Schwarzen  Tafel,  1 Kurventafel  und  489 
Abbildungen  im  Text.  Verlag,  Leipzig:  Georg  Thieme, 
1930. 


M. 


NICHOLT  POWDER 


We  want  every  physician  to 
try  Nichols  Nasal  Syphon 
Powdei'-lts  new  and  unusual- 
ly fine  for  use  with  the  NichoU 
Nasal  Syphon-oi'wheiever 
nasal  cleansing  is  indicated, 

NICHOL/ 

NA/AL  y'YPHON.INC. 
159  East  34ttSt."  N.Y.C. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/J 


The  Flight  of  Time 

The  flight  of  time  brings  changing  conditions  — but  human  nature 
remains  the  same. 

The  practice  of  your  profession  shows  an  evolution  of  theories,  methods 
and  facilities  — but  human  performance  can  never  attain  perfection. 
There  will  always  be  malpractice. 

The  lives  of  your  patients  vary  with  circumstances — but  in  high  station 
or  low  there  is  always  a spark  of  envy  or  avarice  or  greed  or  hate  wait- 
ing for  the  least  provocation  to  blaze  out  against  you  in  a malpractice 
suit.  Even  those  without  foundation  often  succeed  in  their  purpose. 
The  flight  of  time  emphasizes  the  need  of  malpractice  protection  in 
every  practice.  The  past  year  recorded  more  damage  suits  and  greater 
damages  awarded  than  ever  before  in  the  history  of  your  profession. 

t --Jpc > 

FACE  YOUR  FUTURE  FEARLESSLY 

WITH  A 

MEDICAL  PROTECTIVE  CONTRACT 

c ---jOl  j 

cTd£>q  Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Boulevard  5 Chicago,  Illinois 


MEDICAL  PROTECTIVE  CO. 
j 360  North  Michigan  Blvd. 

Chicago,  111. 

Address 

Kindly  send  details  on  your  plan  of 
Complete  Professional  Protection 

City 

1-20 

iff 


i6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ANNOUNCEMENT 

OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION,  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION.  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FU  LG  U RATION  OF  BLADDER  TUMORS,  ETC., 
WILL  BE  GIVEN. 

FOURTEENTH  FLOOR-FOUR-FIFTY 

LOUIS  CLIVE  JACOBS,  M.  D.,  Urologist  SAN  francIsco^ California 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  * DAvenport  7322 


CABLE  WARP  f 
TOWELS 


Westinghouse 
MAZDA  LAMPS 


O’KEEFFE  8C  COMPANY  t 

Incorporated 

WHOLESALE  DEALERS 
BEDDING  * BED  LINENS  , CURTAINS 
Carpets  i Towels  i Table  Linens  i Furniture 
788  Mission  Street  San  Francisco 


Telephones 
Sutter  7599 
Sutter  3458 


Mellin’s  Food 

All  the  resources  and  experience  of  the  Mellin’s  Food  Company  are  concentrated 
upon  the  one  thought  of  making  a product  of  the  highest  possible  excellence  that 
can  always  be  relied  upon  to  accomplish  its  mission — 

A means  to  assist  physicians  in  the 
modification  of  milk  for  inf  ant  feeding. 


This  single-minded  devotion  to  one  job  has  its  reward  in  the  sincere  esteem 
and  ever-increasing  confidence  held  for  Mellin’s  Food  by  physicians  everywhere. 


A Maltose  and  Dextrins 
Milk  Modifier 


Mellin’s  Food  Company 


Boston,  Mass 


gllllllllllllllllllllllllllllllllllllllllllllllllliiiiTO 


SOLUTION  No.  45 

merthiolate 

1:1000 


(Sodium  Ethyl  Mcrcurithiosolicylotc ) 

,TaBLE,  STAINLESS,  NON-IRRITATING  «• 
: mercury  compound  solution  of  high  gcrmic:J-' 
L>  particularly  in  serum  and  other  protein  med'3, 
3>"tab!e  in  this  strength  for  general  application  intir ' 
mtiscpsis  and  nose  and  throat  work.  May  he 
Myswlogical  Salt  Solution  to  any  desired  strength- 


SOLUTION  No.  45 

merthiolate 


M 1 .‘tit*.  m t huuiu ndOSAiac 1 . 

/ Ua,nlc”,  non-irritating  orjrjnj^- 
SyiJ.oludonof  hiKh  Btrmicidal  v 

to  any  desired  >trenff  h- 


&.  CO„  Indianapolis. 


& CO,  IndianapolisT^- 
, '^i!iLl||iiiiiiiiiiiiiliiiiiiiiiiiinii||!i!jJi!^> 


PROGRESS 
TH  ROUGH 
RESEARCH 


Write  for  further 
information 


■ JSierthiolate  Lilly 

(SODIUM  ETHYL  MERCURI  THIOSALICYLATE) 

MERTHIOLATE  is  a new  organic  mercurial  germicide  and  antiseptic, 
potent  in  action  in  the  presence  of  organic  matter,  non-toxic  in  effective 
concentration,  and  non-hemolytic  for  red  blood-cells. 

Merthiolate  is  non-irritating  to  tissue  surfaces.  It  does  not  stain,  is  stable 
in  solution. 

Merthiolate  is  an  effective  agent  for  disinfecting  the  skin  and  tissue  sur- 
faces, for  the  preparation  of  obstetrical  cases;  for  application  to  fresh  cuts, 
abrasions,  denuded  areas;  for  use  as  wet  dressings  and  packs;  for  topical 
application  to  nasopharyngeal  mucous  membranes. 

Merthiolate  is  supplied  by  the  drug  trade  in  i :iooo  isotonic  solution  in 
four-ounce  and  one-pint  bottles. 

ELI  LILLY  AND  COMPANY,  Indianapolis,  U.S.A. 


PROGRESS  THROUGH  RESEARCH 


IT  RO 

U.  u u«» 
ILETIN  , 
INSULIN,  LIUV 

kfo'in  Re*.  U.  S.  P»t.  Of*- 
10-9-23  & 12-23-24 

Units  in  Each  c.c* 
^•236 

Ei!  LiLLY  AND  COMPAQ 
^OlANAPQLlS.  U.  S A 


ILETIN  ! 
^>ULIN,  LIL1 


Units  in  Each  cc. 

^"ciNe  from  the  Islet'** 

'» i,h*5h  distinguishes  tW 

Tn»n^er  license  from  the 
OMARv  LITERATURf  ‘ 
"LV  ON  PHYSICIAN'S 

Nt.Off.  Patented  Oct-*1' 

<3? , ^ cool 


'any,  INDIANA! 


company,  india1 


Iletin  ( Insulin , Lilly')  ivas  the  first  Insulin 
commercially  available  in  the  United  States 


BEFORE  Insulin  was  discovered  the  child  diabetic  under  ten  years  of  age  rarely  lived 
more  than  two  years;  in  the  second  decade,  from  four  to  six  years;  and  after  thirty 
years  of  age,  from  live  to  fifteen  years.  Now,  with  Insulin,  life  may  be  extended  in- 
definitely in  so  far  as  diabetes  is  concerned. 

It  should  not  be  necessary  to  urge  Insulin  therapy  today  in  those  cases  where  it  is 
indicated  but  the  fact  remains  that  many  diabetics  are  dying  without  having  used  it. 

Both  the  physician  and  the  patient  have  a responsibility  in  materially  improving  the 
morbidity  as  well  as  the  mortality  rate  of  diabetes  mellitus  in  this  the  Insulin  era. 

On  account  of  its  characteristic  uniformity,  purity  and  stability  Iletin  (Insulin,  Lilly) 
may  be  relied  upon  whenever  Insulin  is  needed. 

Supplied  through  the  drug  trade  in  5 cc.  and  10  cc.  vials. 

Write  for  pamphlet  and  diet  chart. 


E LI  LI  LLY  AND  COM  PANY  / Indianapolis,  u.  s.  a. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


J7 


4;'^ id  Oz.(app«#- 

D I I^lzed  digitalis  pf< 


"Cl  BA" 

fes?« 

e Method. 

*<2* V?‘fed  preparation 

-llltfte  active  giucos; 

^PUSTRYINBASlEjgl1^' 

-ANysfJ Natives  a lv 

new  vojRr-< 

,roh'bl 


enses  export  P1 


DICIFOUNE 

’’Cl  BA" 

A GOOD  PREPARATION  OF  DIGITALIS 


CIBA  COMPANY 

I N COUP O HATE D 
NEW  YOHK 


For  Oral  Administration 


The  new  one  ounce  bottle  at  no  more 
cost  than  the  former  one-half  ounce 
size  now  offers  to  the  Medical  Pro- 
fession a liquid  digitalis  which  is  not 
only  efficient  but  economical  as  well. 


AMPULES 

For  Hypodermic 
Administration 

Issued  in  packages  of  5, 
20,  and  100  ampules. 


TABLETS 

For  Oral 
Administration 

Issued  in  tubes  of  25  and 
in  bottles  of  100  tablets. 


Be  sure  to  specify  the 
one  ounce  bottle. 


PTE  D 


COU 


ACC  E 


IS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Patient  Types  . . . 

At  the  Threshold  of  Womanhood 

Forbearance  is  called  for  and  real  understanding  between  the  parent 
and  the  daughter. 

It  is  the  physician’s  duty  to  guide  and  manage  the  anxious  daughter 
and  the  anxious  mother  during  these  alterative  and  eventful  changes. 

At  this  period  elimination  is  important  for  both  the  girl  and  the  boy. 
To  assure  bowel  movement,  Petrolagar  is  usually  chosen  by  the  physi- 
cian. It  encourages  natural  peristalsis  without  upsetting  other  functional 
activities. 

Petrolagar,  a palatable  emulsion  of  65%  (by  volume)  pure  mineral 
oil  emulsified  with  agar-agar,  has  many  advantages  over  plain  mineral 
oil.  It  mixes  easily  with  bowel  content,  supplying  unabsorbable  mois- 
ture and  does  not  interfere  with  digestion. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19 


\ GOLD  MINE 

in  your  back  yard  would  certainly  not  be  neglected. 

Let  us  work  the  gold  mine  you  now  have  in  your  office — the  delinquent  and  bad  accounts 
due  you  for  services. 

The  collector  for  "the  butcher,  the  baker,  etc.,”  obviously  cannot  handle  doctors’  accounts 
as  efficiently  or  satisfactorily  as  The  Bureau’s  Collection  Department. 

Nearly  two  thousand  members  of  the  California  Medical  Association,  now  using  our 
service,  testify  to  our  efficiency.  They  are  receiving  through  this  service  an  average  of 
almost  a quarter  of  a million  dollars  annually. 

The  Bureau’s  advertisement  appearing  in  this,  YOUR  official  professional  Journal  con- 
tinuously  for  more  than  three  years,  should  be  sufficient  recommendation  and  proof  of 
efficiency  and  reliability. 

PHONE  OR  WRITE  FOR  DETAILED  INFORMATION 

The  Doctors  Business  Bureau 

Balboa  Building,  GArfield  0460  Brockman  Building,  TRinity  1252 

San  Francisco  Los  Angeles 

The  Only  Business  Service  Exclusively  for  Doctors 
BONDED  Established  in  1916  LICENSED 


TRUTH  ABOUT  MEDICINES 

New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

Note. — These  do  not  represent  all  of  the  actions  of  the  Council, 
but  they  do  represent  those  remedies  manufactured  by  firms  who 
cooperate  with  California  and  Western  Medicine  in  its  advertising 
columns,  and  thereby  with  the  physicians  in  California. 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

Curdolac  Food  Company. — Curdolac  Soya  Flour; 
Curdolac  Casein-Bran  Improved  Flour;  Curdolac 
Soya-Bran  Flour;  Curdolac  Breakfast  Cereal;  Curdo- 
lac Casein  Compound;  Curdolac  Wheat-Soya  Flour; 
Curdolac  Soya-Cereal  Johnny  Cake  Flour;  Curdolac 
Soya-Bran  Breakfast  Food. 

Cutter  Laboratory. — Ampoule  Solution  Silver  Ni- 
trate, one  per  cent;  Typhoid  Paratyphoid  Prophylactic, 
hospital  size  package;  Polyanaerobic  Antitoxin. 

De  Pree  Chemical  Company. — Sulpharsphenamin 
(De  Pree),  0.5  gram  ampoules;  Sulpharsphenamin 
(De  Pree),  0.9  gram  ampoules. 

H.  K.  Mulford  Company. — Gelatin  Compound  Phe- 
nolized (Mulford);  Diphtheria  Toxoid  (Mulford),  30 
cubic  centimeter  vial;  Erysipelas  Streptococcus  Anti- 
toxin, Concentrated,  10  cubic  centimeter  syringe. 

Typho-Bacterin  Mixed  (Triple  Vaccine  TAB),  thirty 
one  cubic  centimeter  vial  package;  Typho-Serobac- 
terin — Mulford  (Sensitized  Typhoid  Vaccine),  three- 
syringe  package;  Normal  Horse  Serum  without  Pre- 
servative; Alder  Pollen  Extract  (Mulford);  Alfalfa 
Pollen  Extract  (Mulford);  Annual  Sage  Pollen  Ex- 
tract (Mulford) ; Apple  Pollen  Extract  (Mulford) ; 
Aster  Pollen  Extract  (Mulford);  Blue  Beech  Pollen 
Extract  (Mulford);  Boneset  Pollen  Extract  (Mul- 
ford); Brown  Grass  Pollen  Extract  (Mulford);  Burn- 
ing Bush  Pollen  Extract  (Mulford);  Burweed  Marsh 
(Continued  on  Page  26) 


Alum  Rock  Sanatorium 
TUBERCULOSIS 

Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 

RATES  AND  FOLDER  ON  APPLICATION 


Consultants  : 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


66 


oar 


d is  full 


A//' 


UNLIKE  the  cupboard  of  childhood  rhyme,  this  cupboard 
is  full.  It  invariably  is ....  in  hospitals  served  by  a 
Troy-equipped  laundry. 

Hospitals  look  to  Troy  laundry  machinery  to  keep  closets 
stocked  with  ample  supplies  of  fresh,  clean  linen.  By  increas- 
ing the  rapidity  of  the  laundering  service,  Troy  equipment 
aids  in  enabling  the  institution  to  operate  on  a minimum 
supply  of  textiles. 

Without  charge  or  obligation,  TROY  HOSPITAL  AD- 
YISORY  SERVICE  will  help  draw  plans  and  prepare 
specifications  for  any  type  or  size  of  laundry.  Feel  free  to 
consult  Troy  engineers  at  any  time. 

TROY  LAUNDRY  MACHINERY  CO.,  INC. 

Chicago  — New  York  City— San  Francisco  — Seattle  — Boston  — Los  Angeles 
JAMES  ARMSTRONG  & CO.,  Ltd.,  European  Agents-.  London  — Paris  — Amsterdam --Oslo. 
Factories:  Bast  Moline,  111., 

TROY 

LAUNDRY  MACHINERY 


SINCE  1879 


THE  WORLD’S  PIONEER  MANUFACTURER  OF  LAUNDRY  MACHINERY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


21 


The  True  Story  of  Acterol 

CHEMISTS  call  it  by  its  correct  chemical  name,  solution 
activated  ergosterol — the  name  by  which  we  first  supplied  it.1 
The  largest  manufacturer  of  rare  sterols  in  America,  early  having 
activated  cholesterol2  (1925),  being  first  in  America  to  commercially 
produce  pure  ergosterol3  and  to  standardize  activated  ergosterol1,4 
(October,  1927),  seeking  to  protect  ourselves  and  the  medical  pro- 
fession against  substitution,  we  coined  the  name  Ac terol — signifying 
activated  ergosterol . The  Council  on  Pharmacy  and  Chemistry 
subsequently  coined  a name,  Viosterol.  As  servants  of  the  American 
Medical  Profession,  we  defer  to  its  wishes  and  now  c^ll  our  product 
Mead’s  Viosterol  in  Oil,  100  D.  The  product  remains  the  same. 

Therefore,  so  long  as  you  specify 


call  it  Acterol,  call  it  Activated  Ergosterol 

call  it  VIOSTEROL  IN  OIL,  100  D 

so  long  as  you  specify  Mead’s, 


You  are  sure  of  getting  the  original  brand 
backed  by  the  longest  manufacturing  and 
clinical  experience.  The  paramount  impor- 
tance of  this  is  evident  from  three  striking 
truths:  (1)  We  established  the  potency  and 
(2)  the  dosage,  both  of  which  (potency  and 
dosage)  are  now  the  official  standards.  (3) 

Mead’s  Viosterol  does  not  turn  rancid. 

Specify  Mead’s  Viosterol  because  it  is  ac- 
curately standardized,  uniformly  potent , 
free  from  rancidity,  and  safe  to  prescribe. 

Mead  Johnson  & Co.,  Evansville , Ind., 
enclose  no  dosage  directions , and  never  ex- 
ploit the  medical  profession. 

V-  Biol.  Chem.,  76:2.  2 Ibid.,  66:451. 

3 Ibid.,  80:15.  *Ibid.,  76:251. 


MEAD’S  VIOS- 
TEROL IN  OIL, 
100  D (or ini- 
tially Acterol). 
Specific  and 
prevent  ive  in 
cases  of  vita- 


WATCH  FOR  SPECIAL  COLOR 
SUPPLEMENT  IN  JOURNAL  OF  THE 
AMERICAN  MEDICAL  ASSOCIATION 
JANUARY  18th,  1930 


min  D deficiency.  Licensed , 
Wisconsin  Alumni  Research 
Foundation.  Accepted,  Council 
on  Pharmacy  and  Chemistry , 
A.M.A.  All  Mead  Products  are 
Co  uncil-Accep  ted. 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 
by  mouth.” 


ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 

ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


ALQUA  WATER— In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 

To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 


Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 

The  Shasta  Water  Company 

Bottlers  and  Controlling  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 

At  All  Druggists 


SOUTHERN  SIERRAS  SANATORIUM 

For  Tuberculosis  and  Allied  Affections 

BANNING,  CALIFORNIA 


Climate  Favorable 

Many  aids  for  comfort  and  convenience. 
Simmons’  Beautyrest  mattresses  throughout. 
Radio  connection  in  each  apartment. 


Throughout  The  Year 

Tempting,  tasteful  foods  prepared  by  a woman  cook. 
Special  dietaries  when  required. 

A spot  of  beauty  in  an  atmosphere  of  contentment. 


RATES  WITHIN  THE  MEANS  OF  THE  AVERAGE  PATIENT 


A REPUTATION  FOR  SERVICE  AND  SATISFACTION 


Charles  E.  Atkinson,  M.  D. 
Medical  Director 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


23 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


BENJAMIN  H.  DIBBLEE 
President 


I.  C.  KNOWLTON 
Secretary 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 

W.  G.  Moore,  M.D. 

Harold  P.  Hill,  M.D. 

Geo.  D.  Lyman,  M.D. 

Howard  H.  Johnson, 
M.  D.,  Med.  Dir. 
Secretary,  Executive 
Committee. 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


CANYON  SANATORIUM  the  Treatment  of  Tuberculosis 


REDWOOD  CITY,  CALIFORNIA 


NESTLED  IN  THE  FOOTHILLS 


For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  Douglas  4486 


H 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  Markbt  331 


Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with  espe- 
cial reference  to  parasites.  Con- 
tainers will  be  furnished 
upon  request 

HERBERT  GUNN,  M.D. 

2000  Van  Ness  Avenue 

San  Francisco  Telephone:  Graystone  1027 

THE  HILL- YOUNG  SCHOOL 

OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi- 
culty. Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child’s 
physician.  Testimonials  from  physicians. 

School  Publications — #2.00  each:  "Overcoming  Cleft 

Palate  Speech,”  "Help  for  You  Who  Stutter.” 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 

2809-15  South  Hoover  Street  WEstmore  0512 

Hazel  E.  Fur scott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  Douglas  9124  380  Post  St 

San  Francisco,  California 

Shumate’s 

PRESCRIPTION  PHARMACIES 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 

Refrigerated  Biologies  > Prescription 
Technique 

Catering  to  the  Medical  Profession  Since  1890 

SAN  FRANCISCO 

QUIZ  COURSE, 

Preparation  For  Medical  Boards, 
Post-Graduate  Medical  Lectures. 

ARTHUR  H.  WHITE,  M.  D. 

1005  Market  Street  San  Francisco 

Phone  Market  3362 

HOLLAND-RANTOS 
COMPANY,  Inc. 

Gynecological  and  Obstetrical 
Specialties 

Descriptive  Leaflets,  Reports  and  Price  List 

Sent  on  Request 

156  FIFTH  AVENUE  NEW  YORK  CITY 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


DIET  QUESTIONS  have  GELATINE  ANSWERS 


HOW  CAN  YOU  MAKE  A 
DIABETIC  KEEP  TO  HIS  DIET 
AND  ENJOY  IT?  . . . 


KIM  OX 

is  the  real 

GEL4TIWE 


As  every  physician  knows,  ordinary  everyday  hun- 
ger has  a way  of  complicating  the  diabetic  diet 
problem.  The  memories  of  patients  are  notori- 
ously short— and  it  is  often  easy  to  forget  the  diet 
when  the  appetite  craves  something“good  to  eat”! 

Knox  Sparkling  Gelatine  has  the  double 
faculty  of  providing  dishes  that  are  “good  to 
eat”— and  also  dietetically  correct  for  diabetics. 

Knox  Gelatine,  being  real  gelatine  — free 
from  sugar,  coloring  and  ready-prepared  flavor- 
ing-combines delightfully  with  the  foods  most 
commonly  prescribed  for  diabetics:  eggs,  cream, 
meat,  fish,  vegetables  and  fruits.  Moreover,  it 
multiplies  the  forms  in  which  these  foods  may 
be  presented,  bringing  to  the  diabetic  menu  a 
tempting  variety  that  will  please  the  most  jaded 
appetite. 

May  we  send  you  the  recipes  contained  in  the 
Diabetic  Recipe  Book,  prepared  by  an  eminent 
dietitian?  If  you  will  clip  the  coupon  below  we 
shall  be  glad  to  send  you  this  book  by  early  mail. 

TTTTTTTTTTTT  TTTTTTTTTTTT  TTTTTTTTTTTT  TT  TTTTTTTTTTTT  TTTTTTTTTTTT  T TTTT  TTTTTTT 

KNOX  GELATINE  LABORATORIES 
417  Knox  Avenue,  Johnstown,  N.  Y. 

Please  send  me,  without  obligation  or  expense,  the  booklets  which  I have 
marked.  Also  register  my  name  for  future  reports  on  clinical  gelatine  tests 
as  they  are  issued. 

□ Varying  the  Monotony  of  Liquid  and  Soft  Diets.  □ Recipes  for  Anemia. 

□ Diet  in  the  Treatment  of  Diabetes.  □ Reducing  Diet. 

□ Value  of  Gelatine  in  Infant  and  Child  Feeding. 


Name 

Address 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SAINT  FRANCIS  HOSPITAL 

AND 

SCHOOL  OF  NURSING 


A GENERAL 


directors 


hospital 


JOHN  GALLWEY, 
M.  D. 

W.  B.  COFFEY, 
M.  D. 

THOS.  E.  SHUMATE, 
M.  D. 

W.  W.  WYMORE, 
M.  D. 

JOHN  H.  GRAVES, 
M.  D. 

M.  O.  AUSTIN, 
M.D. 

J.  H.  O’CONNOR, 
M.  D. 

B.  A.  MARDIS, 

M.  D. 

H.  E.  MANWARINC 


WITH 


ACCOMMODATIONS 


FOR  THREE 


HUNDRED 


PATIENTS 


Tglgphont 


Mdnaging  Dirge  tor 

L.  B.  ROGERS, 
M.  D. 


Address  Communications 


SAINT  FRANCIS  HOSPITAL 


CAMERAS 

For  Every  Purpose 

From  the  simplest  kodak  to  the 
most  elaborate  photographic  ap- 
paratus for  technical  and  pro- 
fessional use. 

Motion  picture  equipment  for 
taking  and  projecting  moving  pic- 
tures in  black  and  white  and  nat- 
ural colors. 

developing 

PRINTING 

ENLARGING 

TRAINER-PARSONS 
OPTICAL  CO. 


228  Post  Street 


San  Francisco 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  19) 

ExteractP(MulfoEr?)rar  ButtercuP  Pollen 

tract  (A  Srf^d)VCa  !f°rnia,  MuSWort  Pollen  Ex- 
nur  (^lllf°rd);  Careless  Weed  Pollen  Extract 
(Mulford);  Cedar  Tree  Pollen  Extract  (MulfordV 

Extrfct™^foEd?ran  ; Crab  Grass  Sen 

Extract  (Mulford) ; Dahlia  Pollen  Extract  (Mulford)- 

Dragon  Sage  Pollen  Extract  (Mulford);  Elm  Tree 

Extract  afXoVd  V*  F^^  J pEn  gHs£  PIantain  Pollen 
-xtract  (Mulford) , Fescue  Pollen  Extract  (Mulford)- 

Golden  Glow  Pollen  Extract  (Mulford);  Hickory 

ree  Pollen  Extract  (Mulford);  Milo  Maize  Pollen 

rMtrfrCt  ford'):  Mock  Orange  Pollen  Extract 

(Mulford);  Oat  Pollen  Extract  (Mulford)-  Olive 
Pollen  Extraet  (Mulford);  Pecan  Tree  Pollen  Fv! 
tract  (Mulford);  Pine  Tree  Pollen  Extract  (Mulford)- 
Poverty  Weed  Pollen  Extract  (Mulford);  Prlirie 
Grass  Pollen  Extract  (Mulford);  Privet  Pollen  Fx! 
tract  (Mulford);  Quack  Grass  Pollen  Extract  (Mul 

Poll  ; pabfblt  B5Afh  PoIlen  Extract  (Mulford);  Rose 
P°’En  Extract  (Mulford);  Salt  Bush  Pollen  Extract 
(Mulford);  Shad  Scale  Pollen  Extract  (Mulford)- 
Sheep  Sorrel  Pollen  Extract  (Mulford);  Slender  Rag- 
weed  Pollen  Extract  (Mulford);  Spring  Amaranfh 
Pollen  Extract  (Mulford) ; Sudan  Grass  Pollen  Ex- 
tract  (Mulford);  Velvet  Grass  Pollen  Extract  (Mul- 
: Western  Giant  Ragweed  Pollen  Extract 
fulford;  Wheat  Pollen  Extract  (Mulford);  Wild 
Oats  Pollen  Extract  (Mulford);  Willow  Tree  Pollen 
nvr1  Tf0  f ( M u If  o r d ) ; Winter  Grass  Pollen  Extract 
(Mulford)’  W F°Xtail  Grass  Pollen  Extract 

National  Drug  Company.— Diphtheria  Toxoid. 

^b0A?PiS0ns  -^aEed  Milk  Company,  Inc. — Thomp- 
son s Maltose  and  Dextrin.  P 

Digitos  Ampoules,  Five' Cubic  Centimeters —Each 
ampoule  contains  digitos  (New  and  Nonofficial  Reme- 
(Continued  on  Page  30) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


EVERY  PHYSICIAN 

should  be  familiar  with  these  two 

SQUIBB  ANTITOXINS 


Erysipelas  Streptococcus 
Antitoxin  Squibb 

As  erysipelas  antitoxin  is  being  more  and 
more  widely  used  its  value  in  erysipelas  is 
being  recognized. 

Erysipelas  Streptococcus  Antitoxin 
Squibb  is  accepted  by  the  Council  on 
Pharmacy  and  Chemistry  of  the  American 
Medical  Association.  It  is  prepared  ac- 
cording to  the  principles  developed  by 
Dr.  Konrad  E.  Birkhaug.  Its  early  admin- 
istration ensures  a prompt  reduction  in 
temperature  and  toxicosis,  clearing  the 
lesions  and  effecting  uncomplicated  recov- 
ery. 

Erysipelas  Streptococcus  Antitoxin 
Squibb  is  distributed  only  in  concentrated 
form  in  syringes  containing  one  average 
therapeutic  dose. 


Tetanus  Antitoxin  Squibb 

Every  wound  in  which  skin  continuity  is 
destroyed  is  a possible  route  of  tetanus 
infection.  Just  as  routine  practice  of  in- 
jecting anti-tetanic  serum  during  the  World 
War  practically  eradicated  tetanus  so  in 
civil  practice  this  disease  might  be  stamped 
out  by  the  same  routine  practice. 

Tetanus  Antitoxin  Squibb  is  small  in 
bulk,  high  in  potency,  low  in  total  solids, 
yet  of  a fluidity  that  permits  rapid  absorp- 
tion. It  is  remarkably  free  from  serum- 
reaction  producing  proteins. 

Tetanus  Antitoxin  Squibb  is  supplied  in 
vials  or  syringes  containing  an  immunizing 
dose  of  1500  units.  Curative  doses  are 
marketed  in  syringes  containing  3,000, 
5,000,  10,000  and  20,000  units. 


(W rite  to  the  Professional  Service  Department  for  Literature) 

E RSquibb  & Sons,  New  York 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


aS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


29 


T 

Mhc 

hurry  y 


“wash” 

at  this 


comes  back  in  a 
memorial  Hospital 


The  Memorial  Hospital,  Owosso,  Michigan, 
’with  a view  of  its  “A merican”  laundry  depart- 
ment, in  which  linens  are  washed  and  ironed  so 
promptly,  perfectly  and  economically. 


BECAUSE  the  Memorial  Hospital, 
Owosso,  Michigan,  has  its  own  “Ameri- 
can” laundry  department,  it  always  has 
plenty  of  linens,  immaculately  washed  and 
perfectly  ironed,  ready  for  service.  Standards 
of  quality  are  high — operating  costs  are  low. 

The  “American”  engineers  who  planned 
and  installed  this  splendid  laundry  will  be 
glad  to  talk  to  you  about  the  advantages  of 
having  such  a department  in  your  hospital, 


operated  under  your  direct  supervision. 
Write — we’ll  have  one  of  these  “specialists” 
call  and  help  you  diagnose  your  laundry 
problem. 

Larry,  the  Laundryman,  says: 

“Let  ’em  shoot  the  work  down  to  us 
tagged  ‘double  rush’ — what  do  we  care? 
If  it’s  service  they  want,  we’re  all  set  to 
give  ’em  plenty  of  it!” 


THE  AMERICAN  LAUNDRY  MACHINERY  COMPANY,  Norwood  Station,  Cincinnati,  Ohio 


San  Francisco 


Los  Angeles 


Seattle 


3° 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


. 

4 

4 

4 

4 

« 

4 

=*= 

! 

ALBERT  SOILAND  CLINIC 

J 

1407  South  Hope  Street 

! 

LOS  ANGELES,  CALIFORNIA 

Telephone  W estmore  1418 

Hours  9:00  to  4:00 

o 

An  institution  fully  equipped 

for  the  study,  diagnosis  and 
treatment  of  neoplastic  disease. 

i 

o 

» 

Albert  Soiland,  M.  D. 

Wm.  E.  Costolow,  M.  D. 

Orville  N.  Meland,  M.  D. 

Egbert  J.  Bailey,  M.  D. 

A.  H.  Warner,  Ph.D.,  Physicist 

-5?- 

=>; 

Supporting 


Qarments 

Comfort 
and  Support 
with  New 
Inner  Pad  Belt 


Where  scientific  abdominal 
uplift  and  support  are  desired, 
this  new  Camp  Inner  Pad  Belt 
(Model  No.  913)  serves  admi- 
rably. Wi.h  the  Patented 
Adjustment  attached  directly 
to  the  sofc  inner  pad,  the  belt 
provides  for  correct  upward 
and  backward  support.  This 
Adjustment  makes  manipula- 
tion easy  and  a stronger  pull 
possible.  The  outer  elastic 
section  controls  extra  adipose 
tissue.  The  Inner  Pad  Belt  in- 
sures maximum  comfort  with 
proper  support.  Dealers  stock- 
ing these  items  add  a service 
which  customers  will  appreci- 
ate . . . and,  at  the  same  time, 
increase  profit  possibilities. 
Sold  by  surgical  houses  and  the 
better  drug  stores. 


Write  for  our  Physicians*  Manual 

S.  H.  CAMP  AND  COMPANY 

Manufacturer!,  JACKSON,  MICHIGAN 
CHICAGO  LONDON  NEW  YORK 

69  E.  Madison  St.  252  Regent  St. . W.  330  Fifth  Ave. 


Dependability  Is  a Factor 
in  Dairy  Products 
Satisfaction 

— and  Golden  State  brand 
products  are  famed  for 
their  dependability. 

— Golden  State  plants  and 
branches  conveniently 
located  throughout  California  make  these 
quality  products  available  to  you  up  and 
down  the  state. 

Golden  State 
Milk  Products  Company 

MILK  r CREAM  , BUTTER 
ICE  CREAM  r COTTAGE  CHEESE 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  26) 

dies,  1922,  p.  138),  five  cubic  centimeters.  H.  K. 
Mulford  Company,  Philadelphia. 

Luminal  Capsules,  One  and  One-Half  Grains. — 
Each  capsule  contains  luminal  (New  and  Nonofficial 
Remedies,  1929,  p.  81),  one  and  one-half  grains. 
Winthrop  Chemical  Company,  Inc.,  New  York. 

Metaphen  2500. — It  contains  one  part  metaphen 
(New  and  Nonofficial  Remedies,  1929,  p.  272),  dis- 
solved in  2500  parts  of  water  containing  0.33  per  cent 
each  of  sodium  bicarbonate  and  sodium  carbonate. 
Abbott  Laboratories,  North  Chicago. 

Diphtheria  Toxoid  (Squibb). — This  diphtheria  tox- 
oid (New  and  Nonofficial  Remedies,  1929,  p.  368),  is 
also  marketed  in  packages  of  one  30  cubic  centimeter 
vial.  E.  R.  Squibb  & Sons,  New  York. — Jour.  A.  M.  A., 
November  9,  1929,  p.  1471. 

Diphtheria  Toxoid  (Cutter).  — Diphtheria  toxoid 
(New  and  Nonofficial  Remedies,  1929,  p.  368),  pre- 
pared from  diphtheria  toxin  whose  L + dose  is  0.2 
cubic  centimeter  or  less  by  treatment  with  0.3  to  0.4 
per  cent  formaldehyd.  It  is  tested  for  antigen  potency 
by  injection  into  guinea-pigs.  It  is  marketed  in  pack- 
ages of  one  immunization  treatment  of  three  one 
cubic  centimeter  vials;  in  packages  of  ten  immuniza- 
tion treatments  of  thirty  one  cubic  centimeter  vials; 
also  in  packages  of  one  thirty  cubic  centimeters  am- 
poule. Cutter  Laboratory,  Berkeley,  California. — Jour. 
A.  M.  A.,  November  16,  1929,  p.  1559. 

Solution  of  Invert  Sugar  (Lilly). — A solution  of  a 
mixture  of  dextrose  and  levulose,  obtained  by  the 
inversion  of  sucrose.  Solution  of  invert  sugar  (Lilly) 
is  used  in  the  injection  treatment  of  varicose  veins. 
It  is  claimed  that  the  use  of  sugar  solutions  such  as 
solutions  of  dextrose  or  of  invert  sugar  have  the 
advantage  over  solutions  of  sodium  chlorid,  sodium 
(Continued  on  Page  36) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3i 


Your  prescriptions  in 
Orthogon  are  filled 
promptly  by  all  Riggs 
houses.  Riggs  is  lo- 
cated conveniently  in 
54  Western  and  mid- 
Western  cities. 


Your 


Patrons 

appreciate 

precision 


RIGGS 

OPTICAL  COMPANY 


QUALITY  OPTICAL  PRODUCTS 


THE  public  is  educated 
to  maximum  service. 
This  is  an  era  of  service.  When  your  patients 
are  informed  that  better  lenses  are  available  they 
appreciate  having  the  merits  of  such  lenses  ex- 
plained and  demonstrated.  When  you  urge  the 
purchase  of  Orthogon  precision  lenses  you  in- 
dicate an  interest  in  utmost  eye  comfort;  a desire  to  more  com- 
pletely translate  your  findings  into  an  effective  prescription.  When 
you  write  "Orthogon’’  on  the  Rx  you  are  giving  better  service 
and  increasing  your  prestige. 

The  Orthogon  series  of  lenses  is  not  a new  product  designed  to 
sell  merely  as  "improved  merchandise.”.  These  lenses  are  the  result 
of  years  of  study  and  experiment  originating  in  the  desire  of  ad- 
vanced refractionists  for  ideal  ophthalmic  lenses. 


32 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


J1 


easure 


Iletin  ( Insulin , Lilly) 

Merthiolate 

Liver  Extract 
No.  343 

Inhalant 

Ephedrine  Compound 
No.  20 

Inhalant 

Ephedrine  (Plain) 

No.  21 

Assayed  and  Standardized 
Pharmaceuticals 

Biologicals 


A FAULTY  gauge  once  discredited  a long  series  of 

measurements  made  by  a famous  investigator. 

In  the  production  of  pharmaceuticals  and  biologicals  fidelity 
to  formula,  and  scrupulous  care  in  weighing  and  measuring  are 
in  vain  if  the  weights  and  measures  are  inaccurate. 

In  the  Lilly  Laboratories  the  equipment  for  maintaining  ac- 
curacy in  these  essentials  consists  of  two  sets  of  standard 
weights  and  measures  and  a balance  designed  for  verifying  and 
adjusting  weights.  One  of  the  two  sets  of  weights  and  measures 
is  a working  set,  the  other  a reference  standard  used  to  control 
the  working  standard.  All  are  adjusted  within  the  tolerance 
limits  prescribed  by  the  United  States  Bureau  of  Standards. 

Deficient  weights  and  measures  are  corrected  or  discarded 
and  destroyed.  In  the  Lilly  Laboratories  each  weight  and  meas- 
ure is  numbered  for  identification.  This  number  is  entered  on 
a card  on  which  is  recorded  the  dates  of  its  inspection  and 
condition. 

Scrupulous  care  in  testing  weights  and  measures  is  but  one 
of  the  many  means  taken  to  make  Lilly  Products  true  to  label 
in  respect,  to  both  quantity  and  quality. 


ELI  LILLY  AND  COMPANY 

INDIANAPOLIS,  U.  S.  A. 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXII  JANUARY,  1930  No.  1 


INTESTINAL  OBSTRUCTION* 

SOME  MEDICAL  ASPECTS 

By  V.  R.  Mason,  M.  D. 

Los  Angeles 

Discussion  by  Charles  D.  Lockwood,  M.  D.,  Pasadena; 
William  J.  Kerr,  M.  D.,  San  Francisco ; Lovell  Langstroth, 
M . D.,  San  Francisco. 

HP  HE  symptoms  and  physical  signs  which  de- 
velop  after  an  acute  obstruction  of  the  bowel 
are  familiar  to  all  physicians.  By  careful  deduc- 
tions it  is  usually  possible  to  predicate  the  ap- 
proximate point  of  the  obstruction,  the  presence 
or  absence  of  asphyxia  of  the  bowel  and,  in  many 
instances,  the  cause  of  the  obstruction.  Never- 
theless the  mortality  rate,  in  general,  remains  far 
too  high.  An  analysis  of  the  records  of  more  than 
one  hundred  patients  operated  upon  for  obstruc- 
tion of  the  bowel  at  the  Los  Angeles  General 
Hospital  during  the  past  year  has  demonstrated 
anew  that  the  delay  between  the  onset  of  symp- 
toms and  the  appearance  of  unmistakable  signs  of 
grave  shock  and  toxemia  is  responsible  for  the 
greater  number  of  deaths. 

FACTORS  CAUSING  DELAY 

The  factors  which  produce  this  delay  are  nu- 
merous, but  due  to  their  importance  will  be  enu- 
merated in  their  order  of  frequency: 

1.  Much  time  is  often  lost  applying  simple 
remedies,  such  as  enemata,  lavages  and  hot  stupes, 
in  the  hope  of  relieving  “gas.” 

2.  In  instances  of  pyloric  obstruction  from 
ulcer,  faith  in  pills,  powders,  and  diets  not  infre- 
quently leads  to  unwarranted  delay  of  operation. 

3.  In  the  more  acute  cases  of  small  bowel 
obstruction  valuable  time  is  frequently  lost  await- 
ing the  results  of  laboratory  procedures  or  gastro- 
intestinal radiographs  or  consultants’  opinions. 

4.  Frequently  the  patient  cannot  be  made  aware 
of  the  seriousness  of  his  condition  before  the  pro- 
gressing toxemia  has  made  operation  hazardous. 

5.  The  abuse  of  sedative  drugs  has  played  a 
minimal  part  in  causing  delay  in  this  series  of 
patients. 

Many  of  these  causes  of  delay  are  beyond  the 

* Read  before  the  General  Surgery  Section  of  the  Cali- 
fornia Medical  Association  at  the  fifty-eighth  annual 
session,  May  6-9,  1929. 


control  of  the  physician.  A number,  however, 
might  have  been  prevented.  In  very  few  acute 
conditions  is  clinical  judgment  so  important  and 
laboratory  studies  so  unimportant.  A flat  radio- 
graph of  the  abdomen  in  the  upright  and  possibly 
in  the  horizontal  position,  blood  counts  and  an 
examination  of  the  urine  should  be  made  at 
once  and  the  results  should  be  obtained  without 
occasioning  appreciable  delay.  Blood  should  be 
withdrawn  for  chemical  analysis,  but  operation 
should  not  be  postponed  on  this  account.  Al- 
though the  results  of  blood  chemistry  determi- 
nations are  quite  characteristic,  their  importance 
in  diagnosis  in  the  early  stages  of  bowel  obstruc- 
tion is  likely  to  be  exaggerated.  Later,  in  the 
progress  of  the  condition  these  results  are  of 
much  value,  for  they  give  an  adequate  idea  of 
the  severity  of  the  toxemia  and,  in  addition,  point 
to  a rational  therapy.  Since  the  administration  of 
physiological  or  hypertonic  salt  solution  should 
be  a routine  procedure  in  all  instances  of  sus- 
pected obstruction  of  the  bowel  the  results  of 
blood  chemistry  determinations  should  not  be 
awaited  at  the  expense  of  earlier  operation. 

CLINICAL  SYNDROME  IN  BOWEL  OBSTRUCTION 

The  exact  cause  of  the  clinical  syndrome  pre- 
sented by  patients  with  obstruction  of  the  bowel 
is  not  completely  known.  Earlier  work  1 empha- 
sized the  importance  of  the  absorption  of  toxic 
material,  either  sterile  or  contaminated,  from  the 
bowel  above  the  point  of  obstruction.  This  hypo- 
thetical toxic  material  was  of  unknown  origin  and 
composition,  and  proof  of  its  absorption  from  the 
bowel  is  still  lacking.  It  is  possible  that  toxic 
material  is  formed  in  an  obstructed  bowel  with 
damaged  mucosa  or,  indeed,  in  a normal  bowel, 
but  it  has  been  impossible  to  prove  that  absorp- 
tion of  such  material  through  the  bowel  wall  is 
frequently  a cause  of  symptoms  or  disease. 

Later  observers  have  given  their  attention  to 
the  loss  of  digestive  and  intestinal  fluid,  inanition, 
dehydration,  and  the  profound  alterations  of  the 
physical  and  chemical  equilibria  in  the  body.  They 
have  also  reemphasized  the  differences  between 
simple  obstruction  and  obstruction  with  asphyxi- 
ated areas  of  bowel.  In  the  former  instance  the 
toxemia  is  less  severe  and  life  may  be  prolonged 
for  a greater  period  of  time  than  in  the  latter. 
In  dogs  with  simple  obstruction  properly  treated, 
death  seems  to  depend  more  on  starvation  than 
on  toxemia.2  With  asphyxiated  bowel,  or  any 


2 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


Table  Giving  Data  from  Twenty-five  Cases  of  Intestinal  Obstruction 


Name 

Number 

1 Age 

Duration  of 

Acute  Symptoms 

Amount  of 

Vomiting 

URINE 

W.  B.  C. 

Temperature 

BLOOD 

Pc  int  of 

Obstruction 

REMARKS 

RESULT 

Albumin  in 

Casts 

Reaction 

Z 

z 

CM 

G 

NaCl 

J.  c. 

18818 

24 

12  hrs. 

2 + 

3 + 

0 

alk 

14,200 

99< 

47 

429 

Jejunum 

Bowel  viable 

Cured 

H.  D. 

44970 

38 

5 da. 

4 + 

1 + 

0 

ac 

6,000 

103° 

33 

67 

231 

Vomiting  and  diarrhea 

Not  operated 

M.  A. 

27445 

56 

48  hrs. 

4 + 

0 

0 

ac 

22,000 

62 

346 

Ilium 

Cyanotic  bowel  not  re- 
sected 

Cured 

Wm.  W. 

48704 

81 

12  hrs. 

1 + 

0 

0 

alk 

99 

61 

330 

Ilium 

Bowel  not  cyanotic 

Cured 

V.  s. 

45071 

68 

5 da. 

4 + 

2 + 

0 

ac 

15,400 

' 98 

42 

32 

396 

Ilium 

Gangrene  6 cm.  resected 

Died 

D.  L. 

47389 

54 

22  da. 

2 + 

1 + 

0 

10,100 

100° 

62 

297 

Ilium 

Bowel  cyanotic 

Cured 

F G. 

36762 

38 

5 da. 

3 + 

1 + 

0 

ac 

8,600 

98° 

379 

Ilium 

Bowel  good  condition 

Cured 

A J. 

35086 

40 

35  da. 

3 + 

0 

0 

ac 

13,200 

992 

47.1 

231 

Ilium 

BowTel  viable 

Cured 

M M. 

29303 

28 

24  hrs. 

1 + 

0 

0 

8,750 

986 

33 

65 

460 

Ilium 

Bowel  viable 

Cured 

E.  M. 

28076 

30 

1 da. 

1 + 

0 

0 

ac 

18,800 

99 

412 

Ilium 

Bow'el  viable 

Cured 

A.  F. 

52189 

69 

1 da. 

2 + 

1 + 

0 

ac 

18,100 

972 

41 

61 

448 

Ilium 

Bowel  viable 

Died 

R G. 

53910 

59 

2 da. 

1 + 

0 

0 

99 

60 

363 

Ilium 

Bowel  viable 

Died 

L.  D. 

27896 

38 

2 da. 

3 + 

0 

0 

alk 

7,000 

98° 

363 

Cecum 

Adhesions  released 

Cured 

G.B.H. 

47730 

54 

21  da. 

1 + 

0 

0 

ac 

29,800 

99 

33 

58 

478 

Colon 

Resection,  partial;  colon 

Died 

R C. 

44427 

57 

3 da. 

2 + 

0 

0 

ac 

22,000 

98° 

35 

371 

Colon 

Resection  partial  carci- 
noma 

Died 

G.  N. 

496 

76 

2 da. 

3 + 

1 + 

0 

ac 

15,400 

98 

60 

462 

Sigmoid 

Resection  sigmoid 

Died 

J.  A.  H. 

2812 

46 

14  da. 

3 + 

0 

0 

alk 

11,400 

98° 

63 

363 

Pylorus 

Gastro-enterostomy 

Cured 

W,  B. 

49066 

40 

30  da. 

3 + 

0 

0 

alk 

7,800 

988 

42 

65 

360 

Pylorus 

Gastro-enterostomy 

Cured 

P.  E. 

46018 

69 

35  da. 

3 + 

0 

0 

acid 

8,500 

97° 

33 

69 

346 

Pylorus 

Not  operated 

G.  H. 

37781 

52 

180  da. 

1 + 

0 

0 

alk 

98° 

33 

58 

378 

Pylorus 

Gastro-enterostomy 

Died 

R.  M. 

48398 

64 

14  da. 

3 + 

0 

0 

alk 

7,200 

98° 

85 

77 

330 

Pylorus 

Gastro-enterostomy 

Died 

A.  G. 

5171 

50 

21  da. 

3 + 

0 

0 

ac 

10,050 

99° 

462 

Pylorus 

Gastro-enterostomy 

Died 

R.  M. 

27181 

39 

14  da. 

3 + 

1 + 

0 

ac 

6,000 

992 

63 

330 

Pylorus 

Gastro-enterostomy 

Cured 

J.  C. 

4528 

44 

21  da. 

3 + 

0 

0 

alk 

98° 

63 

460 

Pylorus 

Gastro-enterostomy 

Cured 

M. 

40 

30  da. 

3 + 

1 + 

0 

alk 

98° 

112 

600 

Pylorus 

Gastro-enterostomy 

Died 

♦N.P.N.  as  mgm.  per  100  cc.  whole  blood;  CO„  as  vol.  per  cent;  Cl  as  mgm.  NaCl  per  100  cc.  whole  blood. 


other  necrotic  tissue  free  in  the  peritoneal  cavity, 
grave  toxemia  is  added  to  alterations  produced  by 
simple  obstruction. 

The  use  of  saline  solution  in  the  treatment 
of  obstruction  of  the  bowel  was  advocated  by 
Hartwell  and  Hoguet 3 in  1912.  Although  they 
believed  the  relief  of  anhydremia  was  the  impor- 
tant factor  their  work  deserves  much  credit. 
Tileston  and  Comfort 4 two  years  later  proved 
that  the  nonprotein  nitrogen  fraction  of  the  blood 
was  increased  in  obstruction.  MacCallum  5 and 
his  associates  in  1920  showed  that  hypochloremia 
and  alkalosis  accompanied  gastric  tetany  pro- 
duced experimentally  in  dogs  and  that  the  symp- 
toms could  be  relieved  by  the  administration  of 
saline  solutions.  Haden  and  Orr  6 in  1923  pub- 
lished their  first  report,  and  in  a series  of  investi- 
gations have  added  much  to  the  knowledge  of  the 
alterations  produced  by  simple  obstruction. 

The  known  facts  may  be  briefly  stated  as 
follows:  At  the  onset  of  obstruction,  fluid  loss 
occurs  by  vomiting  and  probably  by  secretion  into 
the  bowel  lumen.  This  may  be  accompanied  by 


tbe  loss  of  as  much  as  five  grams  of  chlorids  per 
liter  of  vomitus.  As  a rule  the  chlorid  content 
of  the  blood  falls  rapidly.  However,  since  the 
sodium  content  of  the  blood  is  decreased  little,  if 
at  all,  the  resulting  acid-base  imbalance  is  parti- 
ally compensated  by  the  retention  of  C02,  lead- 
ing to  an  alkali-excess  type  of  alkalosis.  When 
the  C02  volume  per  cent  reaches  about  eighty- 
five,  tetanic  symptoms  become  manifest,  but  even 
at  this  time  the  pH  of  the  blood  is  little  altered. 
Since  sodium  represents  about  92  per  cent  of  the 
fixed  base  and  cblorid  and  C02  about  96  per  cent 
of  the  total  acid  radicles  of  the  body,  alkalosis  is 
inevitable  in  any  chlorid  loss  not  quickly  restored. 
Furthermore,  since  “it  is  probable  that  the  main- 
tenance of  a normal  osmotic  pressure  is  of  more 
importance  to  life  than  the  maintenance  of  a 
normal  acid-base  equilibrium,”  the  loss  of  large 
quantities  of  osmotically  active  chlorid  may  be 
compensated  by  the  retention  of  the  less  osmoti- 
cally active  nonprotein  nitrogen  substances  in  the 
blood  although  some  increase  in  the  urinary  nitro- 
gen excretion  may  indicate  an  abnormally  high 


January,  1930 


INTESTINAL  OBSTRUCTION — MASON 


3 


body-protein  metabolism.  Certain  alterations  of 
minor  importance  also  occur.  The  sodium  and 
potassium  content  of  the  blood  decrease  but 
slightly.  Calcium  and  magnesium  are  little  changed 
and  the  quantity  of  sulphur  and  phosphorus  is 
increased. 

Complete  water  and  electrolyte  balances  through- 
out the  course  of  an  intestinal  obstruction  are  not 
available.  In  consequence,  certain  important  data 
of  great  value  are  still  lacking.  The  fate  of  the 
chlorids  is  not  completely  known,  but  observa- 
tion of  clinical  cases  makes  it  reasonable  to  assume 
that  the  loss  of  gastric  contents  by  vomiting  is 
chiefly  responsible  for  the  dehydration,  increased 
viscosity  of  the  blood,  oliguria,  and  chloropenia. 
This  explanation  seems  more  likely  when  one  con- 
siders that  the  same  phenomena  occur  in  cholera, 
in  severe  diarrhea,  and  in  other  states  associated 
with  vomiting  and  diarrhea.  Brown,  Eusterman, 
Hartman,  and  Rowntree  believed  that  renal  in- 
sufficiency might  play  a part  in  the  toxemia.  It 
seems  more  logical  to  assume  that  the  retention 
of  nonprotein  nitrogen  is  compensatory  to  the 
chlorid  loss.  Furthermore,  Blum  7 has  shown  that 
in  certain  types  of  nephritis  loss  of  chlorids  by 
vomiting  or  reductions  of  chlorid  intake  for  thera- 
peutic reasons  will  lead  to  greatly  increased  non- 
protein nitrogen  retention  in  the  blood. 

The  changes  encountered  in  intestinal  obstruc- 
tion : alkalosis,  chloropenia,  and  retention  of 
nonprotein  nitrogen  occur  in  many  conditions  as- 
sociated with  loss  of  gastric  or  intestinal  juices 
and  are  not  diagnostic  of  intestinal  obstruction. 
Furthermore  the  toxemia  of  intestinal  obstruc- 
tion may  be  severe  before  these  changes  make 
their  appearance  and,  as  is  well  known,  this  is 
particularly  true  when  the  point  of  obstruction 
is  high. 

DATA  FROM  TWENTY-FIVE  CASES 

The  important  data  from  the  records  of  twenty- 
five  patients  recently  observed  with  various  types 
of  obstruction  are  summarized  in  the  accompany- 
ing table.  It  will  be  noticed  that  a chloropenia 
was  practically  constant  while  important  degrees 
of  alkalosis  or  of  nitrogen  retention  were  seldom 
observed.  The  lowest  blood  chlorid  occurred  in 
a patient  suspected  at  first  of  having  an  obstructed 
bowel  but  who  recovered  without  operation.  The 
highest  chlorid  content  was  observed  in  a patient 
with  syphilis  of  the  stomach  in  whom  the  pyloric 
obstruction  was  the  indication  for  gastro-enteros- 
tomy.  In  this  instance  the  patient  vomited  con- 
tinuously, but  the  vomitus  contained  only  traces 
of  chlorids,  yet  the  C02  content  of  the  blood  was 
above  one  hundred  volume  per  cent  for  several 
days,  and  the  patient  was  tetanic.  These  excep- 
tional cases  should  call  attention  to  the  need  of 
caution  in  formulating  any  hypothesis  concerning 
the  cause  of  toxemia  and  death  in  acute  intestinal 
obstruction.  Further  studies  of  the  acid-base  bal- 
ance, of  the  osmotic  balance,  and  of  the  part 
played  by  anhydremia,  inanition  and  toxemia  may 


easily  explain  the  exceptional  cases  encountered 
in  any  large  series. 

838  Pacific  Mutual  Building. 

REFERENCES 

1.  Whipple,  G.  H.,  Stone,  H.  B.,  and  Bernheim, 
B.  M.:  J.  Exper.  Med.,  1913,  xvii,  286. 

2.  Foster,  W.  C.,  and  Hausler,  R.  W. : Arch.  Int. 
Med.,  1925,  xxxvi,  31. 

3.  Hartwell,  J.  A.,  and  Hoguet,  J.  P. : Jour.  Am. 
Med.  Assoc.,  1912,  lix,  82. 

4.  Tileston,  W.,  and  Comfort,  C.  W.,  Jr.:  Arch.  Int. 
Med.,  1914,  xiv,  620. 

5.  MacCallum,  W.  G.,  Lintz,  J.,  Vermilye,  H.  N., 
Leggett,  T.  H.,  and  Boas,  E. : Bull.  Johns  Hopkins 
Hosp.,  1920,  xxxi,  1. 

6.  Haden,  R.  L.,  and  Orr,  T.  G.:  Bull.  Johns  Hop- 
kins Hosp.,  1923,  xxxiv,  26. 

7.  Blum,  L.,  and  Weil,  J.:  Bull,  et  Mem.  d.  la  Soc. 
Med.  des  Hop.  de  Paris,  1928,  xliv,  third  series,  1611. 

DISCUSSION 

Charles  D.  Lockwood,  M.  D.  (65  North  Madison 
Avenue,  Pasadena).- — My  discussion  will  be  limited 
to  acute  intestinal  obstruction. 

Little  progress  was  made  in  the  treatment  of  this 
condition  up  to  five  years  ago,  notwithstanding  the 
great  improvements  in  other  fields  of  surgery.  Since 
the  epoch-making  work  of  Orr  and  Haden  ( Journal 
A.  M.  A.,  August  28,  1927),  on  blood  chemistry  in 
relation  to  acute  intestinal  obstruction,  chief  interest 
has  centered  in  the  toxemia  associated  with  obstruc- 
tion and  a more  rational  basis  has  been  found  for 
treatment  of  this  serious  condition.  The  most  fatal 
cases  are  those  where  obstruction  occurs  high  up,  and 
the  toxins  in  the  duodenum  are  most  fatal.  There  has 
been  much  discussion  as  to  the  nature  of  these  toxins, 
whether  they  are  bacterial  in  origin,  or  protein  bodies. 

B.  W.  Williams  of  London,  in  the  Lancet  for  April 
1927,  points  out  the  importance  of  toxemia  due  to 
anaerobes  in  acute  obstruction  and  peritonitis.  The 
late  symptoms  of  peritonitis  are  identical  with  those 
found  in  fatal  cases  of  intestinal  obstruction.  Ady- 
namic ileus  is  the  result  of  peritonitis  and  the  general 
manifestations  of  fatal  cases  of  peritonitis  are  identi- 
cal with  those  of  the  terminal  stages  of  intestinal 
obstruction.  The  chief  symptoms  in  common  are  rapid 
pulse,  cyanosis,  slight  general  icterus,  and  especially 
restlessness  and  a pathologically  acute  consciousness 
up  to  the  very  end.  Williams  points  out  (what  was 
observed  by  Army  surgeons)  that  these  symptoms 
bear  a striking  resemblance  to  those  observed  in 
severe  cases  of  gas  gangrene.  This  led  to  investiga- 
tions to  determine  the  part  played  in  acute  obstruc- 
tion by  anaerobic  organisms.  The  one  most  com- 
monly found  is  Bacillus  ivelchii.  This  organism  is  con- 
stantly present  in  the  intestines  and  produces  a very 
powerful  toxin.  The  organism  grows  best  in  a slightly 
neutral  medium  such  as  is  found  in  the  duodenum.  In 
acute  obstruction  and  late  peritonitis  there  is  great 
proliferation  of  the  Bacillus  noelchii. 

Williams  has  been  using  an  antitoxin  prepared  from 
this  organism  at  St.  Thomas  Hospital  in  London  for 
two  and  one-half  years  in  acute  obstruction  and  peri- 
tonitis associated  with  paralytic  ileus.  Only  the  most 
severe  cases  were  treated.  The  series  consisted  of 
256  consecutive  and  unselected  cases,  and  there  were 
only  three  deaths  in  the  series.  This  is  indeed  a re- 
markable showing  in  a type  of  cases  where  the  normal 
mortality  is  around  50  per  cent. 

This  new  knowledge  together  with  that  made  avail- 
able by  Orr  and  Haden,  in  their  experimental  work 
on  dogs,  I believe  has  laid  the  foundation  for  a revo- 
lution in  our  treatment  of  acute  intestinal  obstruction. 
The  salient  facts  in  Orr  and  Haden’s  work  are:  first, 
the  diminished  chlorids  in  the  blood;  second,  the  in- 
crease in  nonprotein  nitrogen;  and,  third,  increased 
COs  combining  power  of  the  blood.  Orr  also  showed 
experimentally  that  a restoration  of  the  normal  chlor- 


4 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


ids  greatly  prolonged  the  life  of  dogs  with  intestinal 
obstruction,  and  that  jejunostomy  hastened  death. 
Dogs  with  intestinal  obstruction  live  longer  than 
those  with  a simple  high  jejunostomy.  The  life  of 
dogs  with  high  obstruction  was  greatly  prolonged  by 
the  administration  of  chlorids.  In  view  of  this  experi- 
mental evidence  and  the  collected  statistics  in  human 
beings,  the  value  of  jejunostomy  in  intestinal  obstruc- 
tion is  of  doubtful  value.  The  mere  opening  of  a loop 
of  intestines  in  no  way  insures  drainage.  Peristalsis 
is  essential  for  this  process.  The  loops  of  obstructed 
and  paralyzed  bowel  hang  like  wet  rags  over  a rope, 
and  only  stripping  of  each  individual  loop  will  ade- 
quately empty  the  bowel  of  its  toxic  material. 

This  brings  us  to  the  consideration  of  a more 
thorough  method  of  operating  in  early  cases  of  ob- 
struction. Dr.  W.  B.  Holden  of  Portland,  Oregon, 
advocates  complete  eventration  of  the  acutely  ob- 
structed bowels,  and  the  introduction  of  a large  glass 
tube,  secured  in  the  bowel  by  a flange  around  which 
a catgut  suture  is  tied.  All  obstructed  loops  are  then 
quickly  emptied  by  stripping  between  two  fingers  of 
the  gloved  and  vaselined  hand.  He  has  reported  a 
series  of  over  one  hundred  cases  in  which  the  mor- 
tality has  been  reduced  to  20  per  cent  in  the  early 
cases. 

With  all  of  the  foregoing  facts  in  our  mind,  let  us 
outline  the  course  to  be  followed  by  the  surgeon  in 
these  acute  cases  of  obstruction. 

1.  In  cases  diagnosed  early  and  operated  upon 
within  twenty-four  hours  do  not  wait  for  blood  chem- 
istry examinations  nor  for  x-ray  findings.  Open  the 
abdomen  through  a lower  mid-line  incision  and  seek 
for  the  site  of  obstruction.  If  it  is  a band,  a twist, 
or  an  intussusception  that  is  easily  relieved  and  the 
bowel  is  in  active  peristalsis,  no  more  need  be  done. 
If  there  are  many  water-logged  loops  of  bowel,  even- 
trate  on  a hot  towel,  quickly  empty  them  of  their 
contents,  restore  them  to  the  abdominal  cavity  and 
close  without  drainage.  Either  simultaneously  with 
the  operation  or  immediately  following,  give  2000 
cubic  centimeters  of  normal  saline  subcutaneously. 

2.  Cases  which  have  been  obstructed  more  than 
twenty-four  hours  are  usually  toxic.  Immediate  oper- 
ation is  often  contraindicated.  The  surgeon  is  justi- 
fied in  taking  time  for  a blood  chemistry  and  restora- 
tion of  the  chlorids  in  the  blood.  To  this  end,  while 
waiting  the  blood  chemistry  report,  500  cubic  centi- 
meters of  three  per  cent  normal  salt  solution  should 
be  administered  by  hypodermoclysis  and  the  stomach 
washed  out.  In  view  of  the  results  obtained  by 
Williams  in  the  use  of  the  Bacillus  welchii  serum,  if 
obtainable,  its  administration  should  be  begun  to 
counteract  the  effect  of  the  toxins.  Operation  should 
not  be  performed  until  the  chemical  balance  in  the 
blood  has  been  largely  restored. 

Immediate  operation  releasing  the  obstruction  will 
only  permit  a lethal  dose  of  the  toxins  to  escape  into 
the  undamaged  bowel,  where  it  will  be  quickly  ab- 
sorbed. As  soon  as  the  blood  chemistry  approaches 
normal  under  the  continued  administration  of  salt 
solution,  operation  should  be  undertaken  to  remove 
the  obstructing  lesion  or,  if  necessary,  resect  the  gan- 
grenous bowel.  The  success  of  operation  in  these 
advanced  cases  depends  upon  speed  and  accuracy, 
and  provision  should  always  be  made  for  the  escape 
of  gases  through  a catheter  introduced  into  the  bowel 
above  the  site  of  obstruction  in  such  a manner  that 
it  can  be  removed  without  reopening  the  wound. 

The  old  dictum,  operate  immediately  in  acute  in- 
testinal obstruction,  should  no  longer  be  followed 
unqualifiedly.  Each  case  must  be  analyzed  and  the 
treatment  adapted  to  the  individual  case.  Already  the 
beneficial  effects  of  the  new  knowledge  are  being  re- 
flected in  the  mortality  statistics. 

■» 

William  J.  Kerr,  M.  D.  (University  of  California 
Medical  School,  San  Francisco).- — In  the  main,  I am 
quite  in  accord  with  the  views  expressed  by  the 
author  in-  this  excellent  paper  on  intestinal  obstruc- 


tion. There  is  no  doubt  that  many  lives  are  lost 
because  the  condition  is  not  recognized  early  enough 
and  the  necessary  measures  taken  to  give  relief.  As 
the  author  has  stated,  many  of  these  factors  seem 
to  be  beyond  the  control  of  the  physician.  However, 
it  appears  to  me  that  if  the  medical  profession  would 
join  in  a campaign  of  education  the  sufferers  would 
hesitate  to  use  home  remedies  where  the  results  may 
be  of  such  a serious  nature.  Physicians  also  should 
be  more  familiar  with  the  dangers  of  procrastination, 
particularly  in  the  case  of  chronic  ulcer  at  the  pylorus, 
and  should  accept  the  well-established  rule  that  in- 
testinal obstruction  is  one  of  the  conditions  that  de- 
mands surgical  intervention.  We  are  too  free  in  the 
use  of  cathartics  and  morphin  in  cases  of  vomiting, 
distention,  or  pain  in  the  abdomen.  The  latter  should 
most  certainly  be  withheld  until  after  a definite  diag- 
nosis is  established.  The  time  lost  in  waiting  for 
results  of  laboratory  studies  in  many  instances  en- 
dangers the  life  of  the  patient.  If  we  would  be  a 
little  more  careful  to  analyze  the  symptoms  and  the 
progression  and  to  sit  down  by  the  bedside  for  a care- 
ful examination  of  the  abdomen  with  an  analysis  of 
the  location  of  the  distention  and  pain  and  to  observe 
peristaltic  waves,  we  would  more  often  arrive  at  a 
diagnosis  of  the  condition  and  determine  the  location 
of  the  obstruction.  Quite  often  a plain  x-ray  film  of 
the  whole  abdomen  may  reveal  more  correctly  the 
site  of  the  obstruction.  Very  often  I have  found  that 
all  the  tests  that  are  done  only  tend  to  confuse  us  in 
our  decision  as  to  treatment. 

Since  in  most  cases  of  acute  intestinal  obstruction 
the  cause  is  one  which  requires  surgical  intervention 
and  the  life  of  the  individual  depends  upon  the  correc- 
tion or  relief  of  the  obstruction  before  toxic  symp- 
toms have  become  advanced,  we  must  work  with  all 
possible  haste  but  with  the  greatest  clinical  judgment. 
If  a large  amount  of  fluid  has  been  lost  by  vomiting, 
we  can  assume  that  the  chlorids  are  also  low  and 
no  harm  could  come  from  administration  of  large 
amounts  of  fluids  and  chlorids.  The  question  as  to 
whether  the  content  of  the  bowel  should  be  emptied 
and  whether  the  segment  of  the  bowel  should  be 
resected  depends  entirely  upon  conditions  at  the  time. 
There  is  no  doubt  that  removal  of  large  quantities 
of  fluid  from  a paralyzed  or  inactive  bowel  has  been 
of  great  value  in  treatment.  I have  not  personally 
had  any  experience  with  the  use  of  antitoxins  for 
Bacillus  ivelchii.  Doctor  Lockwood,  in  his  discussion 
of  Doctor  Mason’s  paper,  calls  attention  to  the  group 
of  late  cases  where  there  has  been  much  loss  of  fluid 
and  where  alkalosis  has  developed.  I quite  agree  with 
him  that  in  such  cases  operation  is  extremely  hazard- 
ous and  that  in  this  very  case  it  may  be  more  impor- 
tant to  the  patient  to  try  to  restore  the  fluids  and 
the  acid-base  equilibrium  with  a replacement  of  the 
chlorids  before  any  operative  measures  are  attempted. 

In  closing,  I should  like  to  suggest  that  if  we  are 
to  reduce  the  mortality  in  intestinal  obstruction  still 
further,  we  should  attempt  a program  of  education 
for  the  medical  profession  as  well  as  for  the  public 
so  that  this  condition  may  be  early  recognized  and 
properly  treated.  Great  success  has  come  from  treat- 
ing the  diabetic  through  proper  instruction  in  impend- 
ing coma.  Since  a great  majority  of  the  acute  in- 
testinal obstructions  are  complications  occurring  in 
those  who  have  had  previous  abdominal  or  intestinal 
conditions,  we  are  in  a position  to  give  them  certain 
suggestions  which  may  save  hours  and,  therefore, 
many  lives  when  such  accidents  develop.  Further- 
more, we  may  prevent  the  use  of  home  remedies, 
which  are  a contributing  cause  of  mortality  in  many 
cases. 

* 

Lovell  Lancstroth,  M.  D.  (490  Post  Street,  San 
Francisco). — Doctor  Mason  reviews  briefly  the  best 
modern  knowledge  of  the  physiologic  disturbances 
caused  by  intestinal  obstruction  and  reports  the  re- 
sults of  its  application  in  twenty-five  cases.  I can  add 
no  further  interpretation  or  discussion. 


January,  1930 


MEDICAL  CARE  OF  PEPTIC  ULCER — HARTMAN 


5 


MEDICAL  CARE  OF  PEPTIC  ULCER* * 

By  Howard  R.  Hartman,  M.  D. 

Rochester,  Minnesota 

A PEPTIC  ulcer  is  a benign  lesion  of  the  stom- 
ach  or  duodenum.  Perhaps  it  is  secondary  to 
a localized  change  in  the  wall  of  the  viscus  that 
in  turn  is  followed  by  a digestive  phenomenon 
evident  at  the  site  of  the  ulcer.  The  healthy 
stomach  and  duodenum  have  an  inherent  protec- 
tive mechanism  against  autodigestion ; this  may 
be  deranged  by  interference  with  the  blood  sup- 
ply and  consequent  local  structural  change  in 
the  wall.  At  this  point  digestive  phenomena  may 
cause  loss  of  tissue  and  the  formation  of  an 
eroded,  ulcerated  lesion.  This  is  purely  a hy- 
pothesis that  seems  logical  in  the  light  of  clinical 
observations  and  the  study  of  laboratory  data. 
Preliminary  injury  to  the  region  where  ulcer 
occurs  can  be  produced  experimentally  by  a host 
of  detailed  ways  that  can  be  considered  in  groups  : 
(1)  alteration  of  specific  nervous  function;  (2) 
mechanical  and  chemical  injury  to  the  wall,  di- 
rectly or  through  the  blood  supply ; and  ( 3 ) at- 
tack on  the  wall  by  bacteria  carried  in  the  blood 
from  a distant  focus.  Durante,  after  studying 
seventeen  possible  ways  of  producing  ulcer  ex- 
perimentally, conducted  a series  of  experiments 
on  the  nervous  system  of  animals,  and  concluded : 
“Ulcer  may  be  produced  by  any  agent  capable  of 
damaging  the  sympathetic  nervous  system,  as  it 
is  on  the  integrity  of  this  system,  which  controls 
circulation,  secretion  and  profound  sensibility  in 
the  stomach,  that  the  very  life  of  the  gastric  cell 
may  be  said  to  depend.  The  theory  of  trophic 
ulcer  must  be  taken  in  this  sense.’’  The  manner 
in  which  strong  psychic  stimuli  are  capable  of 
altering  normal  vasomotor  control  is  known. 
Blushing  is  an  example.  How  psychic  stimuli 
afifect  not  only  gastric  secretion  and  motility,  but 
the  secretion  of  other  glands  and  organs  also  is 
known.  This  possible  factor,  the  psychic  state, 
requires  consideration  in  the  study  of  the  eti- 
ology of  ulcer.  Furthermore,  it  seems  to  be  an 
important  factor  in  efifecting  a cure  for  ulcer. 

Mann  and  Williams  stated  the  belief  that  in- 
jury at  the  time  of  an  experiment,  and  gastric 
digestion,  lead  to  ulceration.  Mann  noted  acute 
ulcers  in  cats  and  dogs  after  the  suprarenal  glands 
had  been  removed.  Ulcers  developed,  also,  when 
the  pancreatic  juices  were  excluded  and  the  fluids 
that  bathed  the  tissues  were  acid  in  reaction. 
These  two  instances  are  classical  examples  of  a 
host  of  reported  experiments  that  illustrate  the 
chemical  and  the  mechanical  theory  for  the  origin 
of  ulcer.  These  theories  are  well  enough  estab- 
lished to  have  their  influence  on  the  medical  treat- 
ment of  ulcer. 

Although  bacteria  in  association  with  ulcer 
were  noted  in  1874,  to  Rosenow  goes  the  credit 
of  establishing  the  elective  localization  of  bac- 
teria. At  The  Mayo  Clinic  his  principles  are  in 

* From  the  Department  of  Medicine,  The  Mayo  Clinic, 
Rochester. 

* Read  before  the  Nevada  State  Medical  Association, 
Elko,  September  27-28,  1929. 


constant  clinical  application  in  the  treatment  of 
ulcers  as  well  as  of  other  infectious  diseases. 
Reeves,  by  injection  of  gelatin  into  the  arteries 
that  supply  the  stomach,  demonstrated  end  capil- 
laries at  the  usual  site  of  ulceration  in  the  stomach 
and  duodenum.  This  offers  an  anatomic  basis 
for  the  localization  of  infected  emboli  at  the  usual 
site  of  ulceration. 

The  exponent  of  each  hypothesis  concerning 
the  development  of  an  ulcer  can  disprove  that  of 
his  opponents  by  his  data.  I believe  that  an  ulcer 
does  not  develop  from  a single  process,  but  that 
a combination  of  events  is  required.  It  may  be 
that  a single  insult  from  one  or  more  of  the  pos- 
sible causes  will  not  produce  a chronic  ulcer,  but 
that  constant  repetition  of  the  offense  will  lead 
to  the  classical  peptic  ulcer.  The  term  “peptic 
ulcer’’  implies  digestion  of  protein  material  car- 
ried on  by  the  pepsin  of  the  stomach.  Pepsin  is 
active  only  in  the  presence  of  adequate  free 
hydrochloric  acid.  If  one  can  neutralize  that  acid 
in  or  out  of  the  stomach,  digestion  by  pepsin  can- 
not take  place.  As  a corollary,  one  would  expect 
that  an  ulcer  of  the  stomach  or  duodenum  could 
not  be  active  in  the  presence  of  anacidity.  I have 
yet  to  be  convinced  of  the  contrary.  One  might 
argue  that  duodenal  ulcer  could  arise  because  of 
digestion  by  pancreatic  juice.  Proof  of  this  is 
lacking,  and  the  contrary  has  been  shown.  Still, 
I am  open  to  conviction.  Eusterman,  in  an  un- 
published study,  reviewed  forty-three  surgical 
cases  in  which  persistent  achlorhydria  was  present 
but  in  which  an  ulcer  was  discovered  at  opera- 
tion. However,  the  surgeon  reported  that  most 
of  these  ulcers  were  healed. 

The  foregoing  remarks  are  prefatory.  Medical 
treatment  of  ulcer  must  be  directed  against  the 
several  causative  factors  mentioned.  Preferably, 
it  should  be  carried  out  in  a hospital  where  the 
patient  is  under  daily  observation  and  control. 
It  is  essential  to  begin  the  treatment  with  com- 
plete, or  nearly  complete,  neutralization  of  the 
free  hydrochloric  acid,  and  cure  depends  on  one’s 
ability  to  hold  the  acids  in  check  after  a period 
of  complete  neutralization.  It  is  possible  to  do 
this  in  properly  selected  cases,  and  in  making  the 
selection  it  is  necessary  to  consider  several  mat- 
ters: (1)  the  status  of  the  ulcer;  (2)  complicat- 
ing surgical  conditions;  (3)  the  social  status  of 
the  patient;  and  (4)  the  native  intelligence  of  the 
patient  and  his  willingness  to  cooperate  and  carry 
on  when  not  under  supervision. 

The  Status  of  the  Ulcer. — Mechanical  defects  in 
the  digestive  system  must  be  dealt  with  mechani- 
cally. Obviously  a scarred,  contracted,  pyloric 
outlet  which  is  the  result  of  repeated  periods  of 
exacerbation,  healing  and  contraction,  will  not 
be  enlarged  by  diet.  The  pain  and  hyperacidity 
might  be  controlled,  but  retention  of  gastric  con- 
tent as  evidenced  by  vomiting  of  the  retention 
type  or  by  the  finding  of  gastric  residue  on  in- 
tubation, could  not  be  relieved.  The  procedure 
in  acute  perforation  of  ulcer  is  not  open  to  ques- 
tion. Chronic  perforation  demands  operation  if 
some  mechanical  irregularity  results,  although  per- 
foration temporarily  cures  the  ulcer.  Repeated 


6 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


profuse  hemorrhages  preclude  medical  treatment ; 
isolated  or  infrequently  repeated  hemorrhages  do 
not.  Operation  does  not  guarantee  freedom  from 
hemorrhage.  Uncomplicated  gastric  ulcers  re- 
spond readily  to  medical  treatment.  However, 
unless  the  patient  can  be  kept  under  observation 
for  years,  one  hesitates  to  treat  gastric  lesions 
medically  because  of  the  fear  of  carcinoma  being 
present  in  the  ulcer,  or  because  of  the  fear  that 
it  will  develop.  A duodenal  ulcer  practically 
never  becomes  malignant. 

Complicating  Surgical  Conditions. — If  such  a 
condition  as  cholecystitis  or  appendicitis  is  dis- 
covered it  demands  primary  attention.  In  the 
course  of  the  operation  for  such  a disorder,  if 
the  patient’s  condition  warrants  it  a conserva- 
tive operation  for  relief  of  the  ulcer  can  be  under- 
taken. However,  the  surgeon’s  experience  should 
be  sufficiently  broad  to  enable  him  to  decide  that 
surgical  and  not  medical  care  offers  the  best 
chance  of  cure.  Frequently,  visualization  of  an 
ulcer  by  roentgenologic  methods,  or  at  the  oper- 
ating table  is  too  tempting  to  an  ambitious  sur- 
geon. Many  completely  healed  ulcers  probably 
have  led  to  needless  gastro-enterostomy,  pyloro- 
plasty, excision,  and  resection  of  the  stomach. 

Social  Status  of  the  Patient. — No  matter  how 
carefully  one  starts  a course  of  medical  treat- 
ment, it  must  be  completed  to  accomplish  its  pur- 
pose. If  acidity  is  controlled  by  care  of  the 
patient  in  hospital  and  he  is  made  symptom- free 
only  to  find  that  his  resources  are  exhausted,  and 
that  he  must  return  to  his  job  with  the  section 
or  road  gang,  he  finds  himself  subject  to  those 
factors  that  led  to  the  development  of  his  ulcer 
and  he  has  recurrence  of  symptoms.  In  such  a 
case  the  treatment  is  not  to'be  considered  inade- 
quate. However,  the  patient  should  not  have 
been  accepted  as  a subject  for  trial  of  the  medical 
regimen.  It  would  have  been  better  for  him  to 
take  the  shorter,  surgical  route  to  health. 

Native  Intelligence  of  the  Patient  and  His 
Willingness  to  Cooperate  When  Not  Under 
Supervision. — It  is  discouraging  to  find  a patient 
who  demands  food  that  pleases  his  taste  in  spite 
of  its  possible  effect  on  his  ulcer.  It  is  hopeless 
to  have  some  patient  report  that  he  does  not  like 
milk,  and  consequently  to  have  him  demand  that 
something  else  be  prescribed  for  him.  The  pa- 
tient who  says  that  he  is  starving,  when  the  intake 
of  caloi ies  is  adequate  and  has  been  calculated 
ioi  bis  needs,  is  not  a suitable  subject  to  undergo 
the  medical  regimen.  And  then  it  is  dishearten- 
ing  to  find  that  a patient  who  has  followed  your 
advice  to  the  letter  as  long  as  you  made  daily 
calls,  has  disregarded  your  advice  as  to  his  future 
conduct,  because  he  was  feeling  all  right.  In 
spite  of  all  one  may  do,  ulcers  may  recur;  but 
the  number  of  times  that  this  happens  is  probably 
in  diiect  proportion  with  violation  of  principles 
designated  to  prevent  it. 

OBJECTS  OF  MEDICAL  TREATMENT 

After  the  patient  has  been  properly  selected 
what  is  to  be  done?  Needless  to  say,  all  the  in- 
formation regarding  acidity,  roentgenologic  evi- 


dence as  to  the  kind  of  ulcer  present,  and  the 
evidence  concerning  foci  of  infection  in  teeth, 
tonsils  or  prostate  gland  must  be  at  hand.  The 
first,  object  of  the  treatment  is  to  neutralize 
acidity.  Gastric  acidity  is  produced  under  the  in- 
fluence of  the  nervous  system,  the  chemical  nature 
of  the  food,  and  its  physical  properties.  To  my 
mind,  the  neurogenic  theory  of  the  stimulation 
of  gastric  glands  to  the  production  of  hydro- 
chloric acid  is  the  most  potent.  Patients  who 
have  ulcer  are  all  stimulated;  they  usually  come 
from  only  one  stratum  of  society,  only  from  those 
who  have  ambition,  and  usually  ambition  greater 
than  their  physical  endurance  and  nervous  sta- 
bility. Not  infrequently  they  are  passing  through 
some  nervous  crisis  at  the  time  the  ulcer  develops 
and  each  added  shock  to  the  nervous  system  is 
reflected  in  an  exacerbation.  I had  a friend,  an 
influential  stock  broker,  who  made  each  cus- 
tomer s problems  bis  problems.  I knew  this  man 
to  have  an  ulcer  for  years,  and  I observed  that 
his  gastric  upsets  were  coincident  with  the  de- 
pressions in  the  stock  market.  I have  now  on 
my  service  at  the  hospital  a woman,  aged  thirty- 
three  years,  who  is  married  to  a man  aged  sixty 
years.  The  marriage  took  place  ten  years  ago. 
The  man  has  money.  She  says  that  she  has  had 
ten  induced  abortions  each  after  gestation  of  three 
months,  and  she  wears  diamonds.  Her  husband 
is  jealous,  demands  constant  attention  to  his 
wants  and  infirmities,  but  cannot  recognize  symp- 
toms in  his  wife.  He  has  demanded  her  constant 
presence  for  ten  years.  The  picture,  I think,  is 
clear.  She  has  a chronic  duodenal  ulcer,  with  a 
crater. 

1 here  is  no  need  to  multiply  illustrations.  The 
cause  of  this  strain  may  be  very  elusive ; detailed 
search  is  often  necessary  to  find  it.  Yet  it  is  im- 
perative to  be  able  to  discuss  it  with  the  patient, 
for,  I think,  by  so  doing  you  help  him  as  much 
as  by  drugs  and  diet  to  get  rid  of  his  ulcer.  I do 
not  profess  to  be  a psychiatrist  or  neurologist. 
Nevertheless,  I feel  that  if  one  can  gain  the  con- 
fidence of  the  patient,  and  by  a subsequent  hint 
can  cause  him  to  relate  the  tale  of  woe  that  in 
some  way  affects  the  nervous  system,  perhaps 
the  sympathetic  nervous  system  as  suggested  by 
Durante,  one  often  can  disclose  one  of  the  causes 
of  ulcer  and  hyperacidity.  A great  deal  of  help 
for  this  jaded  nervous  system  is  to  get  the  patient 
out  of  his  environment.  At  home  in  bed,  or  in  a 
hospital  in  his  home  town,  the  factors  which  are 
nervously  irritating  are  too  prevalent,  even  under 
the  best  of  circumstances.  That  is  why  I think 
medical  treatment  for  ulcer  is  most  effective  when 
the  patient  is  in  a strange  place.  As  more  specific 
treatment  while  in  the  hospital,  the  patients  are 
given  some  sedative.  Phenobarbital,  gram  0.097 
(grains  1 U>)  once  or  twice  a day,  or  perhaps  bro- 
mids,  or  sodium  iso-amylethvl  barbituric  acid, 
gram  0.097  (grains  \l/2)  are  beneficial.  I feel 
certain  that  the  neurogenic  influence  in  ulcer  pre- 
pares the  soil  for  the  inflammatory  lesion  that  is 
called  peptic  ulcer.  Certainly,  correction  of  the 


January,  1930 


MEDICAL  CARE  OF  PEPTIC  ULCER — HARTMAN 


7 


nervous  condition  as  far  as  possible,  is  essential 
to  cure,  medical  or  surgical. 

Now,  assuming  that  the  malfunctioning  ner- 
vous system  is  understood  and  adjusted,  the  food 
chosen  must  be  such  as  will  reduce  acidity.  Cer- 
tain foods  have  within  themselves  chemicals 
called  secretagogues,  which  chemically  irritate  the 
gastric  mucosa  to  produce  free  hydrochloric  acid. 
Notorious  among  such  foods  are  the  red  meats; 
to  a less  degree,  other  meats.  The  proteins  of 
milk  and  eggs  are  practically  free  of  secreta- 
gogues. Hence  at  first  meats  are  eliminated  from 
the  diet  and  milk  alone  is  used ; later,  eggs  in  suit- 
able form  are  added.  Another  method  by  which 
free  hydrochloric  acid  is  produced  is  by  mechani- 
cal irritation  of  the  mucosa.  Consequently  in 
attempting  to  reduce  the  quantity  of  free  hydro- 
chloric acid  rough  foods  are  eliminated  from  the 
diet.  Even  when  the  patient  is  pursuing  an  ambu- 
latory regimen,  after  dismissal  from  the  hospital, 
foods  that  are  necessary  for  maintenance  of  an 
adequate  intake  of  salt  and  vitamins  and  for  a 
balanced  diet,  but  which  are  rough  and  fibrous, 
should  be  served  in  the  form  of  purees.  None 
of  the  food  should  be  excessively  hot.' 

TECHNIQUE  OF  THE  TREATMENT 

The  method  of  feeding  patients  while  they  are 
in  the  hospital  is  as  follows:  90  to  120  cubic  centi- 
meters (three  to  four  ounces)  of  a mixture  of 
milk  and  cream,  50  per  cent  of  each,  are  given 
every  hour  from  seven  o’clock  in  the  morning 
until  nine  o’clock  in  the  evening,  for  seven  days. 
In  many  patients,  perhaps  in  most  patients,  such  a 
diet  alone  is  not  adequate  to  keep  the  free  hydro- 
chloric acid  neutralized.  Consequently,  alkalis  are 
administered  on  the  half  hour,  only  in  sufficient 
quantities  to  control  the  acidity,  as  determined 
by  aspirations  of  the  gastric  content  and  its  an- 
alysis. Aspirations  are  begun  on  the  third  or 
fourth  day  of  treatment;  the  small  Rehfuss  tube 
is  used.  Occasionally  alkalis  can  be  omitted,  and 
if  so,  so  much  the  better,  for  all  alkalis  are  known 
to  have  a tendency  to  produce  alkalosis,  except 
perhaps  a few  newer  ones,  if  we  can  believe 
the  claims  of  the  manufacturers.  The  aim  is  to 
minimize  the  amount  of  alkali  given  and  yet 
control  the  acidity.  At  the  onset,  one  of  two 
powders  is  given  on  the  alternate  half  hours,  as 
follows  ; number  one  is  made  of  calcium  carbonate 
gram  0.65  (grains  10)  and  bismuth  gram  0.50 
(grains  8)  ; number  two,  of  calcium  carbonate 
gram  0.65  (grains  10)  and  magnesium  oxid 
gram  0.85  (grains  13).  The  magnesium  has  a 
secondary  value  in  helping  to  overcome  the  con- 
stipation that  is  secondary  to  a concentrated  diet. 
This  amount  of  alkali  is  often  found  to  be  in 
excess  of  the  patient’s  needs ; occasionally  more 
is  required.  If  it  becomes  necessary  to  exhaust 
all  means  known  to  neutralize  the  acidity  a poor 
outcome  can  be  predicted  whether  medical  or  any 
other  treatment  is  used.  In  difficult  cases,  espe- 
cially when  aspiration  of  gastric  content  reveals 
hyperacidity  and  hypersecretion,  belladonna  given 
in  divided  doses  until  the  physiologic  effect  is 
obtained  is  of  great  assistance.  In  neurotic  pa- 
tients who  have  pylorospasm  belladonna  has  no 


equal.  Doses  of  ten  to  fifteen  drops  three  times 
a day  are  used.  Blonde  persons  do  not  tolerate 
belladonna  as  well  as  do  swarthy  persons.  Con- 
stipation is  to  be  avoided ; any  one  of  the  many 
preparations  of  mineral  oil,  with  agar,  can  be 
given  with  advantage  to  action  of  the  bowels  and 
without  bad  effects  on  the  ulcer;  in  fact,  I think 
it  helps  healing  of  the  ulcer. 

All  feedings  end  at  nine  o’clock  in  the  eve- 
ning and  are  not  resumed  until  seven  o’clock  in 
the  morning.  These  ten  hours  without  food  occa- 
sionally lead  to  secretion  of  acid,  with  symptoms. 
The  symptoms  call  for  nocturnal  intubations  that 
reveal  the  acidity,  the  neutralization  of  which 
brings  relief.  Rather  than  to  let  the  patient  wait 
for  the  development  of  symptoms  before  neu- 
tralization is  attempted  day  or  night,  it  is  best 
to  anticipate  the  symptoms  and  to  neutralize  the 
acid  before  it  has  accumulated  in  sufficient 
amounts  to  produce  symptoms ; consequently, 
when  distress  at  night  is  once  reported,  the 
patients  are  given  feedings  and  powders  at  night. 
Usually  feedings  at  intervals  of  two  hours  dur- 
ing the  night  are  more  than  adequate,  and  often 
one  or  two  feedings  are  found  to  suffice.  Except 
in  stubborn  cases,  four  to  six  nights  are  usually 
all  that  are  required  for  training  the  stomach  to 
be  at  rest  during  the  sleeping  hours. 

Medicines  and  diet  cannot  overcome  irregu- 
larities in  conduct ; cooperation  is  what  cures 
ulcers.  It  is  a tragedy  to  most  patients  who  have 
ulcer  to  ask  them  to  stop  the  use  of  tobacco. 
Nevertheless  it  must  be  done.  Tobacco  does  not 
cause  ulcer  any  more  than  meat  causes  ulcer;  yet 
tobacco  has  a tendency  to  increase  gastric  secre- 
tion and  acidity.  An  old  German  friend  of  mine 
once  said,  “A  big  meal  is  a fine  thing  because 
you  can  smoke  so  much  better  afterwards.”  The 
large  meal  created  a need  for  more  gastric  juice, 
and  the  tobacco  supplied  the  stimulus.  More 
scientific  proof  of  the  effects  of  tobacco  on  gas- 
tric digestion  was  demonstrated  by  one  of  our 
laboratory  physicians  who  had  an  ulcer.  He  pooh- 
poohed  the  idea  that  smoking  was  detrimental 
until  he  experimented  on  himself.  With  a small 
Rehfuss  tube  in  place,  he  studied  his  gastric  con- 
tents while  he  was  using  tobacco  and  while  he 
was  not  using  it.  He  found  that  he  could  cause 
an  increase  in  the  acidity  of  his  gastric  content 
to  various  levels,  depending  on  the  number  of 
cigarettes  he  smoked. 

Alkalis  are  given  every  hour  until  the  end  of 
the  three  weeks  of  hospitalization,  unless  toxic 
symptoms  develop.  There  is  danger  of  giving 
alkalis  to  excess  and  of  producing  certain  pro- 
dromal symptoms  which  become  accentuated  into 
definite  symptomatic  reactions  corresponding  with 
the  changing  chemistry  of  the  blood.  These  symp- 
toms can  be  increased  even  to  the  point  of  tetanic 
convulsions  unless  the  administration  of  alkalis 
is  materially  reduced  or  stopped.  Rivers  reported 
at  length  on  observations  relative  to  alkalosis. 
Since  we  have  recognized  this  condition  at  the 
Clinic  we  have  not  seen  a typical  case  of  alkalosis 
develop  under  treatment,  not  only  because  we 
have  learned  that  we  can  administer  smaller 


8 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


amounts  of  alkalis  than  usually  are  prescribed  and 
still  bring  about  neutralization  of  the  acids,  but 
also  because  we  have  learned  to  recognize  those 
prodromal  symptoms  which  tell  the  physician  that 
the  condition  of  the  patient  is  bordering  on  intoxi- 
cation. One  of  these  symptoms  is  aversion  to 
milk.  The  patient  complains  that  the  milk  is  too 
rich  or  has  too  much  the  “taste  of  a cow.”  This 
is  associated  with  a little  nausea  and  a headache 
of  low  grade.  In  the  more  severe  forms,  the 
nausea  assumes  the  proportions  of  vomiting,  and 
the  headaches  become  worse.  Should  these  symp- 
toms not  be  recognized  and  the  treatment  be'  per- 
sisted in,  prostration,  with  profuse  perspiration, 
develops;  at  this  time,  if  not  before,  one  finds 

that  there  is  an  elevation  in  the  blood  urea  and 

in  the  carbon  dioxid  combining  power  of  the 
blood,  with  diminution  of  the  chlorids.  I have 
not  found  it  necessary  to  analyze  the  blood  for 

this  altered  chemistry,  because,  at  the  first  sign 

of  intoxication,  that  is,  aversion  to  milk  and  a 
little  headache,  administration  of  all  alkalis  is 
stopped.  Usually  the  order  is  given  that  adminis- 
tration of  milk  be  interrupted  and  that  the  patient 
be  given  a soft  diet.  _ Fruit  juice,  preferably 
orange  juice,  is  given  in  doses  of  four  ounces 
every  few  hours  if  necessary.  From  twenty-four 
to  forty-eight  hours  of  such  treatment  makes  it 
possible,  in  many  cases,  to  resume  the  previous 
treatment  and  to  continue  it  without  interruption. 
Occasionally,  however,  it  is  not  possible  to  carry 
on  the  treatment  to  its  completion  because  the 
patient  is  intolerant  of  the  alkalis  and  the  diet. 

In  the  second  week  the  patient’s  diet  is  in- 
creased a little.  Milk  soups,  gelatin,  cooked 
cereals,  with  cream,  custards,  and  the  like,  are 
served  three  times  a day.  The  feedings  of  milk 
and  the  alkalis  are  kept  up  on  the  half-hourly 
basis. 

During  the  third  week  the  diet  is  materially 
enlarged.  Practically  only  those  foods  that  either 
by  chemical  or  mechanical  action  stimulate  gas- 
tric acidity  are  eliminated,  and  during  this  third 
week  of  hospitalization  the  patient  continues  the 
half-hourly  feedings  of  alkalis  and  milk.  If  the 
patient  has  lost  weight  during  the  early  period  of 
the  treatment,  the  lost  weight  is  regained  by  this 
forced  diet,  in  which  the  intake  usually  is  in 
excess  of  the  2000  calories  a day.  On  dismissal 
from  the  hospital  the  patient  is  admonished  not 
to  depart  from  instructions  because  of  the  penalty 
of  an  exacerbation  of  the  ulcer.  His  meals  are 
patterned  after  the  third  week  diet  with  sufficient 
calories  for  an  ambulatory  life.  Milk  is  taken 
only  midway  between  the  three  regular  meals. 
He  is  cautioned  as  to  his  environment  and  mental 
and  physical  strains,  principally  the  former.  He 
is  urged  not  to  revert  to  the  use  of  tobacco,  to 
abstain  from  condiments,  to  take  at  least  six  alka- 
line powders  a day,  one  an  hour  before  and  one 
an  hour  after  meals,  to  be  certain  of  adequate 
hours  of  rest,  and  to  follow  this  regimen  for  a 
period  of  six  months.  At  the  end  of  six  months, 
a report  usually  is  requested. 

All  foci  of  infection  should  be  eradicated.  This 
declaration  is  based  on  experimental  research. 


Infected  teeth  and  tonsils  should  be  removed  and 
occasionally  prostatic  massage  is  indicated.  Many 
tunes  the  judgment  as  to  what  is  an  infected  tooth 
plays  an  important  part  in  bringing  about  a cure. 
According  to  the  interpretation  of  the  dental 
roentgenographic  film,  which  is  applied  by  my 
associates  and  me,  any  dead  tooth  or  any  tooth 
with  a devitalized  root  is  infected,  irrespective  of 
whether  bacterial  action  has  gone  on  to  rarefac- 
tion of  the  bone  that  is  evident  roentgenographi- 
cally.  Eradication  of  foci  usually  is  begun  in  the 
second  or  third  week  of  treatment  in  hospital. 

I he  contraindications  to  medical  treatment  of 
ulcer  are  few.  Patients  with  nephritis,  of  course, 
do  not  tolerate  well  the  alkaline  treatment,  and 
the  same  is  true  of  persons  who  are  suffering 
from  so-called  essential  hypertension.  Elderly 
persons  do  not  withstand  vigorous  alkalization. 
Under  such  circumstances  one  must  temper  the 
treatment  according  to  the  complicating  factors, 
but  as  a rule  all  persons  who  are  suitable  sub- 
jects stand  the  treatment  very  well.  Experience 
at  the  Clinic  has  led  us  to  believe  that  if,  in  the 
first  few  weeks  of  treatment,  a patient  makes 
prompt  symptomatic  response,  and  if  the  chemical 
analysis  of  the  gastric  content  shows  that  the 
acids  are  easily  controlled,  the  prognosis  is  good 
whether  the  medical  regimen  is  continued  or 
whether  operation  is  performed. 

SUMMARY 

Active  peptic  ulcer  probably  is  caused  by  multi- 
ple factors.  Experimental  data  offer  theoretical 
explanations  of  the  causes  of  ulcer  in  the  human 
being,  namely:  neurogenic  influences,  traumatic 
influences,  and  occult  foci  of  infection.  The  ac- 
tivity of  an  ulcer  seems  to  depend  on  the  degree 
of  free  hydrochloric  acid  present.  An  active  ulcer 
cannot  exist  in  the  presence  of  anacidity.  Non- 
surgical  relief  is  possible  by  removing  the  incit- 
ing factors  as  completely  as  possible  and  by  neu- 
tralizing, with  a suitable  diet  and  alkalis,  the  acid 
that  is  formed  in  spite  of  means  to  reduce  secre- 
tion. The  diet  prescribed  is  free  from  chemical, 
thermal,  and  mechanical  irritating  factors.  Co- 
operation and  good  general  conduct  of  the  patient, 
together  with  continuance  of  a suitable  diet  and 
medication  after  leaving  the  hospital,  for  a period 
of  months,  are  of  vital  importance  in  the  ultimate 
cure.  Of  equal  importance  is  removal  of  occult 
foci  of  infection. 

The  Mayo  Clinic. 

REFERENCES 

Boettcher,  H.:  Zur  Genese  des  perforirenden  Ma- 
gengeschwurs,  Dorpater  Med.  Ztschr.,  1874,  v,  148-151. 

Durante,  Luigi:  The  Trophic  Element  in  the  Origin 
of  Gastric  Ulcer,  Surg.  Gynec.  and  Obst.,  1916,  xxii, 
399-406. 

Mann,  F.  C. : A Study  of  the  Gastric  Ulcers  Follow- 
ing Removal  of  the  Adrenals,  Jour.  Exper.  Med.,  1916 
xxiii,  203-209. 

Mann,  F.  C.,  and  Williamson,  C.  S.:  The  Experi- 
mental Production  of  Peptic  Ulcer,  Ann.  Surg.  1923, 
lxxvii,  409-422. 

Reeves,  P.  B.:  A Study  of  the  Arteries  Supplying 
the  Stomach  and  Duodenum  and  Their  Relation  to 
Ulcer,  Surg.,  Gynec.  and  Obst.,^1920,  xxx,  374-385. 


January,  1930 


P U L MON  ARY  TU 15  ERC  U LOS  I S — POTT  E N G E R 


9 


PULMONARY  TUBERCULOSIS* 

THE  IMPORTANCE  OF  THE  CLINICAL  HISTORY 
IN  ITS  DIAGNOSIS 

By  F.  M.  Pottencer,  M.  D. 

Monrovia 

Discussion  by  Philip  H.  Pierson,  M.D.,  San  Francisco ; 
William  C.  Voorsanger,  M.D.,  San  Francisco;  A.  L. 
Bramkamp,  M.D.,  Banning. 

"[PARLY  tuberculosis  is  a curable  disease.  This 
^ is  true  both  of  the  insidious  type  and  of  the 
type  with  acute  onset.  The  detail  in  the  method 
of  treating  early  cases  of  the  insidious  type  must 
necessarily  differ  from  that  instituted  in  treating 
the  more  acute  types.  While  they  cannot  all  be 
successfully  treated  by  the  same  method,  yet 
modern  medicine  has  devised  ways  by  which 
nearly  all  of  the  early  limited  lesions  can  be 
brought  to  a satisfactory  issue,  whether  the  onset 
be  insidious  or  acute. 

Such  favorable  results,  however,  can  only  be 
attained  regularly  by  the  prompt  institution  of 
the  proper  remedial  measures  before  extensive 
destruction  of  lung  tissue  has  taken  place,  and 
before  serious  inroads  have  been  made  on  the 
patient’s  resistance ; and  further,  before  healing 
is  complicated  by  insurmountable  mechanical 
problems. 

UNDERLYING  BASIS  FOR  CURE  IN 
TUBERCULOSIS 

Early  diagnosis  and  immediate  adequate  treat- 
ment is  the  only  procedure  which  can  make 
tuberculosis  a curable  disease  in  the  great  ma- 
jority of  instances.  Delay,  while  it  does  not 
necessarily  produce  a hopeless  condition,  as  was 
formerly  believed,  is  nevertheless  the  one  great- 
est factor  which  stands  between  the  tuberculous 
patient  and  a life  of  usefulness.  This  fact  must 
be  emphasized  until  it  always  stands  uppermost 
in  the  minds  of  the  doctor  and  the  patient  when 
a diagnosis  of  early  tuberculosis  has  been  made. 

The  diagnosis  of  tuberculosis  in  instances  of 
frank  disease  is  comparatively  easy.  The  knowl- 
edge possessed  by  the  well-trained  practitioner 
should  be  sufficient.  It  is  only  in  the  difficult  cases 
that  there  should  be  much  doubt. 

Many  practitioners  do  not  have  sufficient 
experience  to  become  expert  in  the  diagnosis  of 
difficult  cases.  These  will  require  the  opinion  of 
specialists.  But  careful  history  taking,  as  I shall 
attempt  to  show  in  this  paper,  with  analysis  of 
the  elicited  symptoms,  will  make  the  diagnosis 
fairly  certain  in  nearly  all  instances  of  frank  dis- 
ease, and  will  make  the  diagnosis  probable  in  a 
very  large  percentage  of  positive  border-line  cases. 

Probably  80  per  cent  of  cases  of  early 
clinical  tuberculosis  can  be  placed  in  the  class  of 
“probably”  or  “definitely  tuberculous”  by  the 
analysis  of  a carefully  taken  clinical  history  alone. 
This  statement  is  made  in  face  of  the  fact  that 

* Read  before  the  General  Medicine  Section,  California 
Medical  Association,  at  tbe  Fifty-eighth  Annual  Session, 
May  6-9,  1929. 


tuberculosis  does  not  make  itself  known  in  any 
set  way. 

The  disease,  when  it  becomes  sufficiently  pro- 
nounced to  be  a clinical  entity,  is  recognized  by 
the  fact  that  it  causes  disturbances  in  the  body’s 
normal  physiologic  activity.  The  clinical  history 
should  reveal  its  course  from  the  time  that  symp- 
toms first  manifest  themselves  up  to  and  includ- 
ing the  time  of  examination. 

SYMPTOMS  AND  THEIR  CAUSES 

In  order  to  appreciate  the  nature  of  symptoms 
in  tuberculosis  one  must  understand  what  takes 
place  from  the  time  of  infection  until  clinical  dis- 
ease manifests  itself. 

Tuberculosis  differs  from  the  acute  infectious 
diseases  in  that  the  latter,  as  a rule,  consist  of  one 
single  episode  of  infection  and  immunity 
response,  while  tuberculosis  consists  of  many  such 
episodes.  In  the  acute  infections  the  patient 
either  dies  or  develops  a more  or  less  lasting- 
immunity  to  the  causative  microorganism.  A 
succeeding  infection  of  the  same  nature  is  occa- 
sionally met,  but  only  rarely.  In  tuberculosis,  on 
the  other  hand,  the  whole  clinical  course  of  the 
chronic  disease  consists  of  repetitions  of  bacillary 
inoculations  and  immunity  responses  with  the 
production  of  never  more  than  a relative  im- 
munity. 

In  chronic  tuberculosis,  reinoculations  occur 
in  an  immunized  host  and  therefore  differ  from 
the  primary  infection.  The  host  being  already 
immunized  by  previous  infection,  the  immunity 
response  to  the  reinoculations  does  not  await  the 
usual  prodromal  stage  (which  is  the  period  nec- 
essary to  bring  the  host’s  immunizing  mechanism 
into  play)  but  starts  at  once.  If  a sufficient 
number  of  bacilli  engage  in  the  reinoculation,  an 
inflammatory  reaction  of  varying-  severity  depend- 
ing upon  the  degree  of  allergy  present  is  imme- 
diately called  forth,  by  which  toxins  are  set  free, 
and  pulmonary  nerves  and  local  cells  are  at  once 
irritated,  producing  disturbances  in  the  host's 
physiologic  equilibrium.  These  departures  from 
normal  physiologic  action  are  recognized  as 
symptoms  of  tuberculosis.  Not  only  do  the  symp- 
toms appear  sooner,  but  they  are  apt  to  be  more 
pronounced  than  those  due  to  a primary  inocula- 
lation,  caused  by  equal  numbers  of  bacilli. 

The  immediate  reaction  of  the  host  to  primary 
infection  is  mild  and  symptomless.  Cells  pro- 
liferate and  attempt  to  wall  the  bacilli  in,  form- 
ing tubercles ; but  there  is  no  general  widespread 
body  reaction  until  multiplication  of  bacilli  with 
the  elaboration  and  dissemination  of  tuberculo- 
protein  into  the  tissues  has  taken  place,  and  the 
specific  defensive  forces  of  the  host  have  been 
thereby  aroused. 

If  the  numbers  of  bacilli  engaged  in  reinocula- 
tion are  few,  the  reaction  will  be  mild  and  may  be 
symptomless;  but  if  the  numbers  engaged  in  the 
process  are  sufficiently  large,  then  recognizable 


10 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


Table  1. — Etiological  Classification  of  Symptoms  of  Pulmonary  Tuberculosis 


Group  1 


Group  2 


Group  3 


Symptoms  Due  to  Toxemia  and 
Other  Causes  Acting  Generally 


Symptoms  Due  to  Reflex  Cause 

Hoarseness 
Tickling  in  larynx 


Malaise 

Lack  of  endurance 
Loss  of  strength 
Nerve  instability 

Digestive  disturbances  (hypomo- 
tility  and  hyposecretion) 
Metabolic  disturbances  resulting  in 
loss  of  weight 
Increased  pulse  rate 
Night  sweats 
Temperature 
Blood  changes 


Cough 

Digestive  disturbances  (hypermo- 
tility and  hypersecretion)  which 
may  result  in  loss  of  weight 
Circulatory  disturbances 
Chest  and  shoulder  pains 
Flushing  of  face 

Spasm  of  muscles  of  shoulder 
girdle 

Diminished  motion  of  affected  side 


Symptoms  Due  to  the  Tubercu 
losis  Process  per  se 


Frequent  and  protracted  colds  (tu 
berculous  bronchitis) 

Spitting  of  blood 

Pleurisy  (tuberculosis  of  pleura) 

Sputum 


symptoms  of  disease  appear  within  a few  hours 
after  the  infection  has  taken  place. 

ALLERGY  IN  TUBERCULOSIS 

Allergy  produces  its  effects  on  the  host  in  the 
following  ways:  (1)  it  hastens  the  elaboration 
of  tuberculoprotein  in  the  focus  of  infection ; 
(2)  it  results  in  the  death  of  both  bacilli  and  tissue 
cells;  (3)  through  its  inflammatory  effect  on  the 
nerve  endings  in  the  tissues  it  causes  reflex  symp- 
toms to  appear  in  other  tissues  and  organs ; and 
(4)  acting  locally,  it  produces  certain  recognizable 
effects  in  the  tissues  which  are  the  seat  of  the 
lesion. 

THREE  GROUPS  OF  SYMPTOMS  PRODUCED 

These  modes  of  action  produce  three  groups 
of  symptoms,  each  group  having  a distinct  eti- 
ologic  cause.  The  first  two  produce  the  toxic 
group  ; the  third,  the  reflex  group ; and  the  fourth, 
the  local  group  or  those  caused  by  the  tuberculous 
process  per  se.  I first  proposed  this  grouping  of 
symptoms  in  1913  and  have  used  it  continuously 
in  my  practice  since.  I find  it  very  helpful  in  that 
it  explains  what  is  going  on  within  the  lung.  It 
also  proves  very  helpful  in  differentiating  difficult 
border-line  cases. 

The  important  symptoms  so  grouped  appear 
in  Table  1. 

ADVANTAGES  OF  PROPOSED  GROUPING 

Two  important  advantages  of  considering 
symptoms  according  to  this  grouping  are : first, 
that  of  showing  what  it  is  that  is  operating  to 
disturb  the  patient’s  well-being;  and,  second, 
through  what  agencies  such  disturbance  takes 
place.  The  allergic  inflammatory  reaction  is  re- 
sponsible for  the  production  of  the  symptoms 
in  each  group. 

Nerves,  endocrines,  electrolytes  and  cells  gen- 
erally are  structures  through  which  the  agents 
act  in  the  production  of  the  symptoms  of  the 
toxic  group,  because  they  are  caused  by  circulat- 
ing toxins  acting  generally  throughout  the  body. 

Afferent  and  efferent  nerves  and  the  tissues  in 
the  limited  area  which  come  under  the  influence 
of  the  efferent  impulses  cause  the  reflex  group. 

The  allergic  inflammation  acting  directly  on 
the  tissues  is  responsible  for  the  symptoms  of 
Group  3. 


It  is  evident  that  the  symptoms  which  indicate 
the  presence  of  tuberculous  disease  vary  with  the 
dose  of  bacilli  responsible  for  the  reinoculation, 
the  amount  of  tuberculoprotein  which  gains 
access  to  the  circulating  blood,  the  reacting 
capacity  of  the  patient,  and  the  manner  in  which 
the  disease  progresses  thereafter.  It  is  also  evi- 
dent that  different  degrees  of  sensitization  of 
body  cells  result  from  similar  inoculations  in 
different  individuals  because  of  the  different 
reacting  qualities  which  are  manifested  by  indi- 
viduals possessing  different  cellular  reactions. 

While  bacilli  have  no  power  of  locomotion 
within  themselves,  yet  so  long  as  avenues  of 
escape  remain  for  bacilli  which  are  contained 
within  active  tuberculous  foci,  they  will  gain 
access  to  adjacent  tissues  and  through  the  lymph 
and  blood  and  natural  channels  be  carried  out 
into  other  tissues.  If  the  numbers  of  migrating 
bacilli  are  few,  and  the  amount  of  bacillary  pro- 
tein gaining  access  to  the  body  fluids  is  small, 
reinoculations  may  take  place  at  frequent  inter- 
vals without  causing  any  recognizable  symptoms  ; 
for  while  they  stimulate  and  act  upon  the  im- 
munizing mechanism  qualitatively,  the  same  as 
large  doses  of  bacilli,  or  larger  quantities  of 
tuberculoprotein,  they  produce  a scarcely  per- 
ceptible effect  quantitatively.  The  resulting 
allergic  reaction  may  be  so  slight  as  to  be  micro- 
scopic and  so,  of  course,  produce  no  recognizable 
symptoms ; or,  it  may  be  more  marked  and  still 
not  be  discernible ; or,  it  may  be  so  severe  as 
to  precipitate  a marked  defensive  response  on  the 
part  of  the  host  with  a toxic  syndrome  compar- 
able to  that  which  accompanies  the  acute  infec- 
tions. In  fact,  such  a reinoculation  is  accom- 
panied by  the  same  episode  of  immunity  response 
as  characterizes  such  diseases  as  diphtheria,  scar- 
let fever  or  measles. 

Again  bacillus  bearing  discharges  which  are 
cast  off  into  such  natural  channels  as  the  bronchi 
may  plug  the  same  and  thus  cause  a retention  of 
bacilli  in  situ  until  they  have  initiated  an  infec- 
tion. Such  an  infection  as  a rule  would  produce 
an  abrupt  onset  of  symptoms.  We  do  not  believe 
this  occurs  often  in  the  beginning  of  pulmonary 
disease  except  following  the  rupture  of  a caseat- 
ing  bronchial  gland,  yet  we  must  accept  it  as  not 
an  uncommon  possibility  in  the  extensions  which 


January,  1930 


PULMONARY  TUBERCULOSIS — POTTENGER 


11 


take  place  from  pulmonary  foci  to  unaffected  tis- 
sue during  the  course  of  advanced  tuberculosis. 

There  is  probably  a period  in  all  early  active 
tuberculous  infections,  either  before  or  after  they 
have  made  themselves  known  by  frank  symp- 
toms, when  bacilli  are  carried  in  minimal  numbers 
through  the  body  fluids  from  existing  foci  to  new 
tissues,  and  when  tuberculoprotein  circulates  in 
the  body  fluids  in  minute  quantities.  The  result- 
ing reaction  may  be  so  slight  that  it  produces  no 
recognizable  disturbances  in  the  ' physiologic 
equilibrium  of  the  host.  No  doubt,  many  border- 
line cases  which  react  markedly  and  quickly  to 
the  cutaneous  and  intradermal  application  of 
tuberculin  in  the  presence  of  indefinite  and  incon- 
clusive symptoms  and  thus  puzzle  the  examiner 
in  forming  a conclusion  as  to  whether  or  not 
active  tuberculosis  is  present,  belong  to  this  class. 
They  are  potentially  tuberculous  but  may  not 
become  actually  clinically  ill  unless  larger  reinocu- 
lations take  place.  A clinical  history  in  such  cases 
is  not  conclusive.  Further  evidence  must  be  found 
on  which  to  base  a diagnosis. 

Frequently  repeated  reinoculations,  too,  may  be 
caused  by  larger  numbers  of  bacilli ; and,  larger 
quantities  of  tuberculoprotein  may  escape  from 
existing  foci,  and  still  the  reaction  not  come 
within  the  domain  of  distinct  acute  inflammation 
with  its  marked  toxic  and  reflex  symptoms,  such 
as  characterize  the  acute  infections.  The  patient 
may  have  a slight  elevation  of  temperature,  a 
loss  of  vigor,  fatigue,  possibly  lack  of  appetite 
and  loss  of  a few  pounds  in  weight,  yet  be  unable 
to  point  to  a definite  episode  of  immunity  reac- 
tion such  as  would  characterize  an  acute  allergic 
response. 

The  pathology  in  these  cases  consists  of  slight 
inflammatory  phenomena,  but  so  slight  that  they 
may  be  detected  only  with  difficulty  by  the  usual 
procedures  of  physical  examination,  or  by  the 
x-ray,  except  after  a tuberculin  reaction  of  suffi- 
cient magnitude  to  change  the  mild  allergic 
reaction  of  a predominantly  proliferative  charac- 
ter to  one  of  a predominantly  exudative  (paren- 
chymatous) character. 

Tuberculosis  of  this  type  in  an  active  form 
may  be  present  for  quite  a period  of  time  before 
it  causes  sufficient  symptoms  to  make  a diagnosis 
definite;  in  fact,  may  heal  before  causing  suffi- 
cient symptoms  to  make  the  diagnosis  definite. 

On  the  other  hand,  when  tuberculosis  shows 
itself  as  a frank  disease,  with  a marked  immunity 
response  accompanied  by  an  acute  toxic  reaction 
there  nearly  always  will  be  reflex  phenomena 
present,  and  often,  too,  evidence  of  the  local 
reaction  of  the  disease  in  the  tissues  such  as 
sputum,  a pleural  involvement  or  an  hemoptysis, 
to  make  the  diagnosis  quite  evident. 

It  is  necessary  for  the  profession  to  know  that 
the  disease  may  come  on  insidiously  with  small 
reinoculations  and  no  frank  symptoms,  or 
abruptly  with  acute  toxic  manifestations,  for 


much  of  the  teaching  in  the  past  has  not  taken 
this  sufficiently  into  consideration. 

It  is  very  desirable  but  quite  impossible  to 
assign  definite  values  to  the  different  symptoms. 
This  is  impossible  because  different  people  react 
differently  to  the  same  stimulus;  and,  further 
because  different  organs  in  the  same  individual 
may  show  differences  in  their  response ; and,  still 
further,  because  the  reinoculating  doses  of  bacilli 
are  variable  in  size  and  virulence. 

DIAGNOSTIC  VALUE  OF  SYMPTOM  GROUPS 

The  three  groups  of  symptoms  vary  greatly  in 
their  diagnostic  value.  The  toxic  or  general 
group  is  characterized  by  the  fact  that  it  repre- 
sents harmful  influences  which  affect  structures 
throughout  the  body;  nerves,  endocrine  glands, 
and  body  cells.  The  symptoms  which  accompany 
the  acute  reaction  following  a reinoculation  with 
fairly  large  quantities  of  bacilli,  is  qualitatively 
the  same  as  that  which  follows  reinoculations  of 
milder  degree,  and  similar  to  the  symptoms  which 
accompany  neurasthenic  and  psychasthenic  states 
or  conditions  of  hypo-  or  hyperactivity  in  certain 
endocrine  glands,  such  as  the  thyroid,  gonads  and 
adrenals;  but  they  differ  in  severity.  Nor  does 
the  acutely  toxic  state  in  tuberculosis  differ  in 
symptomatology  from  the  acutely  toxic  state  in 
other  infections;  so  there  is  nothing  significant 
or  of  differential  diagnostic  import  in  the  symp- 
toms of  Group  1.  They  must  be  combined  with 
symptoms  of  Groups  2 and  3 to  possess  diag- 
nostic worth.  They  only  show  that  some  factor 
or  factors  are  producing  a widespread  injury  to 
the  body  tissues  and  functions. 

Symptoms  belonging  to  the  reflex  group,  on 
the  other  hand,  possess  considerable  diagnostic 
value,  even  on  their  own  account.  Irritation  of 
the  larynx,  hoarseness  and  cough  are  one  or  all 
usually  present  in  early  clinical  tuberculosis,  but 
they  do  not  possess  so  great  localizing  worth  as 
the  reflex  spasticity  which  involves  the  skeletal 
muscles ; for  the  cough  reflex  may  be  produced 
by  stimuli  arising  in  many  tissues  other  than  pul- 
monary. The  value  of  the  reflex  symptoms  is 
greatly  increased  by  the  fact  that  some  symptoms 
of  Groups  1 and  3 are  nearly  always  present  at 
the  same  time,  or,  if  not  present,  there  is  a history 
of  their  presence  in  the  near  past ; and  the  com- 
bination of  the  symptoms  of  the  two  or  three 
groups  is  decidedly  more  suggestive  than  those  of 
one  group  alone. 

When  the  lung  is  the  seat  of  allergic  reaction, 
as  it  always  is  in  active  pulmonary  tuberculosis, 
stimuli  are  carried  to  the  central  nervous  system 
over  the  visceral  nerves;  and  transferred  to  those 
muscles  which  receive  their  innervation  from  the 
midcervical  segments  of  the  cord,  causing  them 
to  show  reflex  spasticity.  This  may  be  detected 
as  an  increased  tension  and  as  an  uneven  contrac- 
ture of  the  muscle  bundles  on  palpation,  and  may 
also  be  inferred  from  the  lessened  motion  of  the 
hemothorax  corresponding  to  the  lesion  if  it  is 


12 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


one-sided,  or,  from  the  detectable  asymmetrical 
movements  when  both  sides  are  involved.  Lag- 
ging thus  when  properly  evaluated  becomes  an 
important  sign  of  active  pulmonary  inflammation. 

The  structures  involved  are  the  sternocleido- 
mastoideus,  scaleni,  pectorales,  subclavii,  trapezii, 
levator  anguli  scapulae  and  rhomboidei  muscles, 
and  the  crura  and  central  tendon  of  the  dia- 
phragm. 

This  spasticity  and  the  effects  which  it  exerts 
is  of  the  greatest  diagnostic  worth  and  when 
combined  with  subjective  symptoms  of  a reflex  or 
toxic  nature  immediately  fixes  attention  upon  the 
lung  because  of  its  definite  localizing  nature. 

Flushing  of  the  face  is  also  of  value,  but  we 
rarely  see  it  as  one  of  the  early  symptoms.  It  is 
more  apt  to  appear  after  the  lung  has  been  the 
seat  of  disease  for  some  time. 

The  symptoms  of  Group  3 are  of  the  greatest 
diagnostic  import.  They  are  subjective  symptoms 
about  which  the  patient  will  tell  you.  They  have 
no  more  direct  localizing  value  than  the  spasticity 
of  the  muscles,  but  they  are  complained  of  while 
the  latter  must  be  detected  by  the  examiner. 

Pleurisy,  hemoptysis  and  scanty  sputum  are 
commonly  present  in  early  or  fairly  early  tuber- 
culous lesions.  If  the  sputum  contains  bacilli,  the 
diagnosis  is  made ; but  it  is  sometimes  present  in 
small  amounts  in  early  lesions  without  bacilli 
being  found  in  it  after  most  careful  search. 

Hemoptysis  may  be  met  in  influenza,  and  post- 
influenzal infection,  bronchiectasis,  lung  abscess, 
lung  syphilis  and  malignancies ; but  the  history 
will  usually  suggest  whether  or  not  these  other 
conditions  are  present.  If  symptoms  of  both 
Groups  1 and  2 are  present  with  an  hemoptysis 
of  one-half  to  one  dram  of  bright  blood,  it  points 
most  strongly  to  tuberculosis  as  the  causative 
factor,  and  at  least  calls  for  a longer  observation 
and  a carefully  directed  plan  of  living. 

Pleurisy,  except  it  accompany  influenza,  pneu- 
monia, or  an  injury  to  the  chest,  is  nearly  always 
due  to  tuberculous  infection. 

SUMMARY 

With  the  understanding  that  there  is  only  one 
etiologic  factor  responsible  for  the  symptoms  of 
early  clinical  tuberculosis,  viz.,  the  allergic  reac- 
tion ; and  with  the  further  knowledge  that  this 
causes  the  symptoms  in  one  of  three  ways, 
through  toxins,  reflexly,  or  locally  at  the  point  of 
the  inflammation,  we  are  now  able  to  see  the  com- 
bined value  of  symptoms  of  at  least  two  or  of  all 
three  groups  in  fixing  the  diagnosis  of  a given 
pulmonary  infection. 

Since  the  allergic  reaction  is  also  responsible 
for  the  evidence  found  on  physical  examination 
and  that  revealed  by  the  x-ray,  it  may  be  seen 
that  the  reaction  which  causes  few  symptoms  is 
also  likely  to  cause  few  signs  which  are  demon- 
strable on  physical  and  x-ray  examination.  It  is 
in  such  cases  that  we  need  help  from  all  the 


diagnostic  methods  that  we  have  at  our  command. 
This  paper  is  not  intended  to  belittle  other  meth- 
ods of  examination,  but  simply  to  call  attention 
to  and  to  emphasize  the  importance  of  a clinical 
history,  when  accurately  taken  and  carefully 
analyzed. 

Pottenger  Sanatorium. 

DISCUSSION 

Philip  H.  Pierson,  M.  D.  (490  Post  Street,  San 
Francisco). — This  paper  dealing  with  the  clinical  his- 
tory in  the  ’diagnosis  of  pulmonary  tuberculosis  is 
very  timely.  Today  when  there  are  so  many  short- 
cuts to  diagnosis  by  means  of  laboratory  aids,  the 
careful  taking  of  the  history  is  often  neglected.  It 
has  been  my  custom  to  ask  the  patient  how  long 
ago  he  was  perfectly  well,  active  and  strong  and 
chronologically  put  down  the  symptoms  as  they  have 
occurred,  very  often  over  several  years.  One  of  the 
most  important  groups  of  allergic  phenomena  is  the 
gastro-intestinal  group  mentioned  under  one  and  two. 
Often  suggestive  of  chronic  disturbance  of  the  gall 
bladder,  appendix,  or  colon,  much  time  is  lost  in 
treating  the  patient  for  an  illness  which  is  not  really 
responsible  for  his  complaint.  Likewise  the  histories 
of  frequent  colds  are  merely  allergic  reactions  about 
a pulmonary  or  bronchial  focus.  This  is  particularly 
true  in  childhood.  Among  other  helpful  aids  in  de- 
termining their  sensitiveness  of  tuberculosis  is  the 
intracutaneous  tuberculosis  test.  This  reaction  is 
often  more  marked  at  one  time  than  another.  Serial 
roentgenograms  frequently  bear  out  this  changing 
reaction  about  a pulmonary  focus. 

In  group  two,  Doctor  Pottenger  has  mentioned 
spasm  of  muscles  of  the  shoulder  girdle  as  a reflex 
manifestation  of  trouble  in  the  lungs.  In  early  tuber- 
culosis, especially  in  the  face  of  hemorrhage  where  a 
thorough  examination  is  impossible,  I am  sure  we 
can  gain  much  from  palpating  the  chest  to  determine 
lagging  of  one  or  the  other  side  and  this  reflex  spas- 
ticity of  the  muscles  reflecting  the  underlying  disease. 
To  be  sure  it  takes  a good  deal  of  experience  to  prop- 
erly interpret  this  sign,  but  I feel  that  it  is  well  worth 
special  attention  in  order  that  we  may  be  acquainted 
with  it  accurately  when  it  is  most  needed.  The  old 
adage,  treat  the  patient  and  the  disease  will  get  well, 
is  particularly  true  in  tuberculosis  and  the  recognition 
of  the  many  allergic  phenomena,  as  expressed  by 
Doctor  Pottenger,  will  help  in  choosing  the  proper 
system  of  treatment  for  tuberculosis. 

* 

William  C.  Voorsanger,  M.  D.  (490  Post  Street. 
San  Francisco). — The  diagnosis  of  beginning  tubercu- 
losis depends  largely  upon  symptoms  elicited,  gath- 
ered only  by  careful  questioning  of  the  patient.  As 
the  doctor  so  well  states,  our  hope  for  cure  lies 
in  starting  remedial  measures  before  the  tuberculous 
process  has  made  too  great  inroads  into  the  lungs. 
The  specialist,  too,  seldom  sees  the  beginning  dis- 
ease— too  often,  sad  to  relate,  the  patient  comes  to 
him  with  advanced  tuberculosis  which  has  remained 
undiagnosed.  Careful  history-taking  will  often  elicit 
a slight  cough  of  months’  duration,  pains  in  the  chest, 
a pneumonia  or  influenza  in  previous  years,  a steadily 
growing  loss  of  appetite,  an  occasional  night  sweat — 
but,  most  important  o.f  all,  a definite  statement  of 
fatigability  of  which  the  patient  himself  may  have 
been  ignorant  until  it  is  called  to  his  attention.  While 
these  symptoms  do  not  always  indicate  tuberculosis, 
they  are  highly  suggestive  of  it,  and  if  kept  in  mind, 
will  lead  the  physician  to  make  a complete  examina- 
tion, with  sputum  analysis  and  x-ray  investigation. 

Without  a careful  history,  and  without  properly 
evaluating  elicited  facts,  the  patient  is  often  dismissed 
with  a little  advice  or  a cough  mixture  and  thus  per- 
mitted to  lose  his  chance  of  getting  well.  I agree 


January,  1930 


TEACHING  PERINEAL  PROSTATECTOMY— H INMAN 


13 


fully  with  Doctor  Pottenger  concerning  repetitions  of 
bacillary  inoculations  in  tuberculosis  and  that  we  only 
accomplish  a relative  immunity.  Regarding  the  pri- 
mary infection,  we  have  learned  that  it  does  not 
always  start  in  the  apex  as  formerly  believed;  it 
starts  most  often  infraclavicularly,  and  an  early  lesion 
may  thus  be  overlooked  by  the  ordinary  physical 
examination. 

Doctor  Pottenger’s  grouping  of  symptoms  is  excel- 
lent; you  will  notice  the  most  distressing  ones  are  due 
to  toxemia,  which  can  only  be  combated  by  rest  in 
bed.  How  necessary,  therefore,  to  make  an  early  diag- 
nosis and  get  our  patients  at  rest! 

Time  will  not  permit  lengthy  discussion  of  the 
statement  that  the  allergic  reaction  is  the  main 
etiological  factor  in  pulmonary  tuberculosis.  We  are 
beginning  to  recognize  this  fact  in  other  diseases, 
and  particularly  in  other  pulmonary  conditions;  per- 
haps it  explains  why  we  have  so  often  failed  to  effect 
a cure  in  one  patient  while  accomplishing  it  in  an- 
other. It  is  certainly  a true  and  important  statement, 
if  reactions  in  the  human  body  can  cause  mild  symp- 
toms in  one  person,  and  severe  ones  in  another,  it 
surely  becomes  self-evident  that  a careful  eliciting 
of  all  facts  which  can  have  a bearing  upon  an  early* 
diagnosis  is  a matter  of  the  first  importance. 

fu 

A.  L.  Bramkamp,  M.  D.  (Banning). — For  many 
years,  in  season  and  out  of  season,  Doctor  Pottenger 
has  been  preaching  to  medical  men  this  gospel  of  the 
curability  of  pulmonary  tuberculosis  based  on  early 
diagnosis  and  treatment. 

On  the  whole  it  may  be  accepted  as  a fact  that 
doctors  generally  are  now  somewhat  better  able  to 
recognize  the  clinical  disease  from  physical  signs  than 
formerly  if  serious  and  persistent  effort  is  made. 
However,  in  many  cases,  the  disease  will  have  done 
considerable  damage  in  the  lungs  by  the  time  phys- 
ical signs  are  readily  detectable.  We  need  to  be 
“tuberculosis  minded,”  always  alert  to  the  possibility 
of  its  existence  even  in  the  apparently  well  or  slightly 
indisposed. 

While  it  is  true  that  other  diseases  are  accompanied 
by  many  of  the  symptoms  of  pulmonary  tuberculosis 
of  the  toxemia  group,  if  the  toxemic  symptoms  in  a 
particular  case  are  accompanied  also  by  those  of  the 
reflex  and  focal  groups  the  evidence  is  so  compelling 
that  we  should  consider  the  case  one  of  tuberculosis 
until  some  other  fully  adequate  explanation  is  found. 

Just  as  in  years  past,  moderately  or  far-advanced 
cases  form  the  great  majority  of  patients  in  sanatoria. 
Many  of  these  patients  have  had  relatively  early  diag- 
nosis and  therefore  are  perhaps  themselves  respon- 
sible for  their  failure  to  recover.  Since  the  change  to 
the  present  hopeful  attitude  as  to  the  curability  of 
the  disease,  there  is  lessened  stigma  attached  to  those 
who  have  it.  And  particularly,  since  the  patient’s  own 
efforts  and  cooperation  are  such  large  factors  in  deter- 
mining the  outcome,  can  there  be  any  justification 
for  failure  to  inform  the  patient  early  and  fully  as  to 
the  diagnosis. 

It  is  well  to  keep  in  mind  that  pulmonary  tuber- 
culosis in  children  and  adolescents  is  more  common 
than  formerly  realized;  that  in  these  young  people 
(as  in  some  adults)  physical  signs  of  the  disease  may 
be  very  indefinite  or  altogether  lacking.  In  these 
patients  the  clinical  history  may  have  to  be  relied 
upon  almost  wholly.  Fortunately  in  these  cases  the 
x-ray  often  affords  definitely  corroborative  evidence. 

Doctor  Pottenger’s  emphasis  on  the  value  of  an 
adequate  history  as  a factor  in  the  early  diagnosis  of 
pulmonary  tuberculosis,  even  before  substantiating 
physical  signs  are  present,  is  as  important  and  as 
timely  as  ever. 


THE  TEACHING  OF  PERINEAL 
PROSTATECTOMY* 

By  Frank  Hinman,  M.  D. 

San  Francisco 

Discussion  by  Ralph  Williams,  M.D.,  Los  Angeles; 
R.  L.  Rig  Jon,  M.  D.,  San  Francisco ; Robert  V.  Day,  M.  D., 
Los  Angeles. 

HPHE  operation  of  “conservative  perineal  pros- 
^ tatectomy”  holds  a rather  unique  position  in 
the  field  of  surgery.  It  has  passed  through  sev- 
eral short  periods  of  popularity  alternating  with 
those  of  marked  disfavor.  Few  surgeons  today 
perform  prostatectomy  by  way  of  the  perineum 
and  it  is  a matter  of  some  curiosity  to  the  many 
who  do  not,  why  this  small  group  persists  in  per- 
forming perineal  prostatectomy.  There  are  two 
factors  that  contribute  to  the  disfavor  of  this 
operation.  One  of  these  is  the  so-called  “median 
perineal  prostatectomy”  with  which  it  has  often 
been  confused.  At  the  outset  it  must  be  recog- 
nized that  Young’s  conservative  perineal  pros- 
tatectomy is  the  only  safe  perineal  operation  for 
removing  enlargements  of  the  prostate  and  when 
properly  performed  is  a highly  technical  surgical 
procedure,  whereas  median  perineal  prostatectomy 
is  a blind,  unsurgical  method,  unworthy  of  com- 
parison. The  results  are  in  no  sense  comparable. 
Another  factor  that  has  contributed  largely  to 
the  disfavor  of  conservative  perineal  prostatec- 
tomy is  the  fact  of  its  having  been  attempted  in 
the  past  by  men  unprepared  to  perform  it.  It 
must  be  recognized  that  the  operation  can  be  per- 
formed successfully  in  one  way  and  one  way 
only,  so  far  as  fundamentals  are  concerned,  and 
this  one  way  was  first  outlined  by  Young.  Modi- 
fications that  have  since  appeared  are  of  relatively 
minor  importance.  The  Young  method  preserves 
the  rectum  and  the  external  sphincter  and  the 
ability  properly  to  do  this  is  the  stumbling-block 
of  the  operation. 

THEORETICAL  ADVANTAGES  OF  PERINEAL 
PROSTATECTOMY 

The  theoretical  advantages  of  perineal  pros- 
tatectomy over  suprapubic  prostatectomy  are 
numerous.  Regional  anesthesia  is  much  more 
satisfactory  by  way  of  the  perineum.  Complica- 
tions and  dangers  of  infection  are  much  less,  the 
perineum  having  apparently  a localized  immunity 
which  the  suprapubic  route  lacks.  Furthermore, 
the  suprapubic  incision,  because  of  the  proximity 
and  danger  of  injury  of  the  peritoneum  and  be- 
cause of  the  complications  that  arise  from  infec- 
tions of  the  space  of  Retzius  or  the  perivesical 
regions,  produces  marked  postoperative  burdens 
that  the  perineal  route  escapes.  Keyes,  recogniz- 
ing this  danger  from  infection,  has  advocated 
suprapubic  prevesical  section,  the  bladder  not  to 
be  opened  until  after  it  has  become  adherent  to 
the  edges  of  the  suprapubic  wound  so  as  to  pre- 
vent spread  of  infection.  But  the  suprapubic 
route  rivals  perineal  surgery  only  when  the  open, 

* Read  before  the  Urology  Section  of  the  California 
Medical  Association  at  the  Fifty-Eighth  Annual  Session, 
May  6-9,  1929. 


1+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


visual  operation  of  Thompson- Walker  or  Hunt  is 
performed  and  neither  of  these  can  be  done  by 
a two-stage  method.  The  perineal  route  offers 
better  control  of  hemorrhage  because  of  its  being 
a more  open,  visual  operation  and  of  the  more 
direct  access  for  packing  when  required.  Depend- 
ent urinary  drainage  is  also  obtained,  although 
Fullerton  has  recently  advocated  placing  of  peri- 
neal drains  after  suprapubic  prostatectomy.  Be- 
cause of  less  shock  and  danger  of  the  operation, 
poorer  risks  can  be  subjected  to  it  and  there  is 
an  easier  convalescence.  The  mortality,  as  shown 
by  numerous  published  statistics,  is  at  least  50 
per  cent  less  than  that  following  the  suprapubic 
operation.  The  average  would  be  about  3 per  cent 
for  perineal  as  compared  to  6 per  cent  for  supra- 
pubic in  the  hands  of  those  most  experienced  by 
both  routes.  The  very  practical  disadvantages  of 
the  perineal  method  are  the  greater  difficulty  of 
its  performance,  the  greater  possibility  of  poor 
urinary  control  afterward  and  the  danger  of  pro- 
ducing a rectal  fistula.  Unless  these  dangers  of 
incontinence  and  rectal  injury  can  be  prevented, 
the  perineal  route,  in  view  of  the  marked  advance 
in  the  technique  of  suprapubic  prostatectomy, 
should  be  abandoned.  But  it  is  safe  to  say  that  if 
all  urologists  were  even  fairly  certain  of  not  in- 
juring the  external  sphincter  or  the  rectum,  all 
would  elect  the  perineal  route  because  of  the 
above  advantages. 

CHOICE  IN  METHOD,  AS  INDICATED  BY 
LITERATURE 

A glance  at  the  medical  literature  of  recent 
years  shows  that  there  has  been  a marked  diminu- 
tion in  the  popularity  of  perineal  prostatectomy 
abroad,  but  a very  distinct  growth  in  popularity 
in  the  United  States.  Judging  from  the  titles  in 
the  Index  Me  die  us  alone,  there  were  only  twenty- 
two  foreign,  as  compared  to  sixty-six  American 
publications  on  perineal  prostatectomy  in  the  last 
twelve  years ; whereas,  during  the  previous  twelve 
years,  one  hundred  and  forty-five  articles  ap- 
peared by  foreigners,  as  compared  to  forty-eight 
by  men  in  this  country.  With  few  exceptions,  the 
urologists  in  this  country  who  prefer  the  peri- 
neal route  are  men  who  have  been  trained  by 
Young  of  the  first  and  the  second  generation,  and 
this  alone  is  a good  indication  of  the  superiority 
of  Young’s  method  over  other  perineal  methods. 
It  would  seem  that  ability  to  perform  perineal 
prostatectomy  successfully  is  not  easily  obtained. 
Few  men  who  elect  this  method  have  been  self- 
taught.  Most  of  them  have  first  seen  it  done, 
then  helped  to  do  it,  and  have  finally  done  it 
themselves.  The  success  of  the  operation  depends 
upon  the  mastery  of  three  anatomical  principles: 
first,  exposure  of  the  prostate ; second,  the  com- 
plete enucleation  of  the  hyperplasia ; and,  third, 
proper  repair  with  hemostasis.  These  principles 
have  been  recently  published  1 in  detail  with  illus- 
trations, and  will  be  but  briefly  referred  to  here. 
The  most  difficult  problem  of  the  operation  is 
successful  perineal  exposure  which  is  solely  ana- 

lHinman,  Prank:  Perineal  Prostatectomy,  Contribution 
to  the  section  on  Clinical  Surgery.  Surgery,  Gynecology 
and  Obstetrics,  pp.  668-681,  November,  1929. 


tomical  and  which  requires  for  successful  per- 
formance the  recognition  of  two  anatomical  sign- 
posts : first,  the  central  point  of  the  perineum ; 
second,  the  fascia  of  Denonvillier.  Once  expert 
in  the  proper  dissection  of  these  anatomical  struc- 
tures, the  other  steps  of  the  operation  become  safe 
and  simple. 

It  is  a matter  of  some  surgical  interest  to  know 
whether  the  principles  of  preserving  the  rectum 
and  urethral  sphincter  can  be  successfully  taught, 
for,  if  not,  it  would  seem  that  the  operation  is 
bound  to  fall  into  disfavor.  Recent  medical  litera- 
ture rather  proves  that  the  first  generation  has 
carried  on  successfully,  inasmuch  as  a number 
of  fairly  good-sized  series  with  remarkably  low 
mortalities  and  especially  good  functional  results 
have  been  reported  by  a number  of  Young’s 
pupils.  As  a test  of  ability,  the  results  of  seventy 
operations  performed  by  fourteen  of  the  second 
generation  at  the  City  and  County  Hospital,  while 
in  training,  are  presented  below,  as  well  as  the 
answers  of  this  group  to  a questionnaire  recently 
mailed  them.  Most  of  these  men  have  been  prac- 
ticing urology  for  a very  short  period  so  that 
their  opinions  cannot  be  taken  as  final,  inasmuch 
as  they  have  hardly  had  time  to  fully  test  or 
modify  them.  A minority,  however,  have  been  in 
practice  for  a number  of  years  and  their  opinions, 
therefore,  should  be  more  mature.  Each  one  of 
these  men  has  had  charge  of  the  urological  ser- 
vice of  the  San  Francisco  City  and  County  Hos- 
pital for  at  least  six  months  after  two  or  more 
years’  apprenticeship  as  an  assistant,  and  almost 
without  exception  the  operations  analyzed  are  the 
first  ones  of  this  type  ever  performed  by  him.  In 
addition,  it  must  be  recognized  that  no  more 
severe  test  of  surgery  than  this  could  be  asked 
in  that  these  cases  are  without  exception  free 
clinic  type,  which  are  notably  poorer  risks  than 
private  patients,  and  which  have  had  the  ordinary 
ward  service  without  any  special  assistance  in  the 
way  of  care,  and  in  that  each  man  has  been  more 
or  less  individually  responsible  for  preparation, 
operation  and  postoperative  care.  The  results  are 
not  published  out  of  any  great  satisfaction  in 
them  because,  as  a matter  of  fact,  they  are  not 
good  results ; but  the  results  are  published  in 
order  to  emphasize  the  difficulties  of  learning  how 
properly  to  perform  prostatectomy.  In  order  to 
check  the  situation  the  suprapubic  operations  per- 
formed by  the  same  group  have  been  studied. 
Should  similarly  poor  results  persist  into  private 
practice  with  any  or  all  of  these  men  they  will  no 
doubt  abandon  perineal  prostatectomy  and  under- 
take suprapubic  prostatectomy.  They  may  later 
return  to  the  perineal  route  because  of  greater 
discouragements  suprapubically,  as  this  has  al- 
ready happened  with  one  or  two  of  them.  No 
prostatectomist  can  expect  to  cure  completely 
every  patient  who  comes  to  him  for  operation. 
There  has  been,  however,  a marked  difference  in 
the  relative  degree  of  success  of  these  different 
men,  some  being  remarkably  skillful,  having  no 
rectal  fistulae  and  no  incontinence,  while  others 


January,  1930 


TEACHING  PERINEAL  PROSTATECTOMY — HINMAN 


15 


have  had  a rather  high  mortality  with  one  or  more 
of  these  accidents.  The  series  of  each  individual, 
however,  is  altogether  too  small  to  draw  any  com- 
parative conclusions. 

Results  of  seventy  consecutive  cases  of  perineal 
prostatectomy  performed  by  men  in  training. 

Probably  no  more  rigid  test  of  an  operation 
could  be  asked  than  a series  of  first  cases  per- 
formed without  supervision  by  fourteen  different 
surgeons  in  training.  Seventy  consecutive  pa- 
tients have  been  thus  operated  upon : 

Cases 


Three  operated  one  patient  each  3 

One  operated  three  patients 3 

Two  operated  four  patients  each 8 

Four  operated  five  patients  each 20 

One  operated  seven  patients 7 

One  operated  eight  patients 8 

One  operated  ten  patients. 10 

One  operated  eleven  patients  11 


Fourteen  surgeons  70 


Particularly  severe  is  such  a test  when  it  is 
known  that  these  seventy  were  clinic  patients,  the 
majority  of  whom  were  old  and  enfeebled  indi- 
viduals without  financial  or  physical  reserve  and 
often  enough  broken  in  spirit.  And,  furthermore, 
the  results  must  take  into  consideration  the  fact 
that  the  preoperative  preparation  with  retention 
catheter,  etc.,  the  operation  itself  and  the  post- 
operative dressings  and  treatments  were  largely 
the  sum  total  of  each  surgeon’s  individual  efforts 
inasmuch  as  he  received  indifferent  intern,  nurs- 
ing and  orderly  service,  which  at  best  was  always 
untrained.  The  results  in  this  series  of  the  first 


few  operations  of  fourteen  different  men,  in  that 
they  are  performed  on  county  ward  patients  and 
have  been  operated  in  a general  hospital  on  each 
man’s  sole  responsibility  with  the  assistance  of 
an  indifferent  service  unaccustomed  to  such  cases, 
are  a good  test  of  the  difficulties  and  dangers  of 
perineal  prostatectomy. 

There  were  eight  deaths  in  the  hospital,  a surgi- 
cal mortality  of  11  per  cent;  four  within  forty- 
eight  hours  of  myocarditis  or  hemorrhage;  one 
each  on  the  fourth,  ninth  and  thirtieth  day,  of 
pneumonia  and  renal  insufficiency  (a  low  phtha- 
lein  before  operation  in  one)  ; and  one,  who  had 
a rectal  fistula  in  the  seventh  month  after  pros- 
tatectomy. following  operation  for  repair  of  the 
fistula.  One  patient  was  operated  on  for  an  acute 
gall  bladder  thirty-one  days  after  prostatectomy 
and  died  three  days  later. 

There  were  six  recto-urethral  fistulae,  one  in  a 
patient  who  died  on  the  twenty-sixth  day  of 
pneumonia,  and  another  in  the  patient  mentioned 
above  who  died  after  a repair  operation  seven 
months  after  prostatectomy,  one  which  was  closed 
immediately  and  a suprapubic  prostatectomy  done 
later.  One  closed  spontaneously  within  two 
months,  after  suprapubic  drainage  was  estab- 
lished by  cystotomy;  and  two  were  operated  on 
for  closure  (Young-Stone  method)  two  and  one- 
half  and  six  months  later.  The  last  patient  still 
had  slight  perineal  drainage  on  discharge  two 
months  later.  All  fistulae  were  closed  on  dis- 
charge. 

The  appended  tables  tell  briefly  the  results  fol- 
lowing operation. 


Table  1. — Tabulation  of  Results 

At  Time  of  Discharge  from  Hospital  from  Date  of  Operation 

Control  of 

Urination 

Less  than  weeks 

Less  than  months 

Total 

2 

3 

4 

6 

8 

3 

4 

5 

6 

7 

8 

1.  Good 

2 

15 

6 

5 

2 

30 

2.  Fair 

i 

2 

2 

2 

7 

3.  Poor 

3 

1 

1 

5 

Not  stated 

2 

4 

6 

6 

1 

1 

20 

DURATION  FROM  DATE  OF  OPERATION 

Died  in  Hospital 

1 

2 

3 

4 

3 

6 

7 

8 

1,  2,  3 and  4,  hemorrhage  and  myocarc 
5,  6 and  8,  convulsions  and  pneumonia 
©following  repair  of  recto-urethral  fistu 
©following  operation  for  acute  gall-blac 

© 

itis. 

ia  in 
der. 

7th  month. 

8 

Perineum  dry  and 
permanently  closed 

10 

23 

12 

3 

3 

1 

1 

(by  cystotomy) 

(slight  leakage  after  recto-urethral 
fistula  was  closed.) 

Not  stated 

1 

4 

3 

1 

Recto- urethral  Fistula.  All  closed.  1.  Closed  at  once,  suprapubic  operation  later. 

2 and  3.  Closed  at  4th  and  8th  month  by  Young-Stone  method. 

4.  Healed  spontaneously  with  retention  catheter. 

5.  Died  on  26th  day  (No.  8 above). 

6.  In  7th  month  following  repair. 

6 

16 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


Table  2. — Results  in  twenty-five  consecutive 
suprapubic  cases  performed  by  same  group  of 
men  whose  perineal  results  are  analysed  above. 

Cases 


Two  operated  one  patient  each 2 

Two  operated  two  patients  each 4 

Two  operated  three  patients  each 6 

One  operated  four  patients 4 

One  operated  nine  patients. 9 


Nine  surgeons  25 


It  is  rather  disconcerting  to  find  that  in  this 
small  series  there  is  an  operative  mortality  of 
29  per  cent. 

One  patient  died  in  twelve  hours. 

One  patient  died  in  twenty-four  hours. 

One  patient  died  in  two  days. 

Two  patients  died  in  five  days. 

One  patient  died  in  eleven  days. 

One  patient  died  in  thirty-five  days  of  broncho- 
pneumonia. 

One  patient  died  in  four  months,  two  days  after 
partial  cystectomy  for  tumor  of  the  bladder. 

Eight 

QUESTIONNAIRE  AND  REPLIES 

The  questionnaire  mailed  the  above  fourteen 
men  is  as  follows : 

“Have  you  any  preference  as  between  the  perineal 
and  suprapubic  route  for  prostatectomy? 

State  briefly  your  reasons. 

Have  you  had  rectal  fistulae?  Explain. 

Have  you  had  incontinence?  Explain. 

Will  you  briefly  state  in  general  your  experience 
with  prostatectomy?” 

Replies  have  been  received  from  only  twelve  of 
the  fourteen  and  all  but  one  have  stated  a dis- 
tinct preference  for  the  perineal  route.  Two  of 
those  who  have  been  in  practice  for  several  years 
became  discouraged  with  their  results  perineally 
and  started  to  perform  prostatectomy  through  the 
bladder,  but  after  thirty  or  forty  such  operations, 
decided  that  their  results  by  way  of  the  perineum 
were  better  than  suprapubically  and  returned  to 
the  perineal  route.  Unfortunately  the  question- 
naire is  so  worded  that  one  cannot  tell  whether 
the  fistulae  and  incontinence  asked  about  occurred 
in  private  practice  or  whether  cases  operated  at 
the  City  and  County  Hospital  are  included. 

Rectal  Fistula. — Three  men  state  they  have  each  had 
rectal  fistula  once,  the  explanations  being  as  follows: 
(1)  “Three  days  after  perineal  prostatectomy  a large 
milk  and  molasses  enema  was  given  by  inexperienced 
nurse;  fistula  persisted  until  patient’s  death  six  months 
later  from  carcinoma  of  the  stomach.”  (2)  “I  have 
had  one  rectal  fistula,  due  to  faulty  preoperative 
preparation  of  the  patient  whereby  the  patient  was 
put  on  the  table  soon  after  two  enemas  had  been 
given  without  any  return.  The  fully  distended  rectum 
was  perforated  by  the  index  finger  during  the  pre- 
liminary blunt  dissection  of  the  lateral  fossae.  The 
prostate  was  removed  later  by  the  suprapubic  route.” 
(3)  “I  have  had  one  case  of  rectal  fistula  in  a case 
of  carcinoma.” 

Incontinence. — None  of  these  twelve  men  has  ever 
had  a case  of  incontinence,  although  most  of  them 
speak  of  a temporary  dribble  for  the  first  one  or  two 
months  postoperatively,  after  which  there  was  perfect 
control. 

General  Personal  Experience. — As  to  answers  to  the 
general  personal  experiences,  one  writes:  “I  have  had 


between  twenty  and  twenty-five  cases.  The  results 
have  been  best  where  the  staff  is  trained  and  equipped 
for  perineal  work.  They  are  possibly  harder  to  do 
and  care  for  than  suprapubic  cases  in  some  hospitals 
and  require  a little  more  personal  attention  for  forty- 
eight  hours,  after  which  they  require  less  expert  care 
than  the  suprapubic  cases.  The  greatest  danger  is 
from  hemorrhage  and  its  sequelae  (infection).  I feel 
that  hemorrhage  is  often  not  dealt  with  radically 
enough  or  soon  enough.  The  mortality  may  probably 
equal  or  exceed  suprapubic  because  poorer  risks  are 
accepted  for  perineal  operation  due  to  its  lack  of 
severe  shock  and  use  of  local  anesthesia.”  And 
another  writes : “Twelve  suprapubic  prostatectomies 
with  one  death.  Forty-four  perineal  prostatectomies 
with  no  deaths.  These  are  all  private  cases  and, 
while  the  series  is  small,  with  one  exception,  the  re- 
sults have  been  very  satisfactory.  The  one  exception — 
the  median  lobe  was  not  removed  in  the  perineal 
operation.”  A third  says : “One’s  general  impression 
of  prostatectomy  is  that  the  perineal  route  is  the  more 
surgical  procedure  of  the  two  as  regards  the  opera- 
tive field.  The  suprapubic  method  savors  strongly  of 
crudeness — I refer  particularly  to  the  actual  method 
of  enucleation.”'  A fourth  replies:  “My  short  series  of 
cases,  all  at  the  San  Francisco  Hospital,  have  led  me 
to  believe  that  the  perineal  route,  once  mastered,  gives 
the  best  structural  results.  I have  had  six  cases.  One 
death  two  weeks  postoperatively  from  pneumonia. 
This  patient  was  a bad  risk.  Had  a large  diverticu- 
lum. The  gland  was  carcinomatous  and  very  mark- 
edly adherent  to  the  rectum.  Done  under  spinal  and 
gas-oxygen  anesthesia.  All  other  cases  gave  satisfac- 
tory results.”  A fifth:  “My  own  experience  with  pros- 
tatectomy has  thus  far  been  limited  to  about  twelve 
cases.  From  this  meager  experience  and  what  I have 
gathered  from  the  literature,  it  appears  to  me  that 
future  developments  in  prostatic  surgery  will  be  con- 
summated with  the  primary  control  of  hemorrhage  by 
suture  and  attempts  to  get  primary  wound  healing.” 
A sixth  writes  at  length:  “My  limited  experience  leads 
me  to  believe  that  the  advantages  of  perineal  over 
suprapubic  prostatectomy  are  more  theoretical  than 
practical,  when  we  consider  the  technique  of  the  peri- 
neal method  in  the  past.  Both  methods  probably  have 
certain  advantages,  one  over  the  other,  but  the  com- 
parative ease  with  which  the  suprapubic  operation  can 
be  done  favors  its  more  general  use.  Consequently,  I 
think  the  perineal  operation  ought  to  be  abandoned 
unless  evidence  can  be  adduced  to  show  that  its  re- 
sults are  so  vastly  superior  to  the  suprapubic  as  to 
more  than  offset  the  technical  difficulties  of  the  peri- 
neal. I do  not  think  that  statistics  show  any  vast 
superiority  in  the  results  of  perineal  prostatectomy. 
In  my  opinion  the  future  progress  of  prostatectomy 
lies  in  an  improvement  in  our  present  methods  of 
controlling  bleeding  at  the  time  of  operation.  I think 
that  packing  of  the  prostatic  cavity,  the  use  of  rubber 
bags,  etc.,  can  and  should  be  abandoned.  Without 
their  use  it  is  possible  to  obtain  primary  closure  and 
healing  of  wounds  without  urinary  drainage  and 
thereby  greatly  shorten  convalescence  and  add  to  the 
patient’s  comfort.  My  experience  in  some  twenty  con- 
secutive cases  has  shown  that  satisfactory  control  of 
bleeding  can  be  obtained  in  every  case  without  resort- 
ing to  packs,  etc.,  and  in  90  per  cent  of  them  primary 
healing  will  occur  without  the  wound  breaking  down 
and  draining.  When  it  does  drain  it  is  usually  very 
transient.  In  this  way  it  is  possible  to  discharge 
many  patients  from  the  hospital  in  twelve  to  fourteen 
days  unless  some  complication  such  as  epididymitis 
occurs.  This  is  the  most  common  complication  of 
any  type  of  prostatectomy  and  probably  tying  off  the 
vasa  should  be  routine.  The  perineal  operation  lends 
itself  much  more  readily  to  hemorrhage  control  and 
to  primary  closure  and  healing  than  does  the  supra- 
pubic for  obvious  reasons.  Certainly  if  results  such 
as  these  can  be  obtained  with  the  perineal,  then  the 
suprapubic  operation  ought  to  be  abandoned  unless 
it  can  come  up  to  the  same  standard.”  A seventh 


January,  1930 


TEACHING  PERINEAL  PROSTATECTOMY — 1 1 IN  MAN 


17 


reply,  brief  and  to  the  point,  is  in  full  as  follows: 
Have  you  any  preference  between  the  perineal  and 
suprapubic  route?  “I  prefer  the  perineal.”  State 
briefly  your  reasons:  “(a)  Easier  approach.  ( h ) Pros- 
tate more  accessible  through  perineum  for  clean  enu- 
cleation; ligation  of  bleeders;  removal  of  tags,  etc. 
( c ) Smoother  postoperative  convalescence.  My  supra- 
pubic patients  are  more  apt  to  be  disturbed  by  ab- 
dominal distention  and  are  generally  sicker  than  those 
operated  upon  perineally.  (d)  Lower  mortality  rate, 
(e)  In  my  hands  quicker  closure  of  perineal  fistula 
than  of  suprapubic.  I find  that  both  methods  give 
about  the  same  functional  results,  so  that  because  of 
the  advantages  in  my  experience  noted  above,  I use 
the  perineal  method,  unless  other  factors  enter  to 
modify  the  choice.” 

Have  you  had  rectal  fistulae?  “There  have  been  no 
rectal  injuries  or  fistulae.”  Have  you  had  inconti- 
nence? “There  have  been  no  cases  of  true  inconti- 
nence. In  several  there  has  been  a slight  terminal 
dribbling,  which  in  no  instance  has  persisted  longer 
than  six  months.” 

Will  you  briefly  state  in  general  your  experience 
with  prostatectomy?  “A  total  of  fifty-six  perineals 
with  two  deaths  and  twenty  suprapubics  with  two 
deaths.  Until  recently  have  used  caudal  anesthesia 
for  the  perineal  and  combined  caudal  and  abdominal 
infiltration  for  the  suprapubic.  Have  been  converted 
to  spinal  for  all  prostatectomies,  unless  there  are  defi- 
nite contraindications.” 

CONCLUSION 

The  above  brief  outline  of  the  experience  and 
opinions  of  a few  of  the  second  generation  would 
indicate  that  most  of  them  are  perineal  enthusi- 
asts in  spite  of  early  discouragement.  The  con- 
clusion to  be  drawn,  therefore,  is  that  perineal 
prostatectomy  can  he  taught.  But  the  29  per  cent 
suprapubic  and  11  per  cent  perineal  mortalities 
point  clearly  to  the  need  of  supervision  and  im- 
provement of  the  city  and  county  urological  ser- 
vice in  providing  the  final  stage  of  this  instruction. 

384  Post  Street. 

DISCUSSION 

Ralph  Williams,  M.  D.  (650  South  Grand  Avenue, 
Los  Angeles). — It  seems  to  me  that  we  have  gotten 
away  from  the  subject.  There  are  some  surgeons  who 
have  changed  from  the  suprapubic  to  the  perineal 
prostatectomy.  A good  many  of  them  have  had  a cer- 
tain amount  of  training  in  the  perineal  operation. 
They  took  up  the  suprapubic  operation  because  they 
thought  it  was  easier;  but  when  they  tried  the  peri- 
neal operation  they  found  they  had  to  train  them- 
selves in  the  technique.  Now,  that  is  the  whole  prob- 
lem in  perineal  prostatectomy;  when  it  is  performed 
by  a surgeon  who  has  learned  the  technique  it  is 
technically  worth  witnessing,  but  no  one,  even  those 
who  can  do  it  all  right,  can  teach  another.  Each  man 
has  to  learn  it  himself.  Being,  more  or  less  of  the  old 
school,  I do  the  suprapubic  operation  mostly.  Opera- 
tors of  equal  skill  have  practically  the  same  results 
in  either  operation.  Fistulas  are  not  so  likely  in  the 
suprapubic  operation.  A mortality  of  10  or  15  per 
cent  follows  either  operation  when  done  by  the  gen- 
eral surgeon,  but  a much  lower  per  cent  of  mortality 
follows  work  by  the  trained  urologist. 

* 

R.  L.  Ricdon,  M.  D.  (909  Hyde  Street,  San  Fran- 
cisco).— The  paper  by  Doctor  Hinman  on  “The 
Teaching  of  Perineal  Prostatectomy,”  includes  an 
argument  for  the  superiority  of  the  perineal  route. 
So  far  as  the  matter  of  choice  of  route  is  concerned, 
the  advocates  of  each  method  seem  to  be  thoroughly 
convinced  that  the  one  or  the  other  is  unquestionably 
superior  and  arguments  pro  or  con  are  scarcely  worth 
while;  when  a man’s  mind  is  definitely  made  up  there 
is  little  to  be  gained  in  trying  to  change  it.  The  on- 
coming medical  student  must  of  necessity  accept,  for 


the  most  part,  the  opinion  of  his  teacher.  This  is 
well,  for  each  operation  has  its  place  and  each  should 
be  kept. 

The  teaching  of  either  suprapubic  or  perineal  pros- 
tatectomy is  not  easy.  After  a surgeon  has  thor- 
oughly mastered  the  technique,  it  then  seems  to  him 
so  simple  that  he  has  difficulty  in  realizing  the  per- 
plexities of  the  student.  I am  convinced,  too,  that  a 
student  by  study  and  observation  may  master  the 
various  steps  in  the  operation  and  be  able  to  discuss 
and  answer  questions  intelligently  and  still  be  very 
far  from  really  knowing  the  operation.  It  is  only  by 
doing  the  operation  repeatedly  that  he  acquires  skill. 
It  is  also  certain,  under  our  present  methods  of  teach- 
ing, no  recent  graduate  can  be  a finished  operator; 
his  real  skill  will  come  after  he  has  gone  into  practice 
for  himself  and  has  assumed  full  responsibility,  both 
as  to  manual  manipulation  and  judgment. 

I do  not  believe  a true  test  of  teaching  ability  is 
afforded  by  the  number  of  students  who  continue  in 
the  method  they  have  been  taught.  What  should 
happen,  and  actually  does,  is  that  wider  reading,  more 
extended  observation  and  a growing  experience  en- 
ables the  surgeon  to  choose  the  method  that  gives 
best  results  in  his  hands.  When  he  has  made  this 
independent  choice  he  is  for  the  first  time  fully  taught. 
It  is  manifest  a professor  cannot  supply  all  this 
instruction. 

rtr 

Robert  V.  Day,  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles).- — It  seems  to  me  that  we  should  get 
back  to  what  Doctor  Young  has  always  said,  namely, 
that  each  should  do  the  type  of  prostatectomy  he 
personally  can  do  best;  in  other  words,  the  type  of 
operation  for  which  he  has  been  trained  and  with 
which  he  has  had  the  most  experience.  This  is  a bit 
off  of  the  announced  subject,  but  Doctor  Hinman  has 
himself  brought  up  this  phase  of  the  matter.  Doctor 
Hinman  has  just  stated,  and  seemingly  most  perineal 
prostatectomists  believe  that  only  the  perineal  method 
is  highly  technical.  As  to  the  manner  of  approach, 
this  is  true,  but  as  regards  all  other  steps  in  the  supra- 
pubic operation  I am  sure  that  such  is  not  the  case 
and  no  doubt  this  accounts  for  the  high  mortality 
and  poor  results  when  perineal  prostatectomists  and 
others  without  a background  of  experience  and  train- 
ing in  suprapubic  prostatectomies  attempt  the  supra- 
pubic operation.  Indeed  every  other  factor  except  the 
approach  is  highly  technical  and  requires  great  judg- 
ment if  the  suprapubic  operation  is  chosen. 

As  regards  early  healing,  I personally  dislike  to 
have  the  bladder  wound  heal  under  two  weeks’  time. 
There  are  a pair  of  kidneys  above  that  have  already 
been  damaged  during  the  years  of  developing  pros- 
tatism, or  at  least  there  is  potential  damage.  There- 
fore, too  early  closure  of  the  bladder  and  conse- 
quently the  danger  of  increased  intravesical  tension 
and  tears  of  the  healing  bladder  neck  and  prostatic 
bed  during  the  urinary  act  are  factors  to  be  con- 
sidered. 

If  a patient  is  considered  a good  risk  from  the 
standpoint  of  prostatectomy  the  mortality  will  be 
about  equal,  no  matter  which  type  of  operation  is 
done.  On  the  other  hand,  among  the  poor  risks  com- 
prising 20  to  30  per  cent  of  cases  coming  to  operation 
are  bad  risks,  and  in  this  type  of  case  there  is  no  ques- 
tion but  that  the  perineal  operation  is  safer  from  the 
standpoint  of  immediate  mortality.  Randall  used  to 
say  that  an  hypertrophied  prostate  which  was  largely 
intra-urethral  should  be  removed  perineally,  and  a 
prostate  pushing  into  the  bladder  should  be  removed 
suprapubically.  As  a matter  of  fact  any  prostate  may 
very  well  be  removed  perineally  by  a perineal  pros- 
tatectomist  and,  on  the  other  hand,  any  prostate  may 
satisfactorily  be  dealt  with  suprapubically  by  a fin- 
ished suprapubic  prostatectomist. 

Finally,  after  a practitioner  has  received  the  train- 
ing Doctor  Hinman  speaks  of  under  the  supervision 
of  a master  of  this  operation,  he  has  only  just  begun; 
it  takes  one  hundred  or  more  perineal  operations 
before  he  adequately  masters  the  technique. 


18 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vo!.  XXXII,  No.  1 


THE  CHILD  WHO  WILL  NOT  EAT* 

By  Henry  E.  Stafford,  M.  D. 

Oakland 

Discussion  by  C.  F.  Gelston,  M.D.,  San  Francisco; 
William  W.  Belford,  M.  D.,  San  Diego. 

"OECENT  work  on  the  caloric  value  of  foods, 
vitamin  needs  and  standards  of  weights  and 
heights,  etc.,  has  given  us  valuable  information 
in  feeding  children,  yet  the  complaint  “My  child 
won’t  eat”  is  as  common  or  more  common  than 
ever.  In  a recent  survey  it  was  found  that  only 
10  per  cent  of  children  in  well-to-do  families 
were  eating  properly. 

CAUSES  OF  ANOREXIA  IN  CHILDREN 

Causes  of  failure  in  applying  our  knowledge 
of  feeding  children  may  be  roughly  grouped 
under  three  general  headings : infection,  allergic 
sensitization,  and  psychological  maladjustment. 
Chronic  foci  of  infection  (antrums,  tonsils,  teeth, 
urinary  tract)  we  are  usually  able  to  locate  and 
eliminate.  Acute  infections  are  soon  over  and, 
while  often  the  beginning  of  long  standing  feed- 
ing problems,  do  not  otherwise  concern  us  here. 
The  allergist  is  often  able  to  rule  out  sensitization 
antigens.  Too  frequently,  however,  improper 
habits  of  training,  faulty  daily  routine  and  un- 
satisfactory surroundings  at  mealtime,  keep  the 
child  from  receiving  proper  nourishment.  We 
fail  to  realize  that  the  food  needs  of  individuals 
are  variable;  that  there  are  wide  differences  in 
food  intake  each  day  in  a given  individual  and 
consequently  that  we  are  unable  to  prescribe  food 
in  even  approximately  exact  amounts.  This  latter 
I will  discuss. 

In  so  far  as  I know,  there  is  no  new  “open 
sesame”  to  our  problem.  Its  solution  lies  in  the 
education  and  reeducation  of  parents  and  nurses, 
but  before  this  can  be  accomplished  we  must  have 
a clear  conception  of  the  factors  underlying 
anorexia.  Why  do  so  many  children  never  eat 
well  and  other  healthy  small  folk  suddenly  rebel 
against  food? 

SPECIAL  FACTORS 

Food  Preparation. — Several  of  the  primary 
causes  involve  little  scientific  knowledge  but  have 
only  to  do  with  the  routine  minutiae  of  our  small 
patients’  daily  existence.  Let  us  first  consider  the 
preparation  of  food.  Any  foodstuff  may  be  ren- 
dered distasteful  by  improper  cooking  and  serv- 
ing, for  example,  vegetables  cooked  in  a large 
quantity  of  water  with  all  natural  flavor  and  oils 
removed,  later  pureed  into  an  unrecognizable 
mass  and  served  with  an  over  helping  of  watery 
mashed  potatoes  and,  let  us  say,  a soft-boiled  egg 
stirred  in,  cannot  invite  the  average  child  of 
even  five  or  six.  Yet  how  often  do  we  find  con- 
scientious nurses  and  mothers  cajoling,  urging, 
bribing  this  type  of  food  into  intelligent  children. 

Meals  with  Family. — Equally  common  is  the 
mistake  of  allowing  children  under  six  years  to 

* Read  before  the  .Pediatrics  Section  of  the  California 
Medical  Association  at  the  Fifty-Eighth  Annual  Session, 
May  6-9,  1929. 


eat  with  their  parents.  The  interesting  conver- 
sation of  adults  diverts  the  child  from  the  ob- 
jective of  mealtime.  But  worse,  days  come  when 
Johnny  or  Betty,  because  of  an  intercurrent 
infection,  or  overfatiguing  play,  is  less  inter- 
ested in  food  than  usual.  This  is  promptly  noticed 
by  the  parents  close  at  hand.  Distasteful  food  is 
made  more  so  by  suggesting  that  it  be  eaten. 
When  this  has  been  repeated  several  times  the 
child  finds  himself  the  center  of  attraction  at 
mealtime,  knowing  the  dinner  conversation  will 
promptly  turn  to  him  when  a portion  of  food 
is  left.  Was  there  ever  a child  who  would  not 
sacrifice  a portion  of  spinach  to  be  noticed?  Or 
perhaps  father  has  never  been  trained  to  eat  arti- 
chokes. The  fact  that  it  is  left  on  his  plate  is 
noticed  and  as  promptly  copied  with  the  result 
that  a valuable  foodstuff  is  eliminated  from  his 
son’s  or  daughter’s  diet. 

Time  Irregularity. — Food  between  meals  is  not 
uncommonly  an  early  factor  in  preventing  proper 
eating  at  mealtime.  The  bottle  is  reheated  several 
times,  so  that  the  last  ounce  of  the  prescribed 
formula  may  be  given,  often  reducing  the  feed- 
ing interval  by  a full  hour.  At  a little  later  age 
zwieback,  and  graham  crackers  are  offered  be- 
tween feedings  so  that  an  opening  wedge  is 
formed  for  the  sandwich  and  the  glass  of  milk 
in  the  middle  of  the  afternoon.  The  vicious  cycle 
is  thus  easily  formed — food  between  meals,  less 
food  at  mealtime. 

When  new  tastes  or  coarser  foods  are  added 
to  the  growing  child’s  diet,  another  problem  con- 
fronts us.  If  at  first  small  amounts  of  foreign 
articles  of  food  are  offered  and  the  amounts 
gradually  increased  or  food  with  heavy  cellular 
fibers  is  finely  divided  in  the  beginning — educa- 
tion to  novel  food  elements  is  smoothly  and  easily 
accomplished.  But  on  the  other  hand,  if  either  is 
forced  when  first  given,  it  may  be  years  or  even 
a lifetime  before  such  articles  cease  to  be  dis- 
tasteful to  the  individual  so  treated. 

Spoon  Feeding. — It  is  the  exception  to  see  a 
child  eat  well  who  has  been  spoon  fed  by  nurse  or 
mother  after  the  second  year.  The  average  child 
makes  evident  its  desire  to  handle  the  spoon  itself 
before  this  time.  Because  coordination  is  at  first 
faulty,  less  than  the  average  amount  of  food  is 
taken — whereupon  the  attendant  with  visions  of 
her  charge  wasting  away  amid  plenty,  again 
takes  things  into  her  own  hands.  The  child 
rebels — picture  books  or  a favorite  toy  are  called 
into  service  and  large  portions  of  food  are  poked 
down  to  the  rhythm  of  turning  leaves  or  the 
squeaks  of  a teddy  bear.  The  result  is  obvious. 
The  child  is  fed  because  lie  does  not  eat  well  by 
himself  ; he  does  not  feed  himself  because  he  is 
spoon  fed.  How  unlike  the  results  of  Doctor 
Davis’  experiments  where  ten-month-old  infants 
were  allowed  to  choose  their  own  food  each  day 
from  a large  variety,  and  when  the  intake  was 
averaged  it  was  found  to  form  a balanced  diet 


January,  1930 


THE  CHILD  WHO  WILL  NOT  EAT — STAFFORD 


19 


and  the  progress  of  the  child  was  within  average 
limits. 

Mental  and  Physical  Fatigue. — Lastly  the  tired 
child  is  never  hungry.  This  is  probably  due  to 
the  interference  by  fatigue  of  gastric  peristalsis, 
which  in  turn  is  normally  responsible  for  the  sen- 
sation of  hunger.  Without  hunger  there  is  no 
desire  for  food — or  appetite.  Consequently  the 
child  who  rushes  to  the  dinner  table  tired  from 
play,  rarely  eats  well.  Ten  or  fifteen  minutes’ 
relaxation  between  daily  activities  and  mealtime 
often  makes  the  difference  between  a poorly  or 
well-eaten  meal.  Unfortunately  a child  is  more 
commonly  nagged  into  eating  small  portions  of 
food  which  are  little  wanted  than  to  be  called  a 
few  minutes  before  dinner  so  that  a desire  for 
food  may  be  developed.  Needless  to  say,  fatigue 
from  chronic  infections  and  insufficient  rest 
period  during  either  day  or  night  produce  the 
same  result. 

The  above  mistakes  are  common.  One  or  more 
are  present  at  some  time  in  almost  every  house- 
hold. I think  the  reason  lies  in  the  fact  that  we 
are  educating  our  parents  and  nurses  to  aspire 
to  high  ideals  for  children  without  showing  them 
there  is  a limit  to  their  endeavors.  We  are  giving 
them  facts  without  balanced  clinical  judgment. 

GROWTH  NOT  CONSTANT 

All  children  pass  through  physiological  resting 
periods  in  growth.  In  this  discussion  the  time 
between  the  tenth  and  fourteenth  month  is  by 
far  the  most  important.  When  a child  begins  to 
change  from  his  baby  type  of  stored-up  fat  to 
early  childhood,  muscle  caloric  needs  are  de- 
creased. Failure  to  realize  this  causes  much 
forced  feedings.  Given  a previously  healthy 
child  free  from  infection  who  fails  to  gain  and 
at  the  same  time  refuses  10  to  40  per  cent  of  its 
food,  the  natural  impulse  is  to  first  cajole,  then 
urge  and  then  force.  Each  phase  of  such  man- 
agement is  met  by  an  increasing  resistance  on 
the  part  of  the  child. 

INDIVIDUAL  CALORIC  NEEDS 

We  so  often  fail  to  consider  children  as  indi- 
viduals. Standards  of  heights  and  weights  have 
been  of  real  service  in  calling  attention  to  the  fact 
that  our  small  friend  just  “can’t  grow.”  Popular 
books  on  caloric  and  vitamin  needs  have  aided  in 
giving  us  balanced  diets.  But  to  apply  average 
developmental  standards  or  average  caloric  needs 
to  the  individual  child  is  sheer  folly.  Few  attempt 
it.  However,  the  idea  has  become  firmly  fixed  in 
the  minds  of  many  parents  and  nurses  that  there 
is  a normal  weight  and  height,  and  normal  food 
requirement  for  every  child  of  a given  age.  How 
idealistic  to  raise  a race  of  super-children  con- 
forming to  high  standards ! Every  parent  aspires 
to  such  an  ideal  standard  for  his  son  or  daughter. 
Little  Johnny  is  found  to  be  four  pounds  “sub- 
standard.” Translated  into  his  parents’  minds, 
this  means  nothing  less  than  four  pounds  under 
weight.  Johnny  is  sub-normal.  He  must  be  fed 
up.  Increased  calories  must  bring  him  up  to  the 
ideal.  Parents,  attendants,  and  at  times  his  phy- 


sician, are  arrayed  against  him  to  bring  Johnny 
up  to  standard — please,  let  us  not  say  normal. 
The  boy,  firm  and  in  perfect  health,  but  perhaps 
somewhat  small,  rebels.  The  more  food  that  is 
forced,  the  less  he  eats,  and  he  finally  becomes 
whiny,  irritable  and  begins  to  lose  weight,  all 
because  we  have  attempted  to  force  him  to  con- 
form to  an  empirical  ideal — because  we  have 
failed  to  consider  heredity  and  environment  in 
forming  our  judgment  of  his  general  physical 
condition. 

PREVENTION  OF  MISTAKES  IN  FEEDING 

Preventing  the  above  mistakes  in  daily  routine 
and  child  training  with  the  underlying  faulty 
viewpoints  which  prompt  them,  offers  the  key  to 
the  solution  of  our  problem.  When  we  are  for- 
tunate enough  systematically  to  follow  children 
through  the  first  three  years,  we  are  usually  able 
to  keep  them  from  being  forced  or  urged  to  eat. 
By  explaining  that  different  children  vary  in 
their  caloric  needs ; that  food  requirements  vary 
at  different  times ; that  health  is  not  synonymous 
with  average  weight  and  height  and  that  growth 
progresses  in  uneven  cycles  and  not  in  a steady 
uninterrupted  increase — parents  and  nurses  may 
be  prevented  from  falling  into  the  pitfalls  of  mis- 
management based  on  an  overzealous  attitude. 
In  my  judgment  there  is  never  a time  when  a 
child  should  be  forced  to  eat.  Dr.  Franz  Ham- 
burger, in  a recent  article,  states  it  is  folly  to 
praise  or  urge  a child  to  do  that  which  he  nat- 
urally wants  to  do.  Hunger  and  appetite  are  both 
natural  impulses.  Is  it  not  more  logical  to  use 
them  as  allies  in  training  children  to  eat  than  to 
stifle  both  by  mismanagement?  It  is  far  easier 
to  train  a mother  to  this  attitude  and  so  we  feel 
prevent  anorexia,  than  to  later  attempt  to  solve  a 
feeding  problem  of  five  or  six  years’  standing. 
To  convince  a parent  that  a child  will  not  starve  if 
let  alone  or  that  a decrease  in  weight  will  only  be 
temporary  is  often  a difficult  task.  When  a mother 
can  be  persuaded  to  follow  instructions  for  a 
stated  time,  our  point  is  usually  gained.  It  is 
rarely  accomplished  with  a single  conference  and 
often  is  impossible  unless  the  child  be  seen  at 
frequent  stated  intervals  over  a period  of  weeks. 
The  “art  of  the  practice  of  medicine”  required 
to  convince  parents  that  operative  procedures  are 
necessary  is  little  compared  with  that  needed  in 
gaining  their  confidence  sufficiently  to  permit 
their  children  to  go  without  food  for  a few  days. 
We  have  all  seen  many  small  folk  refuse  food  for 
three  or  four  days,  then  ask  for  meals  and  begin 
to  eat  well  again  when  they  have  always  been 
classed  as  poor  eaters.  Others  will  leave  one 
article  of  food,  e.  g.  milk,  for  weeks,  and  then 
return  to  it  willingly  if  not  urged. 

SUMMARY 

To  summarize  our  attitude  toward  the  child 
who  will  not  eat,  I should  like  to  state  the  sug- 
gestions which  we  give  to  parents  in  feeding 
children. 

1.  That  a well-prepared  meal  be  offered  at 
regular  times. 

2.  That  it  be  served  in  an  appetizing  manner. 


20 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


3.  That  the  child  shall  come  to  the  table  in  a 
proper  mental  attitude,  e.  g.,  free  from  fatigue. 

4.  That  the  child  shall  remain  at  the  table  un- 
interrupted for  thirty  minutes. 

5.  That  no  mention  of  food  be  made  during 
or  between  meals. 

242  Moss  Avenue. 

DISCUSSION 

C.  F.  Gelston,  M.  D.  (384  Post  Street,  San  Fran- 
cisco).— -To  say  that  90  per  cent  of  children  beyond 
the  first  year  have  faulty  eating  habits  sounds  exag- 
gerated, but  is  unquestionably  only  too  true.  Cer- 
tainly, it  would  seem  that  as  physicians  we  should 
seriously  take  cognizance  of  this  problem  and  use  our 
influence  with  parents,  teachers,  nurses,  all  those 
coming  in  contact  with  the  child,  to  prevent,  by  edu- 
cation, such  an  appalling  situation.  It  would  actually 
appear  that  there  is  more  unhappiness,  more  disrup- 
tion of  family  placidity  and  routine  by  this  bad  habit 
than  by  any  one  other  complaint. 

As  is  pointed  out,  training  must  be  begun  early,  at 
the  first  sign  of  this  nervous  anorexia.  As  a rule  this 
becomes  noticeable  in  the  second  year,  although  fre- 
quently enough  at  the  end  of  the  first.  Much  can  be 
gained  if  we  are  only  able  to  impress  upon  the  parents 
the  importance  of  winning  these  first  “battles  of  wills.” 
The  saving  in  peace  of  mind  later  is  incalculable. 
Without  realization,  one  so  easily  slips  into  the  habit 
of  diverting  the  child’s  attention  while,  as  Doctor 
Stafford  literally  expresses  it,  food  is  “poked”  down 
the  youngster’s  throat.  From  this  point  is  a short  step 
to  a “vaudeville  show”  at  every  meal  with  a steadily 
increasing  irritability,  nervousness  and  unhappiness  of 
the  mother,  all  of  which  the  child  thoroughly  enjoys. 
And  to  have  this  repeated  three  times  a day  is  bliss 
itself. 

We  have  a practical  application  of  discipline,  as 
practiced  by  many  mothers  of  several  children.  Such 
a mother  is  not  infrequently  constantly  busy  from 
morning  till  night.  She  simply  has  not  the  time  or 
nervous  energy  to  spend  in  pampering  the  whims  of 
her  offspring.  Food  is  prepared  for  all  of  them,  they 
are  seated  at  table,  and  they  eat  or  do  not  eat  as 
they  see  fit.  The  first-born  may  attempt  for  a long 
time  to  receive  special  attention  but,  sooner  or  later, 
his  overworked  mother  gives  him  the  needed  disci- 
pline, and  the  child,  once  convinced  that  the  game  is 
lost  for  him,  “falls  to.”  If  only  mothers  of  but  one 
child  would  be  as  sensible. 

w 

William  W.  Belford,  M.  D.  (611  Medico-Dental 
Building,  San  Diego). — Doctor  Stafford  deserves  our 
thanks  for  this  timely  paper,  for  the  child  that  does 
not  eat  is  fast  becoming  one  of  our  major  problems. 
By  far  the  larger  group  of  these  children  fall  into  the 
third  class  Doctor  Stafford  describes  as  psychological 
maladjustment.  My  remarks  are  directed  toward  the 
prevention  of  this  problem. 

There  are  many  ways  of  approaching  the  problems 
these  children  and  their  parents  present.  The  pre- 
vention is  relatively  easy  if  we  but  remember  to  edu- 
cate and  direct  the  parents  as  to  what  is  to  be 
expected  in  regard  to  food  habits  and  growth.  In  the 
first  six  months  we  have  learned  that  many  artificially 
fed  children  can  grow  and  develop  satisfactorily  with 
three  feedings  in  the  twenty-four  hours.  Some  chil- 
dren begin  as  early  as  ten  or  eleven  weeks  of  age  to 
take  eight  ounces  of  a moderately  concentrated  feed- 
ing three  times  a day.  This  satisfies  their  hunger  and 
allows  a generous  interval  between  for  digestion.  In 
other  words  they  eat  when  hungry.  When  additional 
foods  are  added  at  six,  seven  and  eight  months  it  is 
seldom  necessary  to  return  to  four  feedings  a day  for 
by  proper  adjustment  plenty  may  be  given  with  each 
meal.  No  between-meal  feedings  are  needed  or 
allowed.  At  varying  intervals  more  foods  are  added, 
but  at  no  time  is  the  parent  or  nurse  allowed  to  force 
or  override  the  child’s  dislike.  The  child  eats  because 


he  is  hungry  and  never  to  please  the  adult.  The  young 
mother  who  starts  out  on  the  line  of  no  forcing,  has  a 
child  who  eats  because  he  satisfies  his  appetite  and 
hunger  and  never  to  please  the  adult  feeding  him  or 
preparing  his  food.  This  mother  seldom  turns  up  with 
the  child  who  will  not  eat. 

In  the  first  twelve  months  the  baby  gains  fast, 
some  ten  to  eighteen  pounds.  After  fourteen  months, 
though,  this  gain  stops  and  for  the  next  four  or  five 
years  the  gain  will  average  about  four  pounds  a year. 
Some  in  the  second  ten  or  twelve  months  may  gain 
only  a pound  or  two  and  be  quite  happy  and  con- 
tented and  growing  steadily  and  satisfactorily.  The 
parents  are  told  of  this,  reassured,  told  again  and 
again  and  before  the  period  of  stationary  weight  or 
slow  gain  comes  on.  Few  are  worried  when  they 
understand  something  of  the  phenomenon  called 
growth. 

I wish  it  had  been  possible  for  Doctor  Stafford  to 
go  into  more  detail  about  the  methods  he  uses.  So 
many  of  these  children,  and  their  parents,  with  bad 
food  habits  have  to  be  cajoled  and  warped  into  new 
ways  and  thoughts  by  all  sorts  of  reasoning.  I dis- 
agree with  Doctor  Stafford  that  children  under  six 
years  should  not  be  permitted  to  eat  with  their 
parents.  The  child  over  two  years  who  eats  because 
he  has  an  appetite  and  hunger  for  food  is  not  often 
upset  in  satisfying  his  needs  by  the  ordinary  family 
conversation.  Children  get  tired  being  constantly 
with  the  nurse  or  their  mother  at  mealtimes,  and 
graduation  to  the  adult  table  is  often  all  that  is  needed 
to  correct  considerable  unhappiness. 

* 

Doctor  Stafford  (Closing). — It  is  good  to  know 
Doctor  Gelston  and  Doctor  Belford  feel  so  keenly 
about  “the  child  who  will  not  eat.” 

All  scientific  progress  calls  forth  new  problems. 
Our  advancing  knowledge  of  nutrition  is  no  excep- 
tion for  anorexia  in  children  is  certainly  an  outgrowth 
of  our  increased  understanding  of  food.  Pediatricians 
will,  of  course,  vary  in  their  methods  of  dealing  with 
children  who  refuse  to  eat  properly,  but  only  when 
parents  and  nurses  recognize  a happy  balance  between 
proper  food  and  the  child’s  psychological  attitude 
toward  mealtime  will  the  full  benefits  of  our  increased 
knowledge  be  manifest. 


BLOOD  SEDIMENTATION  TEST* 

ITS  SIGNIFICANCE  IN  GYNECOLOGY 
REPORT  OF  CASES 

By  Donald  G.  Tollefson,  M.  D. 

Los  Angeles 

Discussion  by  Donovan  Johnson,  M.D.,  Los  Angeles; 
Alice  F.  Maxwell,  M.D.,  San  Francisco. 

ACCORDING  to  Baer  and  Reis  the  phe- 
nomenon  of  the  sedimentation  test  dates  back 
to  the  Crusta  Phlogista  of  the  ancients,  which 
was  first  described  by  Galen.  It  was  noted  that 
blood  from  patients  suffering  from  inflammatory 
disease,  when  allowed  to  stand,  would  separate 
out  into  two  portions — one  serum,  and  one  eryth- 
rocytes. The  various  theories  have  been  so  com- 
pletely discussed  in  the  literature  that  they  are 
purposely  omitted  here.  Probably  the  first  in- 
dividual to  use  this  procedure  in  gynecologic 
diagnosis  was  Lizenmeier,  and  his  technique,  as 
modified  by  Friedlaender,  is  the  one  herein  de- 
scribed. 

The  material  for  this  analysis  is  based  on  some 
two  thousand  readings  on  eight  hundred  and  fifty 
patients  admitted  to  the  obstetric  and  gyneco- 

* Read  before  the  Los  Angeles  County  Medical  Associa- 
tion, February  7,  1929. 


January,  1930 


BLOOD  SEDIMENTATION  TEST — TOLLEFSON 


21 


logic  service  of  the  Long-  Island  College  Hos- 
pital in  Brooklyn,  New  York.  Part  of  the  mate- 
rial here  considered  has  previously  been  reported 
in  a paper  presented  at  the  1927  session  of  the 
American  Medical  Association  by  Polak  and 
Tollefson. 

When  correlated  with  physical  findings  and 
other  laboratory  data  the  sedimentation  test  is  of 
definite  value  in  diagnosis.  A rapid  rate  means 
infection,  and  a slow  rate  excludes  this  possibility. 

Technic. — Draw  0.2  of  a cubic  centimeter  of 
5 per  cent  sodium  citrate  into  a 1 cubic  centimeter 
graduated  tuberculin  syringe.  With  a small  hypo- 
dermic needle  attached,  draw  0.8  of  a cubic  centi- 
meter of  blood  from  one  of  the  small  veins  in 
the  arm,  thus  making  1 cubic  centimeter  of  a 
solution  of  citrated  blood,  which  is  placed  in  a 
standard  calibrated  tube.  Shake  thoroughly  by 
inverting  the  tube  and  take  the  time.  When  the 
erythrocytes  have  settled  to  the  18  millimeter 
mark,  leaving  the  clear  serum  above,  take  the 
time  again.  The  difference  in  minutes  is  the  sedi- 
mentation time.  The  best  period  in  which  to  per- 
form the  test  is  about  three  hours  after  the  last 
meal. 

INTERPRETATION  OF  THE  TEST 

We  have  taken  120  minutes  as  the  sedimenta- 
tion rate  for  the  normal  individual.  Whenever  a 
rapid  sedimentation  time  is  noted  the  reading  is 
taken  to  indicate  an  infection. 

Pregnancy. — However,  Fahreus  in  1917  called 
attention  to  the  variation  in  the  sedimentation 
time  of  patients  who  were  pregnant.  Like  his  re- 
sults, our  series  show  that,  after  the  third  or 
fourth  month,  the  rate  becomes  lower  than  nor- 
mal. Table  1 illustrates  the  reading  in  the  preg- 
nancy group.  In  postpartum  cases  it  is  of  some 
value.  Whenever  the  sedimentation  rate  con- 
tinued to  decrease  or  remain  below  ten  minutes 
the  chances  for  recovery  from  postpartum  infec- 
tion were  extremely  small. 

Carcinoma. — Carcinoma  patients  give  a rapid 
sedimentation  time  whenever  infection  is  present. 
Frommelt  and  Motiloff  5 believe  that  an  increased 
rate  might  be  used  as  a means  of  determining  a 
recurrence  of  the  malignant  growth.  We  believe 
that  the  rapid  rate  is  due  to  infection  occurring 
in  the  tumor  tissue.  Table  2 illustrates  the  read- 
ings in  the  more  common  locations  of  malignancy. 
The  rapid  rate  in  papillary  cyst  is  probably  due 
to  the  low-grade  peritonitis  excited  by  rupture  of 
the  malignant  process. 

After  Operation. — There  is  a definite  increase 
in  the  rate  of  settling,  following  operation,  as  is 
shown  by  fifty  cases,  where  the  test  was  repeated 
at  frequent  intervals  in  order  to  obtain  an  esti- 
mate of  its  value.  We  note  that  following  opera- 
tions there  is  a rapid  drop  with  the  first  three 
or  four  days.  If  the  convalescence  is  proceeding 
normally  the  rate  gradually  ascends ; if  infection 
is  present,  the  rapid  rate  continues  until  this  is 
eliminated.  The  postoperative  drop  in  the  rate 
of  settling  is  probably  due  to  absorption  and 


the  changes  incident  to  anesthesia  and  tissue 
destruction. 

Anemia.  — Secondary  anemia,  according  to 
Cherry,6  causes  a slower  sedimentation  time, 
while  in  our  experience,  where  no  infection  is 
present,  there  is  no  change. 

Average  Readings. — Having  allowed  for  cer- 
tain conditions  which  cause  an  error  in  appre- 
ciating the  significance  of  the  test,  we  find  that 
in  typical  pathologic  conditions  certain  average 
readings,  which,  when  compared  with  other  ob- 
servers, agree  almost  identically.  In  Table  3 a 
few  of  the  more  common  rates  are  charted. 
Whenever  the  sedimentation  time  is  below  thirty 
minutes,  accumulation  of  purulent  material,  either 
as  a circumscribed  abscess,  or  multiple  minute 
foci,  will  be  a constant  finding.  In  active  tubal  in- 
fections with  leukocytosis  and  elevation  of  tem- 
perature, the  rate  of  sedimentation  averages 
thirty-eight  minutes.  Where  this  type  of  infec- 
tion has  been  present  but  not  active,  the  readings 
vary  between  ninety  and  two  hundred  minutes. 
Parametritis  averages  thirty-six  minutes,  while 
the  long-standing  process,  which  is  clinically  in- 
active, averages  one  hundred  and  thirty-six 
minutes. 

As  an  aid  in  diagnosis  two  cases  will  show  its 
value. 

REPORT  OF  CASES 

Case  1. — Patient  2472,  admitted  to  the  hospital  with 
a diagnosis  of  infected  ovarian  cyst,  showed  a sedi- 
mentation time  of  nineteen  minutes.  At  operation,  in 
addition  to  adenoma-carcinoma  of  the  uterus  with 
metastasis,  a subsiding  acute  appendix  was  also  dis- 
covered. 

Case  2. — Patient  3462,  with  a sedimentation  time  of 
twenty-seven  minutes  and  a normal  blood  count,  was 
admitted  for  postoperative  hernia  and  a tumor  mass 
in  the  right  lower  quadrant.  On  exploration  of  the 
abdomen  a parametrial  abscess  was  discovered.  In 
another  case  the  admission  diagnosis  was  fibroid  with 
degeneration.  The  patient  had  a normal  blood  count, 
but  a sedimentation  time  of  fifteen  minutes.  The 
operation  was  postponed.  Patient  developed  a tem- 
perature and  ten  days  later  a pelvic  abscess  was 
drained  per  vagina.  Rapid  sedimentation  spells  in- 
fection. If  not  in  pelvis,  other  parts  of  the  body  may 
harbor  the  focus. 

VALUE  OF  TEST  IN  ECTOPIC  PREGNANCY 
AND  SALPINGITIS 

If  sedimentation  is  an  index  of  the  presence  of 
infection  its  use  might  be  indicated  in  the  differ- 
ential diagnosis  of  ectopic  pregnancy.  It  is  a 
well-known  fact  that  the  leukocyte  count  varies 
markedly,  even  when  taken  at  frequent  intervals. 
Following  intraperitoneal  hemorrhages,  there  is 
a marked  leukocytosis ; but  if  the  bleeding  stops 
the  count  will  approach  normal  within  a few 
hours.  The  temperature  is  also  of  no  value 
in  diagnosing  ectopic  pregnancies.  Comparative 
readings  show  that  the  rate  in  extra-uterine  preg- 
nancy is  slow,  while  that  of  salpingitis  is  rapid 
(Table  4). 

In  ten  ectopic  pregnancies  reported  by  Polak 
and  Mazzola  7 the  average  sedimentation  rate  was 
105  minutes,  while  in  fifteen  of  this  series  the 
average  reading  was  115  minutes.  The  more  ad- 


22 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


vanced  the  pregnancy  the  more  rapid  the  rate,  as 
Table  5 indicates.  The  intact  ectopic  pregnancies 
or  those  with  a slight  rupture,  if  seen  early,  will 
show  a reading  of  around  100  minutes,  while  the 
old  cases,  where  the  symptoms  have  been  of  two 
weeks’  or  more  duration,  give  the  rapid  readings 
of  an  infection.  Apparently  old  hematomas  excite 
a low-grade  peritonitis.  Here  the  test  is  of  little 
significance,  but  when  the  typical  symptoms  of 
either  condition  are  present  and  the  onset  is  of 
recent  date  a slow  rate  is  indicative  of  an  ectopic 
pregnancy,  while  a rapid  rate  suggests  tubal 
infection. 

Two  cases  will  illustrate  this  point. 

Case  3. — Patient  2724,  with  a typical  history  of  a 
postponed  menstrual  period  and  physical  findings  sug- 
gestive of  ectopic  pregnancy,  had  a leukocyte  count  of 
33,400,  but  the  sedimentation  time  was  only  seventy- 
two  minutes.  The  following  day  it  had  dropped  to 
forty-five  minutes,  but  the  findings  were  so  typical 
that  laparotomy  was  done  and  an  acute  salpingitis  was 
discovered. 

i i i 

Case  4. — Patient  6336.  The  history  and  pelvic  find- 
ings were  again  typical  of  an  extra-uterine  pregnancy, 
but  the  sedimentation  time  was  thirty-five  minutes. 
At  operation  an  acute  salpingitis  was  found.  There- 
fore, by  exclusion  of  infection,  the  sedimentation  test 
may  add  confirmatory  evidence  in  the  diagnosis  of 
early  ectopic  pregnancy. 

A SAFEGUARD  IN  ELECTIVE  PROCEDURES 

In  gynecology  at  least  90  per  cent  of  the  opera-  ■ 
tions  are  elective,  and  when  one  considers  the 
danger  of  an  ordinary  laparotomy  in  the  hands 
of  the  most  careful  operator  he  is  at  once  im- 
pressed with  the  danger,  when  seemingly  simple 
fibroid  tumors  are  complicated  by  clinically  in- 
active but  quiescent  infection.  When  leukocytosis 
and  elevation  of  temperature  are  present  we  know 
that  infection  exists ; but  in  those  cases  where  the 
blood  count  and  the  physical  findings  suggest  no 
complication  the  sedimentation  time  is  an  index 
of  the  presence  and  severity  of  the  infection. 

Following  our  previous  report,  we  formulated 
the  rule  that  patients  should  not  be  subjected  to 
laparotomy  if  the  sedimentation  time  was  under 
ninety  minutes.  We  believed  that  when  opera- 
tion was  performed  on  such  patients  the  conva- 
lescence would  be  prolonged,  troublesome  com- 
plication might  arise  and  the  end-result  would  be 
unsatisfactory.  We  have  performed  operations  in 
these  cases,  and  they  have  been  of  value  in  prov- 
ing our  conclusion  in  this  work. 

In  benign  tumors  the  readings  are  normal  (see 
Table  6),  but  coexisting  infection  increases  the 
speed  of  sedimentation.  The  judgment  of  when 
to  operate  is  probably  more  important  than  how 
to  perform  the  procedure. 

Case  5. — Patient,  Mrs.  N.,  was  admitted  to  hospital 
with  a diagnosis  of  tubo-ovarian  disease,  with  a nor- 
mal blood  count  and  normal  temperature,  but  a sedi- 
mentation time  of  thirty-two  minutes.  A hysterec- 
tomy was  performed,  and  a stormy  convalescence 
followed.  She  was  discharged  on  the  twenty-second 
postoperative  day  against  advice,  with  a sedimentation 
time  of  twenty-eight  minutes  and  a marked  pelvic 
exudate.  She  was  seen  in  the  clinic  two  months  later 
and  her  general  condition  was  extremely  poor. 


Case  6. — Patient,  Mrs.  S.,  with  a sedimentation  time 
of  forty-five  minutes,  normal  blood  count  and  normal 
temperature,  had  a hysterectomy  for  fibroids.  Her 
postoperative  course  was  extremely  unsatisfactory; 
she  developed  a wound  infection  which  kept  her  in 
the  hospital  for  thirty-eight  days. 

i i i 

Case  7. — Patient  7107,  had  a pelvic  abscess  in  1925. 
Admitted  to  hospital  in  1928  because  of  pelvic  pain 
and  fibroid  tumor.  The  blood  count  and  temperature 
were  normal  and  the  sedimentation  rate  was  240  min- 
utes. The  danger  of  lighting  up  an  old  focus  was 
eliminated. 

i i i 

Case  8. — Patient  6100,  normal  blood  count  and  nor- 
mal temperature,  had  a sedimentation  time  of  twenty- 
seven  minutes.  Hysterectomy  was  performed.  A 
stormy  convalescence  followed. 

ill 

Case  9. — Patient  8995,  with  a diagnosis  of  fibroids, 
showed  a normal  blood  count  and  sedimentation  time 
of  forty  minutes.  Patient  died  thirty-one  hours  after 
operation.  Diagnosis  at  death  was  given  as  toxemia 
and  cardiac  failure.  Possibly  the  rapid  rise  in  tem- 
perature, pulse  rate  and  respiratory  rate,  indicated  the 
presence  of  some  infection  which  we  did  not  discover. 

TABLE  SHOWING  SEDIMENTATION  TIME  IN 
VARIOUS  CONDITIONS 


Table  1. — Pregnancy 


No.  of 

cases 

Diagnosis 

S.  T. 

33 

Normal  pregnancy 

110  min. 

25 

Postpartum,  normal 

52 

27 

Postpartum,  febrile 

20 

20 

Abortion,  2-3  months 

68 

15 

Abortion,  febrile 

30 

Table  2. — Malignancy 

No.  of 

cases 

Location 

S.  T. 

11 

Cervix 

31  min. 

8 

Ovary 

85 

5 

Breast 

52 

10 

Uterus 

80 

3 

Papillary  cyst  adenoma 

23 

Table  3. — Infection 

No.  of 

cases 

Diagnosis 

S.  T. 

18 

Pelvic  abscess 

16  min. 

22 

Breast  abscess 

23 

31 

Salpingo-oophoritis,  active 

38 

IS 

Salpingo-oophoritis,  inactive 

130 

25 

Pelvic  infection,  active 

36 

31 

Pelvic  infection,  inactive 

136 

Table  4. — Ectopic  Gestation  versus 

Salpingitis 

No.  of 

cases 

Diagnosis 

S.  T. 

10 

Ectopic  (Polak  and  Mazzola) 

105  min. 

15 

Ectopic  (Recent) 

115 

31 

Salpingo-oophoritis,  active 

38 

25 

Pelvic  infections,  active 

36 

Table  5. — Ectopic  Gestation 

No.  of  From 


cases 

onset 

Remarks 

S.  T. 

1 

1 

day 

Free  blood 

170  min. 

2 

8 

hours 

Faint,  immediate  operation 

167 

3 

1 

day 

Some  free  blood 

138 

4 

2 

days 

^Fimbriated  end 

113 

5 

2 

days 

Boldt’s  sign 

102 

6 

7 

days 

No  sharp  pain 

92 

7 

6 

days 

Free  blood 

90 

8 

7 

Tubal  abortion 

89 

9 

2 

weeks 

Rubin  Test  3 months 

74 

10  12 

days 

Old  P.  I.  D. 

57 

11 

4 

weeks 

Peritoneal  exudate 

27 

12 

5 

weeks 

Hematoma,  not  removed 

14 

Table  6. — Benign  Tumors 

No.  of 

Average 

cases 

Diagnosis 

S.  T. 

13 

Ovarian  cysts 

180  min. 

21 

Fibroids 

175 

37 

Fibroids  and  infection 

65 

3 

Fibroids  and  necrosis 

47 

January,  1930 


BLOOD  SEDIMENTATION  TEST — TOLLEFSON 


23 


CONCLUSIONS 

1.  While  Schmitz,  reporting  on  eighty  patients, 
and  Cherry,  reporting  on  seventy-one  patients, 
state  that  the  test  is  of  no  value,  most  writers 
believe  it  has  its  place  in  laboratory  diagnosis 
when  the  blood  count,  temperature,  and  physical 
findings  are  correlated  with  it. 

2.  Rapid  rates  indicate  infection.  Slow  read- 
ing's exclude  this  possibility  of  infection,  regard- 
less of  leukocytosis  and  elevation  of  temperature. 

3.  It  also  is  suggested  that  it  might  be  of  use 
as  a prerequisite  in  the  Rubin  test,  insertion  of 
radium  in  benign  conditions  and  in  diagnostic 
curettage. 

4.  As  it  is  a simple  procedure,  its  routine  use 
seems  justifiable  because  it  may  be  a means  of 
excluding  the  latent  or  quiescent  infection,  when 
an  elective  operation  is  under  consideration,  and 
thereby  prevent  prolonged  convalescence,  mor- 
bidity, and  mortality. 

1401  South  Hope  Street. 

REFERENCES 

1.  Baer  and  Reis,  S.  G.  and  O.:  1925,  xi,  691. 

2.  Linzenmeier,  G. : Zentralbl.  f.  Gynak,  1920,  xliv, 
817. 

3.  Polak  and  Tollefson:  Jour.  A.  M.  A.,  January  21, 
1928,  xc,  No.  3. 

4.  Fahrens,  L. : Hygeia,  1918,  xivii,  124. 

5.  Frommelt  and  Motiloff,  Zentralbl.  f.  Gynak,  1926, 
1,  348. 

6.  Cherry:  Am.  Jour.  Obst.  and  Gynec.,  1926,  xi. 
105. 

7.  Polak  and  Mazzola:  Am.  Jour.  Obst.  and  Gynec., 
1926,  xii,  No.  3,  700. 

8.  Schmitz  and  Schmitz:  Am.  Jour.  Obst.  and 
Gynec.,  1926,  xi,  No.  3,  363. 

DISCUSSION 

Donovan  Johnson,  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles). — Doctor  Tollefson’s  paper  gives  an 
accurate  description  of  the  sedimentation  test  as  it  is 
performed  in  the  majority  of  clinics  in  this  country. 
The  small  glass  test  tubes  :n  place  of  the  long  capil- 
lary tubes  first  used  and  the  standardized  readings  at 
the  18  millimeter  mark  simplify  the  procedure  greatly. 
It  is  a test  that  anyone  can  use,  whether  experienced 
in  laboratory  work  or  not,  and  for  this  reason  I be- 
lieve it  should  be  given  a more  extended  trial.  It  will 
be  only  as  we  use  this  sedimentation  test  that  per- 
sonal conclusions  can  be  drawn  as  to  its  value.  We 
have  listened  to  Doctor  Reuben  Peterson’s  hearty 
recommendation  of  the  test  this  evening  and,  with  the 
knowledge  that  others  are  finding  it  a distinct  advan- 
tage in  the  diagnosis  and  prognosis  of  disease,  I feel 
certain  it  will  not  be  long  until  it  is  in  general  use. 

While  my  experience  with  the  test  in  gynecologic 
cases  has  been  somewhat  limited,  I can  say  I have 
given  it  a good  trial  in  obstetric  patients.  During  the 
past  year,  at  the  Chicago  Lying-In  Hospital,  it  was 
used  repeatedly  in  pathologic  cases  where  the  diag- 
nosis was  in  doubt  or  where  some  light  might  be 
thrown  on  the  prognosis  of  a given  case.  As  has  been 
brought  out  by  others,  the  greatest  value  of  the  test 
is  its  capacity  to  show  the  severity  of  an  infection. 
It  is  also  valuable  as  being  one  of  the  most  delicate 
tests  in  picking  up  an  early  infection.  The  importance 
of  repeated  examinations  at  frequent  intervals  cannot 
be  overemphasized. 

The  value  of  the  sedimentation  test  in  obstetrics  is 
somewhat  limited,  as  compared  to  its  usefulness  in 
gynecology.  This  is  due  to  the  normal  drop  in  the 
sedimentation  rate  during  pregnancy  which  becomes 


confusing  when  comparing  the  rate  with  that  in  the 
nonpregnant  state.  It  was  in  the  hope  of  gaining  a 
definite  idea  of  this  normal  drop  that  a series  of  fifty 
cases  were  followed  through  pregnancy  with  tests 
made  at  regular  monthly  intervals,  over  two  hundred 
and  fifty  determinations  in  all  being  made.  The  pa- 
tients chosen  were  those  passed  on  by  the  internists 
as  being  perfectly  normal  from  a physical  standpoint. 
Each  sedimentation  test  was  checked  by  the  body 
temperature  and  white  blood  count.  A definite  curve 
was  secured  in  each  case,  the  greatest  drop  being 
reached  by  the  sixteenth  and  twentieth  week.  A nor- 
mal variation  of  between  twenty  and  thirty  minutes 
exists  between  different  individuals,  but  it  was  strik- 
ing how  uniform  the  test  remained  throughout  preg- 
nancy in  the  same  individual.  An  excessively  low 
reading  at  any  time  during  pregnancy  may  be  taken 
as  an  indication  of  pathology,  most  valuable  of  course 
during  the  first  half  of  pregnancy,  when  the  normal 
rate  is  still  relatively  high. 

Alice  F.  Maxwell,  M.  D.  (University  of  California 
Hospital,  San  Francisco). — For  the  last  three  years 
every  patient  admitted  to  the  gynecologic  service  of 
the  University  of  California  Hospital  has  had  a sedi- 
mentation test  done  in  addition  to  the  routine  clinical 
and  laboratory  examinations.  In  healthy  women  the 
blood  sedimentation  varies  from  three  to  four  hours. 
As  the  result  of  observation  on  more  than  one  thou- 
sand women,  we  feel  that  the  repetition  of  the  test 
and  its  correlation  with  the  physical  findings,  tem- 
perature, pulse  and  leukocyte  count  is  of  very  definite 
value.  In  the  early  weeks  of  pregnancy  the  rate  of 
sedimentation  is  of  little  or  no  value  in  establish- 
ing the  diagnosis;  in  general  the  sedimentation  time 
decreases  as  pregnancy  advances.  Before  the  fifth 
month  of  pregnancy,  when  the  diagnosis  may  rest 
between  a rapidly  growing  myoma  and  a pregnancy, 
the  test  is  of  no  great  aid;  after  this  period  no  special 
test  is  necessary  to  establish  the  diagnosis.  A rapid 
sedimentation  time  in  a nonpregnant  woman  indicates 
infection,  although  this  infection  need  not  necessarily 
be  confined  to  the  pelvis.  A greatly  decreased  sedi- 
mentation time  may  be  expected  in  all  acute  inflam- 
matory conditions  of  the  pelvis  and  in  severe  toxemias 
due  to  absorption  of  native  or  foreign  proteins.  Un- 
complicated fibroids  (leukocytes  normal,  fever  free) 
invariably  showed  a slight  increase  of  speed  in  sedi- 
mentation; degenerated  fibroids  (in  afebrile  women 
with  normal  leukocyte  counts)  showed  a markedly 
increased  rate.  Large  nonmalignant  ovarian  tumors 
also  showed  a more  rapid  sedimentation  than  the 
norm;  if  associated  with  adhesions  or  ascites  the 
blood  settled  even  more  rapidly.  Cervical  carcinoma 
invariably  showed  a rapid  rate;  especially  in  the  pres- 
ence of  necrosis  or  metastasis.  Pelvic  carcinoma,  in 
general,  showed  rapid  sedimentation.  In  pelvic  in- 
flammation a sedimentation  time  greater  than  sixty 
minutes  is  evidence  against  actual  pus  in  the  pelvis, 
one  under  thirty  minutes  is  invariably  found  with 
purulent  collections.  It  has  long  been  recognized  that 
a subacute  or  latent  pelvic  infection  may  be  reacti- 
vated by  surgical  procedures,  yet  in  these  cases  the 
leukocyte  count  and  temperature  curve  are  often  nor- 
mal. The  rapid  sedimentation,  which  is  always  found 
with  these  often  unsuspected  conditions,  is  a very 
delicate  and  accurate  index  of  the  infection,  and  a 
most  valuable  test  for  the  virulence  of  the  infection. 
The  sedimentation  test  is  also  of  value,  from  a prog- 
nostic point  of  view,  in  cases  of  sepsis,  whether  puer- 
peral, postabortive,  or  postoperative.  It  responds 
more  readily  to  the  virulence  of  the  infection  than 
does  the  leukocyte  or  temperature  curve,  and  is  a 
more  delicate  prognostic  index.  This  simple  test  is 
sufficiently  dependable  to  warrant  its  use  in  every 
gynecologic  patient. 

Doctor  Tollefson  is  to  be  congratulated  on  the  con- 
cise presentation  of  his  work  and  for  the  reasonable 
deductions  drawn  therefrom  and  for  emphasizing  the 
importance  of  a simple  yet  most  valuable  diagnostic 
and  prognostic  laboratory  procedure. 


2+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


KAHN  PRECIPITATION  TEST  FOR  SYPHILIS* * 

AS  USED  IN  CONJUNCTION  WITH  THE 
WASSERMANN  TEST 

By  Newton  Evans,  M.  D. 

Los  Angeles 

Discussion  by  Gertrude  Moore,  M.  D.,  Oakland;  W.  T. 
Cummins,  M.D.,  San  Francisco ; Zera  E.  Bolin,  M.D., 
San  Francisco. 

"P OR  the  greater  part  of  a year  at  the  sero- 
-**-  logical  laboratory  of  the  Los  Angeles  County 
General  Plospital  the  Kahn  test,  in  addition  to  the 
Wassermann  test,  has  been  used  on  all  sera  to  be 
tested  for  syphilis.  During  this  time  (231  days) 
such  parallel  tests  have  been  done  on  17,694  sera. 
Of  the  entire  number  of  specimens  (17,694)  the 
two  tests  were  in  complete  agreement  in  17,112  (or 
96.71  per  cent),  while  in  addition  210  (1.18  per 
cent)  other  specimens  were  in  relative  agreement. 

An  absolute  agreement  means  that  both  tests 
are  either  negative,  or  both  doubtful  (plus-minus 
or  plus),  or  both  positive  (two  plus,  three  plus, 
four  plus)  in  reactions. 

A relative  agreement  means  that  one  test  is 
doubtful  and  the  other  test  either  positive  or 
negative. 

Absolute  disagreement  means  one  test  is  posi- 
tive and  the  other  negative. 

Thus,  of  the  entire  number  approximately  97.9 
per  cent  were  in  either  complete  or  partial  agree- 
ment, leaving  2.1  per  cent  of  complete  disagree- 
ments. These  results,  based  upon  nearly  18,000 
specimens,  are  very  similar  to  other  published 
figures.  In  Doctor  Kahn’s  “Serum  Diagnosis  of 
Syphilis  by  Precipitation”  he  presents  results  of 
comparative  tests  upon  over  100,000  sera  in  his 
own  laboratory,  showing  combined  complete  and 
relative  agreement  in  more  than  99  per  cent. 
T.  J.  Hull  reports  tests  upon  over  25,000  speci- 
mens with  a combined  complete  and  relative 
agreement  of  97.8  per  cent  to  which  our  results 
(97.9  per  cent)  are  very  similar. 

It  is  evident  that  in  laboratories  where  large 
numbers  of  such  tests  are  made  the  results  of 
the  Kahn  method  closely  parallel  those  of  the 
Wassermann  test. 

OUR  EXPERIENCE 

For  some  months  preceding  our  experiments 
with  the  Kahn  method  the  laboratory  was  using 
the  Ivolmer  system  of  the  Wassermann  test  in 
which  a preliminary  qualitative  test  was  made 
upon  all  specimens,  followed  by  a Ivolmer  quanti- 
tative upon  all  cases  in  which  the  preliminary 
qualitative  test  was  positive  or  doubtful.  After 
several  thousands  of  parallel  tests  were  made  and 
it  became  evident  that  the  Kahn  test  could  be 
relied  upon  as  a routine  method,  we  abandoned 
the  plan  of  making  Kolmer  quantitative  upon  all 
positive  or  doubtful  sera  as  evidenced  by  the  pre- 
liminary qualitative  Wassermann  test,  and  applied 
the  quantitative  method  only  in  those  specimens 
where  a disagreement  appeared  between  the  quali- 

*  From  the  Laboratory  of  the  Los  Angeles  County 
General  Hospital,  Unit  No.  1. 

* Read  before  the  Pathology  Section  of  the  California 
Medical  Association  at  the  Fifty-Eighth  Annual  Session, 

May  6-9,  1929. 


tative  Wassermann  and  the  Kahn  test.  This  is 
our  present  plan  and  appears  to  us  to  be  an  en- 
tirely practical  and  satisfactory  routine  method 
of  making  serological  tests  for  syphilis  under  the 
conditions  existing  in  our  hospital,  where  about 
one  hundred  specimens  of  sera  come  to  the  lab- 
oratory daily. 

We  think  the  present  plan  of  making  routine 
parallel  tests,  Wassermann  and  Kahn,  has  defi- 
nite advantages  over  other  methods,  such  as  run- 
ning the  regular  Wassermann  with  two  antigens, 
or  the  method  which  was  formerly  used  in  our 
laboratory  as  described  above,  namely,  the  Kolmer 
qualitative  followed  by  the  Kolmer  quantitative, 
or  the  plan  of  substituting  entirely  Kahn  tests  for 
the  Wassermann  method,  which  it  is  said  is  being 
done  in  some  hospitals  and  notably  in  the  United 
States  Navy  on  ships  away  from  their  bases. 

ADVANTAGES  OF  KAHN  TEST 

1.  It  is  less  time-consuming.  Quicker  results 
and  reports  can  be  secured  and  it  is  more  eco- 
nomical for  this  reason. 

2.  It  is  much  simpler,  as  one  reagent  only — the 
antigen — is  required,  in  contrast  to  the  several 
ingredients  of  the  classical  Wassermann.  No  ani- 
mals are  necessary  to  supply  the  fresh  comple- 
ment. 

3.  Reports  of  those  using  the  Kahn  method 
indicate  that  it  is  a somewhat  more  delicate  indi- 
cator of  the  presence  of  syphilis  than  the  Wasser- 
mann test.  A higher  proportion  of  treated  cases 
and  others  not  reacting  positively  to  the  Wasser- 
mann for  reasons  unknown  do  react  positively  to 
the  Kahn  test.  Our  experience  confirms  this 
opinion.  In  the  372  sera  in  our  series  where  there 
was  definite  disagreement  between  the  two  tests, 
229  were  Kahn  positive  and  Wassermann  nega- 
tive while  only  143  were  Wassermann  positive 
and  Kahn  negative.  In  thirty  cases  where  the 
clinical  histories  and  findings  indicated  the  pres- 
ence of  syphilis,  twenty-one  cases  had  positive 
Kahns  and  negative  Wassermanns,  while  only 
nine  had  positive  Wassermanns  with  negative 
Kahns. 

4.  An  advantage  of  decided  importance  is  the 
fact  that  in  the  great  majority  of  sera  which  for 
any  reason  prove  “anticomplementary”  in  the 
Wassermann  test  (manifesting  an  ability  to  bind 
or  deviate  the  complement  even  in  the  absence  of 
the  antigen),  making  the  reading  of  the  test  im- 
possible in  the  ordinary  titrations,  the  Kahn  test 
is  not  interfered  with  and  will  give  satisfactory 
information  as  to  the  presence  or  absence  of 
syphilis.  In  our  series  from  one-half  to  one  per 
cent  of  the  specimens  proved  to  be  anticomple- 
mentary, and  in  all  of  these  satisfactory  readings 
were  secured  without  trouble  by  the  Kahn  test. 
The  records  of  forty-two  cases  of  this  kind  indi- 
cate that  four  were  negative  with  the  Kahn  test 
and  thirty-eight  were  positive.  Thus,  if  we  had 
been  limited  to  the  Wassermann  method  there 
would  have  been  thirty-eight  positive  cases  where 
we  must  have  reported  that  no  results  could  be 
secured  because  the  specimens  were  anticomple- 
mentary. (There  are  methods  of  securing  results 
on  some  of  these  sera  by  using  high  dilutions  of 


January,  1930 


KAHN  TEST  FOR  SYPHILIS — EVANS 


25 


the  serum  and  appropriate  quantities  of  the  re- 
agents, but  these  are  extremely  complex  and  time- 
consuming,  and  are  not  ordinarily  used.) 

DISADVANTAGES  OF  THE  KAHN  METHOD 

1.  It  is  not  practical  for  tests  of  cerebrospinal 
fluid ; at  least  we  have  found  this  to  be  the  case 
in  our  experience.  These  specimens  are  tested  by 
the  Wassermann  method. 

2.  It  requires  more  experience  and  judgment 
to  read  the  results  of  the  Kahn  reaction  than  to 
recognize  the  varying  degrees  of  hemolysis  in  the 
regular  Wassermann  tests,  and  long  training  is 
essential  on  the  part  of  a technician  if  the  results 
are  to  be  depended  upon ; consequently,  it  is  not 
applicable  to  office  work  unless  done  by  one  who 
has  had  long  experience  in  the  method.  On  the 
other  hand,  it  is  possible  that  some  of  the  modifi- 
cations in  which  the  test  is  made  on  a microscope 
slide  and  read  with  the  microscope  may  be  more 
dependable  in  the  hands  of  persons  without  great 
experience. 

3.  In  our  experience  the  Kahn  test  is  liable  to 
be  “temperamental”  and  the  mixtures  to  vary  in 
degrees  of  general  cloudiness  from  day  to  day,  so 
that  if  the  parallel  Wassermann  tests  were  not 
available  for  comparisons  one  might  be  in  per- 
plexity as  to  the  dependability  of  his  tests.  We 
have  also  found  that  the  preparation  of  a satis- 
factory antigen  is  a more  difficult  and  delicate 
process  than  it  is  to  secure  a satisfactory  Wasser- 
mann antigen. 

ADVANTAGES  OF  COMBINED  METHOD 

1.  In  our  opinion  it  is  preferable  to  use  both 
tests  in  conjunction,  especially  in  laboratories 
where  many  specimens  are  examined,  for  there  is 
a small  proportion  of  cases  with  wide  disagree- 
ment (negative  in  one  test  and  four  plus  in  the 
other)  in  which  the  conflicting  results  are  of 
value,  for  it  is  undoubtedly  true  that  “false  nega- 
tives” in  properly  checked  tests,  either  Wasser- 
mann or  Kahn,  are  much  more  frequent  than 
“false  positives,”  and  therefore  it  is  important  to 
have  the  advantage  of  the  knowledge  presented 
by  the  “positives”  from  either  method. 

2.  When  the  two  systems  are  used  side  by  side 
each  serves  as  a check  upon  the  other,  and  quickly 
makes  evident  any  technical  error  or  defective 
reagents. 

3.  Another  advantage  of  making  parallel  tests 
is  in  learning  to  read  the  Kahn  test.  The  beginner 
tends  to  strain  his  eyes  and  his  imagination  to 
see  fine  precipitates  which  are  not  there,  and  by 
reading  them  as  suspicious  (plus-minus)  and 
checking  against  the  Wassermann  results  which 
are  evidently  negative,  he  will  realize  he  is  at- 
tempting to  read  the  precipitation  test  too  closely. 

In  conclusion,  our  experience  with  the  Kahn 
precipitation  test  leads  us  to  regard  it  as  a distinct 
addition  to  available  and  practically  useful  labora- 
tory methods,  and  we  believe  it  is  particularly 
effective  when  used  in  conjunction  with  the 
Wassermann  tests  in  laboratories  where  large 
numbers  of  specimens  must  be  examined. 

It  gives  me  pleasure  to  acknowledge  the  faith- 
ful labor,  the  helpful  suggestions  and  the  enthusi- 


astic cooperation  of  Bertha  Ogburn  and  Muriel 
Chesnut,  without  which  the  preparation  of  this 
paper  would  have  been  impossible. 

Los  Angeles  County  General  Hospital. 

DISCUSSION 

Gertrude  Moore,  M.  D.  (2404  Broadway,  Oakland). 
Doctor  Evans’  paper  emphasizes  the  importance  of 
the  use  of  both  the  Kolmer  complement  fixation  and 
the  Kahn  precipitant  test  in  the  study  of  syphilis. 
Our  experiences  check  those  of  most  workers,  regard- 
ing the  percentage  of  tests  which  agree.  The  Kahn 
reaction  is  inferior  to  the  Kolmer  in  standpoint  of 
specificity,  and  superior  in  that  it  gives  positive  read- 
ings earlier  in  the  disease  and  longer  after  vigorous 
treatment.  The  Kahn  reaction  is  of  particular  value 
in  determining  the  point  at  which  treatment  should 
be  stopped  in  old  cases  of  syphilis.  We  are  convinced 
that  both  tests  should  be  used  in  all  cases,  but  if  this 
is  impossible  and  one  must  be  selected,  there  is  no 
question  but  that  the  Kolmer  reaction  is  more  reli- 
able and,  therefore,  the  test  of  choice. 

& 

W.  T.  Cummins,  M.  D.  (Southern  Pacific  General 
Hospital,  San  Francisco). — Any  test  for  syphilis  that 
may  be  used  in  conjunction  with  the  Wassermann 
technique  deserves  consideration  on  account  of  the 
unmerited  criticism  which  has  been  passed  upon  the 
Wassermann  technique  by  reason  of  widely  different 
reports  from  different  laboratories.  Numerous  tech- 
niques have  been  offered  and  none  appears  to  have 
survived  substantially  but  the  Kahn  test.  Many  re- 
ports, which  include  the  parallel  examination  of  a 
large  number  of  blood  sera  with  both  techniques, 
attest  to  the  value  of  the  Kahn.  Doctor  Evans  has 
studied  a very  worthwhile  number  of  sera.  His  re- 
port, confirming  the  work  of  Kahn  and  others,  shows 
a very  high  percentage  of  agreement  of  the  two  tech- 
niques. There  are  well-recognized  difficulties  with 
and  disadvantages  of  the  Kahn  test.  The  difficulties 
with  cerebrospinal  fluid  later  may  be  cleared  away. 
Unquestionably  the  advantages  materially  outweigh 
the  disadvantages  of  the  test,  and  it  stands  today  as 
a valuable  means  of  examination  for  syphilis. 

The  discusser  heartily  agrees  with  Doctor  Evans 
that  the  Kahn  test  is  particularly  effective  when  used 
in  conjunction  with  the  Wassermann.  In  my  opinion, 
as  implied  also  by  Doctor  Evans,  the  Kahn  test 
should  not  be  used  alone. 

* 

Zera  E.  Bolin,  M.  D.  (University  of  California  Medi- 
cal School,  San  Francisco). — The  paper  by  Doctor 
Evans  is  in  accord  with  the  testimony  of  practically 
everyone  who  has  run  a large  series  of  comparative 
tests  using  the  Kahn  and  one  of  the  modifications  of 
the  complement-fixation  tests.  The  Kahn  test  is 
based  upon  the  reaction  of  the  “reagin”  in  the  luetic 
serum  with  a very  sensitive  antigen.  Positive  re- 
actions are  shown  by  a precipitation  of  the  colloids 
in  suspension  in  the  antigen. 

Having  had  considerable  experience  with  precipita- 
tion tests  for  syphilis,  including  the  Sachs-Georgi, 
the  Meinecke  and  its  modifications,  and  the  Kahn 
test,  I feel  that  a precipitation  test  should  never  be 
used  alone  as  a diagnostic  procedure. 

The  ease  of  manipulation  of  the  Kahn  test  lays  it 
open  to  use  by  unskilled  workers  who  do  not  under- 
stand the  underlying  principles.  The  antigen  is  hard 
to  prepare.  It  is  hard  to  dilute  so  as  to  get  the  same 
cofloidal  suspension  upon  which,  in  all  probability,  its 
sensitiveness  depends.  The  precipitate  is  hard  to  read 
accurately,  and  the  strength  of  the  reaction  depends 
upon  the  judgment  of  the  person  reading  the  test.  It 
is  most  emphatically  not  a procedure  which  can  be 
turned  over  to  the  office  nurse.  The  specificity  of  this 
precipitation  has  yet  to  be  checked  in  a large  series 
of  entirely  negative  sera.  The  conditions  causing  the 
precipitation  of  the  colloidal  suspension  may  be  in- 


26 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


voked  by  changes  in  the  serum  caused  by  other 
diseases. 

In  my  opinion  this  test  must  be  always  substanti- 
ated by  comparison  with  a sensitive  Wassermann 
technique,  and  the  best  of  these,  as  yet,  seems  to  be 
Kolmer  modification  of  the  complement-fixation  test. 

SCABIES  AND  ITS  COMPLICATIONS* 

By  Thomas  J.  Clark,  M.  D. 
and 

Frank  H.  Stibbens,  M.  D. 

Oakland 

Discussion  by  George  D.  Culver,  M.  D.,  San  Francisco; 
Robert  T.  Legge,  M.D.,  Berkeley;  C.  Ray  Lounsberry, 
M.  D.,  San  Diego. 

HPHE  problem  of  the  medical  adviser  is  very 
often  made  difficult  by  the  absence  of  any 
exact  etiological  data  upon  which  to  base  a diag- 
nosis, and  aid  judgment  in  formulating  proper 
procedure  for  the  care  of  his  patient.  But  in 
scabies  the  etiology  is  known  and  the  fog  of  un- 
certainty is  entirely  dispelled  if  proper  caution  is 
used  in  arriving  at  the  diagnosis.  The  cure  is 
attained  by  selection  from  a very  few  efficient 
remedies  and  by  use  of  the  same  in  the  proper 
strength  and  mode  of  application. 

Scabies  is  not  a difficult  dermatological  ques- 
tion, but  it  is  one  that  should  be  given  careful 
treatment  by  the  attendant  doctor  so  that  a very 
annoying  condition  may  be  properly  and  com- 
pletely cured. 

Cause. — The  disease  is  caused  by  a minute  ani- 
mal parasite  that  lodges  in  the  skin.  This  parasite 
is  a spider.  Human  scabies  is  produced  by  a spe- 
cies known  as  Sarcoptes  scabeii  hominis.  This 
variety  has  become  adapted  to  human  habita- 
tion and  is  readily  passed  on  from  one  infested 
person  to  another.  The  substrata  of  society  con- 
stitute the  reservoir  of  hosts  for  the  unending 
reproduction  of  the  parasites.  Mites  allied  to 
human  acari  are  parasitic  to  horses,  cows,  goats, 
dogs,  cats,  chickens,  and  many  other  animals. 
These  have  made  man  a temporary  host,  but  they 
do  not  become  permanently  entrenched  as  are  the 
sarcoptes  hominis. 

Mites  are  found  in  every  part  of  the  world. 
Many  are  parasitic,  but  there  are  also  varieties 
that  exist  on  decaying  matter  both  vegetable  and 
animal.  In  museums  they  are  troublesome  to  the 
specimens  which  must  be  protected  from  these 
destroyers  that  would  literally  eat  them  up. 

From  animal  to  man  the  transfer  occurs  most 
frequently  by  the  variety  that  causes  horse  scabies. 

After  possessing  its  host  the  female  parasite 
proceeds  to  burrow  into  the  epidermis  to  a suffi- 
cient depth  to  secure  its  nourishment.  The  male 
enters  the  burrow  for  sexual  mating  after  which 
it  retires  to  the  surface  to  seek  out  other  females, 
or  it  burrows  an  offshoot  for  itself  and  dies  in  a 
few  days,  its  life  cycle  from  ovum  through  the 
moulting  periods  and  adult  sexual  life  lasting 
about  one  month.  The  female  remains  in  its 
burrow  and,  after  impregnation  deposits  eggs  in 

* Read  before  the  Dermatology  and  Syphilology  Section 
of  the  California  Medical  Association  at  the  Fifty-Eighth 
Annual  Session,  May  6-9,  1929. 


the  channel  of  the  burrow  at  the  rate  of  one  or 
two  each  day,  for  a period  of  two  or  three  months, 
then  dies.  The  ova  develop  rapidly,  the  young 
mites  appearing  in  from  three  to  six  days.  At 
first  there  is  a larva  stage,  the  number  of  legs  and 
bristles  being  less  than  for  the  adult.  The  body 
surface  is  then  shed.  More  legs  and  bristles  ap- 
pear, and  after  the  second  moulting  the  now 
mature  mite  is  ready  for  the  reproductive  stage. 
About  one  month  in  time  is  occupied  from  ovum 
to  reproduction  period,  but  it  has  been  calculated 
that  one  female  may  have  before  her  death  sev- 
eral hundred  thousand  progeny.  Thus  the  human 
Gulliver  has  plenty  of  Lilliputians  to  attack  him. 

The  cause  of  the  skin  reactions  in  scabies  is 
the  wounding  of  the  skin  tissues  by  the  burrow- 
ing of  the  acarus  into  the  epidermal  layers.  This 
hominis  variety  of  the  parasite  is  not  a surface 
organism,  but  undermines  the  horny  stratified  cell 
layers  so  that  it  may  reach  the  lower  portions  of 
the  epidermis.  Here  it  has  an  abundant  food 
supply,  is  secure  from  danger,  and  may  deposit 
its  ova  for  perpetuation.  The  burrow  is,  there- 
fore, its  home,  its  defensive  quarters,  its  nursery, 
and  its  tomb. 

Symptoms. — The  outstanding  subjective  symp- 
tom of  scabies  is  itching.  So  characteristic  is  this 
symptom  that  “the  itch”  remains  the  common 
name  for  the  disease.  It  will  vary  in  degree  from 
an  intolerable  condition  in  sensitive  individuals  to 
but  a passing  inconvenience  in  the  phlegmatic. 
There  is  loss  of  sleep  from  bed-warmth  itching. 
If  pyogenic  inflammatory  reactions  occur  to  any 
extent,  especially  in  children,  there  may  be  much 
tenderness  and  pain  in  the  hands  and  feet,  the 
buttocks,  and  the  flexures. 

The  eruption  is  found  quite  generally  over  the 
body  surface  as  a discrete  vesicopustulation  or 
papulation.  The  sites  of  preference  are  at  the 
opposed  surfaces  of  the  fingers  and  finger  webs, 
the  wrists,  ulna  border,  the  axillary  folds,  the 
nipples  and  areolae,  the  buttocks  and  genitals. 
Uncomplicated  lesions  are  small,  like  mustard 
seed.  They  are  not  confluent  unless  modified  by 
eczema  or  pyogenic  infection.  Lesions  in  cases 
where  treatment  is  not  started  promptly  become 
larger  and,  as  the  parasites  multiply,  the  skin 
becomes  thickened  and  pustular.  Such  a patient 
presents  a sorry-looking  appearance.  Scabies  as- 
sociated with  diseases  that  modify  the  sensibility 
of  the  skin,  as  in  paralytics  or  in  leprosy,  may 
become  very  extensive  with  thickened  masses  of 
crusts  and  offensive  oozing. 

Complications. — The  complications  of  the  dis- 
ease are  due  -to  pyogenic  organisms  developing 
in  the  skin  with  the  various  phases  of  inflamma- 
tion which  they  produce.  Infection  is  the  more 
readily  brought  about  by  the  burrow  destroying 
the  defensive  qualities  of  the  cornified  epithelium. 

Furuncles,  impetigos,  adenitis,  and  phlegmons 
are  produced. 

Impetigos  are  frequent  in  children.  The  child 
becomes  a mass  of  pustular  sores  and  thick  crusts 
that  involve  the  scalp  and  face  as  well  as  the  rest 
of  the  body.  The  original  infection  by  scabies  in 
these  cases  may  be  overlooked.  The  child  may  be 


January,  1930 


SCABIES — CLARK  AND  STIBBENS 


27 


prostrated  by  fever  and  seriously  ill  from  the 
sepsis. 

Diagnosis. — Diagnosis  of  scabies  in  a well- 
marked  case  is  simple.  Discrete  vesicopustules  or 
papules  distributed  about  the  hands  and  fingers, 
the  wrists,  axillae,  nipples,  abdomen,  buttocks  and 
genitals,  with  the  subjective  symptoms  of  itching 
and  loss  of  sleep  is  suggestive.  The  history  will 
usually  disclose  more  than  one  case  in  a family. 
The  small  burrows  are  not  so  easily  seen.  They 
may  be  found  as  coarse,  threadlike  lines,  one- 
quarter  to  one-half  inch  in  length,  about  the 
areolae  of  the  nipples  or  on  the  glans  penis. 
Urticaria,  furuncles,  impetigo,  are  frequent  ac- 
companying symptoms.  The  parasite  may  be 
extracted  from  its  burrow  in  a recent  vesicular 
lesion,  by  using  the  eve  of  a fine  sewing  needle 
as  a small  curette.  It  is  not  difficult  to  recognize, 
with  a magnifier,  portions  of  the  mite’s  body  or 
legs  thus  recovered  from  the  skin. 

Differential  Diagnosis.  — Diseases  that  would 
have  to  be  excluded  in  the  diagnosis  are  urticaria, 
eczema,  pruritus,  dyshidrotic  conditions,  herpes 
progenitalis,  and  chancre.  Urticarial  wheals  are 
frequently  seen  in  scabies.  They  may  be  due  to 
direct  irritation  of  nerve  endings  from  the  pres- 
ence of  the  parasite  in  close  contact  to  the  nerve 
bulbs  or  as  a proteid  reaction  from  absorption  of 
animal  products  from  the  mite.  In  uncomplicated 
urticaria  a search  should  show  absence  of  vesicles 
and  papules  suggestive  of  the  itch.  Eczema  has 
confluent  lesions  that  fade  gradually  into  sound 
skin  at  its  borders.  Vesicular  eczema  of  the  hands 
and  fingers  will  closely  resemble  scabies,  but  will 
usually  remain  localized. 

Pruritus  shows  scratch  marks  and  a red  skin 
at  times,  but  lacks  the  lesions  of  scabies. 

Dyshidrosis,  either  tineal  or  inflammatory, 
shows  predilection  for  the  hands  and  feet,  the 
palms  and  soles  particularly.  Its  spread  to  other 
portions  of  the  body  is  quite  different  from 
scabies. 

Partially  treated  scabies  may  show  remains  of 
lesions  about  the  genitals  that  are  flattened  pap- 
ules, and  in  association  with  these  are  enlarged 
lymph  nodes  that  would  lead  the  unwary  to  mis- 
take the  picture  for  genital  herpes  or  possibly  a 
primary  case  of  syphilis. 

How  soon  we  can  promise  to  cure  scabies  de- 
pends largely  upon  the  case  and  its  complications. 
The  parasites  can  be  destroyed  in  a day  or  so  in 
most  cases,  and  in  skins  that  are  sensitive  to 
chemical  dermatitis  a week  or  ten  days  will  suffice 
to  arrive  at  a satisfactory  result. 

Unfortunately  a few  patients  become  acaro- 
phobic.  How  one  may  convince  these  unfortu- 
nates that  their  tormentors  are  eliminated  is  a 
problem  in  mental  therapy. 

Treatment. — The  treatment  of  scabies  should 
be  a very  simple  matter.  We  have  a parasite 
lodged  upon  the  skin  and  embedded  at  no  great 
depth  in  the  surface  layers  of  the  skin,  easily 
destroyed  by  comparatively  mild  chemicals,  such 
as  sulphur,  naphthols,  or  the  balsams.  The  attain- 
ment of  a rapid  and  complete  cure  is  possible  in 
the  majority  of  robust  children  and  adults  by  a 


thorough  soap  and  water  scrubbing  of  the  skin 
surface.  This  lathering  to  be  repeated  two  or 
three  times  in  the  course  of  a half  hour  and 
followed  by  a vigorous  massage  into  the  skin  of 
a 12  per  cent  sulphur  and  a 4 per  cent  balsam  of 
Peru  ointment,  which  is  not  removed  for  twenty- 
four  hours. 

The  bedding  and  clothing  of  the  patient  should 
be  treated  with  heat  to  destroy  parasites  lodged 
therein.  Failure  to  carry  out  this  precaution  with 
bedding  and  clothes  will  more  than  likely  reinfest 
the  patient. 

This  rapid  method  of  treatment  is  desirable 
only  in  institutions  or  where  circumstances  would 
not  permit  of  the  milder  and  more  prolonged  care. 
The  preliminary  softening  of  the  cornified  layers 
of  the  epithelium  to  open  the  burrows  and  lesions 
by  scrubbing  is  essential  to  permit  contact  of  the 
chemicals  with  the  parasite  and  the  ova.  But  this 
intimate  introduction  of  the  antiparasitic  agent 
into  the  wounded  skin  is  liable  to  set  up  a 
chemical  dermatitis,  and  if  the  last  of  the  maraud- 
ers has  not  been  destroyed  there  is  soon  reinfes- 
tation of  the  skin. 

In  a large  proportion  of  these  cases  our  prefer- 
ence is  to  furnish  the  family  or  the  patient  with 
a strong  stock  ointment  which  is  reduced  in 
strength  at  the  time  of  use  by  rubbing  up  with 
vaselin. 

Instruct  the  patient  to  bathe  with  warm  water, 
castile  soap,  and  into  the  lather  dust  some  pow- 
dered borax.  This  borax  and  soap  lathering 
should  be  continued  for  ten  minutes,  rubbing  well 
about  the  sites  of  preference  of  the  parasite. 
After  the  bath  apply  a 4 per  cent  precipitated  sul- 
phur vaselin  ointment  in  which  is  also  1 per  cent 
balsam  of  Peru.  Use  this  mild  strength  twice  a 
day  for  two  days  and  then  bathe.  If  there  are  no 
ill  effects  from  the  chemicals  have  the  patient 
double  the  strength  of  the  ointment  for  the  next 
two  days.  After  the  second  bath,  with  change  of 
clothing,  the  milder  ointment  can  be  used  to  finish 
the  course  of  treatment  for  the  week.  Where  a 
mild  dermatitis  is  produced  it  is  well  to  use  5 per 
cent  oxid  of  zinc  incorporated  with  the  sulphur 
to  take  the  place  of  the  balsam  of  Peru. 

In  a family  it  is  desirable  to  have  all  members 
use  the  mild  ointment  during  a course  of  treat- 
ment, even  should  some  show  no  signs  of  the 
disease.  This  extra  vigilance  will  probably  save 
cases  of  delayed  appearance. 

As  “the  itch”  does  itch,  the  patient  is  often  the 
victim  of  the  parasite  for  longer  periods  than  is 
necessary  because  of  friendly  diagnosis  by  drug- 
gist, nurse,  or  companion,  who  ordinarily  pre- 
scribes sulphur  and  lard  because  “that  will  cure 
the  itch.”  Failure  results  from  improper  applica- 
tion of  the  remedy  as  well  as  from  reinfestation 
from  clothes,  bedding,  and  human  contacts. 

1800  Madison  Street. 

DISCUSSION 

Georce  D.  Culver,  M.  D.  (Four  Fifty  Sutter,  San 
Francisco). — Doctor  Clark  and  Doctor  Stibbens  have 
given  us  an  excellent  paper  on  scabies,  and  it  is  a 
timely  one  as  the  disease  is  unusually  prevalent. 
They  call  attention  especially  to  the  infective  com- 
plications. It  is  obviously  true  that  this  feature  is  one 


28 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


of  the  most  important,  as  skin  infections  too  are 
prevalent. 

No  doubt  in  many  instances  we  all  fail  to  recognize 
the  scabetic  element  when  other  conditions  are 
marked.  However,  any  widespread  superficial  infec- 
tion should  bring  to  mind  the  possibility  of  scabies  as 
an  exciting  cause.  And  not  in  every  instance  is  it  a 
simple  matter  to  prove  the  presence  or  absence  of 
scabies. 

When  in  doubt  and  when  the  typical  runs  are 
masked  by  added  infection,  or  when  the  natural  prog- 
ress of  the  disease  is  held  in  abeyance  by  the  patient’s 
occupation,  bringing  his  hands  and  forearms  in  con- 
tact with  deterrent  chemicals  such  as  occurs  with 
those  working  in  the  gasolines  and  oils,  it  is  well  to 
prove  the  presence  of  the  mite  or  its  eggs  or  feces. 
This  usually  can  be  done  by  slicing  off  a suspicious- 
looking  lesion  from  a finger  or  wrist  with  a sharp 
blade,  cutting  as  deep  as  the  papillary  layer,  mounting 
the  flat  specimen  in  glycerin  and  examining  it  under 
a low  power  lens  of  the  microscope. 

Creolin  has  proved  an  excellent  addition  to  the 
therapeutic  armamentarium  for  the  cure  of  scabies. 
It  is  an  excellent  scabicide  in  a nonirritating  strength, 
and  it  has  the  additional  most  desirable  feature  of  act- 
ing as  a decided  antiseptic  help  in  clearing  up  what- 
ever pyogenesis  may  be  present.  It  also  has  a definite 
place  with  skins  that  are  sensitive  to  sulphur. 

It  is  always  well  to  specify  a particular  preparation 
of  creolin.  The  druggist  knows  the  best  one.  Five  per 
cent  strength  in  vaselin  or  incorporated  in  unguentum 
acidi  borici  has  proved  most  satisfactory. 

* 

Robert  T.  Legge,  M.  D.  (University  of  California 
Infirmary,  Berkeley).- — -At  the  students’  infirmary  at 
the  University  of  California,  in  Berkeley,  we  fre- 
quently see  cases  of  scabies.  For  many  years  our 
methods  of  therapy  were  similar  to  those  recom- 
mended by  Doctor  Clark.  Since  Greenwood  pub- 
lished in  the  Journal  of  the  American  Medical  Asso- 
ciation in  1924  “The  Danish  Treatment  for  Scabies,” 
we  have  used  exclusively  this  highly  successful 
method  of  treatment.  This  ointment  depends  upon 
the  production  of  hydrogen  sulphid,  which  enters  the 
skin  and  is  lethal  to  the  parasite.  The  ointment  is 
applied  carefully  all  over  the  body  except  the  hair, 
and  the  patient  is  then  confined  to  bed  for  twenty- 
four  hours.  The  next  morning  the  treatment  is  com- 
pleted by  a hot  soapy  bath  and  the  wearing  of  clean 
clothes.  Failures  are  exceedingly  rare,  and  one  treat- 
ment is  sufficient.  Care  must  be  exercised  to  treat  all 
other  cases  in  the  family.  Protection  against  reinfec- 
tion by  boiling  underclothes,  sulphur  fumigation  of 
bedding,  and  treatment  of  contacts  is  essential. 

# 

C.  Ray  Lounsberry,  M.  D.  (Medico-Dental  Build- 
ing, San  Diego). — I have  listened  to  Doctors  Clark 
and  Stebbins’  paper  on  scabies  with  much  interest, 
because  we,  as  a profession,  are  prone  to  minimize  the 
importance  of  ordinary  diseases.  Scabies  has  been  a 
very  prevalent  disease  since  the  war.  We  who  were 
in  the  service  would  see  whole  companies  of  World 
War  veterans  infested  with  the  itch  mite.  From  our 
war  experiences  we  have  learned  how  to  cope  with 
this  condition  en  masse.  Now  today  we  can  profit  by 
that  experience,  in  our  treatment,  to  some  extent. 

The  Navy  method  of  treatment  was  as  follows: 
Routinely  the  men  reported  to  the  sick  bay,  complain- 
ing of  the  classical  symptoms  of  scabies.  Then  a 
microscopic  examination  of  the  scrapings  from  a 
lesion  was  made  to  determine  definitely  the  exact 
diagnosis  in  each  case.  -The  scabetics  were  then  taken 
to  a shower  room  and  were  given  a hot  bath  and  a 
scrub  with  tincture  of  green  soap,  after  which  they 
were  told  to  rub  into  the  affected  areas  sulphur  in 
combination  with  balsam  of  Peru  ointment.  Then 
they  were  placed  in  the  scabetic  ward.  Of  course,  all 
their  clothes  were  removed  and  clean  pajamas  were 
given  them;  also  clean  bedding  was  provided  daily. 
This  treatment  was  continued  from  three  to  five  days. 
At  the  termination  of  that  time  most  of  the  uncom- 
plicated cases  appeared  apparently  well.  Remember, 


these  cases  were  isolated.  Care  should  be  taken  to 
determine  whether  or  not  the  patient  is  sensitized  to 
sulphur,  because  a sulphur  rash  could  be  severe. 

In  our  clinical  practice  in  southern  California, 
where  we  are  called  upon  to  treat  so  many  illiterate 
Mexicans,  who  live  in  hovels  of  filth,  the  problem  is 
difficult.  They  do  not  follow  out  directions,  and  when 
they  do  they  immediately  reinfest  themselves.  We 
have  printed  directions,  translated  in  Spanish,  and 
written  in  English,  which  helps  us  a great  deal  in  our 
ambulatory  cases. 

Practically  all  our  cases  in  San  Diego  are  compli- 
cated with  impetigo,  as  well  as  other  pyogenic  forms 
of  infection  associated  with  sand  flee,  mosquito,  and 
other  bites — combined  with  boils.  Thus  we  have  a 
mixture  of  diseases  which  are  very  hard  to  treat, 
especially  when  the  ringworm  fungus  is  found. 

Doctor  Stibbens  (Closing). — Primarily,  we  presented 
this  paper  to  emphasize  to  the  general  practitioner 
the  differential  diagnostic  points  and  the  complica- 
tions of  the  disease,  particularly  in  relation  to  im- 
petigo and  other  pyogenic  infections.  If  this  object 
has  been  attained  we  will  feel  that  we  have  been 
amply  repaid. 

The  Danish  treatment,  as  cited  by  Doctor  Legge, 
is  a very  valuable  method  of  attacking  the  disease, 
but,  unfortunately,  cannot  be  used  in  treating  the  very 
young  patient  or  in  severe  cases  of  impetigenous  or 
secondary  infection,  without  great  danger  of  produc- 
ing a very  severe  dermatitis. 

In  these  cases  we  must  first  endeavor  to  subdue  the 
inflammatory  symptoms  and  then  feel  our  way  cau- 
tiously toward  radical  treatment  of  the  disease  by 
gradually  increasing  the  strength  of  our  parasiticides. 
These  cases  require  application  of  boric  acid  lotion  or 
weak  liquor  carbonis  detergens  at  first  and  then,  as 
improvement  occurs,  gradual  change  to  betanaphthol 
or  weak  sulphur  mixtures.  Mercury  in  any  form 
should  be  used  with  extreme  caution  if  the  lesions  are 
extensive. 


THE  DIAGNOSIS  AND  TREATMENT  OF  LUNG 
ABSCESS* 

By  Frank  S.  Dolley,  M.  D. 

Los  Angeles 

Discussion  by  Philip  H.  Pierson,  M.D.,  San  Francisco ; 
Harold  Brunn,  M.D.,  San  Francisco ; F.  M.  Pottenger, 
M.  D.,  Monrovia. 

IR'IVE  years  ago  a patient  harboring  a lung 
abscess  rarely  reached  the  surgeon.  Many 
abscesses  remained  undiagnosed  that  are  now- 
recognized  and  those  found  were  treated  expect- 
antly with  little  or  no  thought  of  surgical  inter- 
vention in  mind.  The  mortality  under  medical 
treatment  alone  was  from  60  to  90  per  cent. 
Today,  with  proper  and  correctly  timed  surgical 
intervention,  the  death  rate  in  the  large  clinics 
is  from  32  to  45  per  cent.  The  treatment  of 
subacute  and  chronic  lung  abscesses  is  rapidly 
becoming  surgical,  and  with  improving  technique 
the  mortality  is'steadily  decreasing. 

CAUSES  OF  PULMONARY  ABSCESS 

The  causes  of  pulmonary  abscess  are  most 
diversified.  They  can  originate  from  the  bronchi, 
blood  or  lymph.  Very  often  the  area  involved 
heals  without  sloughing.  Poor  general  condition 
and  decrease  in  the  bodily  resistance  contribute 
largely  to  lung  cavitation.  Diabetics,  alcoholics 
and  nephritics  are  particularly  susceptible.  Fol- 

* Read  before  the  General  Medicine  Section,  California 
Medical  Association,  at  the  Fifty-eighth  Annual  Session, 
May  6-9,  1929. 


January,  1930 


LUNG  ABSCESS — DOLLEY 


29 


lowing  penetrating  wounds  of  the  chest  or  even 
chest  contusion,  lung  abscess  is  not  uncommon. 
Aspiration  of  food  or  other  foreign  bodies  leads 
frequently  to  lung  abscess.  In  a strong  young 
person  sharp  demarcation  is  the  rule.  The  area  is 
sloughed  out,  the  sequestration  is  expectorated 
and  smooth  healing  can  occur.  A pulmonary 
abscess  following  a metastatic  infarct  from  an 
infected  focus  in  some  other  region  of  the  body 
in  a patient  exhausted  from  previous  illness, 
tends  not  to  be  well  walled  off  but  to  extend  into 
the  surrounding  lung  tissue.  It  is  this  type  that 
is  most  unfavorable. 

The  majority  of  lung  abscesses  develop  in  con- 
nection with  bronchopneumonia.  Influenzal  pneu- 
monia is  particularly  liable  to  such  a complication. 
In  a pneumococcus  inflammation  of  the  lungs  an 
abscess  is  seldom  seen.  In  the  fibrinous  lung 
inflammation  of  the  emphysematous,  pulmonary 
abscess  is  not  an  uncommon  sequela. 

SYMPTOMS 

The  symptoms  are  by  no  means  clear-cut. 
Diagnosis  is  not  always  easy.  The  history  is  of 
great  importance  and  should  be  painstakingly 
obtained  if  the  patient  is  suffering  from  pul- 
monary inflammation.  A severe  chest  contusion 
might  have  caused  a pulmonary  hemorrhage  with 
secondary  infection  and  abscess  formation.  A 
history  of  choking  while  eating,  or  of  uncon- 
sciousness from  any  cause  may  suggest  the  con- 
tributing factor.  Often  careful  inquiry  elicits  a 
past  history  of  sinus  or  throat  infection,  grippe, 
enteritis  or  furunculosis,  from  which  even  weeks 
later  a metastatic  septic  infarct  into  the  lung 
could  initiate  a lung  abscess.  Leg  ulcers  are  par- 
ticularly prone  to  be  the  seat  of  the  original 
inflammation. 

When  a pneumonia  does  not  undergo  reso- 
lution, when  fever  and  rapid  pulse  continue 
and  when  the  cough,  whether  productive  or  non- 
productive, persists,  softening  of  the  lung  tissues 
leading  to  abscess  formation  should  be  strongly 
suspected.  Sudden  profuse  expectoration  of 
purulent  material  is  highly  suggestive.  If  culture 
of  the  pus  shows  a mixed  infection,  the  diagnosis 
is  practically  assured.  Before  the  lung  abscess 
breaks  into  a bronchus  the  cough  is  dry  and  more 
or  less  constant  from  irritation  of  the  vagus  nerve 
terminals  in  the  bronchial  walls.  After  bronchial 
communication  is  established  there  may  be 
cough  only  as  the  abscess  refills. 

Parenthetically,  it  is  of  value  to  note  in  the 
differential  diagnosis  between  empyema  ruptured 
into  a bronchus  and  lung  abscess,  that  in  the 
former  condition  the  pus  shows  regularly  a pure 
culture  of  some  one  organism  and  that  this  cough 
is  generally  constant  rather  than  periodic  as 
obtains  with  lung  abscess. 

The  physical  signs  are  extremely  variable  and 
seldom  aid  materially  in  the  diagnosis.  The 
finding  of  greatest  significance  is  the  variance 
in  the  auscultatory  sounds  over  the  suspected  area 
upon  change  in  the  position  of  the  patient.  With 
the  abscess  containing  fluid  no  sounds  may  be 
heard,  but  with  change  of  the  patient’s  posture 
the  fluid  may  gravitate  into  another  region, 


giving  rales  and  amphoric  breathing  over  an  area 
previously  dull  and  silent. 

DIAGNOSTIC  AIDS 

Aside  from  the  history  the  most  important 
diagnostic  aid  is  fluoroscopy  and  x-ray  films. 
Fluoroscopy  should  be  done  with  the  patient  in 
the  upright  position  if  his  condition  possibly  per- 
mits it.  Films  of  the  subject  flat  in  bed  are  worse 
than  useless.  No  fluid  level  can  appear  in  this 
position.  The  shadows  are  vague  and  indistinct, 
more  suggestive  of  broncho-  or  lobar  pneumonia 
or  empyema,  than  lung  abscess.  In  the  upright 
position  a fluid  level  often  appears,  immediately 
simplifying  the  diagnosis.  Under  the  fluoroscope 
change  of  position  in  the  presence  of  a fluid  level 
enables  one  to  shift  the  air  bubble  above  the  fluid 
in  various  directions,  thus  definitely  outlining  the 
limitations  of  the  cavity.  Upright  antero- 
posterior stereoscopic  films  and  a single  lateral 
one  should  always  be  taken,  for  they  are  almost 
an  indispensable  aid  in  abscess  localization. 

Lipiodol  to  delineate  the  abscess  cavity  is  a 
material  help.  Theoretically  it  would  seem  easy 
for  the  bronchoscopist  to  find  the  particular  lobe 
bronchus  from  which  pus  is  issuing,  inject  lipio- 
dol and  at  once  by  x-ray  demonstrate  the  abscess. 
Flowever,  this  does  not  often  occur.  The  instru- 
ments have  narrow  lumina,  the  oil  is  thick,  con- 
siderable pressure  must  be  exerted  to  inject  it 
and  the  portion  of  the  lobe  receiving  the  delineat- 
ing oil  becomes  drowned.  The  fluoroscope  reveals 
a rather  solid  wall  of  lipiodol  conforming  neither 
to  the  lung  tree  nor  the  supposed  abscess  cavity. 
It  may  or  may  not  be  the  seat  of  the  inflammatory 
process.  Far  more  satisfactory  is  it  for  the  bron- 
choscopist to  inject  through  a larger  instrument 
without  pressure,  the  main  right  or  left  bronchus 
and  allow  the  oil  to  gravitate  into  the  various 
branches  of  the  bronchial  tree.  It  is  seldom  that 
oil  is  shown  within  the  cavity  itself,  but  often 
the  surrounding  uninvolved  bronchi  are  splen- 
didly disclosed  so  that  by  elimination  localization 
may  be  greatly  furthered. 

In  the  region  of  the  chest  presumably  involved 
an  area  sensitive  to  pressure  can  quite  commonly 
be  found,  if  the  abscess  be  not  deep  within  the 
lung.  The  author  believes  this  to  be  one  of  the 
most  reliable  signs  in  the  localization  of  a lung 
abscess.  Pressure  tenderness,  if  present,  in  con- 
junction with  the  other  diagnostic  procedures 
generally  locates  the  abscess  sufficiently  to  war- 
rant approach  at  this  spot.  It  is  the  failure  prop- 
erly to  localize  the  abscess  and,  therefore,  the 
failure  in  the  operative  treatment  that  has 
heretofore  so  dampened  the  ardor  of  the  phy- 
sicians for  surgical  consultation. 

TREATMENT  OF  LUNG  ABSCESS 

The  treatment  of  lung  abscess  now  confronts 
us.  Those  who  develop  pulmonary  suppuration 
are  at  first  and  properly  under  the  care  of  a phy- 
sician. During  the  acute  stage  before  definite 
demarcation  has  occurred  the  treatment  should 
continue  medical.  But  when  an  abscess  is  defi- 
nitely established,  whether  it  is  discharging 
through  the  bronchus  or  not,  if  the  patient  is  not 


30 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


steadily  improving,  the  possibility  of  surgical 
intervention  should  be  considered,  not  by  the 
physician,  but  in  actual  consultation  with  the 
surgeon  with  whom  in  case  of  surgical  interven- 
tion he  would  intrust  his  patient.  There  is  one 
exception  to  the  above  statement  of  initial  delay. 
In  diffuse  lung  gangrene,  immediate  extensive 
thoracotomy  is  most  emphatically  indicated. 

Despite  the  fact  that  the  abscess  has  broken 
into  a bronchus  and  its  contents  are  being  expec- 
torated, if  after  six  to  eight  weeks  of  bed  rest, 
postural  drainage  and  bronchoscopic  suction 
evacuation,  the  cavity  is  not  steadily  decreasing 
in  size  and  the  patient  improving,  operation 
should  be  advised.  When  localized  lung  suppura- 
tion is  suspected  but  no  bronchial  perforation  has 
occurred  and  therefore  no  tell-tale  fluid  level  is 
shown  to  make  the  condition  evident,  if  the  pa- 
tient is  becoming  progressively  weaker  and  his 
symptoms  point  strongly  toward  the  sloughing  of 
lung  tissues,  external  drainage  should  be  accom- 
plished as  soon  as  anatomical  demarcation  of  the 
abscess  is  assured.  This  indication  also  appears 
usually  six  to  eight  weeks  after  the  onset  of  lung 
inflammatory  symptoms.  This  is  not  radical 
since  surgery  properly  performed  as  to  time  and 
method  bas  nearly  bisected  the  mortality  from 
lung  abscess  during  very  recent  years.  It  is  the 
protracted  medical  treatment  that  is  often  radical. 

During  the  period  of  waiting  for  demarcation 
many  abscesses  heal  spontaneously  by  expectora- 
tion. This  is  particularly  true  with  an  abscess 
developing  during  bronchopneumonia.  After  this 
initial  period  the  percentage  of  spontaneous  re- 
coveries rapidly  decreases.  Upper  lobe  abscesses 
drain  better,  since  gravity  greatly  aids.  Collapse 
of  the  cavity  walls,  however,  in  these  upper  lobe 
abscesses  is  often  prevented  by  adhesions  of  the 
pleura  to  the  narrow  rib-ring  at  the  thoracic  apex. 
Lower  lobe  abscesses  are  emptied  by  increased 
expectorative  effort.  In  the  latter  the  intervals 
between  sputum  production  are  longer  and  the 
amount  of  sputum  greater. 

The  aspiration  of  a lung  abscess  for  the  pur- 
pose of  localization  is  almost  invariably  contra- 
indicated until  the  parietal  pleura  is  exposed  and 
definite  assurance  has  been  obtained  that  the  two 
pleural  leaves  are  adherent.  An  exploratory 
puncture  without  this  assurance  is  extremely 
hazardous  to  the  welfare  of  the  patient.  The 
needle  withdrawn  from  the  abscess  is  very  liable 
to  convey  the  infection  into  a pleura  totally  unpre- 
pared for  bacterial  invasion.  Extensive  infection 
of  the  pleura  occurs,  a so-called  pleural  sepsis 
follows  and  death  is  the  usual  ending.  A small 
thoracotomy  opening  to  drain  this  extremely 
septic  material  is  not  sufficient.  To  be  life-saving, 
an  extensive  rib  resection  must  be  carried  out  at 
the  most  dependent  part  of  the  pleural  space 
with  gauze  tamponade  between  the  pleural  leaves. 
Exploratory  needling  therefore  is  definitely  ex- 
cluded from  our  diagnostic  armamentarium  until 
we  are  actually  prepared  to  evacuate  the  pus. 

When  operation  has  become  the  procedure  of 
choice  and  the  collection  of  pus  has  been  located 
with  as  much  exactness  as  possible  in  regard  to 


position  relative  to  the  chest  wall,  a local  tho- 
racoplasty is  performed  directly  over  the  pre- 
sumed site  of  the  abscess. 

It  is  important  that  rib  sections  be  removed 
over  an  area  definitely  larger  than  that  occupied 
by  the  abscess  in  order  that  there  may  be  collapse 
of  the  pleura  and  adherent  lung  sufficient  to  aid 
in  the  obliteration  of  the  cavity  after  its  evacua- 
tion. It  is  far  better  to  resect  too  many  than  too 
few  ribs.  The  intercostal  muscles,  vessels  and 
nerves  together  with  the  rib  periosteum  should  be 
excised  in  order  to  reduce  the  postoperative 
pain  from  pressure  of  the  drainage  tube  or  gauze 
as  much  as  possible.  Without  periosteal  excision, 
rib  regeneration  often  pulls  apart  the  cavity  walls 
again  or  prevents  their  coaptation. 

If  the  pleural  leaves  are  not  firmly  and  broadly 
adherent  they  must  be  made  so,  provided  the 
patient’s  condition  permits  it.  It  is  much  safer 
to  do  a two-stage  operation,  proceeding  no  fur- 
ther in  the  first  stage  than  to  expose  the  parietal 
pleura,  and  tampon  tightly  with  gauze  against 
the  parietal  pleura ; and  do  the  second  stage  eight 
to  ten  days  later  after  adhesions  have  developed. 
If,  however,  immediate  drainage  of  the  abscess 
seems  imperative,  then  one  of  two  means  may  be 
employed  to  exclude  the  general  pleural  space. 
One  may  sew  the  parietal  to  the  visceral  pleura 
as  far  from  the  site  of  the  proposed  opening  into 
the  abscess  as  possible ; or  one  may  pack  tightly 
with  gauze  between  the  pleural  leaves  at  some 
distance  wide  of  the  abscess.  The  latter  method 
has  given  much  more  satisfactory  results  and  is 
accomplished  in  but  a few  moments. 

Positive  intrapulmonary  pressure  under  gas 
and  oxygen  anesthesia  is  indispensable  in  the 
one-stage  operation  if  the  pleural  leaves  are  not 
adherent.  The  mask  about  the  patient’s  mouth 
and  nose  should  fit  tight  enough  so  that  the 
anesthetist  can  raise  the  pressure  within  the 
breathing  bag  sufficient  to  inflate  the  lung  and 
bring  it  tight  against  the  chest  wall.  When  the 
parietal  pleura  is  opened,  collapse  of  the  lung  is 
thus  prevented.  Palpation  of  the  lung  thus  some- 
what inflated  is  rendered  much  easier.  The  ana- 
tomical relation  of  the  area  of  the  lung  induration 
to  the  chest  wall  opening  is  more  certain.  More- 
over the  packing  of  the  gauze  between  the  pleural 
leaves  about  the  abscess  can  be  successfully  ac- 
complished only  by  positive  pressure,  since  with- 
out this  the  lung  under  the  influence  of  a large 
open  pneumothorax  collapses  towards  the  medi- 
astinum and  is  therefore  inches  away  from  the 
chest  wall.  ^ 

General  narcosis  should  be  limited  to  the  short- 
est possible  time.  It  is  usually  preferable  to  resect 
the  ribs  and  expose  the  parietal  pleura  under  local 
anesthesia,  have  the  patient  attempt  to  raise  and 
expectorate  what  pus  may  have  accumulated 
within  his  abscess  cavity,  then  to  proceed  at  once 
thereafter  with  gas  and  oxygen  anesthesia  under 
positive  intrapulmonary  pressure. 

The  choice  of  approach  to  the  pulmonary 
abscess  is  important.  Pus  lying  in  the  upper  lobe 
is  best  reached  from  behind  or  through  the  axilla. 


January,  1930 


LUNG  ABSCESS — DOLLEY 


31 


In  the  posterior  approach  for  an  upper  lobe 
abscess,  the  second  to  the  fifth  ribs  should  be 
excised  para verteb rally  for  six  to  fifteen  cm. 
The  scapula  is  abducted  and  drawn  laterally.  One 
then  has  an  opportunity  to  examine  the  larger 
part  of  the  lobe  suspected  of  harboring  the 
abscess.  If  the  abscess  lies  anteriorly  or  laterally 
the  axillary  incision  is  usually  the  best.  The  arm 
is  elevated  and  the  second  to  fifth  ribs  exposed. 
There  is  little  muscle  in  this  neighborhood  and 
the  approach  is  comparatively  easy.  It  is  seldom 
necessary  to  open  a lung  abscess  anteriorly.  It  is 
only  indicated  when  the  abscess  is  a cortical  one 
in  the  anterior  chest  region.  Lower  lobe  abscesses 
are  the  easiest  to  drain  externally.  The  site  of 
choice  is  also  posteriorly.  Usually  the  para- 
vertebral incision  with  the  removal  of  portions  of 
the  fifth  to  eighth,  or  sixth  to  tenth  ribs  is  the 
most  favorable  one.  A good  view  is  afforded  of 
the  lower  lobe  and  orientation  then  is  not  difficult. 
Often  with  an  extensive  abscess  of  the  anterior 
or  middle  lobe,  a transverse  axillary  incision  with 
a second  incision  downward  through  the  middle 
of  its  course  affords  the  best  exposure. 

When  the  parietal  pleura  is  thoroughly  ex- 
posed and  pleural  adhesions  are  assured,  then  and 
then  only  is  it  permissible  and  advisable  to  explore 
with  a needle.  When  the  pus  is  found,  entrance 
into  the  abscess  is  most  safely  effected  with  the 
thermocautery.  Tearing-  of  the  lung  tissues  very 
greatly  increases  the  danger  of  air  emboli.  Direct 
incision  is  not  contraindicated,  but  hemorrhage 
is  sometimes  more  difficult  to  control  without 
packing.  The  danger  of  air  emboli  is  greatly 
reduced  if  the  patient  is  under  positive  intrapul- 
monary  pressure  when  the  lung  tissue  is  entered, 
since  positive  pressure  within  the  lung  in  a large 
measure  excludes  the  possibility  of  the  entrance 
of  air  into  the  open  veins.  The  external  wall  of 
the  abscess  should  be  opened  as  widely  as  possible 
to  insure  healing  of  its  walls  from  within  out- 
ward. Gauze  packing  or  rubber  tubes  wrapped  in 
gauze  allow  the  best  drainage. 

SUMMARY 

The  time  allotted  can  permit  no  more  than  a 
very  hasty  survey  of  the  treatment  of  pulmonary 
abscess.  Medical  and  bronchoscopic  treatments 
are  of  very  definite  value.  Many  cures  are  thus 
effected.  These  cures  occur  in  a very  great  ma- 
jority of  cases,  however,  during  the  first  eight 
weeks.  Thereafter  the  percentage  of  complete  re- 
coveries markedly  decreases  and  the  mortality 
rate  rises.  If  the  pulmonary  abscess  is  deeply  situ- 
ated within  the  lung,  artificial  pneumothorax  is 
strongly  indicated  for  trial.  It  often  dramatically 
obliterates  the  cavity.  If  the  pleural  abscess  is 
situated  more  superficially,  artificial  pneumothorax 
is  a very  hazardous  procedure.  Should  perfora- 
tion through  the  visceral  pleura  occur,  pleural 
sepsis  follows  with  its  high  mortality.  A tem- 
porary paralysis  of  the  diaphragm  on  the  involved 
side,  accomplished  by  crushing  of  the  phrenic 
nerve  in  the  neck,  frequently  relaxes  the  pulmo- 
nary tissues  sufficiently  when  an  abscess  is  dis- 
charging through  the  bronchus  to  effect  a com- 
plete and  permanent  obliteration  of  the  cavity. 


This  result  is  rarely  achieved,  however,  except 
during  the  acute  or  subacute  stage  of  the  disease. 

The  internist  should  never  desert  his  patient. 
Medical  treatment  is  constantly  required  and  the 
interests  of  the  patient  are  best  conserved  by  his 
frequent  consultation  with  the  surgeon  during 
the  patient’s  postoperative  course.  It  is  the  con- 
sensus of  opinion  today  among  those  who  have 
had  the  most  experience  in  its  surgical  treat- 
ment that  during  the  period  of  development  and 
anatomical  demarcation  a pulmonary  abscess  is 
best  treated  medically;  but  that  after  an  abscess 
is  definitely  diagnosed  and  walled  off,  unless  the 
patient  is  showing  steady  improvement,  the  best 
prognosis  for  lung  abscess  is  by  a rightly  timed 
and  carefully  conducted  surgical  intervention. 

1247  Roosevelt  Building. 

DISCUSSION 

Philip  H.  Pierson,  M.  D.  (490  Post  Street,  San 
Francisco). — This  paper  of  Doctor  Dolley’s  has 
offered  us  a very  clear  and  concise  system  of  pro- 
cedure in  the  diagnosis  of  pulmonary  abscess  and  in 
its  treatment.  In  this  condition,  the  closest  coopera- 
tion of  the  group,  consisting  of  the  bronchoscopist, 
surgeon  and  internist,  is  of  utmost  importance.  If 
this  cooperation  and  consultation  begin  early,  they 
will  be  of  more  value  than  when  asked  for  just  before 
their  particular  services  are  given.  Intensive  medical 
treatment  does  not  mean  a passive  attitude,  waiting 
for  nature  to  do  everything  herself,  but  it  requires 
careful  explanation  to  the  patient  about  the  type  of 
posture  most  suited  to  him,  the  preference  of  circu- 
lating fresh  air  to  merely  open  air,  as  to  an  easily 
digestible  as  well  as  a high  caloric  diet,  particular 
care  of  his  mouth  and  sunshine  when  this  can  be  used 
locally  with  safety. 

Artificial  pneumothorax  is  very  frequently  sug- 
gested as  a possible  form  of  treatment,  but  it  seems 
to  me  its  usefulness  is  so  limited,  namely  to  central 
abscesses  where  dangerous  bleeding  is  a part,  as  to  be 
practically  nil.  These  abscesses  generally  do  well 
under  posture  plus  bronchoscopy. 

In  acute  abscess  lipiodol  gives  very  little  infor- 
mation which  is  not  gained  from  the  pictures,  as 
previously  suggested.  When  the  lipiodol  is  massed 
in  one  section  of  the  lung,  it  may  suggest  the  pres- 
ence of  an  abscess  where  there  is  none  (a  matter  dis- 
cussed at  some  length  by  Mosher).  When  bronchiec- 
tasis has  developed  about  a cavity,  lipiodol  is  then 
helpful  in  detecting  its  amount. 

Series  of  roentgenograms  are  of  great  aid  in  deter- 
mining not  only  the  ultimate  prognosis,  but  the  rate 
of  progression  of  the  disease  condition.  We  have 
found  lateral  films  of  a great  deal  of  value  in  prop- 
erly determining  the  location  and  extent  of  these 
abscesses. 

As  has  been  said,  intensive  medical  treatment 
greatly  reduces  the  mortality  in  pulmonary  abscesses, 
but  at  times  too  long  a delay  in  resorting  to  surgery 
will  allow  the  abscess  wall  to  become  so  rigid  that 
thoracotomy  and  even  thoracoplasty  will  not  be  fol- 
lowed by  collapse  and  it  is  to  avoid  this  condition  that 
the  cooperation  of  the  group  is  of  utmost  value. 

Harold  Brunn,  M.  D.  (384  Post  Street,  San  Fran- 
cisco).— Doctor  Dolley  has  given  us  a very  clear  and 
concise  picture  of  lung  abscess  as  we  see  it  clinically, 
and  has  laid  down  some  very  important  data  for  our 
consideration. 

In  our  own  work  we  find  ourselves  operating  less 
and  less  for  the  acute  abscess.  Under  proper  handling 
we  feel  that  a larger  and  larger  percentage  of  these 
cases  are  cured  by  expectant  treatment;  carrying  out 
a number  of  carefully  planned  procedures  for  each 
individual  case.  It  is  important,  however,  that  if  these 
procedures  do  not  relieve  the  patient  operation  should 


32 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


be  undertaken,  as  Doctor  Dolley  points  out,  before 
the  abscess  becomes  chronic. 

The  treatment  for  an  acute  and  a chronic  abscess 
is  therefore  very  different.  In  the  acute  abscess  we 
attempt  to  establish  drainage  by  posture,  by  bron- 
choscopy and  by  artificial  pneumothorax,  and  we 
choose  the  method  or  methods  depending  upon  the 
case  and  its  progress. 

Of  these  methods  probably  the  bronchoscope  is  the 
most  important  in  removing  plugs  or  granulations  or 
opening  up  a bronchus  with  cocain  and  adrenalin, 
allowing  the  discharge  to  be  liberated.  At  times  also 
we  use  in  addition  after  such  bronchoscopies  carbon 
dioxid  and  oxygen  to  increase  ventilation  of  the  lung, 
which  in  turn  tends  to  keep  the  cavity  empty.  We 
try  to  be  extremely  careful  not  to  allow  time  to  slip 
by  until  the  patient  shall  have  become  so  seriously 
weakened  by  continued  infection  as  to  make  recovery 
difficult,  even  by  operative  interference. 

The  course  of  many  of  these  abscesses  is  very 
erratic  and  each  case  requires  individual  study.  We 
feel  that  one  can  be  very  easily  stampeded  into  a too 
early  operation,  and  if  this  occurs  death  may  ensue 
from  the  dislodgment  of  emboli  which  might  other- 
wise have  cleared  up  under  some  carefully  provided 
system  of  drainage.  Those  patients  that  have  hemor- 
rhage along  with  expectoration  are  the  ones  that  are 
the  most  trying  and  in  these  we  attempt  an  early 
pneumothorax.  Bronchoscopy  here  becomes  more 
dangerous  and  operation  also  carries  with  it  a higher 
mortality. 

In  conclusion  we  wish  to  repeat  that  our  operations 
have  diminished  more  than  half  and  we  believe  we 
are  clearing  up  our  cases  in  a much  quicker  time  by 
correlation  of  the  different  methods  of  producing 
drainage  of  the  abscess. 

F.  M.  Pottenger,  M.  D.  (Monrovia). — Doctor  Dol- 
ley’s  paper  on  the  diagnosis  and  treatment  of  lung 
abscess  presents  to  us  an  excellent  discussion  of 
one  of  the  most  difficult  problems  in  chest  disease. 
The  old  method  of  draining  an  abscess  as  soon  as 
it  is  diagnosed  is  wrong.  During  the  acute  state  of 
an  abscess  it  should  always  be  given  an  opportunity 
to  heal,  and  operative  procedures  should  not  be 
undertaken  until  the  abscess  is  walled  off.  When  the 
acute  pathologic  changes  have  come  to  a standstill, 
and  the  abscess  is  walled  off,  then  operative  pro- 
cedures should  be  undertaken,  if  deemed  necessary. 

In  some  of  these  cases  pneumothorax  will  com- 
press the  tissue  and  bring  about  a satisfactory  heal- 
ing. In  other  cases  it  seems  to  be  insufficient  and 
wholly  fails  to  control  the  pathology. 

If  after  a few  weeks’  medical  observation  the 
abscess  does  not  show  a tendency  to  heal,  the  sur- 
geon should  always  be  called  into  consultation. 

Aside  from  pneumothorax,  in  the  treatment  of  early 
abscess,  drainage  may  be  assisted  by  posture  and 
also  by  bronchoscopy.  Where  the  abscess  drains 
slowly,  bronchoscopy  has  often  given  marked  relief. 
Unless  free  drainage  is  established  and  maintained 
there  is  no  possible  chance  for  healing. 

Doctor  Dolley  (Closing). — I feel  that  little  need  be 
added  except  by  way  of  emphasis  on  the  points  so 
well  brought  out  by  the  discussers.  I shall  close  with 
but  a word  of  further  caution  in  regard  to  the  em- 
ployment of  artificial  pneumothorax  in  the  presence 
of  acute  or  even  chronic  lung  abscess  if  a recent  flare- 
up  involving  the  surrounding  lung  tissue  is  evident. 
I am  firmly  convinced  that  even  if  a lung  abscess 
be  apparently  deep-seated  there  is  grave  danger  of 
acute  pleuritis  with  overwhelming  toxemia  develop- 
ing (under  artificial  pneumothorax  treatment)  either 
through  needle  injury  to  lung  in  an  infected  area  or 
by  actual  extension  of  the  inflammatory  process  to 
the  visceral  pleura  with  subsequent  rupture  into 
pneumothorax  cavity  and  that  only  in  the  chronic 
or  late  subacute  lung  abscesses,  when  all  signs  of 
surrounding  pulmonitis  have  disappeared,  is  this  pro- 
cedure safely  indicated  for  trial. 


CARCINOMA  OF  THE  CERVIX — ITS  SURGICAL 
TREATMENT* 

By  Hans  von  Geldern,  M.  D. 

San  Francisco 

Discussion  by  fVilliam  H.  Gilbert,  M.  D.,  Los  Angeles ; 
Emil  G.  Beck,  M.D.,  Chicago;  C.  G.  Toland,  M.D.,  Los 
Angeles. 

"PREVIOUS  to  the  comparatively  recent  intro- 
^ duction  of  radiologic  therapy,  surgery  had 
been  considered  the  method  of  choice  in  the  cure 
of  uterine  cancer.  As  treatment  with  radioactive 
rays  was  developed  and  perfected,  however,  many 
of  the  strong  advocates  of  radical  surgery  were 
gradually  won  over  to  radiologic  therapy  on  the 
basis  of  the  excellent  results  reported  and  the 
almost  complete  absence  of  primary  mortality. 
Gynecologists  are  still  divided  as  to  the  prefer- 
able procedure,  especially  in  the  early  cases  of 
carcinoma  of  the  cervix. 

EARLY  SURGICAL  PROCEDURES 

The  first  systematic  attempts  at  the  surgical 
cure  of  cervical  cancer  consisted  of  high  amputa- 
tions of  the  cervix  and  vaginal  hysterectomies. 
Freund  in  1878  introduced  the  removal  of  uterine 
cancers  by  the  abdominal  route  and  had  quite  a 
following,  but  this  operation  in  the  hands  of 
others  was  decidedly  unsuccessful  and  surgeons 
again  turned  their  attention  to  the  original  vagi- 
nal technique,  obtaining  far  better  primary  re- 
sults. During  this  same  period  Byrne  introduced 
cautery  amputation  of  the  cervix,  reporting  a 
number  of  cures.  Operators,  however,  soon  real- 
ized that  their  failures  were  the  result  of  incom- 
plete excision  of  carcinomatous  tissue,  and  a 
number  of  surgeons,  notably  Ries,  Clark  and 
Werder,  again  became  interested  in  the  abdominal 
approach,  developing  a radical  procedure  which 
was  perfected  and  popularized  by  Wertheim. 
Werder  later  abandoned  the  operation  he  origi- 
nally proposed  for  a combined  vaginal  and  ab- 
dominal cautery  extirpation. 

RADICAL  OPERATIONS 

The  original  Wertheim  operation  consisted  of 
the  removal  of  the  entire  uterus,  tubes,  ovaries, 
parametria,  paracervical  tissues  and  part  of  the 
vagina,  along  with  an  extensive  dissection  of  the 
regional  glands.  At  that  time  the  only  hope  for 
cure  was  dependent  upon  dissecting  wide  of  the 
carcinomatous  extensions  and  the  technique  car- 
ried with  it  a high  mortality.  In  the  earlier  years 
of  radical  surgery  many  hopelessly  advanced  cases 
were  operated  upon,  but  in  subsequent  years  the 
pendulum  gradually  swung  back  to  less  radicalism, 
with  more  careful  selection  of  patients  for  opera- 
tion and  improvements  in  technique. 

P.  Werner  of  the  II  Frauenklinik,  Vienna, 
recently  described  his  present  technique.  He 
warns  against  immediate  preoperative  manipula- 
tion or  examinations,  and  advises  spinal  anesthe- 
sia. Werner  emphasizes  the  importance  of  after 
treatment,  especially  the  care  of  the  bladder,  and 
carries  out  postoperative  roentgen  radiation  on  all 
patients  as  soon  as  possible  after  the  operation. 

* Read  before  the  Obstetrics  and  Gynecology  Section  of 
the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


January,  1930 


CARCINOMA  OF  CERVIX — VON  GELDERN 


33 


Coincident  with  the  development  of  the  radical 
abdominal  technique,  Schuchardt  announced  an 
extended  vaginal  operation  which  was  improved 
upon  by  Schauta.  This  improved  operation  em- 
bodies the  same  principles  of  block  dissection 
of  the  pelvic  organs  and  their  ligamentous  con- 
nections, but  fails  to  eradicate  involved  glands 
distant  from  the  parametria.  Contamination  of 
the  operative  field,  a great  source  of  danger  in 
the  abdominal  operation,  is  avoided  by  sewing  to- 
gether a vaginal  cuff  about  the  infected  cervix. 
The  operation  is  facilitated  by  a paravaginal  in- 
cision, which  shortens  the  vagina  and  makes  the 
parametria  accessible. 

Statistics  indicate  that  the  incidence  of  injuries 
to  the  adjacent  organs  and  the  percentage  of  five- 
year  cures  are  about  equal  for  either  type  of 
operation.  Most  surgeons  prefer  the  Wertheim 
technique  for  its  accessibility,  but  in  general  agree 
that  the  radical  vaginal  operation  is  especially 
adapted  to  patients  who  are  suffering  from  con- 
stitutional diseases,  to  the  obese  and  the  aged. 
The  primary  mortality  following  the  Schauta 
operation  is  only  about  one-third  that  attending 
the  Wertheim.  The  former  technique,  in  the  past, 
has  been  condemned  by  many  because  of  its  in- 
ability to  reach  metastatic  glands,  but  at  present 
few  surgeons  still  advise  the  routine  removal  of 
lymph  glands,  as  the  experience  of  Schauta, 
Weibel,  and  others  has  been  that  few  patients 
with  lymph  gland  metastases  have  been  cured  by 
surgery.  Gellhorn  points  out  that  each  method 
has  its  special  virtues  and  that  gynecologists 
should  have  at  their  command  the  technique  of 
both  operations. 

Whereas  many  surgeons,  especially  in  America, 
have  stopped  operating  altogether  for  cervical 
cancer,  others  still  adhere  to  the  radical  abdomi- 
nal technique  either  alone,  or  in  combination  with 
radiation,  and  a few  advocate  simple  panhyster- 
ectomy after  complete  preoperative  radiation. 
Stoeckel  and  Toth  routinely  use  pre-  and  post- 
operative radiation  in  conjunction  with  the 
Schauta  operation.  Keene,  Gardner,  Kuhn,  and 
others  favor  cautery  amputation  followed  by 
radium,  especially  in  early  cervical  cancer. 

SELECTION  OF  PATIENTS  FOR  OPERATION 

Before  radium  entered  the  therapeutic  field  the 
aim  of  surgeons  was  to  increase  the  number  of 
operations  for  cancer  of  the  cervix  to  a maxi- 
mum. At  that  time  50  to  90  per  cent  of  patients 
were  operated  upon.  At  present  operability  im- 
plies that  the  growth  is  of  such  limited  extent 
that  a permanent  cure  may  be  reasonably  ex- 
pected. In  general  less  than  20  per  cent  of 
patients  with  cancer  of  the  cervix  are  now  con- 
sidered operable.  Most  gynecologists  now  agree 
that  the  criteria  for  classifying  patients  as  oper- 
able are  normal  mobility  of  the  uterus,  flexible 
and  noninvaded  fornices,  lack  of  parametrial  in- 
filtration, patency  of  the  cervix,  afebrility  and 
absence  of  pathogenic  organisms  in  the  cervical 
secretions. 

An  increase  in  the  number  of  surgical  cures 
will  depend  on  earlier  diagnoses,  all  border-line 


cases  being  reserved  for  radium.  Some  investiga- 
tors contend  that  surgery  should  be  reserved  for 
patients  upon  whom  a positive  diagnosis  can  be 
made  only  through  biopsy  examination.  However, 
Bonney,  whose  operability  rate  is  about  55  per 
cent,  has  obtained  remarkable  results,  curing  33 
per  cent  of  patients  with  carcinomatous  lymph 
glands.  He  claims  that  the  bars  to  operation  are 
deep  and  -extensive  infiltration  of  the  bladder  or 
rectum  and  obstruction  of  the  ureters,  and  has 
overcome  involvement  of  the  whole  vagina  by 
means  of  his  supra- Wertheim  operation.  Not- 
withstanding the  contention  that  radium  cures  as 
many  operable  cases  as  surgery,  it  is  recognized 
that  there  is  a group  of  adenomatous  cancers, 
comprising  about  5 per  cent,  which  fail  to  respond 
to  radium  therapy  and  are,  therefore,  best  treated 
by  surgery  if  within  the  limits  of  operability. 

PROGNOSIS 

The  grouping  of  cervical  carcinomas  proposed 
by  Schmitz  segregates  these  tumors  into  four 
groups,  according  to  the  clinical  extent  of  growth. 
It  is  agreed  that  tumors  belonging  to  Group  1 
are  clearly  operable  and  in  general  offer  a good 
prognosis,  providing  there  are  no  surgical  contra- 
indications and  that  a skillful  radical  operation 
is  performed.  Patients  belonging  to  Group  2 offer 
a questionable  prognosis  and  should  no  longer  be 
operated  upon,  while  those  classified  in  Groups 
3 and  4 are  definitely  considered  inoperable.  Ex- 
perience has  made  it  apparent  that  the  clinical 
extent  of  growth  is  of  greatest  prognostic  indi- 
cation as  far  as  surgery  is  concerned. 

Martzloff  recently  made  a study  of  the  histo- 
pathologic material  obtained  from  a group  of 
patients  upon  whom  radical  surgery  had  been 
performed,  in  order  to  determine  the  criteria 
essential  to  establish  the  prognosis  following 
operative  treatment.  His  classification  of  epi- 
dermoid cancers,  based  upon  the  predominating 
type  of  cell,  and  grouping  according  to  the  degree 
of  cellular  differentiation,  was  used;  a classifi- 
cation not  unlike  in  principle  to  those  of  Broders 
and  Schottlaender  and  Kermauner.  Each  type, 
as  well  as  the  adenocarcinomas,  was  studied  sepa- 
rately with  respect  to  the  duration  of  symptoms, 
clinical  extent  of  growth  and  the  ultimate  results. 
Symptoms  of  over  eight  months’  duration  put  the 
cases  with  spinal  and  transitional  cell  types  be- 
yond the  hope  of  operative  cure,  while  those 
exhibiting  the  more  malignant  spindle  cell  type 
were  found  hopelessly  advanced  before  this  time. 
Metastases  and  paracervical  extension  indicated  a 
poor  prognosis  in  all  types.  Of  the  operable  cases 
the  adenocarcinomas  and  spinal  cell  growths 
showed  the  greatest  incidence  of  permanent  cures, 
and  the  spindle  cell  types  the  least. 

Most  investigators,  however,  place  more  em- 
phasis on  the  clinical  stage  than  upon  histologic 
grouping,  when  surgery  is  used,  while  Wintz, 
Plaut,  and  others  claim  that  there  is  no  reliable 
basis  for  histologic  prognosis  in  cervical  cancer. 
Efforts  have  been  made  to  establish  a prognosis 
from  a study  of  biopsy  specimens,  but  the  recent 
investigations  of  Martzloff  have  shown  that  about 


34 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


one-third  of  the  material  studied  failed  to  indi- 
cate correctly  the  predominating  variety  of  cancer 
cell  in  the  parent  tumor. 

PRIMARY  MORTALITY  AND  COMPLICATIONS 

Generally  speaking,  the  primary  mortality  at- 
tending radical  surgery  has  shown  a marked 
decline,  due  to  a reduction  in  operability  and 
improvement  of  technique,  but  figures  from  dif- 
ferent clinics  show  wide  variation.  This  may  be 
accounted  for  on  the  basis  of  the  types  of  cases 
selected  and  the  methods  of  operative  manage- 
ment. Twenty  years  ago  an  operative  mortality 
of  20  to  25  per  cent  was  considered  the  average 
for  experienced  surgeons.  Statistics  collected  by 
Jacobson  in  1911,  by  Janewav  in  1919,  and 
Heyman  in  1927  show  an  average  operative  mor- 
tality of  19.5,  18,  and  17.2  per  cent  respectively, 
and  Lynch’s  figures,  based  on  over  three  thousand 
Wertheim  operations  performed  by  European  and 
American  surgeons,  showed  16.5  per  cent.  Thirty 
per  cent  of  Wertheim’ s first  one  hundred  cases 
died,  the  mortality  being  later  reduced  to  10  per 
cent.  Werner  reports  that  the  present  operative 
mortality  for  cervical  cancer  in  Wertheim’s  clinic 
is  between  5 and  6 per  cent.  The  percentage 
of  operative  deaths  in  Franz’  clinic  has  dropped 
from  23  to  14  per  cent  and  at  Johns  Hopkins 
from  14  to  7 per  cent.  Recently  Zweifel,  Weibel, 
Graves,  and  Jeff  Miller  report  from  4 to  7 per 
cent.  Operators  using  the  Schauta  technique  now 
have  a primary  mortality  of  between  3 and  4 per 
cent.  German  surgeons  have  reduced  the  death 
rate  by  the  use  of  spinal  anesthesia.  A reduction 
of  surgical  mortality  is  most  essential  to  opera- 
tive treatment  in  its  competition  with  radiologic 
therapy. 

Improvements  of  technique  and  more  limited 
selection  of  patients  for  operation  have  also 
brought  about  a reduction  in  postoperative  com- 
plications. At  Johns  Hopkins  the  following  com- 
plications occurred  in  order  of  frequency:  In- 
fected wounds,  vesicovaginal  and  ureterovaginal 
fistulae,  thrombophlebitis,  peritonitis,  nephropa- 
thies, pulmonary  complications,  rectovaginal  fistu- 
lae, and  intestinal  obstruction.  Shock,  peritonitis, 
pulmonary  and  urinary  tract  complications  were 
responsible  for  the  deaths. 

END  RESULTS 

In  order  to  evaluate  with  some  degree  of  accu- 
racy the  results  obtained  in  the  treatment  of 
cancer  of  the  uterus,  Winter  proposed  as  a stand- 
ard of  curability,  freedom  from  recurrence  for  a 
period  of  five  years.  From  2 to  6 per  cent  of 
cervical  cancers  recur  after  five  years,  but  this 
is  offset  by  the  difficulty  of  tracing  over  a longer 
period.  Before  the  advent  of  radium,  when  sur- 
gery was  the  only  means  of  cure,  a calculation 
of  absolute  cures  seemed  the  fairest  means  of  de- 
termining results,  as  operators  differed  so  widely 
in  their  methods. 

Heyman’s  statistics,  collected  from  twenty  oper- 
ative clinics,  showed  an  average  absolute  cura- 
bility of  19.1  per  cent  and  an  average  of  16.3 
per  cent  for  seventeen  clinics  using  radiologic 
treatment.  These  figures  can  hardly  be  compared 


as  the  radium  statistics  represent  diljerent  mate- 
rial and  more  recent  work. 

With  radiologic  therapy  now  a competitor  of 
surgery,  the  percentage  of  relative  cures  has  be- 
come a better  index  as  to  the  results  of  either  type 
of  therapy  in  similar  cases.  Some  3659  extended 
operations,  collected  from  the  literature  by  Hey- 
man, showed  an  average  of  35.6  per  cent  recovery. 
No  doubt  a considerable  proportion  of  these  cases 
could  not  be  considered  operable  in  the  sense  with 
which  we  use  the  term  today.  Five-year  end 
results,  collected  from  twelve  radiologic  clinics, 
showed  an  average  of  34.9  per  cent  in  operable 
and  border-line  cases.  Wille,  Weibel,  Warnekros, 
Faure  and  Bonney,  enthusiastic  advocates  of  radi- 
cal abdominal  surgery,  in  their  more  recent  re- 
ports show  ultimate  cures  in  early  cases  ranging 
as  high  as  75  per  cent,  quite  comparable  to  the 
results  obtained  in  similar  cases  treated  radiologi- 
cally  in  the  clinics  of  Heyman,  Ward,  Bailey  and 
Healy,  and  Doderlein.  It  must  be  remembered, 
however,  that  these  surgeons  are  unusually  skill- 
ful and  have  developed  the  technique  over  a 
period  of  years  before  such  results  were  obtained. 
A number  of  surgeons  have  obtained  better  re- 
sults after  using  pre-  or  postoperative  radiation 
in  conjunction  with  their  radical  hysterectomies. 
The  use  of  radium  in  combination  with  cauteriza- 
tion or  electrocoagulation  is  in  its  experimental 
stage.  Five  of  six  early  cases  treated  by  cauteriza- 
tion and  radium,  reported  by  John  G.  Clark,  have 
recovered.  Extensive  cauterizations  and  starva- 
tion ligations  as  palliative  procedures  in  advanced 
carcinomas  have  been  largely  superseded  by  radio- 
logic  therapy. 

STANFORD  CLINIC  OBSERVATIONS 

Of  eighty-seven  patients  with  carcinoma  of  the 
cervix  treated  in  the  Stanford  women’s  clinic 
from  1912  to  1924,  twenty-six  were  radically 
operated  upon  and  of  these  38.5  per  cent  re- 
mained free  of  recurrence  five  or  more  years. 
The  operative  mortality  was  11.5  per  ment  with 
no  operative  deaths  among  fifteen  patients  treated 
between  1918  and  1924.  The  absolute  curability 
was  13.8  per  cent.  Most  of  the  patients  were 
treated  with  radium,  preoperatively,  four  to  five 
weeks  prior  to  operation,  postoperative  radiation 
being  reserved  for  cases  in  which  there  was  in- 
complete extirpation  or  in  which  recurrences 
developed.  Palliative  procedures  used  in  the  treat- 
ment of  inoperable  cancers  consisted  of  the  use 
of  acetone,  Percy  cautery,  Pacquelin  cautery,  and 
radiation.  There  was  no  apparent  relation  be- 
tween the  duration  of  symptoms  and  the  clinical 
extent  of  the-disease.  Since  1925,  with  the  hope 
of  improving  results,  radium  has  been  used  in  this 
clinic  almost  to  the  exclusion  of  operative  inter- 
ference, following  the  cross-fire  technique  used  at 
Radiumhemmet.  Thus  far  too  few  patients  have 
been  followed  over  a sufficiently  long  period  to 
draw  conclusions. 

CARCINOMA  OF  THE  BODY  OF  THE  UTERUS 

Many  of  those  who  have  completely  abandoned 
operative  procedures  for  cancer  of  the  cervix 
admit  that  surgery  is  indicated  in  carcinoma  of 
the  fundus.  Controversy  still  exists  as  to  the 


January,  1930 


CARCINOMA  OF  CERVIX — VON  GELDERN 


35 


extent  of  removal.  Although  Weibel  and  Peter- 
son obtained  their  best  results  by  using  the  radical 
technique,  the  present  method  of  choice  is  total 
hysterectomy  with  bilateral  adnexectomy.  It  is  an 
accepted  fact  that  this  method  offers  from  65  to 
80  per  cent  permanent  cures.  Some  European 
operators  favor  vaginal  hysterectomy  for  body 
carcinoma.  Eymer,  Polak,  Crile,  Ward,  Healy, 
and  others  advocate  total  hysterectomy  and  sal- 
pingo-oophorectomy  along  with  preoperative  and 
also  postoperative  radiation  if  necessary.  The 
uterus  may  be  removed  either  a few  days  or  from 
four  to  six  weeks  after  thorough  intra-uterine 
radiation. 

It  is  all  important  that  an  early  diagnosis  be 
made.  Diagnostic  curettage  must  be  followed  by 
intra-uterine  radium  unless  laparotomy  is  to  be 
performed  at  once.  The  prognosis  in  general  is 
better  than  in  cancer  of  the  cervix,  due  to  a rela- 
tively late  penetration  and  involvement  of  the 
surrounding  structures  and  a lower  degree  of 
malignancy.  Mahle  studied  these  tumors  histo- 
logically and  found  that  cures  were  much  more 
frequently  obtained  in  the  less  malignant  types. 
Norris  and  Vogt,  in  a study  of  115  cases  of  body 
carcinomata,  report  a primary  mortality  of  7.3 
per  cent,  with  50  per  cent  of  operative  cases 
and  35  per  cent  of  those  treated  by  radium  sur- 
viving a five-year  period.  Van  S.  Smith  and 
Grinnell  report  five-year  cures  in  45  per  cent  of 
a similar  group  treated  by  surgery.  They  express 
the  opinion  that  radium  is  inferior  to  hysterec- 
tomy in  the  treatment  of  fundus  cancers.  The 
results,  with  operative  treatment  on  323  oper- 
able body  carcinomas  collected  from  eight  clinics, 
showed  an  average  of  58.8  per  cent  recovery, 
whereas  118  operable  cases  treated  with  radium 
showed  47.5  per  cent.  Sixty  per  cent  of  the  oper- 
able patients  treated  at  Radiumhemmet  were 
cured,  and  on  the  basis  of  these  figures  Heyman 
concludes  that  radium  can  well  compete  with  sur- 
gery in  the  treatment  of  body  carcinomas. 

CONCLUSIONS 

1.  There  is  a general  tendency  toward  the 
limitation  of  radical  surgery  to  carefully  selected 
early  cases  of  carcinoma  of  the  cervix. 

2.  The  clinical  extent  of  growth  is  the  greatest 
single  prognostic  indication  following  extended 
operations. 

3.  Experienced  surgeons  are  now  operating  for 
cancer  of  the  cervix,  with  a primary  mortality  of 
less  than  8 per  cent. 

4.  The  best  surgical  results  are  obtained  when 
radiation  is  used  in  conjunction  with  extended 
operations  for  cancer  of  the  cervix. 

5.  Panhysterectomy  and  double  salpingo-oophor- 
ectomy  in  conjunction  with  radiation  is  the 
method  of  choice  in  the  treatment  of  carcinoma 
of  the  body  of  the  uterus. 

6.  Until  further  comparative  statistics  based  on 
the  treatment  of  early  cervical  carcinomas  are 
available,  it  is  well,  before  we  abandon  surgery 
altogether,  that  we  keep  an  open  mind  on  this 
phase  of  the  subject. 

490  Post  Street. 


DISCUSSION 

William  H.  Gilbert,  M.  D.  (746  Francisco  Street, 
Los  Angeles). — Cancer  of  the  cervix  and  cancer  of 
the  breast  still  remain  debatable  questions.  Rapid 
metastasis  in  both  these  locations  means  a high  per- 
centage of  recurrences  and  deaths.  Unquestionably, 
cancer  is  a curable  disease  when  discovered  in  its 
early  stages.  Surgery,  the  cautery,  or  radium  will 
cure  at  that  time.  It  seems  to  me  that  the  best  we 
can  look  for  in  the  treatment  of  advanced  cancer  of 
the  cervix  is  a 25  per  cent  cure.  This  is  the  figure 
supplied  by  Haydon  of  Stockholm,  Sweden,  and  prob- 
ably represents  the  highest  percentage  of  cures  of  all 
types  of  cases  and  applies  to  the  use  of  radium  and 
x-ray  radiation  exclusively.  Surgery  has  never  been 
able  to  equal  this  record  in  the  type  of  cases  alluded 
to.  In  the  surgical  treatment  of  early  cancer  of  the 
cervix  the  figures  are  in  favor  of  operative  procedure. 
After  all  has  been  said  and  done,  we  come  back  to 
the  question  of  the  personal  equation.  Much  of  the 
good  results  obtained  through  surgery  depends  upon 
the  judgment  and  skill  of  the  operating  surgeon.  This 
is  equally  true  of  the  radiologist.  He  must  have  had 
a wide  range  of  observation  and  experience  in  the 
use  of  radium  and  x-ray.  I have  used  all  the  accepted 
methods.  Percy’s  cautery,  in  early  cases  in  which  I 
resort  to  surgery,  is  my  method  of  choice.  I believe 
the  radical  hysterectomy  made  with  the  cautery  knife 
is  the  best  technique  to  follow.  In  more  advanced 
cases  I have  cooked  the  cancer  with  the  cautery  and 
have  seen  the  patients  die  of  septicemia  afterward. 
I have  also  seen  the  same  result  after  large  doses  of 
radium.  I believe  the  radium  technique,  as  followed 
by  Ward  of  the  New  York  Woman’s  Hospital,  has 
given  me  the  best  results.  How  to  cure  cancer  is  a 
tremendous  question  of  great  interest  to  the  human 
race,  and  a gigantic  problem  for  the  medical  pro- 
fession to  solve.  Much  water  has  run  over  the  dam 
and  much  will  follow  before  the  question  is  answered 
to  the  satisfaction  of  both  the  public  and  the  pro- 
fession. At  the  present  time  I am  inclined  to  believe 
that  metastatic  cancer  patients  will  live  longer  and 
be  more  comfortable  if  let  alone.  When  cancer  be- 
comes a general  infection,  any  local  treatment  we 
may  use  will  be  of  little  avail. 

Education  of  both  the  laity  and  profession  as  to 
the  necessity  of  early  diagnosis  and  treatment  will  do 
much  toward  decreasing  the  mortality  rate  of  cancer. 

To  summarize,  I would  say  that  at  this  time  an 
early  diagnosis,  a splendidly  qualified  surgeon,  and 
an  expert  radiologist  are  absolutely  necessary  to  the 
cure  of  cancer. 

# 

Emil  G.  Beck,  M.  D.  (Chicago,  Illinois). — Doctor 
Von  Geldern  has  given  us  an  unbiased  opinion  on  the 
relative  value  of  surgery  and  radiotherapy  in  the 
treatment  of  carcinoma  of  the  cervix,  and  has  clearly 
defined  the  indications  for  each,  or  of  a combination 
of  the  same.  Whenever  a discussion  on  carcinoma  of 
the  cervix  takes  place,  our  main  object  is  to  find 
out  whether  surgery  or  radiotherapy  offers  the  best 
chance  for  permanent  cure  or  the  longest  period  of 
prolongation  of  life.  Statistics  from  American  clinics 
and  from  abroad  indicate  that  the  status  is  still  in 
favor  of  surgery  combined  with  preoperative  and  post- 
operative radiation. 

Radiation  without  surgery  in  cervical  carcinoma 
has,  however,  gradually  gained  in  popularity,  as  the 
surgeons  become  convinced  of  its  merits.  It  has  one 
thing  in  its  favor,  namely,  practically  no  mortality, 
and  less  expense  to  the  patient. 

The  comparative  value  of  surgery  or  radio  therapy 
cannot  be  estimated  by  merely  counting  the  deaths 
or  by  the  five-year  end  results.  We  must  take  into 
account  that  the  worst  cases  fall  into  the  hands  of  the 
radiologist.  Many  cases  in  which  merely  an  explora- 
tion is  done  and  regarded  as  inoperable  apply  to  the 
radiologist  and  thus  the  fatal  end  results  is  charged 
to  radiology  and  not  to  surgery. 

It  is,  however,  most  essential  that  the  surgeon  and 
the  radiologist  cooperate  in  order  to  give  the  patient 


36 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


the  best  chance  for  recovery.  If  I were  asked  to  men- 
tion the  most  essential  requirements  in  cancer  therapy 
I would  unhesitatingly  say,  cooperation  between  sur- 
geon and  radiologist. 

In  cancer  of  the  cervix  we  should  really  expect 
more  favorable  results  than  in  other  parts  of  the 
body.  It  is  in  the  earlier  stages  accessible  to  direct 
radiation  similar  to  the  superficial  epitheliomata  of 
the  skin  or  lip.  It  is  only  when  the  body  of  the  uterus 
and  the  intrapelvic  glands  are  affected  that  the  case 
becomes  uncontrollable.  We  must  bear  in  mind  that 
unless  we  can  destroy  the  last  cancer  cell  we  may 
expect  a recurrence.  In  other  words,  every  retained 
cancer  cell  after  an  operation  is  a potential  recurrent 
cancer.  Since  the  individual  cancer  cell  is  not  palpa- 
ble or  visible  during  an  operation,  the  surgeon  is  not 
always  able  to  tell  whether  any  cells  have  been  re- 
tained in  the  wound  and  thus  it  is  essential  that  post- 
operative radiotherapy  should  be  carried  out  most 
efficiently.  Fortunately  this  can  be  carried  out  with 
greater  ease  in  carcinoma  of  the  cervix  because  the 
tube  of  radium  may  be  placed  in  direct  contact  and 
into  the  cavity  of  the  uterus.  The  additional  x-ray 
treatment  has  also  been  efficiently  worked  out  by 
experts. 

One  word  about  the  correct  and  early  diagnosis. 
Not  every  ulceration  of  the  cervix  in  a woman  who 
has  borne  children  and  who  is  suffering  from  an 
endocervicitis,  is  a carcinoma.  In  suspicious  looking 
ulcers  we  resort  to  biopsy.  In  the  smooth  granulated 
ulcer  I have  usually  resorted  to  a test  by  treating 
them  with  20  per  cent  silver  nitrate  and  bismuth 
application.  The  nonmalignant  ulcer  will  usually  yield 
to  this  treatment,  but  if  it  does  not,  then  it  becomes 
a suspicious  case,  and  the  biopsy  clears  the  diagnosis. 

& 

C.  G.  Tolaxd,  M.  D.  (1930  Wilshire  Boulevard,  Los 
Angeles). — In  a consideration  of  the  treatment  of 
carcinoma  of  the  cervix  it  is  impossible  to  state  defi- 
nitely that  any  one  procedure  is  the  best.  Some  of 
our  leading  gynecologists  favor  the  use  of  radium 
alone,  others  frequently  employ  a radical  operation, 
many  advocate  irradiation  and  operation  combined, 
and  a few  use  the  cautery.  Where  there  is  such  a 
diversity  of  opinion  it  can  be  assumed  that  no  treat- 
ment is  entirely  satisfactory. 

If  the  surgeon  could  be  reasonably  certain  in  the 
early  cancers  of  the  cervix,  that  the  malignant  cells 
had  not  extended  into  the  parametrium;  and  that  no 
general  or  local  contraindications  existed  to  an  opera- 
tion; then  a radical  operation  would  be  the  method 
of  choice. 

Unfortunately  the  number  of  patients  with  an  early 
cervical  carcinoma  who  present  themselves  for  exami- 
nation is  extremely  small.  The  onset  of  the  disease 
is  insidious  and  in  the  early  stages  the  symptoms  are 
not  sufficiently  striking  to  force  the  patient  to  submit 
to  a rather  indelicate  examination. 

Where  the  malignancy  has  extended  beyond  the 
cervix,  an  operation  has  very  little  to  offer  the  pa- 
tient. There  is  considerable  danger  of  disseminating 
the  cancer  cells  as  a result  of  the  operative  trauma, 
and  even  in  skilled  hands  there  is  some  immediate 
mortality. 

The  combination  of  surgery  and  irradiation  un- 
doubtedly has  produced  excellent  results,  but  there  is 
some  question  as  to  whether  the  same  results  could 
not  have  been  obtained  with  radiation  alone. 

In  our  own  work  the  results  from  surgery  have 
seemed  so  uniformly  unsatisfactory  that  we  have 
abandoned  operative  procedure  entirely.  For  the  past 
eight  years  all  cases,  whether  early  or  late,  have  been 
treated  by  the  radiologist  exclusively.  The  combina- 
tion of  x-ray  and  radium  has  been  employed,  and 
even  in  the  advanced  cases  rather  surprisingly  good 
results  have  been  obtained,  with  the  additional  feature 
of  practically  no  mortality. 

In  this  field,  as  in  operative  technique,  a high  de- 
gree of  skill  and  experience  is  necessary.  Trouble- 
some abscess  formation,  a prolonged  proctitis,  or 
other  undesirable  complications  may  follow  too  en- 
thusiastic irradiation. 


When  the  carcinoma  has  confined  itself  to  the 
fundus  of  the  uterus  we  have  not  found  radium  so 
effective.  A radical  operation  has  given  the  patient 
the  best  chance  for  a cure.  The  abdominal  total  hys» 
terectomy  has  been  the  safest  and  most  satisfactory. 


THE  LURE  OF  MEDICAL  HISTORY 


A NOTE  ON  THE  MEDICAL  BOOKS  OF 
FAMOUS  PRINTERS* 

PART  I 

By  Chauncey  D.  Leake,  Ph.  D. 

San  Francisco 

/TJl'OOD  printing  has  always  exercised  its  own 
peculiar  fascination  on  those  who  love  the 
beautiful,  and  with  recent  historical  and  artistic 
interest  in  the  subject,  as  evidenced  by  the  en- 
thusiasm for  finely  printed  private  press  work, 
it  has  become  dignified  to  a fine  art.  It  is  one  of 
the  delightful  sidelights  of  the  historical  study  of 
medicine  to  follow  along  the  developments  in  the 
art  of  printing.  Almost  all  phases  of  the  history 
of  printing  as  a fine  art  may  be  traced  in  medical 
books. 

THE  ORIGIN  OF  PRINTING 

In  ancient  Greek  and  Roman  times,  and  all 
through  the  Middle  Ages,  books  were  painfully 
and  slowly  copied  out  by  hand  by  professional 
scribes.  Naturally  this  was  a poor  process,  and 
very  expensive.  Only  the  very  rich  could  afford 
books  made  by  such  a method  and,  of  course, 
there  was  great  restriction  in  the  distribution  of 
such  as  were  copied.  The  manuscripts  were  usu- 
ally richly  bound  and  carefully  preserved,  for 
they  represented  wealth  in  view  of  their  difficulty 
of  production.  In  many  libraries  of  the  period 
these  manuscript  books  were  tightly  chained  to 
reading  stalls  and  indeed  this  same  practice  con- 
tinued in  some  cases  after  the  publication  of 
printed  books. 

It  has  always  been  supposed  that  the  Chinese 
invented  the  device  of  movable  type  by  which 
repeated  impressions  of  the  same  figure  might  be 
made.  It  can  only  be  proved  that  they  used  seals 
for  stamping  in  quite  the  same  way  that  the 
Romans  and  many  other  peoples  used  similar 
stamps.  It  remained  for  western  ingenuity  actu- 
ally to  invent  printing. 

The  first  printing  effort  to  be  successful  was 
that  initiated  by  Johan  Gutenberg  of  Mainz  in 
Germany.  Here,  after  great  labor  in  cutting  the 
wood  blocks  to  imitate  as  closely  as  possible  the 
hand-made  letters  of  the  manuscripts,  he  pub- 
lished with  Johan  Fust,  the  first  printed  book,  a 
great  folio  bible,  between  the  years  1450  and 
1455.  The  method  of  producing  this  book  was 
kept  secret.  It  was  hoped  that  people  would  sim- 
ply believe  that  the  book  had  been  put  out  in 
large  numbers  by  the  employment  of  a great  many 

* This  preliminap'-  study  was  inspired  by  the  notable 
collection  of  medical  classics  exhibited  by  Dr.  LeRoy 
Crammer  at  the  University  of  California  Medical  School 
in  February,  1929.  Helpful  stimulus  has  also  been  received 
from  conversations  with  Dr.  Sanford  Larkey.  It  is  hoped 
that  their  influence  may  maintain  a lively  interest  in  some 
of  the  more  artistic  aspects  of  medical  publication  among 
California  physicians. 


January,  1930 


FAMOUS  MEDICAL  PRINTERS — LEAKE 


37 


rotoiiumi  cr  comic 
mmn. Quid’  (mi 
imt  moioimnoncj 
ylimmn  imtvihme 
mimrinwc  tnliim 
urlPicnmuiuul 
cvtuuomr  annum 
cuituicuaiofrtin.i 
icfoiuirciim- 1]  tv 
ItmCPlOlJVlICllMl 
iinmiumiccorpib 
crmtuu 
aipieur 
iguui 
ctofpir 
ucuciio 

!,,i'o)mumucOiiii’T 
ncmim  picmmttw 
cocy  (mtioiumair 
Y .mcomfmpliwn 
lutnu'cvpmcitnir. 
ptiiiu'iiiicmnno 


fiisrtiunmnmiafcc 
ihufcucuctictiiinT 
ft'icniPpmianilm. 
Crmcinniipiinaii 
fco'iua’piciinftPluif 
cnimn'maitianu 
imlTrcimti  oiucm 
imcmmurcoimn  uc 
ncmi.CtuntliumL 
nimuciitDfii.-uio!c 
rtliamie.cVfugjw 
iirfiimf.crosciufiflt 
lorumnimuocroU). 
vc  Unm  Liiiurui.ru 
fut'ftimutvnii’cruul 
umMirmliccnirQl!  ( 
cnnmimusiiwirfu)  ’ 
it  rtr  micro  ft  muff 
iuinv<uoft>urmD« 
auvccinmiomoOi 
minim  emu- « 
inmnuiitcort^ul 


* 


* i 


Fig.  1. — Illuminated  page  from  manuscript  of  Juan  Gil  of 
Zamora,  Opus  contra  Venena,  written  in  Spain  about  1400.  Early 
printed  books  attempted  to  imitate  manuscript  work  such  as  this. 


scribes,  and  that  the  printing  would  appear  to  be 
real  hand  copying.  All  the  early  printed  books 
attempted  to  imitate  as  far  as  possible  the  features 
of  hand  copying. 

Along  about  1465  Mainz  was  sacked  by  in- 
vaders in  the  sporadic  warfare  of  the  period  and 
the  printers  were  scattered  over  Europe.  Even 
before  this,  however,  Gutenberg  and  Fust  had 
quarreled  and  had  separated.  Many  of  the  better 
printers  were  attracted  by  the  artistic  patronage 
and  appreciation  of  handicraft  in  Italy  so  that  the 
best  early  printing  developed  from  the  presses  in 
Florence  and  Venice. 

Soon  now  a great  flood  of  books  were  offered 
to  the  public,  and  at  prices  cheaper  by  far  than 
could  ever  have  been  made  by  hand  lettering. 
Education  of  the  masses  began  in  full  blast. 
Naturally  the  wealthy  aristocrats  objected,  and 
at  first  many  obstacles  were  placed  in  the  way  of 
the  printers.  Permission  had  to  be  obtained  for 
printing,  and  all  sorts  of  difficulties  were  brought 
up.  The  wealthy  continued  for  a time  to  have 
their  books  hand-lettered  and  bound  as  sumptu- 
ously and  as  richly  as  could  be. 

THE  FIRST  MEDICAL  BOOKS 

Medical  manuscripts,  of  course,  were  among 
the  most  precious  of  those  handed  down  and 
copied  through  the  ages.  Most  of  them  are  now 
in  the  great  European  libraries,  and  their  com- 
parison is  one  of  the  hardest  tasks  of  the  scholars. 
With  the  introduction  of  printing,  hand  sheets 
calling  attention  to  certain  ways  of  maintaining 
health  in  plagues  or  epidemics  were  circulated 
during  the  seventh  decade  of  the  fifteenth  cen- 


tury. Not  counting  the  works  of  Pliny  and  Aris- 
totle, which  were  early  printed,  one  of  the  first 
medical  books  was  a little  tract  on  poisons  written 
by  Peter  of  Abano,  and  published  for  the  use  of 
the  medical  students  at  Padua  in  1473.  But  the 
first  real  medical  book  of  any  consequence  to  be 
published  was  the  magnificent  folio  of  Aulus 
Cornelius  Celsus,  De  medicine  libri  octo,  1478. 
This  was  issued  from  the  press  of  Nicolus  Jensen 
of  Florence,  in  Italy,  and  became  famous  as  one 
of  the  first  books  to  introduce  the  new  Roman 
letter.  As  was  said  before,  the  first  books  at- 
tempted to  imitate  as  closely  as  possible  the  rather 
thick,  heavy  hand  lettering  of  the  scribes.  Books 
which  continued  to  use  this  heavy  sort  of  type 
are  now  said  to  be  printed  in  blark  letter.  The 
type  was  usually  what  we  refer  to  commonly  as 
“Old  English.”  The  plain  slender  grace  of  the 
ancient  Roman  lettering  carved  on  the  monuments 
and  inscriptions  all  over  the  Roman  Empire  was 
not  adopted  into  book  printing  until  the  time  of 
Nicolus  Jensen.  Jensen’s  Roman  type  has  be- 
come very  famous,  and  within  recent  years  some 
of  the  leading  typographers,  such  as  Bruce  Rogers, 
have  come  back  to  the  use  of  modified  Jensen 
type. 

This  book  of  Celsus  is  one  of  the  real  classics 
of  medicine.  Celsus  was  a Roman  gentleman  who 
apparently  lived  during  the  Augustan  era,  and 
who  wrote  a number  of  books  on  various  as- 
pects of  the  classical  Roman  civilization.  He 
was  what  might  be  called  the  first  encyclopedist. 
His  book  on  medicine  was  not  popular  at  the 
time  it  was  written,  but  with  the  advent  of 
printing  became  one  of  the  chief  medical  authori- 
ties, and  went  through  some  one  hundred  and 
five  editions,  and  is  still  widely  read  for  its  classi- 
cal charm  and  its  good  common  sense.  It-  was 
the  chief  medical  work  written  in  Latin.  Most 
of  the  other  authorities  appeared  in  Greek,  and 
one  of  the  tasks  of  the  Renaissance  scholars  was 
to  get  a good  Greek  manuscript  and  make  a read- 
able Latin  translation  from  it. 

THE  INCUNABULA 

An  interesting  arbitrary  convention  among 
bibliographers  assigns  special  value  to  any  book 
printed  before  1500.  Such  a book  is  called  an 
inclinable , or  “cradle  book,”  and  most  careful 
pedigrees  have  been  worked  up  for  all  such  books. 
For  example,  an  exact  census  is  kept  of  all  such 
books  which  may  have  found  their  way  into  the 
United  States. 

The  leading  authorities  on  incunabula  were 
Hain  and  Copinger,  who  tried  to  make  a com- 
plete check  list  with  accurate  descriptions  of  all 
the  incunabula.  Booksellers  and  bibliophiles  use 
such  a check  list  to  “collate”  copies  they  have. 
Sir  William  Osier  made  a similar  check  list  for 
medical  incunabula  up  to  1480.  He  lists  some  one 
hundred  and  seventy  medical  books  printed  up  to 
that  time.  The  chief  ones  are  Aristotle,  Avicenna, 


38 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


/A-  »•*  < 

. #■ 

$>2obemIum 


/wt  ■*«-  ■ 


TRrft  m»  j racnatea  bwitinfi 
i^abMiiramrjuc  Bma<n 
^dJKifrJtKlfjllJOGn  er 
lyw  ■KttutaJtfortus  oc  cdfo 
(•fafVH  ui.yf£><fw  pHas  £rtfc« 
f owbJkj  txita  mpltceer  (ml 
* onaJ  J . iob*c«  m twu  men 
~ i oacMposa  i aif  fame  t>ofla 
» fofli  kit tinuKo foli (nrt 
n.:mra  ip.ius  botu.lH  J vnfl  tonuj  boio 
WOx<  poirnm  appops-uii  i i ptii<  fcetoia 
-j..', uu.£jita  Jai  Mutant bona  Ji£  no 
t-itno:  40^45  ccuporkUTKiwa  nd-ga 
r-J tern in poivtl uc bore  ftdfoau 
i n.  qncipfcp cli otioJn  fxx  cil  q6  cx« 

1 piVoioc  Ix'aifo.-nnu.Sinelvnwct 
unorilT  quep  c* j «1I  foauna  n5  coon 
gu  die-  fdtcc.koj  mi  cdco.'dar  -£3oca’ 
^dfcoI'c-L-O.  in  cfon-i  foauue.  tua 
fount  q jiru.ilkuj  querent  nuliomo 
plidjlTcoJwiotrp  thu) at  cnrrxpulia 
m a font  iureXmatk  niiiri  cojnoTcdu 
ns«ti  otrantonc  atxumr  oifecdijcflcc 
tw  tv»u  ccipotw  Tom  iLuora  beau  bo 
mtntsxo  non  lira  bom  trn  appwpjuw. 
k«l  rtrnUu'  jUjc  inbcrnu.  wfa  *t«  afe 
bMuoanfiTKH  igfajbulora  m fvtf 
lt-«  bofe  pojiui~  iibt  jpfiiopaatrrf  ( 

W cfl  qt*  ce  i<lia  fnocw  0*ai  Seneca  I 
I quad!  efftloU  od  Luatiii  ipm  ^xiocjo 
iid  phajJtnjDJgniw  os  ratioan,  life 
nsee  -i  Rofirait  puQxr  eg  ; pauoa«a. 
jlrilo'r  <aTIo^:to.fijPt  ut»na»  ru  co 
TTUtoOity  u-.  txDrw  co~yD(i&«fctU 
quads  alii  i‘it  Cicro . iyi  ousm  rrLuqjj 
' feign ii.fi  foiuo  to  bueCTnantri.  Jijiqtf 
SomgTsnds  (ntniT  qnaFlvna.Jpliat 
I 171  iwflntr  hoiipol  its  lie  ar»p:opna 
rx  tu  ga  4P.r<r  bona  aicJFu  dipitopa 
Cup  o per  vnfi  bonu  i/i  frrDsc  i i'pofj- 
tin  ipr:  pf>  13  cdumiftvT  pot  Odinln-Jn 
cRtniit.'Jnqmtusqoidf  txTt®  . 

tuw  bsc.utfT  ooo  rigir.  T>nmo  cm  tsgU 
•pfuis  ad  pfnam  natnrale  indatattxic;  ■ ^ 
t affcaiifun^a  ipfi*  ab  ipfacTtoncaj 


oeauoon*:  i rnpcimmd.'pnma  gdi 
uttfli  ai  qkU.  pndl  <ni  iricnuti'5  boim 
tm  t»«i  uJturaUo  itma  online  -i"‘ 
qQulc  iB^ifccfnbiin.^Sfd  sdfulTior 
WUB  orrot  eddudt.  fjiamaojinotw 
KHWiD’ot  ex  cnmbncqsasio  er  boia  oa 
ginb  onpRcaonc-rtg:  ipto  to  foo  ft 
ne  otiiaa  sunaaoc  iJpmlW’i'i;  iiloz 
no  cat  -VJUh  ratuto^iCHnuutio  oa  a 
Cil  ■ lOrnbLK  bo  in,.  <^S5tOuj  \vro 
rsobw  boat  iMCumltf  prsmaitj 
tw/ji  TaWi:  J*m  nsagw.  1 p5i3>\T 
go  pjmu  pyCt  boio  o^TUiali  ipfcabc. 
Sia  mujiciiaifvii  nacjisito  ipfecuo  < ru 
tursm;  ulHUiiot  alkanfl  ai  lujppa; 
gfcaoneSu  H cfl  q$  ok  pb«  i p^ptnv'o 
ru-m  fti^cnncenl  qdj  outmo  ' optio  j 
c ippaiUUjUpfci  fomu  rrl  pfonocc. 
alnui  qui-ic  btuc^num-fjpbj  piowo. 
aluid  aiit  aptu  ruoi  dfc  ippacrc  a iSp, ! 
ticrjrcH'n  hn  ipnuo  ru air  j.Cipfa  rnu- 
utu  vC  j^cuitHlc^d  bd  tit  ointralKiT  j 
imjfetQftvp^ocnidf  tpfamc  q»mj  f 
ad  cotpus-^qim  *i  aifl-tdiua  ad  tor . 
ptia-mnafat  pamo  lob  impfcat  qtv 
date,  i ^pteT  6 oats  tit  iUh  nroeaug  , 
nKTU-touj  ipm  pduana  »b  impcrtixu 
i,i<iU(Jtc  -id  cinxi  rd  adpfeatox^ , 
njiiif  wuiigcis  ecupouo  -ab  crnifcoo  co 
rupcntibuo  orftnltdc.  "Raj  rjrurJ  abjo ; 
tradidu  coaosj  w fui  coipu  oefen  hone  ■ 
cjocJdmtxln  botr’crTHic  scjytijs  oetrf 
qacidicodb  po-OflJHlac  l nun  quead 
reoJo  pccostb".  totiU-  otbwbg  prpn^  ■ 
dilCtt  jdtiol.  £ jkf  <T<a  ad  atom  ru<u 
tur  i pf ctnu.'C'Gn to <yni  ad  a! Jtn  ficnli- 
lasi.afqwd  ad  inidlnani.  tJuontnj  ad 
fcnigitu  vcl  appoitnu.  i K eft  qt>  wcu 
pbc  p'eiintc'—^d  qutdc  fdnp  oei'CJi 
dd  opciTU-  Uidef  atit  i rn  bw  quoddi 
injutudUr  qokmp  .td uen.it  -;obui-Jt 
rpnu.appenoio  fertiuuuio.  fc:  Nx  no; 
ctaiietbKopoaUiU^pnJi  Ciuwwad 
otti\oao»Ki\Tii  Cnfiuiliup  c reiiite  toil 
cupifccne  qucu^nii  noino  er  pmo  cd 
tomuai  ^eeudb  rtalen  ipRa’q'td 
ud  a to;  uitHkcuoj.  t Kdt  qr>  owi  pbo 
;,  j aia.o.  q1  oftvn  pins  rmcrf-ifoe  liaii 
tsbtiLi  ran  in  q mbtl  dt  o»pk.ni  vFin  i 
feriptii-Un  ctum  paulo  an  otat.  THcv? 
nullin  mnihabjaicintdlranofenidu 
ruatri.im  bit  qua  poffthlw  Tixatno  c 
* ? nil’ll  toon  cor  q font  once  lint  "dlt- 

gtre.TSum'’ aac  att' e jnt  ino  rfettdtisi 


OS*- 


■ ..i~x 


-e  o o 


Fig.  2. — First  page  of  Jolianis  de  Jaduno,  Tres  libros  de  anima 
Aristotelis,  published  in  Venice,  July  1,  1480,  by  Johanis  Colonie. 
Note  how  type  and  illumination  imitates  manuscripts  of  period. 


Dondis,  Celsus,  Dioscorides,  and  Pliny.  It  is 
remarkable  that  the  real  Renaissance  authorities 
in  medicine,  Galen  and  Hippocrates,  were  not 
printed  until  after  this  time. 

Check  lists  of  medical  incunabula  in  leading 
American  medical  libraries  have  been  published 
from  time  to  time  in  The  Annals  of  Medical 
History.  The  chief  collections  of  medical  in- 
cunabula in  this  country  are  in  the  Surgeon- 
General’s  Library  and  in  the  College  of  Phy- 
sicians in  Philadelphia.  Sir  William  Osier’s  col- 
lection is  with  his  historical  books  at  McGill.  In 
the  recently  issued  Bibliotheca  Osleriana  there  is 
a full  description  not  only  of  Osier’s  incunabula, 
but  also  of  all  the  finely  printed  books  in  his  great 
collection. 

THE  FIRST  ILLUSTRATED  MEDICAL  BOOK 

In  1493  there  appeared  in  Venice  a huge  folio 
volume  called  Fasciculus  Medicinae,  which  pur- 
ported to  be  a collection  of  little  medical  works 
assembled  by  a certain  Johannes  de  Ketham.  It 
included  the  anatomical  notes  of  Mundinus,  a 
celebrated  Bolognese  professor,  the  first  to  revive 
formal  dissection,  and  a tract  or  two  by  Rhazes, 
the  great  Arabian  physician.  This  book  at  once 
became  popular,  and  in  1500  and  later  in  1513, 
was  republished  in  most  magnificent  form.  The 
publisher  was  the  celebrated  Gregorius  de  Gre- 
goris,  one  of  the  best  of  the  early  Venetian 
printers,  and  his  fame  was  muchly  enhanced  by 


this  beautiful  book.  It  has  been  called  the  finest 
illustrated  book  up  to  the  time,  and  it  was  the 
first  illustrated  medical  book. 

The  illustrations  are  very  clear,  simple,  archi- 
tectural line-drawings,  which  have  been  trans- 
ferred to  wood  with  consummate  skill.  The 
“statuesque  ease”  of  the  figures,  and  the  firm, 
simple  outlines  of  the  settings,  have  won  for 
these  pictures  the  admiration  of  all  artists. 

There  are  in  all  ten  cuts  in  the  book.  There 
are  the  traditional  “wound  men”  and  “bleeding 
men,”  and  also  the  traditional  circle  of  urine 
glasses.  These  pictures,  in  crude  form,  had  been 
circulated  for  some  time  as  separate  sheets,  and 
showed  the  places  on  a man  where  he  might  be 
bled,  and  the  colors  of  the  different  types  of 
pathological  urines,  or  the  kinds  of  wounds  a man 
might  receive.  But  the  best  of  the  pictures  are 
those  of  the  professor  in  his  chair,  supposed  to 
be  Petrus  de  Montagna,  reading  to  his  students 
from  some  authority,  while  his  prosector  points 
out  on  a cadaver  below  the  parts  of  the  body  ex- 
posed by  the  menial  barber.  The  other  is  the 
very  beautiful  sickroom  scene,  in  which  an  elderly 
woman  is  shown  reclining  on  a high  bed  while 
one  servant  smoothes  the  sheets  and  another  brings 
food.  Below  are  two  pages  holding  incense  tapers, 
for  the  patient  has  plague,  while  a physician  feels 
the  pulse  of  the  sick  woman,  meanwhile  holding 
an  aromatic  sponge  to  his  nose  to  keep  away  the 
infection.  This  picture  is  reproduced  for  this 
article. 

Gregorius  really  fostered  illustrated  medical 
books.  He  used  some  of  his  cuts  for  several 
different  books.  For  instance,  in  1502,  he  issued 
a collection  of  some  of  the  supposed  medical 
books  from  the  famous  school  of  Salerno,  under 
the  name  of  Articella,  or  Johannitius,  and  called 
Liber  Ysagogue.  This  carried  a cruder  picture 
of  the  “bleeding  man,”  and  is  here  reproduced  in: 
order  to  illustrate  the  kind  of  picture  this  famous 
representation  was.  The  various  points  on  the- 


Fig.  3. — Sick  room  scene  from  Ketham’s  Fasciculus  Medicinae r 
Gregorius,  Venice,  1500,  the  finest  illustrated  book  to  that  date. 


January,  1930 


FAMOUS  MEDICAL  PRINTERS — LEAKE 


39 


Fig.  4. — “Bleeding  man,”  from  Articella,  Liber  Ysagogue , Venice, 
1502. 

body  show  the  places  from  which  blood  may  be 
drawn. 

THE  ALDINE  PRESS 

The  original  printers  did  not  use  a title  page. 
To  have  done  so  would  have  spoiled  the  illusion 
of  the  work  having  been  hand-lettered  like  a 
regular  manuscript.  The  custom  developed  of 
putting  a little  note,  called  a colophon,  at  the  end 
of  the  printing,  telling  by  whom  the  work  was 
done,  where,  and  when.  Later  the  printers  began 
to  use  a distinctive  mark,  or  printer’s  device,  with 
which  to  identify  the  hooks  made  by  them.  One 
of  the  first  of  these  famous  devices  was  the 
anchor  and  dolphin  of  the  great  house  of  Aldus 
Manutius,  the  founder  of  a family  of  celebrated 
Venetian  printers.  He  was  also  among  the  first 
to  use  a title  page.  This  was  a very  simply  printed 
front  page  telling  what  the  volume  contained  and 
also  carrying  the  device  as  an  identification. 

But  the  Aldine  Press  is  chiefly  renowned  for 
its  introduction  of  italic  type  fonts.  The  older 
type  fonts  were  based  on  the  hand-lettering  of 
the  scribes  or  upon  the  carvings  of  the  ancient 
Roman  stonecutters.  The  beautiful  italic  style  is 
said  to  have  originated  from  an  attempt  on  the 
part  of  the  Aldine  Press  to  imitate  in  type  the 
delicate  handwriting  of  Petrarch,  the  great  Re- 
naissance humanist  and  author. 

Among  the  famous  Aldine  medical  books  is  an 
early  edition  of  Celsus,  printed  in  1528,  entirely 
in  italics.  This  is  one  of  the  first  medical  books 
to  have  a title  page.  With  the  clarity  and  brilli- 
ance of  its  type,  and  the  fine  quality  of  the  paper 
used,  it  is  indeed  a book  well  worth  cherishing. 

Another  famous  book  from  the  Aldine  Press 
is  the  first  Greek  edition  of  Hippocrates.  This 
appeared  in  1526,  and  contained  all  the  supposed 
works  of  Hippocrates  in  the  original  Greek.  The 
character  of  the  Greek  type  used  became  famed 


as  the  prototype  of  similar  fonts  employed  by 
later  printers. 

The  Aldine  Press  achieved  great  renown 
through  its  publication  in  magnificent  format  of 
the  chief  classical  writers  of  antiquity.  The  pub- 
lication of  these  books  not  only  was  a commercial 
success,  but  it  also  contributed  in  a marked  de- 
gree to  an  appreciation  on  the  part  of  the  people 
at  large  of  the  finer  literary  remains  of  the 
ancients. 

GREAT  FRENCH  PRINTERS 

Printing  did  not  make  a good  start  in  Paris ; the 
city-  was  too  much  under  the  control  of  the  con- 
servative aristocrats.  In  Lyons,  however,  nearer 
the  artistic  centers  of  Italy,  fine  printing  early 
flourished. 

Most  of  the  early  sixteenth  century  books  of 
Lyons,  however,  were  still  printed  in  black  letter. 
The  newer  fonts  were  slow  to  be  introduced. 
Among  the  prized  early  medical  books  from 
Lyons  are  various  works  of  Symphorien  Cham- 
pier,  1472-1539,  the  great  French  humanist  who 
did  so  much  to  give  the  real  meaning  of  Galen 
and  Hippocrates,  and  who,  using  his  name  as  a 
clue,  perhaps,  tried  to  harmonize,  or  produce  a 
symphony  from  the  conflicting  ideas  of  Galen, 
Hippocrates,  Aristotle,  and  the  Arabs.  This  work 
was  the  octavo  De  medicinis  Claris  scriptoris, 
issued  by  Etienne  Gueynard,  in  1506. 

Gilbert  de  Villiers  was  another  important  Lyons 
printer,  who  issued  the  beautiful  second  edition 
of  Dioscorides  as  a quarto  in  1512.  This  carried 
one  of  the  best  sixteenth  century  woodcuts  on 
the  title  page,  a variant  of  the  familiar  scene  of 
an  author  presenting  his  book  to  his  patron.  An- 
other important  work  published  by  Villiers  was 
the  Opera  Parva  of  Rhazes  in  1511.  This  again 
was  in  the  convenient  octavo  size. 

The  earlier  printers  published  their  books  in 
.the  regular  large  folio  size  of  the  ordinary  manu- 

IN  HOC  VO  LV  MINE  HA.EC 
C ON  TINEN  T VR . 

A.  V R E L r I CORNELI  I CELST  MEDICTNAE 
L I B R I • VIII.  QVAMEMENDATTSSIMT, 

CRAECIS  ETfAM  OMMIBVS 
DICTIONIBVS  RESTI* 

TVIIS. 

QV  INTI  SERENI  LIBERDE  MEDICINA 
ET  IPSE  CAJTICATISSJ 

A.CCEDIT  INDEX  INCELSVM,  ETSERE- 
NVM  SANE  QV  A M COPIOSVS- 


fEvetutorUtn  dccrtto,ru  quit  al'nfio  in  loco  VtTttt£&itionk 
hot  librot  btfnmat,imfrtffo('u(  alibi 

Fig.  5. — Title  page  to  the  1528  Aldine  edition  of  Celsus,  showing 
the  Aldine  device  and  italics. 


40 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  I 


La  dificdtion  des  parties  clu  corps 

humain  dmiTce  cn  rrois  liurcs,  fai<f>z  par  Charles  Eflicnnc 
dotflcurcn  Mcdccine:  aucc  les  figures  &i  dcclarano  dcs  in 
cifions.compofccs  par  Eflicnnc  de  la  Riuicrc  Chirurgicn. 


Impnmc  a Paris,  chcz  Simon  de  Colincs. 

I 5 4-  6. 

Auec  prnulegc  du  Roy. 

Fig.  6. — Title  page  to  Charles  Estienne’s  La  dissection  des  parties 
du  corps,  published  by  Simon  de  Colines  in  Paris,  in  1546. 

scripts.  It  was  the  Lyons  printers  who  popular- 
ized the  more  convenient  smaller  sizes.  Books  are 
usually  classified  by  size  according  to  the  number 
of  times  the  printed  sheets  are  folded  in  binding. 
Just  folded  once  they  are  “in  folio.”  Folded  to 
give  four  pages,  they  are  “in  quarto” ; to  give 
eight  pages  they  are  “in  octavo,”  and  so  on. 

The  most  famous  Lyons  printer  was  Gryphius, 
who  appropriately  enough  used  a griffin  as  his 
device.  In  1532  he  published  in  12mo  one  of  the 
first  authoritative  Latin  translations  of  the  Greek 
of  Galen  and  Hippocrates,  made  by  the  great 
Francois  Rabelais,  author  of  the  first  novels, 
Gargantua  and  Pantagruel.  Rabelais  lectured  for 
many  years  on  medicine,  and  is  even  supposed  to> 
have  written  his  witty  novels  in  the  attempt  to 
make  his  sick  patients  laugh  and  thus  the  more 
easily  get  well. 

In  these  handy  little  formats  most  of  the 
ancient  medical  authorities  were  issued  from  the 
busy  press  of  another  more  strictly  medical 
printer  in  Lyons.  This  was  Rovillius,  whose  de- 
vice may  be  seen  on  many  of  the  early  Renais- 
sance medical  texts.  He  put  his  books  out  es- 
pecially for  the  use  of  students — that  is,  in  a 
handy  form,  and  at  a little  more  reasonable  price 
than  that  charged  for  the  more  magnificent  tomes 
of  other  printers. 

With  Simon  Colines,  Paris  came  into  its  own 
in  the  fine  art  of  printing.  The  bootlegging  of 
Lyons  books  into  the  capital  made  it  apparent  that 
there  was  real  demand  for  good  books,  and 
Colines  secured  the  ecclesiastical  permission  to  do 
his  best.  He  issued  many  texts  of  Galen,  with 
translations  made  by  the  best  literary  men  of  the 
time,  among  them  Thomas  Linacre,  who  founded 

Note : Pictures  of  the  title  pages  of  many  of  the  books  mentioned 
above  may  be  seen  in  Sir  William  Osier’s  Evolution  of  Modern 
Medicine,  New  Haven,  1920.  In  the  huge  catalogue  of  his  library, 
compiled  by  W.  W.  Francis,  Archibald  Malloch,  and  L.  L.  Mackali 
( Bibliotheca  Osleriana) , one  may  find  interesting  notes  on  many  of 
the  significant  finely  printed  medical  books.  One  may  also  turn  to 
the  many  beautiful  catalogues  issued  by  Maggs  Bros,  of  London, 
R.  Lier  of  Florence,  and  Hertzberger  of  Amsterdam,  for  items 
about  the  medical  books  of  the  famous  presses  of  the  world. 


the  Royal  College  of  Physicians  of  London,  and 
Guinter  of  Andernach,  one  of  the  teachers  of 
Vesalius.  He  also  issued  in  1537  one  of  the  rare 
little  medical  tracts  of  Michael  Servetus,  who  dis- 
covered the  pulmonary  circulation,  and  who  was 
burned  under  Calvin  at  Geneva  in  1553  for  his 
theological  ideas.  One  of  Colines’  most  ambitious 
medical  books  was  the  De  dissectione  partium 
corporis  humanis  of  Carolus  Stephanus,  or  Esti- 
enne  (1506-1564),  who  was  himself  a member 
of  a great  family  of  Parisian  printers,  and  who 
antedated  Vesalius  in  trying  to  make  a real  study 
of  the  human  anatomy.  Unfortunately  this  fine 
folio  did  not  have  the  same  artistic  plates  that 
made  Vesalius’  work  so  successful,  and  it  was 
not  published  until  two  years  after  the  appear- 
ance of  Vesalius’  book. 

The  Stephanus  family,  Robert,  Charles,  and 
Henri,  published  several  fine  medical  works.  The 
first  folio  of  Alexander  of  Trales,  in  Greek  text, 
came  from  their  press  in  1548.  Henri  himself 
wrote  and  printed  one  of  the  first  and  handiest 
medical  dictionaries,  the  Dictionarium  medicum 
in  octavo  in  1564. 

University  of  California  Medical  School. 

(Part  II  of  this  paper  will  be  printed  in  the 
February  issue.) 


CLINICAL  NOTES  AND  CASE 
REPORTS 


EXTENSIVE  FRACTURE  OF  SKULL* 

REPORT  OF  CASE 

By  S.  Nicholas  Jacobs,  M.  D. 
and 

Lawrence  M.  Trauner,  M.  D. 

San  Francisco 

HPHE  following  case  is  interesting  from  the 
standpoint  of  the  great  amount  of  damage 
sustained  by  the  skull,  yet  resulting  in  complete 
recovery  of  the  patient. 

F.  L.,  male,  white,  age  twenty-two,  on  February  12 
was  thrown  to  the  street  from  a motorcycle,  strik- 
ing his  head  against  the  curbing.  He  was  rendered 
unconscious  for  about  five  minutes,  after  which  he 
was  semistuporous.  Upon  removal  to  the  Sutter  Hos- 

* From  the  Sutter  Hospital,  San  Francisco. 


Fig.  1.— Lateral  View 


January,  1930 


CASE  REPORTS 


41 


Fig.  2. — Posteroanterior  View 

pital  it  was  noted  that  there  were  multiple  lacera- 
tions about  the  scalp  and  face  with  evidence  of  con- 
siderable hemorrhage.  There  was  no  bleeding  nor 
escape  of  cerebrospinal  fluid  from  the  ears,  nose  or 
mouth.  Respiration  was  regular  and  quiet,  18  per 
minute;  pulse  regular,  80  per  minute;  blood  pressure, 
120/80.  There  was  no  motor  disturbance  of  the  face 
or  limbs.  Deep  and  superficial  reflexes  were  all  pres- 
ent and  normally  active.  Pupils  were  equal,  regular, 
and  reacted  to  light.  There  was  some  vomiting,  but 
not  of  the  projectile  type. 

Three  to  four  hours  later  some  symptoms  of  acute 
intracranial  pressure  developed:  the  blood  pressure 
showed  a marked  fluctuation  ranging  from  90  to  130 
systolic  and  10  to  68  diastolic,  with  a consequent 
variation  of  the  pulse  pressure;  the  pulse  and  respira- 
tion became  slower,  but  remained  regular.  This  con- 
dition lasted  five  days,  after  which  the  symptoms 
subsided,  the  blood  pressure,  pulse,  and  respiration 
remaining  at  constant  levels.  Temperature  was  sub- 
normal upon  admission  and  normal  thereafter. 

X-ray  pictures  taken  upon  admission  showed  (Figs. 
1 and  2)  a very  extensive  comminuted  fracture  involv- 


Fig.  3. — Showing  a large  ovoid  defect  in  the  right  parie- 
tal bone  where  the  comminuted  and  overlapping  fragment 
had  been  removed. 


ing  both  parietal  bones.  On  the  right  side  a fragment 
had  been  depressed  into  the  cranial  cavity.  There  was 
also  a depression  of  the  upper  fragment  of  the  parietal 
on  the  left  side.  There  was  a marked  diastasis  of  the 
coronal  suture  and  of  the  sagittal  suture  anteriorly. 
This  diastasis  no  doubt  accounted  for  the  symptoms 
subsiding  after  the  immediate  effects  of  shock:  the 
patient  had  decompressed  himself. 

The  patient’s  general  condition  improved  steadily 
under  absolute  bed  rest  and  sedatives.  At  this  time 
the  question  arose  as  to  the  advisability  of  surgical 
intervention,  it  being  felt  that  the  depressed  piece 
of  bone  would  irritate  the  cerebral  cortex.  However, 
due  to  the  extreme  shock  sustained,  it  was  deemed 
advisable  to  wait  one  month  before  removal  was  at- 
tempted. This  was  concurred  in  by  Dr.  H.  Naffziger, 
who  saw  him  in  consultation  with  us.  The  patient 
improved  steadily  during  this  interval  of  time  and 
operation  was  then  performed.  The  fracture  and 
overlapping  bone  were  exposed  through  an  inverted 
U-shaped  skin  flap.  After  removing  the  overlapping 
portions  of  bone,  the  dura  was  found  to  be  intact  but 
markedly  thickened  and  congested.  X-ray  pictures 
were  taken  four  days  after  the  operation  (Fig.  3). 

Recovery  was  uneventful  and  the  patient  was  al- 
lowed to  leave  the  hospital  on  the  fourteenth  day  after 
operation.  The  trephined  area  in  the  right  parietal 
region  was  protected  externally  by  an  aluminum  plate. 
He  did  not  complain  of  any  headache  or  dizziness 
and  was  mentally  alert.  He  has  continued  to  improve 
up  to  the  present  time,  seven  months  after  the  acci- 
dent, and  no  signs  of  cerebral  irritation  have  de- 
veloped. The  trephined  area  has  filled  in  to  within  a 
space  one  centimeter  in  diameter. 

1065  Sutter  Street. 


SELF-RETAINING  INTRA-UTERINE 
PESSARY 

REPORT  OF  CASE 

By  Olga  McNeile,  M.  D. 

Los  Angeles 

A FTER  eighteen  years’  experience  with  differ- 
ent  forms  of  self -retaining  pessaries,  it  has 
finally  been  my  privilege  to  find  one  that  is  nearly 
perfect. 

The  glass  stems  used  in  the  past  were  satis- 
factory except  for  the  danger  of  breaking  (I  have 
removed  several  broken  ones).  The  aluminum, 
gold,  and  silver  ones  caused  a cervical  irritation 


42 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


in  a very  short  time,  and  had  to  be  introduced 
with  the  use  of  capsule  which  contaminated  them. 
All  the  old  types  were  made  in  a limited  number 
of  sizes  which  often  were  not  adapted  to  the  indi- 
vidual anatomical  structure. 

I mentioned  my  problem  to  a friend  of  mine, 
Mr.  J.  J.  Cantor,  a designer  of  medical  appli- 
ances, who  thereupon  devised  a pessary  which  I 
have  used  during  the  past  six  months.  Indica- 
tions for  its  use  were  dysmenorrhea,  with  or  with- 
out an  anteflexion,  and  sterility.  This  pessary  can 
be  introduced  when  the  patient  is  in  the  office. 
Slight  dilatation  may  be  necessary.  The  pessary 
can  be  altered  to  various  lengths  to  suit  individual 
requirements. 

The  pessary  holds  itself  well  in  position  and 
does  not  cause  any  irritation  or  odor,  even  after 
being  worn  for  six  months.  After  the  usual  dila- 
tation under  an  anesthetic,  the  cervical  muscle 
tissue  is  torn,  often  causing  a secondary  contrac- 
tion. By  wearing  this  type  of  pessary,  from  one 
to  six  months,  the  cervical  canal  becomes  perma- 
nently dilated. 

REPORT  OF  CASE 

Mrs.  X. — Introduced  pessary  after  usual  dilatation. 
She  had  borne  two  children.  Operation  for  cervical 
repair  followed.  This  repair  had  a contracted  cervical 
canal  so  the  ordinary  uterine  sound  would  not  pass; 
and  also  had  caused  severe  premenstrual  dysmenor- 
rhea and  sterility.  Pessary  was  easily  removed  after 
having  been  worn  for  six  months.  At  no  time  did  it 
cause  erosion  of  the  cervix  or  any  leukorrhea.  Six 
months  have  passed  since  its  removal,  the  dysmenor- 
rhea no  longer  exists,  and  the  cervical  canal  is  of 
normal  diameter. 

2007  Wilshire  Boulevard. 


SURGICAL  CATASTROPHES  FOLLOWING 
OVERLOOKED  STONE 

REPORT  OF  CASE 

By  Stanley  H.  Mentzer,  M.  D. 

San  Francisco 

D -65787,  white,  male,  age  forty-one,  garage  me- 
chanic. 

Family  History  and  Past  History. — Unessential. 
Present  Illness. — Patient  had  been  perfectly  well  until 
one  year  ago  when,  after  no  previous  indigestion  or 
other  suggestive  signs  of  biliary  disease,  he  suddenly 
developed  an  attack  of  severe  pain  in  the  right  upper 
quadrant  which  radiated  posteriorly;  some  nausea  but 
no  vomiting,  no  jaundice,  no  clay-colored  stools.  Since 
that  time  he  had  had  characteristic  gall-bladder  dis- 
tress with  true  qualitative  food  intolerance;  flatulence 
and  belching  thirty  to  sixty  minutes  after  meals.  No 
chills  or  fever. 

Operation  (Elsewhere) . — Under  ether  anesthesia,  a 
relatively  noninflammatory  gall  bladder  containing 
two  cholesterin-rich  stones  was  found.  During  the 
cholecystectomy  the  gall  bladder  was  ruptured.  Some 
bile-oozing  occurred.  The  abdomen  was  closed  with 
a Penrose  drain. 

Interval  History.  — Patient  was  practically  well  for 
one  year  except  for  slight  jaundice,  which  was  inter- 
mittent. There  was  no  severe  pain,  no  chills  or  fever, 
until  the  second  attack  of  distress  one  year  after  the 
first  operation.  Then  rather  suddenly  the  patient  de- 
veloped severe  pain  in  the  upper  abdomen  with  deep 
jaundice,  chills,  fever,  and  clay-colored  stools.  A 
diagnosis  of  common  duct  stone  was  made  and  at 
operation  I found  a stone  in  an  anomalous  cystic 
duct  which  ran  parallel  to  the  common  duct  for  most 
of  its  length  and  drained  into  it  close  to  the  ampulla 
of  Vater.  Signs  and  symptoms  of  acute  duct  obstruc- 


tion were,  therefore,  due  to  the  extraneous  mass, 
i.  e.,  the  stone  within  the  cystic  duct  pressing  on  the 
common  duct.  The  stone  was  removed  and  a catheter 
sutured  into  the  cystic  duct  for  drainage.  The  com- 
mon duct  was  open  and  thoroughly  explored,  and  no 
stones  were  found. 

Postoperative  Course. — Patient  drained  bile  freely 
and  had  an  uneventful  convalescence  until  the  four- 
teenth day,  when  he  got  up  out  of  bed.  He  had  been 
walking  about  the  ward  approximately  half  a day 
and  felt  reasonably  well,  when  he  suddenly  fell  over 
in  a faint  which,  he  stated  later,  had  been  induced 
by  severe  upper  abdominal  pain.  He  rapidly  went 
into  shock,  and  four  hours  later  I performed  an  ex- 
ploratory operation.  Preoperative  diagnosis  of  bile 
peritonitis  or  mesentery  thrombosis  was  made.  The 
abdomen,  however,  was  filled  with  serosanguinous 
fluid,  four  quarts  of  which  were  removed.  Small  areas 
of  fat  necrosis  were  observed  in  the  omentum  and 
transverse  mesocolon  and  the  diagnosis  of  acute 
hemorrhagic  pancreatitis  was  obvious.  Literally  fist- 
fuls of  pancreatic  tissue  were  scooped  from  the  tail 
and  body  of  the  pancreas.  Abundant  Penrose  and 
gauze  drainage  was  effected  from  the  sloughing  area 
about  the  pancreas  through  the  transverse  mesocolon 
and  anterior  abdominal  wall. 

Patient  had  a stormy  convalescence  characterized 
essentially  by  vomiting  and  by  digestion  of  the  ab- 
dominal wall,  due  to  pancreatic  juice.  This  was  con- 
trolled more  or  less  by  Fuller’s  earth  dressings  and 
later  by  beef  juice  and  hydrochloric  acid  dressings. 

Three  weeks  later  a secondary  closure  of  abdominal 
wall  had  to  be  performed.  Patient  was  discharged 
from  hospital  three  months  after  the  second  opera- 
tion. There  was  still  slight  drainage  through  the 
abdominal  wall.  A month  later  drainage  had  stopped 
and  patient  was  practically  well — as  he  has  remained 
twelve  months  after  his  discharge  from  the  hospital. 
There  are  no  signs  of  pancreatic  insufficiency. 

Note. — The  case  is  of  unusual  interest  because  of: 
(1)  The  surgical  catastrophes  following  overlooked 
stone;  (2)  Anomalous  course  of  cystic  duct;  (3)  De- 
velopment of  acute  hemorrhagic  pancreatitis;  and 
(4)  Recovery  from  this  lesion  after  early  surgical 
intervention. 

450  Sutter  Street. 


Mme.  Curie  Here  for  Second  Gift  of  Radium. — 
America  has  been  recently  hostess  to  the  greatest 
woman  scientist  the  world  has  ever  known.  Mme. 
Marie  Curie,  co-discoverer  of  radium,  has  come  to 
accept  a second  gift  of  a gram  of  the  precious  sub- 
stance from  her  friends  and  admirers  in  this  country. 
When  the  first  gram  was  presented  to  her  in  1921, 
she  turned  it  over  to  the  Curie  Institute  of  the  Uni- 
versity of  Paris.  The  second  gram  will  be  given  to 
the  Warsaw  Cancer  Hospital,  which  since  1921  has 
rented  a gram,  Mme.  Curie  herself  paying  the  rental 
with  the  income  of  a money  gift  she  received  with  the 
first  gram  of  radium.  Warsaw  is  Mme.  Curie’s  native 
city,  although  she  has  worked  and  lived  most  of  her 
life  in  Paris.  Mme  Curie  and  her  husband,  Pierre 
Curie,  discovered  radium  but  refused  to  make  any 
personal  profit  from  their  discovery.  They  gave  it  to 
the  public  together  with  the  methods  they  evolved 
for  producing  radium.  These  same  methods  are  in 
use  today  in  the  radium  industry.  For  years  these 
great  and  generous  scientists  struggled  with  a meager 
income  and  without  even  an  adequate  laboratory. 
Pierre  Curie,  struck  by  a truck,  died  in  1906  without 
ever  having  a proper  laboratory  in  which  to  use  his 
great  talents.  Mme.  Curie  finally  acquired  the  labora- 
tory, planned  too  late  for  her  husband  to  enjoy,  in 
the  Curie  Institute.  However,  the  small  supply  of 
radium  in  her  laboratory  was  needed  by  the  govern- 
ment during  the  war,  and  after  the  armistice  she 
found  herself  without  any  of  the  precious  substance. 
Then  her  admirers  and  friends  in  America  came  to 
the  rescue  with  the  gram  of  radium  and  the  money 
which  was  meant  to  make  living  conditions  easier  for 
her.  Characteristically,  she  used  it  to  rent  radium  for 
the  Warsaw  Cancer  Hospital. — Science  Service. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 


THE  CAUSES  OF  ANGINA  PECTORIS 

Robert  William  Langley,  Los  Angeles.- — 
We  are  still  far  from  having  an  exact  conception 
of  the  mystery  of  pain  in  angina  pectoris.  As- 
suming, with  MacKenzie,  that  the  pain  is  an  ex- 
pression of  heart  muscle  fatigue  or  anemia,  the 
causes  then  are  those  which  produce  degenera- 
tive changes  in  either  the  heart  or  blood  vessels 
or  both.  A definite  symptom  complex  arises  on 
the  basis  of  the  above  pathological  changes,  and 
this  we  call  angina  pectoris. 

No  doubt  true  angina  may  occasionally  be 
found  on  the  basis  of  spasm  of  the  vessels  at 
the  base  of  the  heart  and  theoretically  upon  the 
basis  of  a spasm  of  the  coronary  vessels,  but  on 
the  whole,  actual  pathological  changes  tending 
toward  the  production  of  sclerosis  in  these  vessels 
are  to  be  found  in  the  great  majority  of  cases. 

The  time-worn  expression  “the  wear  and  tear 
of  life”  while  not  conveying  a great  deal  to  the 
average  layman  must  certainly  be  considered  an 
important  causative  factor  in  angina  pectoris. 
The  stress  of  the  busy  commercial  world,  the 
tremendous  pressure  and  worry  to  which  so  many 
individuals  are  subjected  constantly,  are  very  im- 
portant causative  factors.  When  these  factors  are 
combined  with  prolonged  irritation,  such  as  re- 
peated bacterial  or  parasitic  invasion,  over  indul- 
gence in  alcoholic  stimulants,  tobacco  and  other 
toxins,  high  blood  pressure  and  its  consequent 
degenerative  changes,  the  true  manifestations  of 
angina  pectoris  are  frequently  found.  The  inci- 
dence of  this  affection  is  greater  by  far  in  indi- 
viduals with  highly  organized  nervous  systems 
whose  lives  show  achievements  in  fields  of  mental 
endeavor.  Certain  classes  apparently  are  affected 
more  than  others.  The  occurrence  among  Jews 
is  very  common  while  rather  uncommon  in  the 
negro,  for  instance. 

MacKenzie,  after  analyzing  hundreds  of  cases, 
divided  them  into  five  groups  as  follows : 

1.  People  in  advanced  life,  about  fifty-five  and 
over,  in  whom  the  changes  in  the  arteries  are 
leading  to  a deficient  supply  of  blood  in  all  the 
organs,  and  in  whom  the  arterial  changes  are 
more  advanced  in  the  heart. 

2.  People  in  whom  the  arterial  changes  are 
proceeding  in  the  heart  with  greater  rapidity  and 
the  disease  is  not  capable  of  being  checked  and 
a fatal  issue  speedily  follows. 

3.  People  with  damaged  valves,  especially  aortic 
regurgitation. 

4.  People  whose  hearts  are  embarrassed  by 
having  to  labor  against  arterial  destruction,  as 


in  chronic  disease  of  the  kidney  with  high  blood 
pressure  and  damaged  arteries. 

5.  A small  indefinite  group  comprising  rare 
conditions  impossible  to  classify. 

It  will  be  seen  from  this  classification  that  Mac- 
Kenzie gave  very  little  credit  to  acute  cardiac 
irritants  or  toxins  giving  rise  to  true  angina  pec- 
toris. It  is  quite  true  that  he  discussed  a group 
of  cases  giving  rise  to  atypical  manifestations 
similar  to  angina  pectoris  which  he  chose  to  call 
pseudo-angina,  truly  an  unfortunate  term.  An- 
gina pectoris  is  a real  entity,  according  to  our 
present  conception,  and  the  pathology  does  not 
permit  the  recognition  of  this  false  type.  Attacks 
of  angina  are  frequently  precipitated  by  taking 
food.  This  is  especially  true  if  the  individual 
attempts  physical  effort  shortly  after  taking  a 
meal.  It  becomes  necessary  to  insist  upon  this 
relation  of  food  and  effort  to  the  pain  of  angina, 
for  many  patients,  and  even  some  doctors,  con- 
sider the  signs  very  certain  evidences  of  indi- 
gestion. 

* * * 

Joseph  M.  King,  Los  Angeles. — Much  has 
been  written  and  many  speculations  indulged  in 
regarding  -the  exact  causation  of  that  symptom 
complex  called  angina  pectoris,  and  while  the  true 
pathology  of  any  condition  and  its  etiology  are 
of  the  utmost  importance,  yet  our  chief  concern 
as  bedside  practitioners  is  the  correct  diagnosis, 
prognosis,  and  treatment. 

Several  heart  conditions  give  rise  to  anginal 
pain,  and  when  a patient  presents  himself  it  is 
wise  to  differentiate  these  if  possible,  even  when 
he  has  as  symptoms  only  the  classic  triad  of 
substernal  or  more  rarely  precordial  pain,  with 
radiation  to  various  parts  of  the  body  but  chiefly 
the  left  shoulder  and  arm,  and  a sense  of  im- 
pending death  during  the  seizure.  Syphilis  of 
the  aorta,  weakening  as  it  does  the  resistance  of 
the  vessel  wall,  presents  a stretching  which  often 
gives  rise  to  a true  anginal  symptom  complex.  In 
this  connection  it  is  well  to  remember  that  the 
Wassermann  test  is  not  always  positive  in  syphilis 
of  the  blood  vessels,  and  in  suspicious  cases  not 
only  should  it  be  repeated  but  the  history  should 
be  thoroughly  considered  and  very  careful  x-ray 
studies  made  for  possible  widening  of  the  vessel. 
In  this  way  only  can  one  avoid  the  unpleasant 
awakening  a few  years  later  to  the  fact  that 
the  pathology  presented  has  led  on  to  aneurysm, 
untreated. 

It  is  well  also  to  remember  that  the  substernal 
pain  may  be  very  low  or  even  absent,  and  that  the 
radiation  of  the  pain  is  variable.  Due  to  epigastric 


43 


44 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


or  abdominal  distress  angina  has  not  infrequently 
been  mistaken  for  acute  gall-bladder  disease,  gas- 
tric ulcer,  or  even  acute  perforation  from  ulcer, 
renal  colic,  or  acute  appendicitis.  But  a careful 
consideration  of  the  history,  the  absence  of  fever, 
the  normal  leukocyte  count,  the  presence  of  re- 
spiratory difficulty,  and  the  age  of  the  patient  will 
usually  serve  to  rule  out  acute  abdominal  con- 
ditions. The  diagnosis  of  “indigestion”  when 
made  on  an  elderly  patient  who  has  distress  on 
exertion  after  a hearty  meal  should  be  looked  on 
with  grave  suspicion.  In  fact,  if  pain  in  the  chest 
is  clearly  related  to  exercise,  especially  if  associ- 
ated with  a full  stomach  or  mental  emotion,  it 
should  be  regarded  as  anginal  unless  proved 
otherwise. 

While  many  emotional  states  may  be  accom- 
panied with  seeming  distress,  it  is  certainly  mis- 
leading to  term  them  “pseudo-angina”  or  “false 
angina.”  It  is  also  a cloak  for  our  lack  of  exact 
knowledge  of  the  particular  case,  for,  as  Potain 
has  said,  “There  are  no  false  diseases;  there  are 
only  false  diagnoses.”  Many  of  the  attacks 
termed  pseudo-angina  are  in  reality  the  early 
manifestations  of  a malady  which  will  ultimately 
claim  the  patient’s  life.  It  must  be  remembered 
that  angina  may  run  a much  longer  course  than 
was  formerly  supposed  and  that  many  patients 
suffering  with  angina  have  very  mild  attacks  for 
years.  We  must  also  remember  that  severe  an- 
ginal attacks,  leading  even  to  death,  may  not  be 
accompanied  by  severe  pain. 

On  the  other  hand,  now  that  the  laity  has  be- 
come so  conversant  with  the  symptoms  of  various 
diseases,  many  neurotic  individuals  present  them- 
selves with  a history  difficult  to  evaluate.  A suffi- 
cient study  of  the  patient,  however,  serves  to 
show  his  emotionalism.  If  the  physician  is  so 
fortunate  as  to  be  present  during  one  or  two  of 
these  attacks,  which  seldom  give  the  impression 
of  true  pain,  he  will  usually  have  no  difficulty  in 
ascribing  these  cases  to  psychic  phenomena. 

Finally  we  should  not  overlook  the  toxic  an- 
ginas brought  on  by  tobacco,  and  possibly  occa- 
sionally by  tea  or  coffee.  These  are  very  easy  to 
determine.  The  giving  up  of  the  supposed  dele- 
terious substance  is  followed  very  promptly  by 
a cessation  of  the  attacks. 

* * * 

Harry  Spiro,  San  Francisco. — In  a case  of 
suspected  angina  pectoris  the  history  is  of  the 
utmost  importance.  A patient  may  have  physical 
signs,  laboratory  signs,  and  x-ray  signs  showing 
that  an  aortitis  is  present,  that  a degree  of  myo- 
cardial disease  is  present,  or  that  hypertension  or 
hypotension  exists  with  no  symptoms  of  pain. 
That  patient  has  not  angina  pectoris.  His  prog- 
nosis is  better  than  that  of  another  patient  with 
identical  physical  and  laboratory  findings  who 
complains  of  pain  in  the  region  of  the  heart 
coincident  with  exercise  and  distinct  relief  by  rest. 
This  latter  symptom  is  of  utmost  importance  and 
almost  pathognomonic  of  angina  pectoris. 

The  points  in  the  history  that  indicate  a true 
angina  are : first,  pain  with  exercise,  and  second, 


relief  of  that  particular  pain  by  rest.  I do  not 
agree  with  the  author  who  speaks  of  “angina  pec- 
toris without  pain” ; I know  a patient  may  have  a 
coronary  artery  thrombus  and  no  pain. 

Of  more  than  ordinary  importance  is  the  char- 
acter of  the  pulse  during  an  attack  of  angina  pec- 
toris. Very  often  a physician  is  led  to  question 
the  presence  of  an  attack  of  angina  pectoris  be- 
cause the  patient  has  a moderately  slow,  fairly 
strong  and  perfectly  regular  heart  beat  during 
the  attack  of  pain.  He  may  have  observed  his 
patient  between  attacks  of  pain  and  noted  that 
the  pulse  is  practically  the  same  as  during  the 
attacks  of  pain.  This  ordinarily  is  the  rule.  It  is 
exceptional  (to  be  noted  later),  to  find  a varia- 
tion in  the  pulse  during  an  attack.  The  above 
character  of  the  pulse  is  not  indicative  of  the  mild- 
ness of  the  condition.  A “good”  pulse  during 
attacks  is  not  safe  datum  upon  which  to  base 
either  diagnosis  or  prognosis. 

When,  however,  in  an  attack  the  pulse  rate  is 
very  fast  or  the  volume  or  size  very  small,  or 
the  volume  very  changeable,  when  the  pulse  seems 
to  fade  out  and  get  stronger  again  under  the 
fingers,  the  patient  is  in  deadly  peril  and  the  prob- 
abilities are  that  this  attack  of  angina  pectoris 
has  been  caused  by  a fresh  coronary  artery  throm- 
bus. When  during  an  attack  the  pulse  becomes 
small  in  volume  and  remains  so  for  days  and  then 
develops  irregularity,  even  extrasystoles,  death 
may  be  imminent.  When  following  an  apparent 
recovery  from  an  attack  of  angina  pectoris  pro- 
duced either  by  an  irritable  aorta,  a spasm  of  the 
coronary,  or  coronary  thrombus,  the  pulse  re- 
mains rapid,  the  patient  feels  well  and  anxious 
to  get  up,  he  is  still  in  danger  and  should  not  be 
permitted  to  get  up  until  the  pulse  rate  has  low- 
ered permanently  to  around  eighty-four. 

Pain  in  the  heart  region,  not  distinctly  related 
to  exercise  or  relieved  by  rest,  but  associated  with 
palpitation  coming  on  without  apparent  reason 
may  be  indicative  of  ventricular  tachycardia. 
During  an  attack  of  ventricular  tachycardia  the 
type  pulse  is  a very,  very  fast  run  of  short  or 
long  duration,  immediately  followed  by  a slowing 
of  rate  and  then  an  apparently  rapid  increase.  At 
the  apex  beat,  when  a rapid  ta-ta-ta  is  heard  as 
fast  as  can  be  counted,  an  exact  diagnosis  is 
imperative,  and  an  electrocardiogram  should  be 
made.  Not  infrequently  a patient  has  attacks  of 
pain  in  the  region  of  the  heart  or  under  the  ster- 
num, unrelated  to  exercise  or  to  excitement  but 
to  an  attack  of  palpitation  of  very  rapid  heart 
action  of  which  the  patient  is  conscious.  This 
may  be  merely  an  arrhythmia  of  some  sort  which 
if  relieved  may  permanently  cure  the  patient  of 
attacks  of  so-called  angina  pectoris.  This  arrhyth- 
mia may  be  either  extrasystoles,  auricular  or  ven- 
tricular, in  series,  causing  tachycardia  or  the 
above  mentioned  ventricular  tachycardia,  both  of 
which  conditions  are  frequently  and  brilliantly 
relieved  by  quinidin. 

I believe  there  is  a relationship  between  the 
degree  of  pain  and  the  prognosis,  that  is,  the 
greater  the  pain  the  more  dangerously  ill  the 


January,  1930 


BEDSIDE  MEDICINE 


45 


patient ; the  easier  to  produce  pain  the  more  dan- 
gerous; the  length  of  time  the  pain  lasts — the 
longer  the  duration  of  pain  the  more  severe  the 
case;  the  quicker  the  relief  with  drugs  the  less 
dangerous  the  case ; and  attacks  of  pain  markedly 
increased  in  frequency  call  for  extreme  caution ; 
however,  some  patients  only  have  one  or  two 
attacks  of  pain  and  then  death. 

* * * 

J.  Marion  Read,  San  Francisco. — If  every 
patient  with  albuminuria  had  Bright’s  disease,  if 
every  one  with  a murmur  had  endocarditis,  and 
if  precordial  pain  radiating  down  the  arm  always 
meant  angina  pectoris,  etc.,  the  diagnostic  prob- 
lems of  the  internist  would  be  greatly  simplified. 

While  true  angina  pectoris  describes  a fairly 
definite  clinical  picture  there  are  no  characteristic 
physiologic  or  anatomic  changes  found  ante-  or 
postmortem.  It  is  probably  because  of  this  fact 
that  the  term  “angina  pectoris”  has  been  used  to 
describe  almost  all  precordial  or  substernal  pain 
radiating  down  the  left,  or  right  arm,  or  both. 

When  used  in  this  sense  the  term  really  repre- 
sents a symptom  complex  rather  than  a clinical 
entity.  But  as  bedside  physicians,  it  is  in  this 
guise  that  diagnostic  problems  present  themselves 
to  us. 

While  the  greatest  number  of  disease  states  in 
which  this  sensory  symptom  complex  occurs  are 
cardiac,  or  circulatory,  it  may  be  found  also  in 
mediastinitis,  herpes  zoster  or,  perhaps  more  fre- 
quently, in  the  radicular  syndrome. 

Typical  anginal  pain  may  occur  in  paroxysmal 
tachycardia,  or  anemia  (especially  the  pernicious 
form),  and  in  hypothyroidism.  In  all  of  these  the 
heart  itself  may  be  organically  sound,  but  the  seat 
of  the  pain  is  nevertheless  in  the  heart.  Typical 
anginal  pain  may  occur  also  in  aortic  insufficiency. 
Anginal  pain  occurs  in  coronary  artery  disease, 
including  thrombosis  and  in  true  angina  pectoris. 
There  may  be  some  question  as  to  whether  or  not 
the  same  pathologic  changes  underlie  both  dis- 
eases, but  I refer  to  true  angina  pectoris  to  desig- 
nate the  clinical  picture  described  by  William 
Heberden,  who  chose  the  term  “angina”  because 
of  the  sensation  of  pressure  or  constriction  which 
is  such  a prominent  symptom  of  this  condition, 
and  which  the  term  really  means.  Heberden 
wrote,  “The  seat  of  it  and  the  sense  of  strangling, 
and  anxiety  with  which  it  is  attended,  may  make 
it  not  improperly  to  be  called,  angina  pectoris.” 

But  by  long  usage  the  term  “angina”  has  come 
to  be  translated  pain,  rather  than  suffocation,  and 
there  are  described  under  the  heading  of  angina 
pectoris  almost  every  cardiac  affection  associated 
with  pain.  For  purposes  of  prognosis,  treatment 
and  further  study  of  cardiac  disease  characterized 
by  pain,  it  seems  logical  to  restrict  the  term 
“angina  pectoris”  to  the  small  group  of  cases 
which  so  clearly  fit  the  description  given  by 
Heberden,  namely,  those  whose  attacks  are  pro- 
duced nearly  always  by  exertion,  are  accompanied 
by  an  alarming  sensation  of  suffocation,  pain,  and 


impending  death,  in  whom  the  attack  ceases  with 
absolute  immobility  and  who  usually  die  suddenly. 

It  seems  probable  that  the  pain  which  occurs 
in  true  cardiac  affections  (excluding  pericarditis 
and  aortitis)  is  in  the  great  majority  of  cases  due 
to  anoxemia  of  the  heart  muscle,  either  relative 
or  absolute.  Disease  of  the  coronary  arteries, 
anemia,  and  hypotension,  all  predispose  to  myo- 
cardial anoxemia  and  all  these  may,  singly  or  in 
combination,  be  factors  in  precipitating  attacks  of 
angina  pectoris. 

Despite  the  same  age  incidence  and  the  fre- 
quent necropsy  finding  of  coronary  artery  changes, 
there  is  an  additional  nervous  factor  which  plays  a 
prominent  part  in  angina  pectoris.  Brain  workers, 
those  with  highly  organized  nervous  systems,  the 
“high  strung,”  nervous,  emotional  and  mentally 
active  individuals  seem  predisposed  to  this  dread 
disease.  It  occurs  in  almost  epidemic  form  fol- 
lowing financial  crises,  earthquakes,  wars,  and 
other  calamitous  happenings.  It  is  much  more 
frequently  encountered  in  private  practice  than 
in  clinics  or  hospitals  for  the  poor.  The  same  can- 
not Ije  said  of  coronary  thrombosis,  which  seems 
to  strike  rich  and  poor  alike.  Incidentally,  the 
latter  disease  may  occur  without  pain,  although 
the  accompanying  objective  signs  are  numerous, 
while  in  angina  pectoris  these  are  usually  few,  if 
any,  while  the  subjective  manifestations  take  first 
rank  among  those  of  all  other  diseases. 

In  the  last  twenty  years  the  work  of  Herrick 
and  others  has  established  coronary  thrombosis 
as  a clinical  entity  and  its  subjective,  as  well  as 
objective,  manifestations  are  usually  distinguish- 
able from  true  angina  pectoris.  I cannot,  there- 
fore, agree  with  the  previous  writer  when  he  says 
that  an  “attack  of  angina  pectoris  has  been  caused 
by  a fresh  coronary  artery  thrombosis.” 

The  action  of  nitrites  in  angina  pectoris  and 
the  seemingly  favorable  results  which  have  at- 
tended cervical  sympathectomy  in  some  cases  are 
features  which  warrant  further  consideration  and 
tend  to  distinguish  this  disease  from  coronary 
thrombosis.  * * * 

William  Dock,  San  Francisco. — The  occur- 
rence of  substernal  (usually  not  submammary) 
distress,  on  effort,  excitement,  or  exposure  to 
cold,  which  is  relieved  by  rest  (often  in  the  erect 
posture)  or  by  nitrites,  is  sufficient  for  a “work- 
ing diagnosis”  of  angina.  If  the  pain  occurs  more 
after  meals,  on  ascent  but  not  on  the  level,  and 
radiates  into  arms  or  upper  abdomen,  the  im- 
pression is  strengthened.  Absence  of  all  physical 
evidence,  by  x-ray,  electrocardiogram,  blood  pres- 
sure, and  physical  examination  does  not  alter  the 
diagnosis.  The  pain  may  be  partly  abdominal  and 
accompanied  by  nausea,  but  the  relation  to  effort 
is  typical  and  of  the  greatest  importance. 

Similar  pain,  of  longer  duration,  and  even 
occurring  at  rest  may  be  due  to  paroxysmal 
tachycardia,  thyroid  disease,  profound  anemia, 
aortic  stenosis  or  insufficiency,  or  to  occlusion  of 
a coronary  artery,  and  should  be  sharply  differ- 
entiated from  pure  angina  pectoris. 

The  prognosis  varies  with  frequency,  severity, 
and  duration  of  disease.  The  longer  the  disease 


46 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


has  lasted  without  increase  in  severity  the  better 
the  prognosis,  and  the  greatest  care  should  be 
given  to  those  who  have  had  only  a few  attacks. 
Very  severe  attacks  may  recur  for  many  years 
and  hence  no  absolute  prognosis  can  be  given. 
Certain  physical  findings:  pulsus  alternans  (as 
noted  in  taking  systolic  pressure);;  gallop  rhythm 
on  exercise ; hypertension  increased  during  at- 
tacks ; abnormal  ventricular  complexes  in  the 
electrocardiogram,  all  suggest  a shorter  course. 
There  is  no  marked  correlation  between  senile 
sclerosis  of  the  aorta,  which  Doctor  Spiro  in- 
cludes in  the  x-ray  diagnosis  of  “aortitis”  and 
severity  of  heart  disease.  Anatomically  the  root 
of  the  aorta  and  coronaries  may  be  severely  dam- 
aged, even  by  syphilis,  with  no  change  in  the  arch, 
and  severe  sclerosis  of  arch  and  descending  aorta 
occur  often  with  the  root  of  the  aorta  and  coro- 
naries undamaged. 

As  to  therapy,  rest  (especially  after  meals), 
moderation  in  eating,  drinking,  and  exercise  are 
of  greatest  importance.  The  most  useful  drug  is 
nitroglycerin,  to  be  taken  under  the  tongue  for 
attacks  of  pain,  or  on  occasions  such  as  -stair- 
climbing,  sexual  intercourse,  etc.,  which  pre- 
dispose to  attacks.  Theobromin  in  ten-grain  dose 
three  times  a day  for  prevention  of  attacks  occa- 
sionally gives  a satisfactory  result;  theocin  and 
euphyllin  but  rarely  succeed  when  this  fails,  but 
should  be  tried.  Superior  cervical  sympathectomy 
is  often  effective  and  is  less  dangerous  than  other 
types  of  operative  treatment. 


Blindfolded  Pilots  Fly  Spiral  Courses. — Experi- 
ments conducted  have  demonstrated  that,  when  blind- 
folded, an  airplane  pilot  will  nearly  invariably  show 
the  same  tendency  to  deviate  from  the  straight  path  of 
flight  and  take  up  a spiral  one,  that  a blindfolded  per- 
son does  when  in  motion  on  the  ground,  it  was  stated 
September  7 by  the  National  Advisory  Committee  on 
Aeronautics. 

The  statement  in  full  text  follows: 

Tradition  says  that  the  normal  tendency  of  a man 
who  is  walking  without  visual  reference,  as  when 
lost  in  a forest  or  in  a dense  fog,  is  to  take  a circular 
path. 

This  traditional  tendency  has  been  investigated 
experimentally  and  reported  upon  exhaustively  by 
Dr.  Asa  A.  Schaeffer  of  the  zoological  laboratory  of 
the  University  of  Kansas.  He  finds  that,  whether 
walking,  swimming,  rowing  a boat,  or  driving  an 
automobile,  the  tendency  of  a blindfolded  person  is 
always  to  follow  a spiral  path. 

Such  a tendency  would  naturally  be  of  greater  im- 
portance in  flight  than  perhaps  anywhere  else,  and  it 
was  the  intention  of  these  experiments,  carried  on 
by  the  National  Advisory  Committee  for  Aeronautics 
at  Langley  Field,  Virginia,  to  determine  whether  the 
same  tendency  normally  appeared  in  the  piloting  of 
aircraft. 

For  the  purpose  of  these  experiments,  a dual  con- 
trol VE-7  airplane  was  used.  The  subject  pilot  was 
placed  in  the  front  seat,  which  was  located  approxi- 
mately at  the  center  of  gravity  of  the  airplane.  In 
this  position  the  subject  pilot  was  less  influenced  in 
piloting  by  the  accelerations.  A safety  pilot,  who 
also  served  as  observer,  occupied  the  rear  seat. 

A face-mask  type  of  goggles,  in  which  the  glasses 
were  replaced  by  light-tight  pieces  of  cardboard  and 
black  paint,  was  used  as  a very  effective  blindfold. 

The  subject  was  usually  directed  to  take  off  and  fly 
to  some  safe  altitude  at  which  steady  air  conditions 
existed,  in  the  meantime  getting  accustomed  to  the 


flying  qualities  of  the  airplane.  At  this  point  the  ob- 
server took  over  the  controls,  and  the  subject  pilot 
assumed  the  “blind  condition’’  but  putting  on  the 
goggles. 

The  airplane  was  then  brought  into  position  for 
straightway  flight  by  the  observer  and  turned  over 
to  the  subject  pilot,  who  then  attempted  to  maintain 
straight  flight. 

It  was  found,  without  exception,  that  no  subject 
pilot  maintained  a straight  flight  path  for  any  appreci- 
able time,  but  soon  brought  the  airplane  into  a prop- 
erly banked  turn,  which  was  maintained  for  varying 
periods.  This  circling  flight,  after  a few  turns,  fre- 
quently assumed  a shorter  radius  with  a consequent 
greater  bank,  terminating  in  the  nose  dropping  well 
down  into  a diving  spiral. 

At  this  point  the  safety  pilot  reassumed  the  control 
and  placed  the  airplane  again  in  straight  flight  or  in 
a wide  turn  to  the  left  or  right,  and  the  subject  pilot 
then  attempted  to  attain  and  maintain  straight  flight, 
as  previously  explained.  There  appeared  little  differ- 
ence in  the  results,  whether  they  started  in  straight 
flight  or  in  a turn. 

A . continuous  record  was  kept  during  the  intervals 
of  flight  made  by  the  subject  pilot.  By  assuming  a 
zero  starting  point  at  the  beginning  of  each  flight,  it 
was  possible  to  follow  the  course  of  the  airplane,  in- 
cluding at  the  same  time  information  in  regard  to  the 
degree  of  bank,  air  speed,  and  any  unusual  maneuver 
that  the  pilot  made  in  his  endeavors  to  maintain  a 
straight  course. 

In  the  total  number  of  cases  examined,  it  was 
found  that  equally  as  many  turned  to  the  right  as  to 
the  left,  while  a very  small  proportion  of  the  flights 
showed  a heterotropic  tendency,  that  is,  to  turn  in 
either  direction,  or  to  reverse  directions  in  a single 
flight.  Whether  the  subject  pilot  was  right-  or  left- 
handed  made  little  difference  in  this  respect. 

Many  pilots  have  felt  that  the  flying  sense  was 
largely  one  of  muscular  balance  and  that  visual  refer- 
ence played  a more  or  less  insignificant  part.  These 
experiments  should  serve  to  remove  this  idea,  and 
develop  appreciation  of  the  fact  that  muscular  bal- 
ance plays  an  extremely  small  part  in  flying,  except- 
ing in  correlation  with  visual  reference  in  the  develop- 
ment of  a polished  technique. 

Visual  references  of  some  sort  must  be  provided, 
either  by  the  horizon,  or  by  the  reflection  of  the  sun 
or  moon  while  in  dense  fog  or  clouds,  or  by  proper 
instrumental  equipment. 

It  will  be  noted  that  these  experiments  in  no  way 
parallel  any  normal  condition  of  flight,  since,  being 
blindfolded,  the  subject  pilot  had  absolutely  no  oppor- 
tunity for  visual  reference  of  any  kind,  a condition 
which  seldom  could  occur  in  actual  practical  flight. 

The  fact  should  not  be  neglected  that  the  use  of 
proper  navigational  instruments  provides  an  artificial 
horizon,  if  not  in  a single  instrument,  then  in  the 
correlation  of  several  instruments,  such  as  a turn  and 
bank  indicator  and  an  air-speed  meter. — United  States 
Daily,  September  9,  1929. 


First  International  Congress  on  Mental  Hygiene 
will  be  held'^at  Washington,  D.  C.,  May  5 to  10,  1930. 
Many  subjects  are  listed  on  the  program  of  the  First 
International  Congress  on  Mental  Hygiene,  just 
received  from  John  R.  Shillady,  administrative  secre- 
tary, 370  Seventh  Avenue,  New  York  City.  Practi- 
cally all  aspects  of  mental  hygiene  will  be  covered 
at  the  congress.  Details  of  the  program  have  been 
worked  out  by  a committee  of  which  Dr.  Frankwood 
E.  Williams,  medical  director  of  the  National  Com- 
mittee for  Mental  Hygiene,  is  chairman,  collaborating 
with  correspondents  in  many  countries.  Topics  are 
now  ready  for  publication,  and  are  contained  in  an 
informing  thirty-three-page  Preliminary  Announcement, 
obtainable  from  headquarters  office.  The  congress 
will  be  held  in  Washington,  D.  C.,  May  5 to  10,  1930. 
President  Hoover  accepted  the  honorary  presidency 
of  this  congress,  and  delegates  are  expected  from 
more  than  thirty  countries. 


January,  1930 


EDITORIALS 


47 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Official  Organ  of  the  California,  Utah  and  T^e-vada  t Medical  cAssociations 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 

Telephone  Douglas  0062 

TC~~  f GEORGE  H.  KRESS 

t'dltors I EMMA  W.  POPE 

Associate  Editor  for  Nevada  . . . HORACE  J.  BROWN 

Associate  Editor  for  Utah J.  U.  GIESY 

Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 

single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  Address. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned. 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  _ not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects.  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 

Contributions — Exclusive  Publication. — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


EDITORIALS 


THE  C.  M.  A.  AND  THE  YEARS  1929  AND  1930 

Greetings. — Another  calendar  year  has  come 
to  its  close,  and  a new  year — 1930 — has  been 
ushered  into  existence.  California  and  West- 
ern Medicine  again  has  the  privilege  of  extend- 
ing the  felicitations  of  the  season  to  its  readers, 
and  of  expressing  the  hope  that  1930  will  be  a 
year  of  progress  for  organized  medicine  in  the 
states  of  California,  Nevada  and  Utah,  and  of 
satisfactory  achievement  for  the  members  of  the 
medical  associations  of  those  commonwealths. 

At  this  time  when  resolutions  for  the  new  year 
are  the  order  of  the  day,  it  may  be  proper  also  to 
dwell  for  a few  moments  on  some  of  the  aims 
which  were  realized  in  1929. 

* * * 

California  Medical  Association  Incorporation. 
The  California  Medical  Association  by  vote  of 
more  than  two-thirds  of  its  members  has  ap- 
proved the  recommendations  of  the  Council  and 
of  the  House  of  Delegates  that  it  be  incorpo- 
rated in  accordance  with  the  resolutions  passed 
at  the  last  annual  session  at  San  Diego.  This 
fait  accompli  should  be  gratifying  to  the  entire 
membership  of  the  Association.  It  is  particularly 
pleasing  to  the  members  of  the  Council,  who  have 
given  much  thought  and  study  to  the  subject  dur- 
ing the  last  several  years  and  who  are  convinced 


that  this  incorporation  will  make  for  a more  sub- 
stantial association  permanency  and  for  greater 
developmental  progress  than  would  otherwise 
have  been  possible. 

* * * 

Revised  Constitution  and  By-Laws. — Closely 
identified  with  the  incorporation  of  the  California 
Medical  Association  was  the  revision  of  the  con- 
stitution and  by-laws  of  the  Association.  A copy 
of  the  new  rules  of  procedure  has  been  mailed 
to  all  members  of  the  California  Medical  As- 
sociation. Any  member  who  has  not  received  a 
copy  is  requested  to  notify  the  central  office  at 
San  Francisco. 

This  revised  constitution  and  by-laws  has  at- 
tracted the  attention  of  the  national  and  of  other 
state  associations,  and  at  the  annual  conference 
of  state  society  secretaries  and  editors  which  was 
held  at  the  American  Medical  Association  head- 
quarters at  Chicago  in  November  last,  the  editor 
of  this  journal  was  invited  to  read  a paper  on 
the  subject.  It  is  our  belief  that  these  new  rules 
of  procedure  will  not  only  work  for  the  advance- 
ment of  the  California  Medical  Association,  but 
that  a considerable  number  of  the  provisions  will 
commend  themselves  to  other  state  medical  or- 
ganizations as  being  worthy  of  adoption.  The 
changes  which  were  incorporated  are  those  which 
past  experience  suggested.  Through  these  new 
rules  the  transaction  of  association  and  organiza- 
tion business  should  be  made  more  easy  and  more 
effective. 

* * * 

Womans  Auxiliary  of  the  California  Medical 
Association. — The  year  1929  saw  the  founding 
of  a “Woman’s  Auxiliary  of  the  California  Medi- 
cal Association.”  In  some  other  states,  such  or- 
ganizations have  proved  to  be  of  real  value. 
Scientific  medicine  needs  the  cooperative  aid 
which  can  come  through  such  auxiliaries.  What- 
ever makes  for  better  understanding  among 
physicians  and  their  families  makes  for  better 
organization.  Nowadays  women’s  clubs  exercise 
a strong  influence  on  civic  affairs.  The  families 
of  physicians  have  a natural  interest  in  public 
health  problems.  A state  Woman’s  Auxiliary  of 
the  California  Medical  Association,  composed  of 
component  county  woman’s  auxiliaries,  can  be- 
come a real  factor  in  promoting  public  health 
work.  The  basic  rules  which  were  laid  down  for 
this  new  organization  in  relation  to  the  state  and 
component  county  medical  societies,  should  make 
it  possible  for  work  to  be  carried  on,  not  only 
without  friction,  but  to  the  great  advantage  of 
the  aims  of  organized  medicine. 

* * * 

The  Coffey  Plan. — For  want  of  a better  name, 
the  studies  which  for  some  time  have  been  carried 
on  by  the  Council  and  certain  standing  commit- 
tees of  the  California  Medical  Association,  and 
bearing  on  the  evolvement  of  a plan  which  aims 
to  bring  efficient  medical  and  surgical  service  to 
that  large  group  of  citizens  who  are  in  what  might 
be  called  certain  portions  or  strata  of  the  great 
middle  class  of  our  population,  while  at  the  same 
time  safeguarding  the  standards  and  interests  of 


48 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


scientific  and  organized  medicine  and  of  indi- 
vidual practice  as  it  exists  today,  are  referred  to 
as  the  “Coffey  Plan.”  As  has  been  previously 
stated  in  this  column,  Dr.  Walter  B.  Coffey  of 
San  Francisco  submitted  a plan  designed  to  ac- 
complish ends  such  as  the  above,  as  a working 
basis  for  further  studies.  He  is  not  committed 
to  his  tentative  outline  nor  are  the  members  of 
the  Council  committed  to  it.  But  it  serves  as  a 
good  starting  basis  for  further  study  and  investi- 
gation. 

The  problem  is  a most  difficult  one,  and  if 
California  can  solve  it  in  good  part,  and  in  such 
manner  as  to  accomplish  the  ends  noted  in  the 
previous  paragraph,  it  will  be  very  much  to  the 
credit  of  the  California  Medical  Association.  The 
members  of  the  Council  are  colleagues  who  have 
had  long  experience  in  private  and  institutional 
and  organization  medical  practice,  they  are  men 
who  are  practical  and  of  good  judgment  of  values, 
and  their  studies  should  make  for  progress  in  the 
solution  of  some  of  these  very  vexing  problems 
which  have  been  thrust  before  us,  through  the 
great  changes  which  in  recent  years  so  unexpect- 
edly have  taken  place  on  so  broad  a scale  in  the 
ways  and  standards  of  living  of  very  many  of  our 
lay  fellow  citizens. 

* * * 

Possible  Revision  of  Medical  Practice  Act.— 
A large  special  committee,  with  a San  Francisco 
group,  a Southern  California  group,  and  an  At- 
large  group,  has  been  appointed  to  make  a special 
study  of  the  Medical  Practice  Act  of  California. 
If  the  studies  of  this  committee  lead  to  nothing 
more  than  endorsement  and  codification  of  the 
present  provisions  of  the  Medical  Practice  Act, 
that  in  itself  would  be  worth  the  while.  The  studies, 
however,  should  lead  to  more  than  that.  These 
medical  practice  laws  are  the  legal  standards 
which  are  laid  down  for  the  guidance  of  medical 
men  and  women.  Such  statutes  should  conform 
to  the  highest  standards  of  scientific  medicine, 
and  should  make  for  the  best  possible  protection 
of  the  public  health,  as  well  as  of  the  interests 
of  the  medical  profession.  The  members  of  that 
profession,  through  many  years  of  service  in 
county  and  other  public  hospitals,  have  placed 
the  citizens  of  California  under  heavy  obligation 
for  the  gratuitous  work  so  altruistically  given. 
Because  of  the  generous  service  which  was  and 
is  so  gladly  and  efficiently  given,  the  medical  pro- 
fession is  especially  worthy  of  consideration  when 
its  members  put  forth  legislative  suggestions  de- 
signed to  better  protect  the  health  of  the  people 
and  to  promote  the  material  and  cultural  interests 
of  our  commonwealth.  In  making  these  state- 
ments we  are  not  boasting.  We  are  simply  call- 
ing attention  to  a record  of  service  which,  because 
of  a foolish  modesty  or  oversensitiveness  on  the 
part  of  the  medical  profession,  has  permitted  the 
lay  public  to  accept  the  same  as  a matter  of  course 
and  often  without  any  sense  of  appreciation. 

* * * 

Possible  Basic  Science  Law  for  California. — 
The  last  several  decades  have  witnessed,  especi- 
ally in  California,  the  legal  recognition  of  such 


a considerable  number  of  cultist  practitioner 
groups  that  some  members  of  the  profession  have 
acquired  the  habit  of  thinking  that  all  remedial 
legislation  to  curb  such  deplorable  introduction  of 
low  educational  and  professional  standards,  as  it 
is  usually  found  to  exist  in  new  cultist  groups,  is 
quite  hopeless.  Such  attitude  of  resignation  to 
an  evil  is  neither  necessary  nor  proper.  It  is  quite 
possible  that  in  the  past  our  profession  has  ap- 
proached the  solution  of  certain  of  these  cultist 
medicine  problems  by  the  wrong  routes.  There 
is  a safe  groundwork  upon  which  can  be  built 
legitimate  opposition  to  cultist  or  low  standard 
healing  art  practice.  That  groundwork  rests  upon 
the  axiomatic  principle  that  all  intelligent  citizens 
concede  and  agree  that  a certain  amount  of  pre- 
liminary education,  as  well  as  professional  train- 
ing, should  be  possessed  by  every  practitioner  of 
the  healing  art  who  seeks  a legal  sanction  to  prac- 
tice and  to  have  under  his  custodianship,  the 
health  and  lives  of  lay  fellow  citizens  who  come 
to  him  in  good  faith. 

A high  school  education  is  conceded  by  all  per- 
sons to  be  a very  legitimate  preliminary  minimum, 
as  regards  education,  which  should  be  necessary 
to  professional  training  proper.  The  value  of  a 
high  school  preliminary  education  is  this,  that  it 
will  increase  the  difficulty  for  cultist  promoters 
of  the  future,  through  inability  to  obtain  a suffi- 
ciently large  number  of  disciples  having  a full 
high  school  education,  to  profitably  launch  their 
cultist  movements.  With  only  a small  group  of 
adherents  in  their  first  student  bodies,  it  should 
be  possible  in  the  future  to  keep  such  as  yet 
unborn  cultist  and  low  standard  educational 
groups  from  receiving  legal  recognition.  A proper 
basic  science  law  will  make  it  easier  to  accom- 
plish this  beneficent  result  for  the  citizens  of  Cali- 
fornia. Therefore  the  special  committee  referred 
to  in  the  comments  on  the  California  Medical 
Practice  Act  will  also  study  basic  science  laws. 

* * * 

Standing  Committees  of  the  California  Medical 
Association. — Chapter  V of  the  new  by-laws 
deals  with  standing  committees.  A directory  of 
standing  committees  is  printed  in  every  issue  of 
California  and  Western  Medicine  (see  front 
cover  index  under  Miscellany).  The  attention 
of  members  of  such  committees  is  called  to  this 
Chapter  V of  the  by-laws,  in  which  is  outlined 
the  organization  work  to  be  covered  by  each  com- 
mittee. All  standing  committees  should  be  active 
agents  in  promoting  the  welfare  of  the  California 
Medical  Association.  Section  21  of  Chapter  V 
specifies  that  a written  report  must  be  submitted 
annually  by  every  standing  committee  so  that 
the  same  may  be  printed  in  the  “Preconvention 
Bulletin”  for  the  information  of  members  of  the 
House  of  Delegates.  Members  of  standing  com- 
mittees are  therefore  requested  to  read  Chapter  V 
and  to  get  their  work  under  way  so  that  reports 
may  be  ready  for  the  Del  Monte  session  of  the 
House  of  Delegates.  The  central  office  of  the 


January,  1930 


EDITORIALS 


49 


Association  in  such  work  is  at  the  service  of  all 
committees,  and  invites  correspondence  and  offers 
its  full  cooperation. 

* * * 

Last,  But  Not  Least,  the  Year  1930  Is  a State 
Election  Year. — This  caption  is  presented  to  re- 
mind us  of  our  individual  civic  obligations  to  be 
interested  in  the  complexion  of  the  next  state 
legislature,  many  of  whose  assembly  and  senate 
members  will  be  elected  in  the  fall  of  1930.  These 
particular  lay  fellow  citizens  who  will  have  legis- 
lative powers  should  be  contacted  at  an  early 
day  and  an  intelligent  effort  made  to  acquaint 
them  with  the  viewpoints  of  physicians  as  regards 
maintenance  of  proper  standards  in  medical  licen- 
sure and  in  public  health  activities.  It  is  not  fair 
to  criticize  members  of  the  assembly  and  senate 
when  they  vote  in  opposition  to  the  maintenance 
of  such  standards  if  we  have  made  no  previous 
attempts  to  acquaint  them  with  medical  prob- 
lems which  may  come  before  them,  and  to  inform 
them  why  we  hold  certain  opinions  thereon.  The 
medical  profession  does  sufficient  service  in  the 
protection  of  the  public  health  of  California  to 
merit  careful  consideration  of  its  viewpoints. 
Legislators  will  be  found  to  be  glad  to  give  such 
consideration  if  proper  contacts  are  made  from 
the  beginning.  Every  member  who  knows  a 
state  assemblyman  or  state  senator  or  a pros- 
pective state  assemblyman  or  senator  may  well 
cultivate  such  acquaintanceship  or  friendship,  for 
it  later  on  might  be  of  real  value  in  the  protection 
of  public  health  interests.  In  responsibilities  such 
as  this  every  member  of  the  California  Medical 
Association  can  be  of  service.  The  officers  of  the 
Association  can  only  act  for  and  speak  on  behalf 
of  their  fellow  members. 


NEW  COUNTY  SOCIETY  OFFICERS— SOME 
OF  THEIR  PROBLEMS 

The  New  Year  Brings  Nezv  County  Officers .• — - 
Once  again,  at  the  beginning  of  this  new  year, 
most  of  the  component  county  societies  of  the 
California  Medical  Association  will  find  them- 
selves taking  up  their  meeting  and  other  work 
under  new  groups  of  officers.  Some  of  these  offi- 
cers will  have  gone  through  the  apprenticeship  of 
other  society  positions  of  responsibility,  and  es- 
pecially if  they  have  functioned  as  secretaries  of 
their  societies  they  will  be  able  to  have  a some- 
what intimate  knowledge  and  judgment  of  county 
society  work  and  needs.  It  is  well,  however,  no 
matter  how  great  our  past  experience  may  have 
been,  at  the  beginning  of  work  that  will  cover  the 
program  of  a calendar  year,  to  make  somewhat 
of  a survey  of  the  objects  which  a county  society 
should  seek  to  accomplish.  On  that  account  some 
of  these  aims,  which  in  times  past  have  been  dis- 
cussed in  detail,  will  be  here  commented  upon. 

* * * 

Intensive  and  Extensive  Functions  of  a County 
Unit. — The  development  of  a county  medical 
society  may  be  said  to  fall  under  two  major  heads. 

The  one  set  of  major  activities  are  of  an  in- 
ternal or  intensive  nature  and  have  to  do  with 


all  those  efforts  which  would  bring  to  the  mem- 
bers of  the  county  society  the  most  profitable  as- 
sociation possible ; while  promoting  the  unity  and 
good  understanding  of  the  members  and  so  mak- 
ing for  a component  county  society  that  will  find 
its  proper  local  place  in  the  scheme  of  state  and 
national  expressions  of  organized  medicine. 

The  other  set  of  major  responsibilities  has  to 
do  with  the  outward  or  external  work  or  exten- 
sive activities  of  a county  unit.  Here  come  up 
membership  problems  of  nonaffiliated  physicians, 
and  contacts  wherein  the  county  society  as  an 
organization  and  through  its  members  as  indi- 
viduals makes  its  influence  felt  in  civic  affairs 
and  in  lay  and  affiliated  organizations. 

That  county  unit  will  have  the  best  record  for 
progress  whose  officers  visualize  its  problems  in 
these  two  fields  and  who  use  intelligent  and  prac- 
tical efforts  to  solve  the  same.  The  responsibility 
for  successful  or  nonsuccessful  performance  of 
a county  society’s  activities  for  the  year  1930 
must  necessarily  rest  upon  the  officers  who  by 
their  fellows  have  been  selected  for  positions  of 
honor,  because  of  the  belief  of  their  fellow  mem- 
bers that  as  officers  they  would  generously  give 
of  themselves  in  service  to  organized  medicine. 

* * * 

Medical  Meetings  Should  Have  a Twofold 
Nature,  Scientific  and  Good  Fellowship. — Medi- 
cine is  a growing  science.  Its  members  seek  the 
inspiration  and  stimulation  which  comes  from 
consideration  and  discussion  of  the  experiences 
and  problems  presented  by  colleagues.  Therein 
lies  the  basis  of  the  scientific  programs  of  medical 
meetings. 

Essayists  should  be  of  two  classes : One,  local 
members  who  present  studies  and  problems  con- 
cerned with  local  practice  and  with  whom  ex- 
change of  opinion,  from  the  standpoint  of  local 
environment,  makes  for  more  efficient  methods 
in  practice;  two,  invited  guest  speakers.  In  Cali- 
fornia the  component  county  societies,  through 
the  extension  lecture  department  of  the  Cali- 
fornia Medical  Association  (see  page  294  of  the 
October  1929  issue),  have  an  opportunity  to 
bring  to  local  society  meetings  colleagues  from 
other  cities  who  are  prepared  to  present  papers 
on  a large  number  of  scientific  topics.  County 
societies  owe  it  to  their  own  members  from  time 
to  time  to  invite  one  or  more  of  such  guest 
speakers  to  their  meetings.  A perusal  of  the  pro- 
ceedings of  some  of  the  county  units  shows  that 
they  are  alert  to  the  advantages  to  be  derived  from 
such  outside  speakers.  The  program  committees 
of  every  county  society  should  hold  a meeting  at 
an  early  date  and  outline  in  fairly  definite  form 
the  work  to  be  covered  in  the  scientific  meetings, 
and  what  local  and  guest  speakers  are  to  be  in- 
vited. A program  committee  which  permits  the 
scientific  proceedings  to  rest  on  what  may  be 
called  haphazard  voluntary  presentation  of  papers 
is  not  often  in  position  to  congratulate  itself  on 
having  made  a real  effort  properly  to  do  its  work. 

Program  committees  should  also  appreciate 
that  the  development  of  good  fellowship  and  of 
fine  and  generous  understanding  between  mem- 


50 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


bers  of  a county  medical  society  may  be  quite  as 
important  as  the  scientific  problems.  Informal 
bufit’et  lunches  and  suppers  are  big  aids  in  this, 
as  is  attested  by  the  goodly  number  of  county 
societies  which  report  such  activities.  A county 
medical  society  whose  members  are  broken  up 
into  groups,  with  only  casual  acquaintanceship 
or  friendship  relations  between  members,  cannot 
really  be  stated  to  be  a well  organized  county 
unit,  no  matter  how  large  its  numerical  mem- 
bership may  be.  The  medical  profession,  in 
greater  degree  than  ever  before,  today  needs  good 
fellowship  among  its  members  because,  without 
such  understanding,  the  medical  profession  will 
not  be  in  position  to  solve  to  best  advantage  the 
economic  and  social  problems  connected  with  medi- 
cal practice.  Let  us  know  one  another  and  under- 
stand one  another.  Such  understanding  will  make 

for  our  individual  and  our  collective  development. 

* * * 

A Special  Topic  for  Study  in  1930. — Reference 
has  been  made  in  this  column  to  certain  studies 
being  carried  on  by  state  society  officers  in  rela- 
tion to  evils  that  would  threaten  medical  practice 
in  case  state  medicine  ever  acquired  a foothold. 
These  topics  of  the  so-called  “high  cost  of  medi- 
cal care’’  (an  unfortunate  misnomer),  and  of  so- 
called  “state  medicine,”  are  worthy  of  a place  on 
the  program  of  every  county  society  in  California 
if  for  no  other  reason  than  to  show  how  large 
and  many  are  the  problems  connected  therewith, 
and  how  very  difficult  is  their  solution.  If  the 
members  of  each  county  society  will  study  these 
questions,  then  a foundation  will  have  been  laid 
for  a better  evaluation  of  any  plan  that  might 
later  on  be  presented  by  the  parent  or  state 
association. 

All  physicians  must  earn  money  in  order  to 
live.  These  topics  have  much  to  do  with  these 
money  or  economic  phases  of  professional  prac- 
tice. It  is  worse  than  silly  to  imply  that  they 
should  not  have  a place  or  serious  considera- 
tion in  our  meetings.  Some  of  our  present-day 
problems  have  arisen  in  good  part  because  of 
our  accentuation  and  overemphasis  of  scientific 
papers,  with  almost  total  neglect  of  papers  or 
discussions  having  to  do  with  the  economic  prob- 
lems of  medical  practice.  As  a group  we  may  be 
peculiar  in  that  we  may  not  strive  for  much  mone- 
tary enrichment  or  material  ease  or  luxury,  but 
that  is  no  reason  for  pretending  that  economic 
problems  must  not  be  mentioned  or  discussed  in 
our  meetings. 

* * * 

Womans  Auxiliaries  in  County  Societies. — In 
the  Miscellany  department  of  this  issue  of  Cali- 
fornia and  Western  Medicine  is  printed  an 
outline  of  work  for  woman’s  auxiliaries.  In  this 
column,  in  the  November  1929  issue,  page  351, 
were  printed  some  comments  on  how  to  organize 
county  woman’s  auxiliaries.  Prior  to  the  next 
annual  session  at  Del  Monte  on  April  28,  every 
component  county  society  should  aim  to  bring  a 
woman’s  auxiliary  into  existence.  The  advantages 
of  such  auxiliaries  have  been  outlined  elsewhere. 
The  California  Medical  Association  has  com- 


mitted itself  to  the  sponsorship  of  such  organiza- 
tions. Each  county  society  should  do  its  part  by 
bringing  such  a local  auxiliary  into  being.  The 
state  auxiliary  will  then  be  able  to  take  up  its 
further  work  in  earnest  when  the  annual  session 
convenes  at  Del  Monte.  Here  again  the  credit  or 
discredit  of  forming  or  not  forming  such  county 
auxiliaries  must  rest  largely  on  the  shoulders  of 
the  officers  of  our  county  medical  societies. 

* * & 

Revision  of  County  Society  By-Laws. — A con- 
siderable number  of  county  societies  have  rather 
loose  rules  of  procedure.  They  learn  this  to  their 
sorrow  when  certain  difficulties  arise.  Every 
county  society  must  conform  to  and  adopt  those 
portions  of  the  constitution  and  by-laws  of  the 
California  Medical  Association  which  apply  to 
component  county  societies.  Every  member  of 
every  county  society  in  the  California  Medical 
Association  has  recently  received  a copy  of  the 
state  society  constitution  and  by-laws.  Here  again 
we  have  a convenient  working  basis  or  starting 
point  in  a consideration  of  a possible  revision  of 
county  society  constitutions  and  by-laws. 

It  would  be  a distinct  advantage  to  medical 
organization  in  California  if  the  constitutions  and 
by-laws  of  all  county  societies  were  modeled  in 
good  part  after  this  California  Medical  Associa- 
tion general  pattern.  Would  it  not  be  a wise  pro- 
cedure if  every  county  society  in  the  near  future 
appointed  a committee  to  bring  in  a report  on  a 
possible  revision  of  its  constitution  and  by-laws, 
with  instructions  to  use  the  California  Medical 
Association  draft  as  a basis  for  incorporation  of 
such  local  modifications  as  local  needs  or  customs 
might  make  desirable  ? It  should  not  be  difficult  to 
make  such  transpositions.  Each  county  society 
thus  would  be  working  in  closer  harmony  and 
cooperation  with  other  county  societies  as  well 
as  with  the  parent  state  organization.  A better 
opportunity  for  such  a study  could  not  be  asked 
for,  because  all  members  have  a copy  of  the 
printed  state  constitution  and  by-laws  as  a basis 
for  comparison.  This  will  be  a good  year  in  which 
to  make  such  a study. 

* * * 

Membership  Growth. — Every  member  receives 
each  year  two  directories  of  California  physicians. 
One  of  these  directories  is  issued  by  the  Cali- 
fornia Medical  Association  and  the  other  by  the 
Board  of  Medical  Examiners  of  the  State  of 
California.  The  general  county  arrangement  of 
names  foll®ws  the  same  general  form  in  the  two 
publications.  It  is  therefore  easy  to  scan  the  lists 
in  the  different  counties  and  to  note  who  are  the 
nonmembers. 

Other  things  being  equal,  mere  graduation 
from  certain  high-grade  schools  of  medicine 
should  imply  that  each  such  graduate  should  be 
affiliated  with  organized  medicine.  If  such  is  not 
the  case,  the  reasons  for  such  nonaffiliation  should 
be  known  to  the  society  officers. 

With  so  easy  and  simple  a method  of  refer- 
ence, why  should  not  every  county  society  in- 
struct a standing  or  special  committee  on  mem- 
bership to  bring  in  to  it  or  its  council  a report 


January,  1930 


EDITORIALS 


51 


on  presumably  eligible  physicians  who  are  non- 
members? Why  must  this  type  of  work  be  left  to 
happy-go-lucky  chance?  We  are  organized  in 
medicine  to  promote  scientific  standards  and  to 
promote  the  interests  of  the  public  health  and 
the  welfare  of  our  members.  Let  us  use  that 
same  common-sense  acumen  and  judgment  in 
these  matters  which  we  see  everywhere  mani- 
fested by  business  and  other  organizations  which 
are  successful.  The  practice  of  medicine  is  very 
individualistic,  it  is  true,  but  in  our  group  organi- 
zation and  group  efiforts  we  should  use  those 
methods  which  are  recognized  as  efficient  parts 
and  parcels  of  group  activities.  Bringing  all  eligi- 
ble nonmembers  into  active  membership  affilia- 
tion with  us  is  one  of  the  very  special  of  such 
group  activities.  If  we  give  this  work  its  proper 
recognition  our  county  units  and  our  state  asso- 
ciation both  will  profit  and  be  the  stronger.  Such 
a study  should  be  promoted  by  all  county  society 
officers  who  wish  to  see  their  societies  go  on  to 
fullest  possible  development. 


INDIVIDUALISM  AND  THE  GROUP  SPIRIT 
IN  THE  PRACTICE  OF  MEDICINE 

Individualism  in  Medicine. — The  December  is- 
sue of  California  and  Western  Medicine  pre- 
sented as  its  opening  article  a paper  on  “Individ- 
ualism in  Medicine,”  from  the  pen  of  this  year’s 
retiring  president  of  the  American  Medical  Asso- 
ciation, Dr.  W.  S.  Thayer  of  Johns  Hopkins 
University.  The  paper  was  of  such  exceptional 
worth  that  the  wish  comes  that  every  member  of 
the  California,  Nevada  and  Utah  Medical  Asso- 
ciations would  take  the  time  to  read  it.  Its  clarity 
and  charm  in  describing  some  modern-day  tend- 
encies in  medical  practice  will  amply  reward  all 
who  give  it  their  perusal  and  consideration. 

In  none  of  the  learned  professions  are  men 
called  upon  to  play  such  lone  hands,  as  it  were, 
and  to  lead  such  individualistic  professional  lives 
as  in  the  practice  of  medicine.  As  a matter  of 
fact,  it  is  almost  impossible  to  conceive  of  suc- 
cessful practice  without  such  individualism.  This 
personal  contact  with  a patient  and  the  responsi- 
bility for  one’s  patient  is  a something  which,  as 
Dr.  Thayer  well  states,  cannot  be  passed  to  an- 
other. It  is  also  equally  true,  as  he  points  out, 
that  “cooperation  in  the  mere  sense  of  division  of 
responsibility  is  not  cooperation.” 

It  is  good  for  us  to  keep  in  mind  these  funda- 
mental principles  which  have  to  do  with  the  art 
and  science  of  medical  practice,  for  in  so  doing  we 
may  be  saved  the  embarrassment  of  finding  our- 
selves worshiping  at  the  altars  of  what  seem  today 
to  be  scientific  facts,  but  which  in  the  light  of  the 
tomorrow  may  have  far  less  real  value  than  their 
supposed  worth  of  the  present  would  indicate. 

In  our  quest  for  greater  attainment  in  the 
scientific  phases  of  medical  practice,  it  is  also  wise 
not  to  belittle  those  important  procedures  which 
have  to  do  with  what  is  the  art  of  medicine,  lest 
in  so  doing  we  create  limitations  of  outlook  that 
may  keep  us  from  measuring  up  to  that  full  effi- 


ciency which  is  characteristic  of  the  highest  type 
of  physicians.  And  above  all  else,  let  us  guard 
ourselves  well,  so  that  we  join  not  that  fortu- 
nately somewhat  limited  group  in  our  own  profes- 
sion who  might  be  called  the  intellectual  snobs, 
and  who  in  our  profession,  as  in  other  callings 
where  such  self-sufficient  individuals  are  found, 
magnify  the  little  extra  book  or  other  knowledge 
or  skill  or  success  which  they  may  have  acquired 
until  it  becomes  a detriment  to  themselves  and  to 
their  capacity  for  larger  service,  as  well  as  a re- 
flection on  that  large  group  of  physicians  who 
seek  increased  knowledge  and  efficiency  for  the 
heart  and  mind  satisfaction  of  being  able  to  be 
more  useful  to  their  patients,  while  at  the  same 
time  endeavoring  to  maintain  that  humility  of 
demeanor  which  has  always  been  associated  with 
real  greatness,  wherever  found. 

* * * 

The  Group  Spirit  in  Medicine. — Medicine  needs 
the  stimulus  of  group  association  as  well  as  that 
which  is  a part  of  individualism.  The  group  spirit 
in  medicine  may  be  said  to  have  two  major  ex- 
pressions. 

One  of  these  major  phases  of  group  spirit  was 
indicated  when  Dr.  Thayer  called  attention  to  the 
need  of  group  association  and  cooperation  in  the 
care  of  individual  patients.  That  expression  of 
group  spirit  is  one  of  which  every  physician  must 
avail  himself,  unless  he  be  absolutely  isolated  and 
far  away  from  his  fellows.  Even  then  such  an 
isolated  colleague  can  maintain  cooperative  effort 
through  his  journals,  with  his  fellows  who  are 
more  fortunately  situated,  by  learning  from  their 
writings  concerning  the  newer  methods  of  pro- 
cedure that  would  be  to  the  advantage  of  his 
patients. 

As  an  expression  of  the  second  major  phase  of 
group  spirit,  this  journal,  and  the  state  medical 
associations  which  sponsor  it,  can  be  taken  as 
examples.  Another  name  for  this  particular  phase 
of  group  spirit  is  “organized  medicine.”  Every 
activity  carried  on  by  organized  medicine,  that  is, 
all  efforts  put  forth  by  groups  of  physicians  who 
form  various  medical  societies,  are  efforts  which 
are  an  expression  of  this  type  of  group  spirit.  To 
partake  of  the  same,  one  must  enter  into  the  work 
with  unselfish,  impersonal  motives,  and  with  the 
determination  to  work  and  serve  in  the  activities 
which  are  put  forth  by  such  societies,  when  they 
endeavor  in  the  advances  made  by  civilization,  to 
place  the  standards  and  practice  of  medicine  on 
the  highest  possible  plane  of  service. 

In  such  an  organization  plan  the  splendid 
scheme  propounded  and  put  into  being  years  ago, 
whereby  in  every  county  of  these  United  States 
one  medical  organization,  and  only  one,  was  to  be 
officially  recognized,  these  to  make  up  the  state 
organizations,  and  those  in  turn  to  compose  the 
national  or  American  Medical  Association,  has 
been  the  means  of  explaining  much  of  the  remark- 


52 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


able  progress  which  is  to  the  credit  of  American 
medicine  during  the  last  three  decades. 

But  creditable  as  that  record  of  achievement  in 
organization  may  be,  it  is  far,  far  from  what  it 
could  or  should  be.  All  about  us,  on  every  hand, 
are  organizations,  seemingly  without  end,  which 
seem  to  have  a more  substantial  substratum  in 
material  resources  than  that  possessed  by  organ- 
ized medicine.  Yet  none  of  these  organizations 
have  so  large  a proportion  of  members  who  do  so 
much  service  for  unfortunate  fellow  citizens, 
often  without  monetary  or  other  reward,  as  that 
of  the  profession  of  medicine.  It  is  conceded  by 
all  honest  thinking  members  of  the  laity  who  have 
studied  these  matters  that  the  medical  profession 
is  entitled  to  more  recognition  for  its  altruistic 
principles  and  work  than  it  actually  receives.  Yet 
the  fact  remains  that  the  ancient  profession  of  the 
healing  art  could  learn  much  concerning  effective 
organization  from  a host  of  groups  and  societies 
that  seem  to  have  been  born  but  yesterday. 

Wherein  then,  do  we  fail  ? Is  it  because  we  do 
not  sufficiently  dissociate  ourselves  from  our 
daily  individualistic  lives  ? Do  we  not,  through 
such  non-association,  prevent  the  realization  of 
achievement  results  which  would  be  ours  were  we 
only  to  contact  with  one  another  and  work  shoul- 
der to  shoulder  with  one  another,  as  could  rightly 
be  expected  of  colleagues  in  a noble  profession  to 
which  each  has  pledged  his  faith  and  homage? 

It  has  been  the  fashion  of  some  members  of 
our  profession  to  decry  medical  organizations  and 
medical  society  work.  Yet  these  same  colleagues 
are  often  usually  more  than  willing  to  accept  any 
and  all  official  honors  which  such  medical  organi- 
zations can  bestow  upon  them.  Sometimes  one  is 
almost  tempted  to  think  that  some  of  these  non- 
cooperative,  non-group  spirit  colleagues,  who  give 
practically  nothing-  to  the  medical  organizations 
which  protect  the  interests  of  all  of  us,  indulge  in 
their  criticisms,  largely  because  in  their  selfish- 
ness, they  have  inwardly  taken  umbrage  at  such 
official  nonrecognition,  or  because  they  look 
with  envious  eyes  on  official  recognition  of  col- 
leagues to  whom  such  honors  have  come  as  a 
reward  for  altruistic  service.  To  cover  up  their 
personal  non-cooperation,  they  pose  as  being 
above  medical  societies  and  indifferent  to  the  work 
of  such  organizations.  Such  colleagues  should 
remember  that  even  though  they  themselves  are 
unwilling  to  cooperate  in  group  efforts,  it  is  not 
necessary  to  belittle  or  tear  down  the  work  of 
other  more  generous  colleagues. 

In  conclusion  let  us  repeat  that  individualism  in 
medicine  will  always  be  with  us  because  the  na- 
ture of  our  professional  work  constantly  accen- 
tuates individualistic  spirit.  On  the  other  hand, 
the  group  spirit  seems  to  assert  itself  with  us,  only 
in  spasmodic  form.  In  some  colleagues  it  is 
strong,  in  others  it  seems  altogether  absent.  We 
belong  to  those  who  hold  that  the  group  spirit  in 
medical  practice  should  be  nurtured  and  devel- 
oped. It  is  the  happy  combination  of  individual 


and  group  effort  that  will  give  American  medi- 
cine the  opportunity  to  make  its  greatest  strides 
in  the  future. 

* * * 

MARY  BAKER  EDDY— A LETTER  AND  A 
BOOK  REVIEW 

Policy  of  This  Journal  on  Religious  and  Public 
Health  Matters. — It  is  the  policy  of  this  journal 
not  to  discuss  religious  matters  in  its  pages.  This 
policy,  however,  does  not  preclude  the  mention 
or  presentation  of  information  having  to  do  with 
general  principles  related  to  public  health  respon- 
sibilities, or  with  basic  principles  in  news  or  edu- 
cational procedures  when  such  principles  become 
involved  in  the  acts  of  either  healing  or  non- 
healing religious  groups. 

That  is  why  in  this  issue  is  here  printed  so 
unusual  a caption  reference  as  that  which  heads 
these  comments.  The  object  thereof  is  to  call 
attention  to  an  open  letter  which  is  printed  in  the 
Correspondence  column  of  the  Miscellany  De- 
partment of  this  number,  and  to  a review  which 
appears  in  the  Book  Review  column. 

* * * 

Astounding  Statements  in  the  Letter. — The 
letter  referred  to  gives  the  experiences  of  a 
member  of  the  California  Medical  Association  in 
trying  to  purchase  a copy  of  the  biography  en- 
titled “Mrs.  Eddy — The  Biography  of  a Virginal 
Mind”  by  Dakin,  in  the  different  book  stores  and 
department  store  book  departments  of  Los  An- 
geles. The  perusal  of  the  letter  will  give  a shock 
when  it  is  learned  that  a book  brought  off  the 
press  by  a reputable  publishing  house  and  having 
the  sanction  of  the  United  States  Government  to 
go  thrdugh  the  mails  seemingly  should  be  practi- 
cally barred  from  the  sales  counters  of  such 
stores.  Certainly  if  such  book  and  department 
stores  do  so  un-American  a thing  out  of  slavish 
or  other  fear  of  one  group  of  citizens  who  may 
be  averse  to  having  the  biographical  volume  read 
by  other  Americans,  then  it  is  proper  that  such 
stores  should  appreciate  that  such  actions  on  their 
parts  will  be  given  publicity.  Such  publicity 
among  the  two  camps  of  for  and  against  citizens 
will  permit  such  stores  to  receive  what  they  pre- 
sumably seek,  namely,  to  benefit  from  the  business 
accruing  to  them  from  the  larger  purchases  made 
by  whichever  group  of  citizens  is  seemingly  fa- 
vored through  such  partisan  espousal  of  interests. 

* * * 

Principles  Involved  Are  Important.-- Because 
a knowledge  of  biographical  data  is  more  or  less 
essential  to  an  understanding  of  the  physical, 
psychological  and  supposedly  spiritual  doctrines 
propounded  by  the  founder  of  a spiritual  heal- 
ing sect,  which  in  its  work  or  mission  contacts 
somewhat  intimately  with  public  health  work  and 
procedures,  members  of  the  medical  profession 
have  a very  natural  interest  in  such  a biography. 
Because  of  the  free  speech  and  free-press  princi- 
ples which  are  involved,  references  to  the  letter 
and  book  review  are  accordingly  here  made  so 
that  all  readers  who  so  desire  may  acquaint  them- 
selves more  fully  concerning  the  issues  and  facts 
involved. 


MEDICINE  TODAY 

Current  comment  on  medical  progress,  discussion  of  selected  topics  from  recent  books  or  periodic  literature,  by 
contributing  members.  Every  member  of  the  California  Medical  Association  is  invited  to  submit  discussion 
suitable  for  publication  in  this  department.  No  discussion  should  be  over  five  hundred  words  in  length. 

Ophthalmology 

Chronic  Dacryocystitis. — Cordes  and  Martin 
have  called  attention  to  the  subject  of  chronic 
dacryocystitis  by  reporting  the  cure  of  epiphora 
and  suppuration  in  over  90  per  cent  of  selected 
cases  by  doing  the  Mosher-Toti  operation.  This 
procedure,  as  well  as  the  Dupuy-Dutemps  opera- 
tion, makes  an  opening  from  the  tear  sac  into  the 
nose  by  using  a skin  incision  and  intranasal 
manipulation.  The  West  procedure  is  done  by 
intranasal  manipulation  only.  From  a review  of 
the  literature  one  finds  that  the  percentage  of 
cures  reported  by  any  one  of  these  methods  in 
competent  hands  averages  well  over  85  per  cent. 
Cases  must  be  selected  where  the  obstruction  is 
in  the  lacrimal  duct  and  where  the  canaliculi  are 
intact.  In  the  face  of  statistics  such  as  these  we 
must  recognize  that  extirpation  of  the  lacrimal 
sac  for  the  treatment  of  chronic  dacryocystitis 
should  no  longer  be  the  procedure  of  last  resort. 
We  know  that  one  always  has  more  or  less 
troublesome  epiphora  after  extirpation  of  the  sac, 
so  that  when  there  is  an  85  per  cent  possibility  of 
reestablishing  drainage  the  patient  is  entitled  to 
the  benefit  of  one  of  these  procedures  before  ad- 
vising removal  of  the  sac. 

M.  F.  Weymann, 

Los  Angeles. 


Medicine 

INTRODUCTION 

The  Present  Status  of  Liver  Function  Tests.* * 

The  time  for  evaluation  of  the  various  liver 
function  tests  has  come.  Thirty  years  ago  Strauss 
introduced  the  first  liver  function  test  and  the  last 
twenty  years  have  seen  intensive  work  on  this 
subject,  particularly  in  the  United  States.  This 
feeling  that  we  can  take  stock  in  what  has  been 
accomplished  is  widespread,  as  can  be  seen  from 
the  recent  publication  of  large  series  of  from  300 
to  1200  cases  in  which  comparisons  between  the 
various  liver  function  tests  are  drawn.  Moreover, 
judging  by  the  remarkable  similarity  of  opinions 
of  various  workers  on  the  relative  merits  of  these 
tests,  such  a feeling  is  entirely  justified. 

The  brief  summary  presented  here  is  based  on 
a survey  of  the  recent  literature  in  addition  to  the 
experience  in  this  field  of  the  University  of  Cali- 
fornia Department  of  Medicine  which  comprises 
a series  of  nearly  six  hundred  cases  in  which  the 
Rose  Bengal  liver  function  test,  developed  by 

* From  the  Department  of  Medicine,  University  of  Cali- 
fornia Medical  School,  San  Francisco. 

* Read  before  the  General  Meeting  of  the  San  Fran- 
cisco County  Medical  Society,  April  9,  1929. 


Delprat,  Kerr,  and  Epstein,  was  done  and  smaller 
series  of  most  of  the  tests  which  will  be  discussed. 

There  are  two  great  classes  into  which  all  tests 
of  liver  function  can  be  divided,  the  metabolic  and 
the  excretion  tests. 

PART  i 

Among  the  functions  of  the  liver,  those  pertain- 
ing to  carbohydrate  metabolism  are  of  great 
importance,  and  here  we  have  the  well-known 
levulose-  and  galactose-tolerance  tests.  The  objec- 
tions to  these  sugar-tolerance  tests  as  an  indi- 
cation of  liver  function  are  twofold.  The  first 
and  very  real  objection  is  that  while  sugar  me- 
tabolism suffers  in  diseases  of  the  liver,  beyond 
reasonable  doubt,  with  the  present  technique, 
this  is  susceptible  of  consistent  demonstration 
only  by  group  averages.  In  the  individual  cases, 
even  of  proved  liver  disease,  the  results  of 
these  tests  are  so  often  within  the  upper  limits 
of  normal  as  to  rob  them  of  any  great  signifi- 
cance. The  second  objection  is  that  other  organs, 
such  as  the  pancreas,  the  pituitary,  and  the 
muscles,  also  play  a prominent  role  in  carbo- 
hydrate metabolism  and,  therefore,  any  discovered 
abnormalities  of  it  may  not  be  due  specifically 
to  liver  deficiency.  The  first  difficulty  may  in 
time  be  overcome  by  improved  technique  of  the 
tests.  The  second  objection  in  theory  we  never 
will  be  able  to  disregard  totally.  However,  the 
probability  is  that,  in  practice,  with  a suitable 
sugar-tolerance  test  at  hand,  it  will  present  no 
greater  difficulties  to  the  diagnosis  of  liver  dis- 
ease than  the  fact  that  sugar  utilization  is  not 
solely  dependent  on  the  pancreas  interferes  with 
our  diagnosis  of  diabetes. 

Another  set  of  functions  of  the  liver,  of  prime 
importance,  deals  with  the  metabolism  of  nitrogen 
compounds,  and  many  phases  of  it  were  selected' 
at  one  time  or  another  as  reflecting  in  a qualita- 
tive or  quantitative  way  the  functional  activity  of 
the  liver. 

Here  can  be  mentioned  studies  of  urea,  uric 
acid,  total  nonprotein  nitrogen  and  amino-acid 
fractions  of  the  blood  and  that  of  ammonia,  un- 
determined nitrogen,  amino-acids,  urea  and  uric 
acid  in  the  urine,  as  well  as  the  quantitative  inter- 
relations of  these  substances. 

Unfortunately,  even  the  best  of  these  tests  up 
to  the  present  were  open  to  the  same  two  objec- 
tions as  the  sugar-tolerance  tests,  namely,  con- 
sistency of  results  only  in  the  case  of  disease 
groups,  but  not  individuals  and  the  possible  influ- 
ence of  changes  in  other  organs  on  the  outcome 
of  any  given  test.  However,  the  appearance  of 
the  amino-acids,  leucin  and  tyrosin  in  the  urine 


53 


54 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


can  be  accepted  as  evidence  of  rapid  liver  tissue 
disintegration. 

Some  very  hopeful  work  on  the  urea  forma- 
tion function  of  the  liver  is  in  progress  at  the 
Mount  Sinai  Hospital  in  New  York,  but  there  is 
need  of  more  work  before  final  judgment  can  be 
passed  on  this  test. 

Only  recently  attempts  were  begun  to  deter- 
mine the  detoxicating  power  of  the  liver,  and 
Vesell  and  Sherwin  have  obtained  promising  re- 
sults with  acetylation  of  para-aminobenzoic  acid 
by  the  liver. 

The  obvious  conclusion  from  the  foregoing  is 
that  at  present  metabolic  function  tests  of  the 
liver  cannot  be  recommended  for  practical  use. 

T.  L.  Althausen,  San  Francisco. 

(Part  II  will  be  printed  in  next  issue.) 

Ear,  Nose  and  Throat 

T^ecognition  of  Infected  Tonsils. — While 
J\_  the  theory  of  focal  infection  is  based  on 
scientific  foundation,  the  practical  application  of 
this  theory  is  in  many  instances  not  so  scien- 
tifically worked  out. 

Recognition  of  infection  in  tonsils  well  illus- 
trates this  point.  In  the  majority  of  cases  only 
the  size  of  the  tonsil  is  considered,  whereas  their 
size,  color,  presence  of  pus  or  caseous  debride 
in  the  crypts,  and  bacterial  flora  by  culture,  should 
be  examined  and  secondary  manifestations  of 
infection  be  taken  in  consideration. 

History  of  frequent  colds  and  sore  throats, 
complaint  of  lack  of  pep,  fatigue  and  lowered 
resistance  to  infection  supply  signs  of  a toxic 
condition  which  may  be  the  result  of  an  infection 
in  the  tonsils. 

It  is  a customary  routine  to  notice  first  of  all 
the  size  of  the  tonsils.  In  the  textbooks,  the 
statement  is  usually  made  that  the  size  of 
the  tonsils  is  normal  if  they  do  not  project  from  the 
pillars,  otherwise  they  are  hypertrophied.  In  the 
light  of  modern  knowledge,  this  definition  should 
be  revised.  In  children  very  large  hyperplastic 
tonsils  can  often  be  seen  as  a manifestation  of 
status  lymphaticus.  The  pathologic  significance 
of  this  type  is  rather  negative,  the  enlargement 
causing  only  a mechanical  obstruction.  On  the 
other  hand,  the  observations  of  many  authors 
definitely  establish  the  fact  that  even  very  small 
remnants  of  not  completely  removed  tonsils,  if 
infected,  may  be  the  cause  of  very  serious  com- 
plications. 

Therefore,  not  the  size  of  the  tonsils,  but  the 
presence  of  infection  in  them  should  be  first 
established.  The  anterior  pillar  should  be 
retracted  and  gentle  pressure  be  exerted  upon 
the  tonsil  and,  in  a surprisingly  large  number  of 
cases,  a drop  of  liquid  pus  or  of  caseous  matter 
will  be  pressed  out  from  some  of  the  crypts,  even 
when  the  tonsil  at  sight  appeared  more  or  less 
innocent. 

The  color  of  the  tonsil  and  of  the  surrounding 
parts  supply  a great  deal  of  information.  While 


in  normal  condition,  its  color  does  not  differ  from 
the  surrounding  mucous  membranes ; when 
inflamed,  various  shades  of  red  discoloration  are 
present.  In  adults,  infected  tonsils  of  fibrous 
type,  or  submerged  tonsils,  are  usually  pale, 
whereas,  the  inlets  of  the  crypts  are  inflamed  and 
a characteristic  red  border  is  present  along  the 
anterior  pillars,  indicating  a deeply  seated  infec- 
tion. The  extension  of  the  infection  from  the 
tonsil  to  the  lymphatic  tissue  on  the  lateral  walls 
of  the  pharynx  and  into  the  hypo-pharynx, 
should  be  considered.  Systemic  manifestations  as 
rheumatism,  neuralgias,  myocardial  involvement 
and  so  on,  are  signs  of  secondary  foci  of  infection. 

A complete  study  of  the  tonsil  should  include 
a bacteriologic  examination  of  the  flora  of  the 
pus  expressed.  Besides  different  groups  of 
staphylo  or  streptococci  sometimes  tubercle 
bacilli  or  Vincent’s  bacilli  can  be  found.  In  single 
instances  syphilitic  lesions  on  the  tonsils  will  be 
established. 

Benjamin  Katz,  Los  Angeles. 


Medicine 

The  Stramonium  Treatment  of  Chronic  En- 
cephalitis.— Acute  encephalitis  occurs  most 
commonly  in  the  form  of  postinfluenzal  epi- 
demics, but  may  occur  sporadically.  Formerly  it 
was  called  encephalitis  lethargica,  but  as  the  tend- 
ency to  sleep  has  become  uncommon  in  recent 
years  the  term  of  epidemic  encephalitis  is  now 
usually  applied.  In  a large  number  of  cases  it 
lapses  into  the  chronic  form,  or  the  chronic  stage 
becomes  manifest  up  to  one  or  even  two  years 
following  the  acute  illness,  the  interval  period 
often  being  one  of  good  health.  Not  infrequently 
no  antecedent  acute  stage  can  be  identified. 

The  most  constant  clinical  feature  of  chronic 
encephalitis  is  the  Parkinsonian  syndrome.  The 
flexion  attitude,  the  mask-like  face,  the  muscular 
rigidity  and  the  propulsion  gait,  together  with 
tremor,  make  up  this  syndrome,  but  the  last  symp- 
tom, so  constant  in  idiopathic  parkinsonism  of 
old  people,  is  often  lacking.  There  are  many  com- 
plications dependent  on  the  extrapyramidal  tract 
system,  some  of  which  may  well  be  considered 
part  of  the  disease.  Common  ones  are  brady- 
kinesia,  blepharospasm,  oculogyric  crises,  drool- 
ing, slow  speech,  trismus,  hyperhydrosis,  dys- 
phagia, myalgias,  hvperpnea,  myoclonic  spasms, 
paresis,  and  catatonia.  Mental  changes  may  be 
striking/ but  retardation  is  frequently  inconspicu- 
ous. In  children  there  may  be  a complete  altera- 
tion in  character,  the  so-called  apachism.  Adults 
are  subject  to  emotional  outbursts  often  consid- 
ered hysterical,  and  in  the  worst  cases  their  re- 
sponse is  so  poor  that  it  is  difficult  to  estimate  the 
condition  of  their  intellect. 

The  onset  of  the  symptoms  of  the  chronic  stage 
is  insidious.  The  condition  is  usually  diagnosed 
as  “neurosis”  or  “hysteria.”  It  may  be  months,  or 
even  years,  before  typical  parkinsonism  develops 
together  with  some  or  many  of  the  other  late 
symptoms.  After  a variable  period  of  time  the 
disease  in  many  patients  apparently  becomes 


January,  1930 


MEDICINE  TODAY 


55 


arrested.  A few  remain  active  and  able  to  carry 
on  some  sort  of  suitable  work,  many  are  semi- 
invalids requiring  considerable  attention  but  still 
able  to  get  about,  but  the  majority  are  bedridden 
invalids.  Doctor  Crossman  of  Washington,  D.  C., 
recently  stated  that  217  of  273  hospitalized  chronic 
encephalitis  patients  were  totally  disabled. 

Institutions  care  for  many  of  these  patients 
and  they  are  a great  problem.  When  we  realize 
that  a large  number  have  to  be  bathed,  clothed, 
fed,  and  waited  upon  for  every  want  and  need, 
often  while  in  full  possession  of  their  mental 
faculties,  it  is  evident  that  any  therapy  which 
will  in  any  way  improve  their  condition  will  be 
of  great  value. 

Four  and  one-half  years  ago  Juster  reported 
encouraging  improvement  in  a case  treated  with 
large  doses  of  Datura  stramonium.  A year 
later  observations  on  twenty-four  cases  similarly 
treated  were  briefly  reported  upon  from  Paris, 
also  with  good  results.  Only  three  articles  have 
appeared  in  English  to  date.  Two  noted  that 
almost  all  symptoms  improve  under  Juster’s 
method  of  treatment  and  that  all  cases  improve 
except  the  aged  ones.  Jacobson  and  Epplen  pre- 
sented at  the  last  American  Medical  Association 
meeting  in  Portland  a review  of  twenty-six  cases 
including  some  with  true  Parkinson’s  disease. 
They  used  the  tincture  of  stramonium,  and  con- 
cluded that  all  patients  were  benefited,  some  re- 
markably so.  These  reports  together  with  a brief 
one  on  four  cases  from  the  Veterans’  Bureau 
represent  all  the  available  information  on  the  sub- 
ject. Articles  are  still  appearing  in  the  medical 
journals  discussing  the  treatment  of  chronic  en- 
cephalitis which  do  not  even  mention  Juster’s 
method  of  therapy. 

The  essence  of  this  method  of  treatment  is  to 
use  large  doses  of  stramonium.  A daily  total  dose 
of  6 to  12  cubic  centimeters  of  the  tincture  or 
1 to  2 grams  of  the  dried  leaves  is  the  most  effec- 
tive. Equal  doses  of  the  tincture  are  given  three 
times  a day,  beginning  at  1 cubic  centimeter  t.  i.  d. 
and  working  up  to  3 or  4 cubic  centimeters  t.  i.  d. 
within  three  days.  Improvement  is  usually  noted 
within  forty-eight  hours.  The  treatment  must 
continue  indefinitely,  as  the  patients  relapse 
within  a few  days  if  it  is  stopped.  Signs  of  in- 
tolerance or  overdosage  by  this  method  are  not 
frequent.  They  are : difficulty  of  vision,  dryness 
of  the  mouth,  nausea,  a sense  of  constriction  in 
the  chest,  and  diarrhea.  All  of  these  clear  up  in 
two  or  three  days  on  suspending  treatment,  and 
do  not  tend  to  recur  on  using  smaller  doses.  As 
to  prognosis  it  is  impossible  to  judge  which  pa- 
tients will  receive  the  greatest  benefit,  as  fre- 
quently bad  cases  of  long  standing  are  helped  the 
most. 

The  improvement  is  striking  in  many  cases, 
particularly  in  the  patients’  mental  attitude.  They 
nearly  all  “feel  better.’’  Their  activity  and  their 
powers  of  enjoyment  may  be  greatly  increased. 
Some  bedridden  invalids  are  actually  able  to  be 
up  and  about,  and  others  less  afflicted  are  able 
to  resume  light  work.  Many  are  at  their  best  if 
they  take  hyoscin  in  addition  to  stramonium,  and 


this  should  not ‘be  lost  sight  of.  All  patients  are 
not  benefited,  but  certainly  for  the  great  majority 
Juster’s  method  of  stramonium  treatment  stands 
out  as  one  of  the  really  great  advances  in  modern 
therapeutics,  particularly  as  chronic  encephalitis 
has  previously  always  been  a discouraging  con- 
dition for  any  form  of  therapy. 

Garnett  Cheney,  San  Francisco. 


Substandard  Ether  Is  Seized  by  Government. — The 
largest  shipment  of  ether  for  anesthesia  ever  detained 
by  the  Federal  Government  was  seized  at  Bayway, 
New  Jersey,  recently  after  laboratory  tests  had  shown 
that  samples  from  a lot  consisting  of  108,300  quarter- 
pound  tins  were  below  the  standards  required  under 
the  Federal  Food  and  Drugs  Act.  The  seizure  was 
made  by  the  Food,  Drug,  and  Insecticide  Adminis- 
tration, United  States  Department  of  Agriculture, 
which  enforces  the  Food  and  Drugs  Act.  This  ether 
did  not  meet  the  requirements  of  the  United  States 
Pharmacopeia,  which  is  the  standard  designated  by 
the  Food  and  Drugs  Act  for  drugs  in  interstate  com- 
merce or  imported  from  abroad. 

The  seized  ether  is  part  of  a lot  made  during  the 
World  War  for  the  Government.  It  was  in  storage 
until  1926,  by  which  time  it  had  deteriorated  to  such 
degree  as  to  be  unfit  for  use  as  an  anesthetic.  The 
War  Department  then  sold  it  at  a low  price  under 
bond  that  it  was  not  to  be  used  or  resold  for  use  as 
an  anesthetic  but  only  for  technical  purposes,  such 
as  in  laboratories,  for  dry  cleaning,  or  for  fuel  in 
starting  motors.  Contrary  to  the  terms  of  the  bond, 
some  of  this  ether,  labeled  as  anesthetic  ether,  was 
consigned  to  hospitals  in  small  lots.  These  small  lots 
were  seized  at  once.  Now  this  large  shipment  has 
been  removed  from  the  channels  of  trade  by  action 
under  the  Food  and  Drugs  Act. 

Although  improvement  has  been  made  in  the  manu- 
facture and  packaging  of  ether  in  the  last  few  years, 
some  ether  still  shows  deterioration  upon  standing 
in  sealed  tins.  For  this  reason  authorities  have  been 
especially  vigilant  in  the  inspection  of  ether. 

Whether  or  not  ether  that  has  deteriorated  is  harm- 
ful to  patients  on  the  operating  table,  a matter  upon 
which  medical  authorities  do  not  entirely  agree,  is 
quite  beside  the  point  in  the  administration  of  the 
Food  and  Drugs  Act.  It  is  the  duty  of  the  officials 
enforcing  this  law  to  remove  from  interstate  com- 
merce all  ether  that  fails  to  meet  the  standards  set 
by  the  United  States  Pharmacopeia. — United  States 
Department  of  A griculture , Office  of  Information,  Press 
Service. 


Progress  and  Poverty. — Peculiar  as  it  may  seem, 
along  with  great  wealth  we  have  associated  great 
poverty.  Henry  George,  fifty  years  ago,  coined  the 
expression  “Progress  and  Poverty”  as  the  title  to  his 
memorable  book  which  has  had  a tremendous  sale 
since  its  publication.  Henry  George’s  contention  is 
truer  today  than  it  was  half  a century  ago  when  the 
greater  part  of  the  population  was  rural  and  in  closer 
contact  with  the  source  of  maintenance.  It  is  said 
that  at  present  those  with  incomes  of  $10,000  and  up- 
ward number  only  two-thirds  per  cent  of  the  whole 
population;  only  six  per  cent  have  incomes  of  $3000 
and  14  per  cent  are  in  the  $2000  class.  This  means 
that  86  per  cent  of  the  people  have  incomes  less  than 
$2000  a year.  Through  high-pressure  salesmanship 
and  the  moving-picture  theaters  and  other  ways  of 
absorbing  incomes  many  of  these  small  incomes  are 
spent  before  they  are  earned,  leaving  no  provision  for 
emergencies  to  which  category  illness  belongs.  So 
while  the  medical  profession  has  nothing  to  say  in 
regard  to  the  distribution  of  moneys  appropriated,  we 
cannot  but  be  greatly  interested  in  charity  as  a social 
problem.  Broadly  speaking,  while  charity  may  evoke 
generous  responses  on  the  part  of  the  giver  the  in- 
creasing necessity  for  it  indicates  something  wrong 
with  our  social  and  industrial  life. — The  Journal  of  the 
Michigan  State  Medical  Society,  December  1929. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION 


MORTON  R.  GIBBONS President 

LYELL  C.  KINNEY - - President-Elect 

EMMA  W.  POPE Secretary 


OFFICIAL  NOTICES 

Council  Meeting. — The  next  meeting  of  the  Council 
will  be  held  at  the  office  of  the  Association,  Room 


2004,  450  Sutter  Street, 

San  Francisco, 

January  18, 

1930,  at  10  a.  m. 

* 

* * 

Apportioned  Delegates 

and  Alternates 

to  Annual 

Meeting,  1930.  Membership  as  of  November  1,  1929.* 

Members 

Delegates  to 

County 

Nov.  1,  1929 

1930  Session 

Alameda  

404 

9 

Butte  

18 

1 

Contra  Costa 

37 

1 

Fresno  

103 

3 

Glenn  

7 

1 

Humboldt  

36 

1 

Imperial  

22 

1 

Kern  

48 

1 

Lassen-Plumas  

14 

1 

Los  Angeles 

1760 

36 

Marin  

19 

1 

Mendocino 

15 

1 

Merced  

20 

1 

Monterey  

28 

1 

Napa  

25 

1 

Orange  

86 

2 

Placer  

26 

1 

Riverside  

48 

1 

Sacramento  

125 

3 

San  Benito  

7 

1 

San  Bernardino  

106 

3 

San  Diego  

217 

5 

San  Francisco  

931 

19 

San  Joaquin  

83 

2 

San  Luis  Obispo  

15 

1 

San  Mateo  

29 

1 

Santa  Barbara  

74 

2 

Santa  Clara  

142 

3 

Santa  Cruz  

30 

1 

Shasta  

9 

1 

Siskiyou  

15 

1 

Solano  

17 

1 

Sonoma  

45 

1 

Stanislaus  

39 

1 

Tehama  

11 

1 

Tulare  

36 

1 

Tuolumne  

6 

1 

Ventura  

29 

1 

Yolo-Colusa  

25 

1 

Yuba-Sutter  

13 

1 

Total 

4720 

116 

♦Constitution  and  By-Laws  of  the  California  Medical 
Association  as  amended  and  adopted  May  8,  1929.  Article 
V,  Section  2. — Basis  of  Representation  of  Component 
County  Societies.  Each  component  county  society  shall 
be  entitled  to  be  represented  by  one  delegate  and  one 
corresponding  alternate  for  every  fifty  active  members 
thereof,  and  also  by  one  delegate  and  one  corresponding 
alternate  for  each  fraction  of  fifty  active  members  in 
excess  of  fifty  or  multiple  thereof  as  of  the  first  day  of 
November  of  the  year  preceding  a current  annual  session. 
Every  component  county  society  having  less  than  fifty 
active  members  shall  be  entitled  to  be  represented  by 
one  delegate  and  one  corresponding  alternate. 


Special  Committee  on  California  Medical  Practice 
Act. — At  the  last  meeting  of  the  Council  a special 
committee  on  revision  of  the  California  Medical  Prac- 
tice Act  and  a possible  basic  science  law  was  author- 
ized and  appointed.  Members  of  the  California 
Medical  Association  are  invited  to  send  suggestions 
to  the  general  chairman  or  the  subcommittee  chair- 
men. The  committee  is  made  up  of  representatives  of 
the  Council,  of  the  Board  of  Medical  Examiners,  and 
of  the  medical  colleges  of  California,  and  is  composed 
as  follows: 

Bay  region  group:  Morton  R.  Gibbons,  San  Fran- 
cisco, group  chairman;  Emma  W.  Pope,  T.  Henshaw 
Kelly,  Walter  B.  Coffey,  Joseph  Catton,  Langley 
Porter,  William  Ophuls,  Hartley  Peart,  San  Fran- 
cisco; Oliver  D.  Hamlin,  Oakland. 

Los  Angeles  group:  George  H.  Kress,  Los  Angeles, 
general  chairman;  Percy  T.  Magan,  Los  Angeles, 
group  chairman;  William  Duffield,  William  Cutter, 
William  Molony,  Los  Angeles;  Lyell  C.  Kinney,  San 
Diego. 

At  large  group:  Junius  Harris,  Sacramento,  group 
chairman;  Percy  Phillips,  Santa  Cruz;  Charles  Pink- 
ham,  San  Francisco;  Frederick  Gundrum,  Sacramento. 


COMPONENT  COUNTY  SOCIETIES 

ALAMEDA  COUNTY 

The  annual  meeting  of  the  Alameda  County  Medi- 
cal Association  was  held  at  the  Ethel  Moore  Me- 
morial Building  on  Monday,  November  18,  at  8:15 
p.  m. 

The  scientific  program  of  the  evening  was  pre- 
sented by  the  staff  of  Peralta  Hospital,  the  first  paper 
being  a report  of  an  interesting  case  of  fibrosarcoma 
of  the  lung  by  Dr.  R.  T.  Legge.  Doctor  Legge  re- 
ported a patient  who  came  to  him  with  a history  of 
an  acute  pneumonia  followed  by  empyema  and  drain- 
age. The  pneumonic  process  was  typical  in  every 
way,  and  the  chest  had  been  drained  of  a purulent 
fluid  over  a considerable  period.  The  first  examina- 
tion showed  much  fluid  in  the  left  chest  with  atelec- 
tasis of  the  left  lung  and  a heart  which  was  pushed 
definitely  to  the  right.  X-ray  of  the  right  chest 
showed  a large  mass  diagnosed  clinically  as  a malig- 
nant tumor  of  the  lung.  The  tumor  at  autopsy  proved 
to  be  a fibrosarcoma.  An  interesting  point  about  this 
case  was  the  fact,  as  pointed  out  by  Doctor  Legge, 
that  a definite  tumor  mass  had  been  discovered  in 
this  patient’s  chest  two  and  one-half  years  before  his 
death.  At  this  time  the  mass  was  diagnosed  as  be- 
nign, probably  a dermoid  cyst.  Doctor  Legge’s  paper 
was  discussed  by  Dr.  C.  L.  McVey,  who  brought 
out  the  fact  that  there  is  a definite  increase  in  malig- 
nant tumo/s  of  all  types  and  in  all  locations,  but  that 
there  is  a particular  increase  in  cancers  of  the  lung. 
Doctor  McVey  further  discussed  the  differential  diag- 
nosis of  this  lesion  particularly  in  connection  with 
the  x-ray.  Doctor  Scudder  reported  a case  of  primary 
fibrosarcoma  of  the  lung.  X-ray  diagnosis  of  chest 
tumors  was  discussed  by  Doctor  Jelte. 

The  second  paper  of  the  evening  was  by  W.  O. 
French,  Jr.,  on  “Coccidioidal  Granuloma.”  Doctor 
French  reported  a case  which  appeared  to  be  a pri- 
mary coccidioidal  infection  of  the  peritoneum  which 
is  the  first  recorded  case  of  coccidioides  limited  to 
the  peritoneal  cavity.  In  the  discussion  of  this  paper 
Dr.  H.  J.  Templeton  showed  two  cases  of  well 
developed,  definitely  proved  coccidioidal  granuloma, 
both  of  which  have  completely  healed  under  a treat- 


56 


January,  1930 


STATE  MEDICAL  ASSOCIATIONS 


57 


ment  consisting  of  intramuscular  injections  of  col- 
loidal copper  together  with  vaccine  therapy.  This 
paper  was  discussed  by  Doctors  Frank  Bowles,  L.  M. 
Boyer,  and  W.  A.  Perkins. 

The  third  paper  of  the  evening  was  a discussion  of 
the  physical  findings  in  a group  of  depressed  indi- 
viduals by  Sidney  K.  Smith.  Doctor  Smith  pointed 
out  the  importance  of  seeking  a physical  background 
for  mental  depression  of  various  types.  Doctor 
Smith’s  paper  was  discussed  by  Dr.  Q.  O.  Gilbert. 
Following  the  scientific  program  the  annual  reports 
of  the  chairmen  of  the  various  standing  committees 
and  of  the  president  and  secretary-treasurer  were 
read.  The  tellers  reported  the  results  of  the  annual 
election,  and  our  new  president,  Dr.  A.  M.  Meads, 
was  called  to  the  chair. 

Gertrude  Moore,  Secretary. 

* 

CONTRA  COSTA  COUNTY 

The  Contra  Costa  County  Medical  Society  met  on 
December  10,  at  Richmond. 

Election  of  officers  for  1930  resulted  as  follows: 
President,  J.  W.  Bumgarner  of  Richmond;  vice-presi- 
dent, S.  N.  Weil  of  Selby;  secretary-treasurer,  L.  H. 
Fraser  of  Richmond.  Delegate  for  1930  and  1931, 
U.  S.  Abbott  of  Richmond.  Alternate  delegate  for 
1930  and  1931,  J.  F.  Feldman  of  Richmond. 

L.  A.  Hedges  of  Richmond  was  elected  for  three- 
year  term  as  censor,  to  serve  with  H.  L.  Carpenter 
and  John  L.  Beard,  both  of  Martinez. 

A committee  composed  of  U.  S.  Abbott  and  L.  H. 
Fraser  of  Richmond  and  J.  M.  McCullough  of 
Crockett  was  chosen  to  represent  the  society  at  a 
mass  meeting  to  be  held  at  Memorial  Hall,  Rich- 
mond, on  December  13,  to  discuss  measures  to  secure 
a veterans’  hospital  for  the  East  Bay  region. 

L.  St.  John  Hely  presided  over  this  meeting. 

* * * 

The  annual  banquet  of  the  Contra  Costa  County 
Medical  Society  was  held  on  December  7 at  the  new 
Hotel  Carquinez,  in  Richmond.  This  social  gathering 
was  pronounced  a most  enjoyable  event  by  all  who 
attended,  with  friendships  engendered  and  mirth  and 
pleasure  predominant  features.  All  those  who  were 
absent  missed  a real  treat. 

Dr.  J.  W.  Bumgarner  presided  as  toastmaster  in 
the  absence  of  President  L.  St.  John  Hely,  and  kept 
things  lively  throughout  the  evening. 

A delicious  turkey  dinner  was  served;  there  was 
excellent  music,  furnished  by  the  Milano  Trio,  be- 
tween courses.  Dancing  was  enjoyed  by  all  at  the 
conclusion  of  the  banquet. 

It  was  the  consensus  of  opinion  that  such  social 
contact  among  the  members  of  the  society  and  their 
wives  goes  far  toward  producing  a close  bond  of 
friendship. 

Thos  present  were:  Dr.  and  Mrs.  J.  W.  Bumgarner, 
Dr.  and  Mrs.  G.  W.  Bumgarner,  Dr.  and  Mrs.  J.  F. 
Feldman,  Dr.  M.  Keser  and  Miss  Driscoll,  Dr.  Rosa 
Powell,  and  Miss  Redmond,  Dr.  and  Mrs.  U.  S. 
Abbott,  Dr.  and  Mrs.  F.  W.  Overdahl,  Dr.  and  Mrs. 
I.  O.  Church,  Dr.  and  Mrs.  H.  D.  Neufeld,  Dr.  and 
Mrs.  M.  L.  Fernandez,  Dr.  and  Mrs.  J.  M.  McCul- 
lough, Dr.  and  Mrs.  S.  N.  Weil,  Dr.  and  Mrs.  L.  A. 
Hedges,  Dr.  and  Mrs.  L.  H.  Fraser,  Dr.  and  Mrs. 
Hall  Vestal. 

S.  N.  Weil,  Secretary. 

KERN  COUNTY 

Thursday  evening,  November  21,  the  Kern  County 
Medical  Society  held  its  monthly  meeting  at  the  Kern 
General  Hospital,  Bakersfield. 

Seymour  Strongin,  Keene,  resident  physician  of 
Stony  Brook  Retreat,  and  M.  A.  Williamson  of  Lone 
Pine  were  elected  to  membership  in  the  society. 

Officers  for  the  coming  year  were  elected  as  fol- 
lows: E.  A.  Schaper,  president;  E.  S.  Fogg,  vice- 
president;  George  E.  Bahrenburg,  secretary-treasurer. 


F.  J.  Gundry  was  appointed  as  delegate  to  the  state 
convention  to  be  held  next  year  in  Del  Monte,  with 
J.  M.  Kirby  as  alternate. 

Arrangements  were  made  for  our  annual  banquet, 
which  is  to  be  held  at  the  Bakersfield  Club,  Thursday 
evening,  December  12. 

Rex  Duncan  of  the  Oncologic  Institute  of  Los  An- 
geles was  the  speaker  of  the  evening,  and  gave  a 
most  interesting  address  on  the  treatment  of  cancer. 
He  stated  that  cancer  was  on  the  increase;  that  at  the 
present  time  it  was  the  cause  of  10  per  cent  of  all 
the  deaths  of  those  over  forty  years  of  age.  This  dis- 
ease occupies  second  place  as  the  cause  of  death,  and 
now  destroys  more  lives  than  tuberculosis,  which  oc- 
cupies fifth  place.  Doctor  Duncan  emphasized  the 
fact  that  cancer  is  not  hereditary.  It  is  exceedingly 
important  that  an  early  and  accurate  diagnosis  be 
made.  He  brought  out  the  fact  that  frequently  cases 
first  seen  by  irregular  practitioners  who  fail  to  recog- 
nize the  condition  present  are  later  seen  by  compe- 
tent medical  men  when  they  are  so  far  advanced  as 
to  be  beyond  help.  Cancer  at  present  is  treated  by 
x-ray,  radium,  cautery,  and  surgery.  Best  results  are 
secured  in  many  early  cases  of  cancer  by  giving  x-ray 
and  radium  treatments.  In  selected  cases  cautery  and 
surgery  may  be  used  to  advantage. 

While  the  medical  society  was  in  session  the  wives 
of  physicians  met  in  another  part  of  the  General 
Hospital,  where  a Woman’s  Auxiliary  to  the  county 
medical  society  was  organized.  The  following  officers 
were  elected:  Mrs.  F.  A.  Hamlin,  president;  Mrs. 
F.  J.  Gundry,  first  vice-president;  Mrs.  A.  R.  Moodie, 
second  vice-president;  Mrs.  C.  S.  Compton,  secretary- 
treasurer. 

In  the  future  the  Woman’s  Auxiliary  will  have  a 
monthly  meeting  in  conjunction  with  the  regular 
meeting  of  the  Kern  County  Medical  Society. 

E.  A.  Schaper,  Secretary. 

SACRAMENTO  COUNTY 

The  Sacramento  Society  for  Medical  Improvement 
met  at  the  Senator  Hotel  on  November  19,  and  were 
called  to  order  by  Doctor  Pope  at  8:40  p.  m. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

Dr.  W.  A.  Beattie  reported  a case.  This  was  a 
case  of  dysentery  in  an  infant  six  and  one-half  months 
of  age.  The  child  was  in  the  third  week  of  sickness 
and  was  given  carbohydrates  by  mouth,  colonic 
flushes  and  saline  solution  by  hypodermoclysis.  After 
two  days  the  patient  refused  food,  and  a generalized 
edema  resulted.  Rales  were  heard  in  the  chest.  A 
catheterized  specimen  of  urine  showed  many  hyaline 
casts.  The  saline  was  discontinued  and  the  edema 
began  to  clear,  and  within  forty-eight  hours  after  the 
discontinuing  of  the  saline  the  urine  had  cleared  of 
casts. 

The  paper  for  the  evening,  “Acute  Perinephritic 
Abscess,”  was  presented  by  Dr.  G.  Rhodes  of  San 
Francisco. 

Doctor  Rhodes  had  recorded  and  studied  a list  of 
over  thirty  cases  and  based  his  findings  on  these 
cases.  In  almost  all  of  these  cases  the  patient  gave 
a history  of  a previous  skin  infection,  such  as  boils 
or  carbuncles,  and  no  previous  history  of  a kidney 
infection.  In  children  the  secondary  infection  usually 
localizes  in  the  bone  marrow  while  in  adults  the 
common  site  is  a perinephritic  abscess. 

Showers  of  organisms  are  squeezed  out  of  the  origi- 
nal focus  and  these  lodge  in  the  perinephritic  fat. 
The  fat  has  a poor  circulation  and  the  arteries  here 
are  end  arteries,  being  branches  of  the  renal  arteries. 
Rupture  of  renal  abscesses  may  likewise  cause  the 
same.  It  is  not  due  to  the  lymphatics. 

The  staphylococcus  is  the  causative  organism.  It 
forms  clumps  and  more  easily  blocks  the  arteries. 
Streptococcus  is  rare. 

In  children  it  is  hard  to  diagnose.  Lassitude  occurs 
and  they  run  a septic  course.  In  adults  the  course 


58 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


may  be  slower  and  they  may  have  tenderness  over 
the  appendix.  Acute  symptoms  come  on  suddenly. 
A severe  pain  usually  occurs  over  the  kidney  region. 
They  may  have  general  infection  symptoms,  or  it  may 
be  referred  to  the  hip. 

The  polymorphonuclear  count  is  high.  Cystoscopic 
examination  is  negative,  and  x-ray  is  the  first  posi- 
tive evidence.  This  is  due  to  an  obliteration  of  the 
lateral  border  of  the  psoas  muscle.  X-ray  at  the  early 
onset  shows  a shadow  and  the  shadow  then  is  lost. 
The  persistent  obscuring  of  the  shadow  is  the  best 
diagnostic  factor.  A scoliosis  of  the  lumbar  verte- 
brae away  from  the  abscess  may  occur. 

The  paper  was  discussed  by  Doctors  Hale,  Beach, 
Rulison  and  Lee,  and  was  well  illustrated  with  lan- 
tern slides. 

A communication  from  the  Eastman  Kodak  Com- 
pany, in  regard  to  films  for  teaching,  was  read. 

There  being  no  further  business  the  meeting  ad- 
journed. 

Hans  F.  Schluter,  Secretary. 

SAN  BERNARDINO  COUNTY 

Minutes  of  the  regular  meeting  of  the  San  Bernar- 
dino County  Medical  Society  held  at  the  San  Ber- 
nardino County  Hospital  on  December  3. 

The  meeting  was  called  to  order  by  Dr.  A.  T.  Gage, 
first  vice-president,  in  the  absence  of  the  president. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

There  being  no  business  to  attend  to,  the  follow- 
ing program  of  the  evening  was  immediately  begun: 

The  Injection  of  Varicose  Veins  with  Sclerosing 
Solutions,  and  illustrated  by  motion  pictures,  was  the 
subject  of  the  first  paper  by  Dr.  Thomas  O.  Burger 
and  Dr.  Harold  G.  Holder,  San  Diego.  Discussion 
opened  by  Dr.  C.  G.  Hilliard. 

Circulatory  Disturbances  of  the  Extremities  was 
presented  by  Dr.  Joseph  K.  Swindt,  Pomona.  Dis- 
cussion opened  by  Dr.  Philip  Savage. 

Luncheon  was  served  at  10:30  o’clock,  seventy-five 
members  being  present. 

While  the  regular  medical  meeting  was  in  progress 
the  formation  of  a Woman’s  Auxiliary  to  the  Cali- 
fornia Medical  Association  was  going  on  in  the 
nurses’  home. 

'fC' 

SAN  DIEGO  COUNTY 

In  honor  of  Admiral  Stitt  and  Captain  Carpenter 
the  combined  organizations  of  the  San  Diego  County 
Medical  Society  and  the  Naval  Hospital  met  at  the 
Naval  Hospital  on  the  evening  of  November  12.  The 
speaker  of  the  evening  was  Dr.  Carl  Rand,  neuro- 
logical surgeon  of  Los  Angeles,  who  talked  on  the 
diagnosis  of  brain  tumors.  Doctor  Rand’s  discourse 
was  very  interesting  and  helpful,  particularly  to  the 
general  practitioner.  He  pointed  out  that  many  cases 
of  brain  tumor  went  undiagnosed  until  curative  treat- 
ment was  impossible,  and  therefore  an  especial  burden 
lay  upon  the  general  practitioner  who  first  saw  these 
patients.  The  more  outstanding  features  in  the  his- 
tory and  physical  examination  were  stressed  with  an 
outline  of  the  more  important  diagnostic  measures. 
The  more  technical  features,  particularly  of  operative 
treatment,  were  outlined.  After  the  meeting,  light 
refreshments  and  a social  time  were  enjoyed. 

On  November  5 and  6,  Dr.  Thomas  Addis,  pro- 
fessor of  medicine  at  the  Stanford  University  Medical 
School,  addressed  the  San  Diego  Academy  of  Medi- 
cine on  the  diagnosis  and  treatment  of  Bright's  dis- 
eases. The  special  clinical  methods  developed  by 
Doctor  Addis  during  the  past  fifteen  years,  and  which 
are  now  widely  used  both  in  this  country  and  abroad 
as  a basis  for  diagnosis  and  prognosis  in  this  group 
of  diseases,  were  described.  The  second  lecture  was 
preceded  by  a short  clinic  in  which  patients  repre- 
senting the  major  forms  of  Bright’s  disease  were  pre- 


sented and  served  as  a basis  for  a general  considera- 
tion of  each  type.  Doctor  Addis  is  at  the  present  time 
the  president  of  the  American  Society  for  Clinical 
Investigation.  The  following  officers  were  elected 
for  the  San  Diego  Academy  of  Medicine  for  1930: 

A.  E.  Elliott,  president;  William  E.  Sisson,  vice-presi- 
dent; C.  O.  Tanner,  treasurer;  William  W.  Belford, 
secretary. 

The  following  officers  were  elected  for  the  San 
Diego  County  Medical  Society  for  the  year  1930: 
C.  M.  Fox,  president;  F.  H.  Carter,  vice-president; 
W.  H.  Geistweit,  Jr.,  secretary;  William  W.  Belford, 
treasurer.  Councilors:  W.  F.  McColl,  L.  C.  McAmis, 
and  W.  O.  Weiskotten.  Delegates:  F.  L.  Macpherson 
and  T.  O.  Burger  (two-year  term) ; C.  E.  Rees  and 

B.  J.  O’Neill  (one-year  term).  Alternates:  A.  J. 
Thornton,  G.  B.  Worthington,  and  L.  W.  Zochert 
(two-year  term);  E.  S.  Coburn  (one-year  term). 

Doctors  T.  Coe  Little,  A.  J.  Thornton,  J.  G.  Omel- 
vena,  O.  G.  Marsh,  E.  S.  Coburn,  George  B.  Worth- 
ington, L.  W.  Zochert,  and  Mr.  W.  C.  Crandall 
attended  the  excellent  program  of  the  Southern  Cali- 
fornia Medical  Association  at  Los  Angeles,  November 
8 and  9.  L.  W.  Zochert  has  joined  the  ranks  of  the 
“air-minded,”  and  flies  back  and  forth  to  northern 
conventions. 

Henry  A.  Christian,  professor  of  medicine  of  Har- 
vard Medical  School,  will  give  a lecture  on  January  25 
at  the  Scripps  Clinic.  The  doctor  will  choose  his  own 
subject.  Robert  Pollock. 

SAN  JOAQUIN  COUNTY 

The  annual  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  at  the  banquet  table  in  the 
dining  room  of  the  Stockton  Country  Club,  Decem- 
ber 5,  at  7 p.  m. 

Twenty-nine  members  and  five  visitors  were  pres- 
ent: Doctors  R.  Flarity,  R.  A.  Hunt  and  H.  O. 
Tucker,  guests  of  Dr.  Barton  J.  Powell;  T.  L.  Sutton 
of  Stockton;  and  Langley  Porter,  dean  of  the  Univer- 
sity of  California  Medical  School,  guest  and  speaker 
of  the  evening. 

The  members  present  were:  Doctors  N.  P.  Bar- 
bour, J.  W.  Barnes,  J.  F.  Blinn,  R.  A.  Buchanan, 

C.  A.  Broaddus,  H.  S.  Chapman,  Fred  J.  Conzelmann, 
J.  T.  Davison,  J.  F.  Doughty,  Linwood  Dozier,  F.  T. 
Foard,  P.  B.  Gallegos,  S.  Hanson,  C.  V.  Holliger,  J.  P. 
Hull,  H.  E.  Kaplan,  R.  V.  Looser,  F.  S.  Marnell, 
R.  T.  McGurk,  T.  C.  O’Connor,  F.  J.  O’Donnell,  H.  C. 
Peterson,  B.  J.  Powell,  D.  R.  Powell,  G.  H.  Rohr- 
bacher,  F.  B.  Sheldon,  J.  J.  Sippy,  H.  Smythe,  and 
C.  V.  Thompson. 

Before  being  seated  at  the  banquet  table  the  mem- 
bers bowed  their  heads  in  a momentary  silence  in 
memory  of  our  departed  colleagues,  Doctors  C.  L. 
Six,  J.  E.  Oliver,  and  F.  P.  Clark. 

The  annual  meeting  was  called  to  order  at  8:30 
p.  m.  by  C.  V.  Thompson,  president  presiding. 

The  minutes  of  the  previous  meeting  were  read  and 
approved.  The  secretary-treasurer  read  his  annual 
report,  w^ich  was  approved  and  ordered  filed. 

The  chairman  called  for  the  report  of  the  tellers 
which  read  as  follows: 

H.  E.  Kaplan,  president;  G.  H.  Rohrbacher,  first 
vice-president;  F.  T.  Foard,  second  vice-president; 
C.  A.  Broaddus,  secretary-treasurer. 

Board  of  Directors — Drs.  C.  A.  Broaddus,  H.  S. 
Chapman,  C.  F.  English,  R.  T.  McGurk,  H.  E.  Kap- 
lan, D.  R.  Powell,  J.  J.  Sippy,  Hudson  Smythe,  C.  V. 
Thompson. 

Admission  Committee — F.  J.  Conzelmann,  chair- 
man; J.  F.  Blinn,  H.  J.  Bolinger,  B.  J.  Powell, 
Hudson  Smythe. 

Ethics  Committee — J.  W.  Barnes,  chairman;  H.  S. 
Chapman,  C.  F.  English,  D.  R.  Powell,  Margaret  H. 
Smyth. 

Finance  Committee — J.  V.  Craviotto,  chairman; 
J.  D.  Dameron,  D.  R.  Powell. 


January,  1930 


STATE  MEDICAL  ASSOCIATIONS 


59 


Program  Committee — G.  H.  Sanderson,  chairman; 
P.  B.  Gallegos,  G.  H.  Rohrbacher. 

State  Delegates — J.  W.  Barnes,  B.  J.  Powell. 

Alternates — R.  T.  McGurk,  C.  V.  Thompson. 

The  chair  presented  Dr.  Langley  Porter,  dean  of 
the  University  of  California  Medical  School,  who 
gave  an  interesting  and  practical  talk  on  Greek  medi- 
cine, illustrated  by  lantern  slides. 

Fred  J.  Conzelmann,  Secretary. 

SAN  MATEO  COUNTY 

The  regular  meeting  of  the  San  Mateo  County 
Medical  Society  was  held  at  the  Oak  Tree  Inn  in 
San  Mateo  on  the  evening  of  November  20. 

Following  dinner  and  a social  hour,  Dr.  A.  C.  Reed 
of  San  Francisco  gave  an  exceedingly  interesting  lec- 
ture, illustrated  by  slides  compiled  while  on  a re- 
search trip  in  the  tropics  in  the  interests  of  tropical 
medicine.  Much  of  interest  was  learned  concerning 
not  only  the  medical  status  of  these  countries,  but 
also  their  customs  and  culture. 

In  a short  business  session  following,  it  was  de- 
cided to  concentrate  the  efforts  of  the  society  on 
obtaining  an  isolation  hospital  in  this  county  at  the 
Community  Hospital  at  Beresford. 

Dr.  A.  Gerlach,  resident  physician  at  the  Com- 
munity Hospital,  was  admitted  as  a new  member  to 
the  society. 

The  next  meeting  will  be  a joint  meeting  with  the 
Santa  Clara  County  Medical  Society,  to  be  held  De- 
cember 18,  in  San  Mateo,  the  place  to  be  announced 
at  a later  date. 

Erma  B.  Macomber. 

* 

SANTA  BARBARA  COUNTY 

The  regular  meeting  of  the  Santa  Barbara  County 
Medical  Society  was  held  at  the  St.  Francis  Hospital 
on  Monday  evening,  December  9. 

The  meeting  was  called  to  order  at  8:30  o’clock  by 
President  Brush. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

As  the  annual  meeting  is  to  be  held  Monday  eve- 
ning, January  13.  1930,  the  president  appointed  the 
following  committees: 

Scientific  Program — Dr.  Ullmann,  chairman;  Dr. 
Robinson  and  Dr.  Atsatt. 

Supper — Dr.  P.  C.  Means,  chairman. 

Entertainment — Dr.  Irving  Wills,  chairman. 

It  was  the  unanimous  decision  of  the  members 
present  that  the  annual  meeting  be  held  at  the  Uni- 
versity Club. 

It  was  moved,  seconded  and  carried  that  the 
program  and  entertainment  committees  draw  from 
the  treasury  sufficient  funds  to  cover  any  nominal 
expenses. 

The  scientific  program  was  opened  by  a paper  by 
Dr.  Rexwald  Brown  on  “Indication  for  Hysterectomy 
in  a Fibroid  Uterus.”  This  paper  was  discussed  by 
Doctors  Ullmann,  Robinson,  Eder,  Sansum,  Geyman, 
Shelton,  and  Schurmeier. 

Doctor  Henderson  then  gave  a paper  on  “Myeloge- 
nous Leukemia,”  with  a report  of  a case.  This  was 
discussed  by  Doctors  Ullmann  and  Brush. 

There  being  no  further  business  the  meeting  ad- 
journed. 

William  H.  Eaton,  Secretary. 


SANTA  CRUZ  COUNTY 

The  November  meeting  was  held  November  21  at 
the  Hotel  Reseter,  Watsonville.  Following  a very 
enjoyable  dinner,  President  Fehliman  called  the  meet- 
ing to  order  and  the  routine  business  was  attended  to. 


The  application  for  membership  of  Dr.  F.  P.  Shenk, 
who  recently  came  to  Santa  Cruz  as  an  eye,  ear,  nose, 
and  throat  specialist,  was  read  and  referred  to  the 
board  of  censors.  Election  of  officers  for  1930  resulted 
as  follows:  M.  F.  Bettencourt  of  Watsonville,  presi- 
dent; J.  C.  Farmer  of  Felton,  first  vice-resident;  O.  C. 
Marshall  of  Watsonville,  second  vice-president;  S.  B. 
Randall  of  Santa  Cruz,  secretary-treasurer.  Censors: 
P.  T.  Phillips,  W.  G.  Hatch,  and  E.  Eiskamp.  Dele- 
gate: L.  Liles  of  Watsonville.  Alternate:  P.  T. 
Phillips  of  Santa  Cruz. 

Dr.  J.  Lumford  of  Oakland  was  the  guest  speaker 
of  the  evening  and  presented  a very  commendable 
illustrated  discussion  of  the  subject  of  “Ringworm  of 
the  Feet.”  Diagnosis,  treatment,  and  prophylaxis 
were  considered  and  discussed  by  those  present.  The 
wide  distribution  of  this  type  of  fungus  infection  and 
the  difficulties  encountered  in  its  eradication  added  to 
the  importance  of  Doctor  Lumford’s  paper. 

The  following  were  present:  Visitors — Dr.  Tipton 
of  Watsonville,  Dr.  F.  P.  Shenk  of  Santa  Cruz,  and 
Dr.  Lumford  of  Oakland.  Members:  Bettencourt, 
Congdon,  Farmer,  Fehliman,  Gaynor,  Harrington, 
Marshall,  Nittler,  P.  T.  Phillips,  A.  L.  Phillips,  and 
Randall. 

Samuel  B.  Randall,  Secretary. 


SONOMA  COUNTY 

The  Sonoma  County  Medical  Society  held  its  last 
meeting  of  the  year  on  December  12  at  the  Petaluma 
Hotel,  Petaluma.  The  meeting  was  well  attended  to 
hear  Dr.  Dudley  Smith  speak  on  rectal  diseases.  His 
subject  was  covered  very  ably,  especially  from  the 
practical  side,  which  was  very  greatly  appreciated  by 
the  society. 

Dr.  J.  H.  Wright  and  Dr.  B.  L.  Baldwin,  both  of 
Healdsburg,  were  elected  to  membership. 

The  following  officers  were  elected  for  the  ensuing 
year:  President,  Chester  Marsh  of  Sebastopol;  vice- 
president,  A.  Morse  Bowles  of  Santa  Rosa;  secretary, 
J.  Leslie  Spear  of  Santa  Rosa;  treasurer,  T.  Hubert 
Reiss  of  Santa  Rosa;  censor,  W.  C.  Shipley  of  Santa 
Rosa;  delegate,  J.  Walter  Seawell  of  Healdsburg; 
alternate,  Stuart  Z.  Peoples  of  Petaluma. 

J.  Leslie  Spear,  Secretary. 

* 

TULARE  COUNTY 

The  regular  meeting  of  the  Tulare  County  Medical 
Society  was  held  at  Motley’s  Cafe  in  Visalia.  Sjxteen 
persons  were  present  for  the  dinner  at  6:30  o’clock, 
and  a few  arrived  later. 

Members  present  were:  Doctors  Annie  Bond,  E.  C. 
Bond,  Lipson,  Rivin,  Fowler,  Furness,  Zumwalt, 
Seligman,  Tourtillott,  Preston,  Campbell,  Ginsburg, 
Rosson,  and  Kohn. 

The  meeting  was  called  to  order  at  7:30  o’clock  by 
President  Furness. 

The  minutes  of  the  last  meeting  were  read  and 
approved. 

The  following  officers  were  elected  for  the  coming 
year:  H.  G.  Campbell,  president;  Ray  Rosson,  vice- 
president;  S.  S.  Ginsburg,  secretary-treasurer;  Gilbert 
Furness,  delegate;  H.  G.  Campbell,  alternate;  D.  L. 
Seligman,  censor. 

Dr.  William  B.  Faulkner  of  San  Francisco  was 
present  and  gave  us  a talk  on  surgery  of  the  chest. 
The  talk  was  illustrated  with  lantern  slides,  and  was 
especially  valuable  from  the  standpoint  of  diagnosis 
and  bronchoscopy.  It  was  moved  that  a vote  of 
thanks  be  given  Doctor  Faulkner  for  his  excellent 
talk  and  the  trouble  he  took  to  come  down  and 
address  us. 

A short  discussion  followed,  and  the  meeting  ad- 
journed at  9:40  o’clock. 

Horace  G.  Campbell,  Secretary. 


. 60 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


CHANGES  IN  MEMBERSHIP 
New  Members 

Alameda  County — John  Joseph  Carden,  Herbert  C. 
Bolstad. 

Monterey  County — Lavelle  P.  Davlin,  Roy  M.  Fortier. 
Sacramento — Louis  Charles  Barrette,  Irene  Knox 
Mugford,  Wayne  Evans  Pollock,  Dorothy  Walsh 
Schallig. 

San  Bernardino  County — Darrell  E.  Hayhurst. 

San  Diego  County — Sheridan  A.  Lockwood,  Stephen 
A.  Parowski. 

San  Francisco  County — Harry  H.  Jacob. 


Transferred  Members 

Orville  Rockwell,  from  San  Francisco  to  Napa 
County. 

Elisabeth  McVeen  Saphro,  from  Los  Angeles  to 
Monterey  County. 

H.  Spencer  Hoyt,  from  Los  Angeles  to  Monterey 
County. 

Deaths 

Aikin,  Ilo  Rafenel.  Died  at  Oakland,  December  10, 
1929,  age  53  years.  Graduate  of  Hahnemann  Medical 
College  of  the  Pacific,  San  Francisco,  1898.  Licensed 
in  California,  1898.  Doctor  Aikin  was  a member  of 
the  Alameda  County  Medical  Society,  the  California 
Medical  Association,  and  the  American  Medical 
Association. 

Berndt,  Richard  M.  H.  Died  at  San  Francisco,  No- 
vember 16,  1929,  age  73  years.  Graduate  of  the  Uni- 
versity of  California  Medical  School,  1893.  Licensed 
in  California,  1894.  Doctor  Berndt  was  a member  of 
the  San  Francisco  County  Medical  Society,  the  Cali- 
fornia Medical  Association,  and  a Fellow  of  the 
American  Medical  Association. 

Bullock,  Newell  Harris.  Died  at  San  Francisco, 
November  13,  1929,  age  56  years.  Graduate  of  Rush 
Medical  College,  Illinois,  1908.  Licensed  in  California, 
1908.  Doctor  Bullock  was  a member  of  the  Santa 
Clara  County  Medical  Society,  the  California  Medical 
Association,  and  a Fellow  of  the  American  Medical 
Association. 

Miller,  Ulysses  Grant.  Died  at  Los  Angeles,  No- 
vember 27,  1929,  age  61  years.  Graduate  of  Marion- 
Sims  College  of  Medicine,  Missouri,  1891.  Licensed 
in  California,  1904.  Doctor  Miller  was  a member  of 
the  Los  Angeles  County  Medical  Association,  the 
California  Medical  Association,  and  a Fellow  of  the 
American  Medical  Association. 

Mott,  George  Hervey.  Died  at  Pacific  Grove,  De- 
cember 1929,  age  64  years.  Graduate  of  Western 
Reserve  University  School  of  Medicine,  Cleveland, 
1888.  Licensed  in  California,  1926.  Doctor  Mott  was 
a member  of  the  Monterey  County  Medical  Society, 
the  California  Medical  Association,  and  the  American 
Medical  Association. 

Reynolds,  Clyde  G.  Died  at  Hilt,  December  6,  1929, 
age  33  years.  Graduate  of  University  of  Nebraska 
College  of  Medicine,  Omaha,  1924.  Licensed  in  Cali- 
fornia, 1925.  Doctor  Reynolds  was  a member  of  the 
Siskiyou  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 


Simpson,  Frank  William.  Died  at  Hayward,  De- 
cember 8,  1929,  age  53  years.  Graduate  of  University 
of  California  Medical  School,  1900.  Licensed  in  Cali- 
fornia, 1900.  Doctor  Simpson  was  a member  of  the 
Alameda  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

Zbinden,  David  Burdett.  Died  at  Alhambra,  No- 
vember 20,  1929,  age  40  years.  Graduate  of  Vanderbilt 
University  School  of  Medicine,  Nashville,  Tennessee, 
1913.  Licensed  in  California,  1917.  Doctor  Zbinden 
was  a member  of  the  Los  Angeles  County  Medical 
Association,  the  California  Medical  Association,  and 
a Fellow  of  the  American  Medical  Association. 


THE  WOMAN’S  AUXILIARY  TO  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION 

OFFICIAL  NOTICE 

The  Woman’s  Auxiliary  of  the  California  Medical 
Association  is  happy  to  call  to  your  attention  the 
editorial  on  page  351  of  the  November  California  and 
Western  Medicine,  regarding  their  organization,  and 
request  that  if  you  have  not  already  done  so  that  you 
appoint  a committee  on  organization  as  suggested  in 
the  article. 

May  I ask  that  you  keep  me  informed  as  to  the 
result,  and  send  me  the  names  of  one  or  two  women 
from  your  county  who  will  probably  be  active  in  the 
formation  of  the  unit,  as  I hope  to  have  material  from 
the  national  organization  for  their  use. 

The  southern  counties  are  responding  with  enthu- 
siasm, and  I hope  the  North  will  soon  be  as  active. 
As  you  know,  the  object  of  the  Auxiliary  is  to  be  all 
that  its  name  implies — an  aid — a reserve  force — an 
auxiliary!  Organized  for  the  purpose  of  responding 
to  any  call  from  the  medical  profession.  To  promote 
dependable  health  education,  instead  of  leaving  it  to 
those  who  are  interested  in  spreading  cult  propa- 
ganda. Every  physician’s  wife  should  feel  it  a privi- 
lege to  have  a part  in  this  work. 

May  we  have  your  hearty  cooperation? 

Jean  Rogers,  President. 

Petaluma,  Sonoma  County. 


A COUNTY  AUXILIARY’S  WORK* 

The  Woman’s  Auxiliary  to  the  American  Medical 
Association  is  an  organization  composed  of  the  com- 
bined membership  of  the  state  auxiliaries,  which  in 
turn  are  made  up  of  auxiliaries  to  county  medical 
societies. 

The  first  auxiliary  was  formed  in  1917  at  Dallas, 
Texas.  Out  of  that  grew  similar  organizations  all 
over  the  state.  In  1919  a state  auxiliary  was  organ- 
ized in  San  Antonio,  Texas. 

Other  states  became  interested  in  the  work  and  in 
St.  Louis,  1922,  during  the  meeting  of  the  American 
Medical  Association,  the  matter  of  forming  a national 
auxiliary  was  presented  to  the  House  of  Delegates. 
It  was  endorsed  by  that  body  and  the  Woman’s 
Auxiliary  to  the  American  Medical  Association  was 
organized,  with  nine  states  enrolled. 

It  is  now  in  its  fourth  year  of  national  activity, 
having  twenty-seven  states  already  organized,  with 
others  in  the  process  of  organization — more  than  half 
the  states  in  the  Union! 

Where  there  is  a county  medical  society  there 
should  be  an  auxiliary.  It  has  been  uniformly  noted 
that  there  is  more  interest  and  enthusiasm,  and  a 
greater  spirit  of  comradeship  among  the  members  of 
the  county  medical  society  if  there  is  an  active  auxili- 
ary working  in  the  community. 

The  National  Auxiliary  does  not  attempt  to  dic- 
tate, but  desires  to  cooperate  with  all  auxiliaries  in 
carrying  out  their  work. 

* * * 

The  object  of  the  Woman’s  Auxiliary  to  the  Ameri- 
can Medical  Association  is  to  be  all  that  its  name 
implies— an  aid,  a reserve  force — -an  auxiliary!  Or- 
ganized for  the  purpose  of  responding  to  any  call 
from  the  medical  profession. 

To  do  all  the  w'ork  assigned  to  it  from  time  to 
time  by  the  American  Medical  Association. 

To  promote  closer  social  contact  between  the  fami- 
lies of  physicians. 

To  assist  in  lightening  the  burdens  of  humanity. 

To  help  preserve  the  health  of  the  people. 

The  members  of  the  Woman’s  Auxiliaries  to  the 
American  Medical  Association  are  those  who  have 


* Abstract  of  a leaflet  printed  by  the  National  Auxili- 
ary, and  here  presented  for  the  information  of  newly 
organized  county  auxiliaries  of  California. 


January,  1930 


S'l'A'l  E MEDICAL  ASSOCIATIONS 


61 


paid  their  annual  dues  to  the  national  organization 
through  their  county  and  state  auxiliary. 

Where  there  is  no  local  auxiliary  a physician’s  wife 
may  become  a member-at-large  by  paying  annual 
dues  of  $2.  Wives  of  the  members  of  the  Medical 
Corps  of  the  Army,  the  Navy,  and  the  Public  Health 
Service  are  especially  invited  to  become  members-at- 
large,  if  it  is  impossible  for  them  to  have  county 
affiliations. 

Each  state  sends  its  auxiliary  president  and  presi- 
dent-elect, two  delegates  and  their  alternates  to  repre- 
sent it  at  the  annual  session  which  meets  at  the  same 
time  as  the  American  Medical  Association. 

Every  phase  of  the  work  is  first  passed  upon  by  the 
executive  board,  which  meets  just  before  the  annual 
session.  After  the  election  of  officers,  the  new  execu- 
tive board  is  called  together  to  hear  the  plans  outlined 
by  the  incoming  president. 

Another  called  meeting  is  usually  held  in  the  fall 
before  the  activities  begin.  Matters  of  immediate  im- 
portance should  be  referred  to  the  president  and 
members  of  the  Liaison  Committee.  This  committee 
is  appointed  by  the  trustees  of  the  American  Medical 
Association. 

* * * 

For  this  year  the  National  Auxiliary  board  has  ac- 
cepted the  following  recommendations  from  the 
president: 

To  organize  auxiliaries  in  unorganized  states  and 
to  urge  all  state  presidents  to  form  auxiliaries  wher- 
ever there  is  a county  medical  society. 

To  outline  health  programs  approved  by  the  Liaison 
Committee  to  be  presented  before  other  organizations. 

To  secure,  if  possible,  moving  pictures  to  illustrate 
the  importance  of  the  annual  physical  examinations 
by  the  family  physician.  Each  member  of  every 
household,  servants  included,  should  be  examined. 

To  recommend  to  all  clubs  that  they  place  capable 
physicians’  wives  in  charge  of  club  health  depart- 
ments in  order  to  secure  authoritative  programs. 

To  assist  in  providing  health  talks  over  the  radio 
by  prominent  physicians  and  health  officers.  These 
speakers  should  be  appointed  by  the  County  Medical 
Society. 

* * * 

In  order  that  the  greatest  possible  good  shall  be 
accomplished  it  is  necessary  that  the  Woman’s  Auxili- 
ary to  the  American  Medical  Association  have  the  full 
cooperation  of  all  the  members  of  the  American 
Medical  Association  and  their  wives.  It  is  the  earnest 
endeavor  of  the  Auxiliary  to  bring  its  work  to  the 
attention  of  all  who  are  interested  in  the  welfare  of 
our  people. 

Every  physician’s  wife  should  feel  it  a privilege  as 
well  as  her  duty  to  promote  dependable  health  educa- 
tion, not  leaving  it  in  the  hands  of  those  who  are 
interested  in  spreading  the  propaganda  of  various 
cults. 

She  can  aid  materially  in  the  auxiliary’s  effort  to 
impress  upon  all  club  members  a proper  conception 
of  the  real  mission  of  organized  medicine,  especially 
in  its  crusade  of  preventive  medicine. 

She  may  gain  much  from  her  club  activities,  but 
she  can  give  even  more  to  her  club  cooperating  with 
the  auxiliary  in  its  health  education  program. 

A woman  forfeits  none  of  her  own  happiness  nor 
her  family’s  when  she  lends  her  time  and  influence 
beyond  the  confines  of  her  own  household.  Her 
power  is  made  greater  and  her  outlook  on  life  clearer 
by  her  contact  with  other  women. 

* * * 

Activities 

The  work  of  county  auxiliaries  may  be  divided  into 
three  groups — social,  philanthropic,  and  educational. 

Auxiliaries  should  meet  each  month  from  October 
to  June,  making  reports  and  recommendations. 

In  addition  to  the  reports  of  the  committees,  a 
paper  may  be  read  or  a speaker  provided  to  address 


the  members  on  subjects  of  particular  interest  to 
them. 

A social  hour  may  follow  with  light  refreshments. 

I.  Social  Group 

This  group  may  be  divided  into  the  following  com- 
mittees: Membership,  Telephone,  Courtesy,  and  En- 
tertainment. 

The  Membership  Committee  keeps  the  members 
active  in  securing  new  members.  This  committee 
visits  the  wives  of  members  of  the  County  Medical 
Society,  enlisting  interest  in  the  local  work. 

The  Telephone  Committee  divides  the  membership, 
each  taking  an  equal  number  of  names;  it  is  their 
duty  to  telephone  each  member  at  least  one  week  in 
advance  to  remind  them  of  the  time  and  place  of 
meeting,  and  to  ascertain  how  many  can  attend.  The 
lists  of  acceptances  are  turned  over  to  the  chairman 
of  the  entertainment  so  that  she  may  know  for  how 
many  to  provide.  The  chairman  of  the  Telephone 
Committee  informs  the  members  of  the  Executive 
Board  of  their  meetings. 

When  the  medical  society  wishes  some  prompt  ser- 
vice from  the  auxiliary,  the  Telephone  Committee  can 
get  the  information  to  the  entire  membership  within 
a few  hours. 

The  Courtesy  Committee  calls  upon  the  wives  of 
physicians  soon  after  they  become  members  of  the 
County  Medical  Society. 

If  a member  is  ill  or  bereaved,  this  committee  lends 
its  sympathy  and  service.  Visits  are  made  also  when 
out-of-town  physicians’  families  are  ill  in  local  hospi- 
tals. Courtesies  are  extended  to  wives  of  physicians 
while  they  are  visiting  in  the  city. 

The  Entertainment  Committee  may  select  the  place 
of  meeting,  appoint  hostesses  for  the  season,  and  pro- 
vide refreshments,  except  when  an  individual  member 
wants  to  entertain.  Each  member  may  be  assessed 
her  pro  rata  for  the  entertainments,  or  it  may  be 
added  to  the  dues  for  the  year.  The  refreshments 
should  be  light  and  within  the  means  of  all  the 
members. 

The  first  meeting  of  the  season  may  be  an  after- 
noon tea  given  in  honor  of  the  officers.  The  president 
makes  a short  talk  and  announces  committees  which 
she  has  appointed  to  carry  out  the  plans  for  the  year. 

Near  the  holiday  season  an  evening  affair  may  be 
given  in  honor  of  the  president  and  officers  of  the 
County  Medical  Society. 

The  last  meeting  of  the  season  may  be  an  afternoon 
program  given  in  honor  of  the  mothers  of  the  phy- 
sicians. 

The  annual  reports  and  election  of  officers  may 
come  before  the  program. 

II.  Philanthropic  Group 

This  group  is  divided  into  as  many  committees  as 
are  necessary  to  carry  on  the  work  as  outlined  by 
each  individual  auxiliary. 

It  is  recommended  not  to  undertake  too  much  at 
first,  but  to  increase  the  activities  as  the  interest 
grows.  There  is  always  more  to  be  done  than  there 
are  funds  available  with  which  to  “carry  on.”  Each 
auxiliary  selects  the  greatest  need  of  its  community 
and  undertakes  to  make  its  influence  felt  by  cooperat- 
ing in  every  possible  way  with  charitable  enterprises 
of  the  city. 

Committees  and  subcommittees  undertake  the 
following: 

To  visit  all  the  charity  wards  of  the  hospitals,  tak- 
ing fruits,  flowers,  etc. 

Books  and  toys  are  taken  to  the  Children’s  Hospi- 
tals, and  a story  hour  provided  for  the  convalescents. 

Layettes  are  made  for  needy  mothers. 

Showers  of  linen  and  clothing  are  given  for  the 
Baby  Hospitals. 

Surgical  dressings  and  aprons  made  for  doctors  and 
nurses  in  their  charity  work. 

Gowns  and  bedjackets  for  Tuberculosis  Hospitals. 


62 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


Visits  are  made  to  Institutions  for  the  Aged,  fur- 
nishing them  with  diversion  and  entertainment. 

Soldiers,  old  and  young,  are  provided  with  games, 
radios,  victrolas,  edibles,  automobile  rides,  Christmas 
trees,  etc. 

A milk  fund  is  provided  for  undernourished  school 
children. 

Healthful  school  lunches  prepared  and  served  to 
school  children  at  minimum  cost. 

First-aid  tents  furnished  Boy  Scouts,  rest  tents  for 
Salvation  Army  camps. 

Stockings  filled  and  sent  to  Empty  Stocking  Cru- 
sade, Christmas  boxes  furnished  Red  Cross  for  dis- 
tribution. 

Loans  to  needy  physicians’  families. 

III.  Educational  Group 

This  group  consists  of  two  important  committees — 
Educational  and  Program — and  as  many  subcommit- 
tees as  are  needed  to  carry  on  the  work. 

The  Program  Committee  selects  the  subjects  to  be 
discussed  at  each  meeting  and  provides  the  speakers. 

This  group  prepares  a tribute  to  the  members  who 
die  during  the  year,  which  is  read  at  the  last  meeting 
of  the  season. 

Outline  campaigns  for  securing  birth  registrations. 

Cooperate  with  Chambers  of  Commerce  and  their 
health  programs. 

Furnish  reports  each  month  of  current  events  in 
medical  progress. 

Interest  boys  and  girls  in  giving  health  plays  in 
schools. 

Cooperate  with  health  officers  in  their  work,  es- 
pecially in  rural  districts. 

Furnish  good  speakers  to  go  before  clubs  to  pre- 
sent health  programs  with  moving-picture  illustrations. 

Create  sentiment  for  county  health  units. 

Assist  legislative  committees  of  County  Medical 
Societies,  when  needed,  in  promoting  good  health 
measures — but  carefully  avoiding  participation  in  any 
kind  of  politics  whatsoever,  except  upon  the  recom- 
mendations of  the  local  county  or  state  medical  or- 
ganization or  the  Liaison  Committee  to  the  auxiliary. 

The  Health  Education  Committee  makes  a study  of 
the  subject  to  be  discussed  throughout  the  year. 

Health  laws  pertaining  to  county  and  state. 

What  constitutes  pure  milk  and  water. 

Food  and  sanitation. 

Midwife  problems. 

History  of  medicines. 

Lives  of  great  physicians. 

History  of  American  Medical  Association,  Cali- 
fornia Medical  Association,  etc. 

Offer  scholarships  to  sons  and  daughters  of  phy- 
sicians. 

Gives  prizes  for  the  best: 

Essay  on  health. 

Physical  test  of  school  children. 

Sanitary  school  buildings. 

Best  drilled  R.  O.  T.  C. 

Boy  Scout  who  makes  best  physical  record. 

Cleanest  block  in  city. 


. KERN  COUNTY 

At  the  request  of  the  state  medical  society,  the 
wives  of  the  members  of  the  Kern  County  Medical 
Society  met  in  the  library  of  the  Kern  General  Hos- 
pital at  8 o’clock,  Thursday,  November  21,  to  form 
an  auxiliary  to  the  men’s  organization.  Those  present 
were:  Mesdames  F.  A.  Hamlin,  F.  G.  Gundry,  C.  H. 
Fox,  W.  H.  Moore,  C.  S.  Compton,  G.  E.  Bahren- 
burg,  K.  S.  McKee,  R.  M.  Jones,  A.  E.  Schaper  of 
Keene,  A.  R.  Moody  and  Johnston  of  Taft. 


Mrs.  F.  A.  Hamlin,  acting  as  temporary  chairman, 
read  the  constitution  and  by-laws  of  the  Auxiliary, 
explaining  its  purpose.  The  following  officers  were 
then  unanimously  elected  to  serve  for  the  ensuing 
year:  Mrs.  F.  A.  Hamlin,  president;  Mrs.  F.  G. 
Gundry,  first  vice-president;  Mrs.  A.  R.  Moody  of 
Taft,  second  vice-president;  Mrs.  C.  S.  Compton, 
secretary-treasurer. 

The  constitution  and  by-laws  were  then  formally 
adopted,  and  it  was  agreed  to  meet  on  the  third 
Thursday  of  every  month  at  the  County  Hospital.  It 
was  decided  to  serve  light  refreshments  and  have 
some  entertainment  each  meeting,  with  the  idea  of 
becoming  better  acquainted.  Mrs.  F.  A.  Hamlin,  Mrs. 
G.  E.  Bahrenburg,  andMrs.  R.  M.  Jones  were  ap- 
pointed as  a committee  for  the  first  meeting. 

Meeting  was  adjourned. 

Edna  C.  Compton,  Secretary. 

LOS  ANGELES  COUNTY 

Formation  of  Woman’s  Auxiliary  of  the  California 
Medical  Association.  — A committee  composed  of 
Mrs.  James  F.  Percy  (chairman),  Mrs.  Walter  P. 
Bliss,  and  Mrs.  George  G.  Hunter  called  a meeting 
of  the  wives,  daughters,  sisters,  and  widows  of  phy- 
sicians in  good  standing  in  the  Los  Angeles  County 
Medical  Association  on  December  27,  1929,  to  form  a 
Woman’s  Auxiliary  to  the  Los  Angeles  County  Medi- 
cal Association. 

ec 

SAN  BERNARDINO  COUNTY 

Minutes  of  the  meeting  of  the  Woman’s  Auxiliary 
to  the  California  Medical  Association  which  met  in 
San  Bernardino  on  December  3. 

The  wives  of  the  doctors  of  the  San  Bernardino 
County  Medical  Society  were  invited  to  attend  a 
meeting  at  the  nurses’  home  of  the  County  Hospital, 
Decertiber  3,  at  8 p.  m. 

Mrs.  A.  L.  Weber  of  Upland,  one  of  the  committee 
appointed  by  the  councilors  of  the  San  Bernardino 
County  Medical  Society,  was  in  the  chair  and  called 
the  meeting  to  order. 

Letters  from  Dr.  Emma  Pope  and  Mrs.  Jean 
Rogers,  explaining  the  purpose  of  the  meeting  were 
read,  also  the  constitution  of  the  Woman’s  Auxiliary 
of  the  California  Medical  Association. 

Discussions  and  explanations  followed. 

Mrs.  Frank  H.  Pritchard  of  Colton  then  moved  we 
form  an  auxiliary  to  the  San  Bernardino  County 
Medical  Society  and  adopt  the  constitution  of  the 
Auxiliary  of  the  California  Medical  Association. 

Mrs.  Cherry  of  Rialto  seconded  the  motion.  The 
chairman  put  the  question,  and  the  motion  was  unani- 
mously carried. 

The  chairman  proceeded  with  the  election  of  offi- 
cers. Mrs.  F.  E.  Clough  was  nominated  for  president. 
Nomination  seconded  and  was  unanimously  elected. 

Mrs.  Weber  then  invited  Mrs.  Clough  to  take  the 
chair.  Mrs.  Clough  continued  with  the  election,  and 
the  following  officers  were  unanimously  elected:  Mrs. 
Walter  Pritahard  of  Colton,  first  vice-president;  Mrs. 
A.  L.  Weber  of  Upland,  second  vice-president;  Mrs. 
C.  L.  Curtiss  of  Redlands,  secretary-treasurer. 

Mrs.  Mulvane,  superintendent  of  nurses  of  the 
County  Hospital,  offered  the  nurses’  home  for  either 
social  or  business  meeting  any  time  it  was  needed. 

Fifteen  out  of  the  seventeen  women  present  joined 
the  new  society. 

Letters  from  Mrs.  W.  E.  Macpherson  and  Mrs. 
O.  I.  Cutler  of  Loma  Linda,  expressing  their  regrets 
that  they  could  not  be  present  at  our  first  meeting 
but  hoped  to  be  at  later  ones,  were  read  by  the 
secretary. 

Nominations  for  delegates  to  the  state  meeting 
were  then  in  order.  Mrs.  Frank  Pritchard  nominated 
all  of  the  officers.  Mrs.  Emmons  made  an  amendment 
to  the  motion  that  the  board  of  directors  designate 


January,  1930 


STATE  MEDICAL  ASSOCIATIONS 


63 


which  ones  should  be  delegates  and  alternates.  This 
motion  was  seconded,  voted  and  carried. 

Mrs.  Walter  Pritchard  then  made  a motion  that 
tentative  dues  be  set  at  $1.  Seconded  and  carried. 

Motion  was  made  by  Mrs.  Walter  Pritchard  that 
a meeting  be  held  the  first  Tuesday  in  March,  1930 
at  the  San  Bernardino  County  nurses’  home.  Motion 
was  seconded  and  carried. 

Next  motion  made  was  that  the  first  and  second 
vice-presidents,  with  the  board  of  directors,  be  respon- 
sible for  a social  meeting,  this  meeting  and  the  next 
business  meeting. 

Meeting  was  then  adjourned  by  motion  from  the 

floor. 

Mrs.  Ethel  E.  Curtiss,  Secretary. 


NEVADA  STATE  MEDICAL 
ASSOCIATION 

W.  A.  SHAW President 

R.  P.  ROANTREE,  Elko * President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 

HORACE  J.  BROWN Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 


COMPONENT  COUNTY  SOCIETIES 

WASHOE  COUNTY 

The  Washoe  County  Medical  Society  met  on  Tues- 
day evening,  November  12,  at  the  City  Hall,  Reno. 
Dr.  J.  L.  Robinson,  president,  in  the  chair. 

Applications  of  three  new  members  were  endorsed 
by  the  board  of  censors,  and  the  secretary  was 
ordered  to  notify  the  same. 

The  scientific  program  for  the  night  was  a sym- 
posium on  pneumonia.  Owing  to  the  absence  of  three 
of  the  essayists,  the  program  was  considerably  in- 
complete. However,  Doctor  Lane,  whose  part  was 
the  obtaining  of  the  pneumonia  record  of  the  state  for 
the  past  ten  years,  gave  as  complete  a report  as  was 
possible.  There  seems  to  be  a decided  carelessness  or 
an  evasion  by  the  physicians  regarding  the  reporting 
of  reportable  cases  as  listed  by  the  state  secretary. 
Records  are  so  incomplete  as  to  be  practically  worth- 
less. Doctor  Lane  had  made  a most  worthy  effort  by 
going  to  Carson  and  conferring  there  with  Doctor 
Hamer,  but  the  records  obtainable  were  far  from 
complete.  We  hope  that  the  physicians  of  the  state 
will  cooperate  with  Doctor  Hamer  in  his  insistent 
effort  to  have  the  proper  reports  come  in  as  requested. 

Dr.  M.  A.  Robinson,  one  of  the  state’s  veteran  phy- 
sicians and  anesthetists,  gave  an  elaborate  resume  on 
the  subject  of  postoperative  pneumonia,  which  was  of 
considerable  interest  in  view  of  the  fact  that  the  pro- 
fession is  now  fully  aware  that  the  selection  of  an 
anesthetist  is  about  as  necessary  as  the  selection  of 
the  surgeon.  Doctor  Robinson  will  elaborate  the 
paper  for  a future  occasion. 

The  closing  meeting  of  the  year  will  be  held,  place 
yet  to  be  announced,  on  the  evening  of  December  10. 
The  speaker  will  be  Dr.  George  R.  Smith,  superin- 
tendent of  the  Nevada  State  Hospital.  Doctor  Smith 
will  speak  on  the  conditions  of  the  insane  of  the  state. 
We  bespeak  a good  attendance  and  good  time. 

There  being  no  further  business  the  meeting  ad- 
journed. 

* * * 

The  last  meeting  of  the  year  for  the  Washoe 
County  Medical  Society  was  held  at  Hutton’s  Hut, 
on  the  outskirts  of  Reno,  on  Tuesday  evening, 
December  10. 

This  meeting  being  President’s  night,  the  retiring 
president,  Dr.  J.  L.  Robinson,  reserved  the  hut 
for  the  occasion  and  the  genial  host  served  those 
present  with  a bounteous  turkey  dinner.  Music  and 
refreshments  made  the  twenty-five  men  present  a 


happy  congenial  company.  Owing  to  the  previously 
inclement  weather,  the  secretary  received  a number 
of  regrets  from  many  who  could  not  attend. 

Two  new  names  for  membership  were  read  and 
referred  to  the  board  of  censors.  The  present  mem- 
bership is  fifty-two.  There  are  several  prospects  in 
sight  for  a bigger  and  more  active  membership.  In 
the  secretary’s  letter  announcing  the  meeting,  it  was 
suggested  and  thought  advisable  that  the  society 
reach  out  to  all  surrounding  towns  where  a medical 
society  does  not  exist  and  invite  these  unaffiliated 
county  men  to  join  the  Washoe  County  Society.  If 
they  cannot  attend  the  meeting  during  the  inclement 
seasons  of  the  year,  their  membership  and  discussion 
when  they  are  able  to  be  present  will  be  mutually 
helpful. 

After  the  dinner  was  served,  Doctor  Robinson,  who 
has  done  splendid  work  during  the  year  in  investi- 
gating conditions  in  California,  with  reference  to  the 
necessity  of  Washoe  County  having  a community 
hospital,  read  a concise,  fact-bearing  paper,  setting 
forth  many  substantial  arguments  as  to  the  present- 
day  needs  of  such  a hospital.  In  summarizing  the 
future  growth  of  Reno,  with  its  great  outlying  terri- 
tory, he  dwelt  upon  the  past  substantial  growth  of 
Reno,  showed  how  it  was  a center  for  railroad,  air- 
way, and  automobile  travel.  The  fact  that  with  our 
tourist  travel  for  the  past  summer,  the  hotels  could 
not  take  care  of  the  .tourist  patronage,  that  new 
enterprises  were  under  contemplation,  new  hotels  to 
be  constructed  on  Lake  Tahoe,  that  the  Lassen  Park 
project  was  under  way,  and  because  of  many  other 
business  enterprises,  Doctor  Robinson  showed  that 
to  keep  pace  with  the  growing  need  for  community 
hospitalization  we  should  bestir  ourselves,  as  a united 
profession,  to  secure  the  final  approval  of  thirty  per 
cent  of  the  taxpayers  to  sign  up  for  a community 
hospital  at  the  fall  election  of  1930.  With  this  done, 
the  people  of  Washoe  County  could  establish  a hospi- 
tal similar  in  function  to  the  great  Los  Angeles 
hospital  now  about  completed  and  the  beautiful  High- 
land Hospital  in  Oakland.  Public  hospitalization — • 
not  of  the  old-fashioned  type  for  paupers — is  the  com- 
ing thing  of  the  future,  and,  as  Doctor  Robinson  well 
stated,  community  hospitalization  is  a demand  to  be 
considered  in  exactly  the  same  class  as  community 
schools  and  community  police  protection.  It  is  the 
coming  thing  whereby  any  citizen  can,  if  he  so 
elects,  choose  the  benefit  of  medical  and  surgical  at- 
tendance from  the  community  in  which  he  has  lived 
and  helped  to  build  up.  A community  hospital  will 
solve  the  question  of  the  public  of  today,  wherein  it 
is  so  frequently  said  that  but  two  classes  of  people 
can  receive  good  medical  and  surgical  care,  namely, 
the  indigent  and  the  millionaire.  This  type  of  a hospi- 
tal will  relieve  people  of  moderate  means  of  painful 
embarrassment,  and  when  they  are  unfortunate  in 
being  ill  they  can,  with  this  new  form  of  extended 
aid,  avail  themselves  of  the  benefits  of  a community 
hospital  at  such  prices  as  they  can  afford  to  pay. 

Doctor  Robinson's  paper  had  the  earmarks  of  well 
digested  thought,  facts  summarized  and  presented  in 
a forcible  manner,  and  was  well  received. 

Dr.  George  H.  Smith,  superintendent  of  the  Nevada 
State  Hospital  for  the  Insane,  followed  with  a splen- 
did paper  giving  a resume  of  the  conditions  of  the 
insane  population  of  Nevada.  For  lack  of  space,  we 
cannot  enlarge  upon  this  excellent  presentation,  ex- 
cept to  say  that  those  not  present  missed  a good 
thing. 

The  election  of  officers  for  the  ensuing  year  re- 
sulted in  the  election  of  Dr  E.  E.  Hamer,  secretary 
of  the  Nevada  State  Board  of  Health,  as  president; 
Dr.  E.  L.  Creveling,  vice-president;  Dr.  Thomas  W. 
Bath,  secretary-treasurer. 

A brief  report  of  the  financial  condition  of  the 
society,  with  a resume  of  the  active  work  and  splen- 
did cooperation  of  the  members  was  given  by  the 
secretary. 

The  meeting  adjourned,  with  happy  felicitations  and 
expressions  of  a most  cordial  professional  feeling. 

Thomas  W.  Bath,  Secretary. 


6+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City. President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY,  701  Medical  Arts  Building. 

Salt  Lake  City .Associate  Editor  for  Utah 


COMPONENT  COUNTY  SOCIETIES 

SALT  LAKE  COUNTY 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society  was  held  at  the  Newhouse  Hotel,  Salt 
Lake  City,  Monday,  November  25,  at  8 p.  m. 

The  meeting  was  called  to  order  at  8:03  o’clock  by 
President  C.  M.  Benedict.  Forty-five  members  and 
six  visitors  were  present. 

The  minutes  of  the  previous  two  meetings  were 
read  and  accepted  without  correction. 

The  following  clinical  program  was  presented  by 
the  members  of  the  medical  department  of  the  Uni- 
versity of  Utah,  under  the  supervision  of  B.  I.  Burns: 

Experiments  with  the  Female  Sex  Hormone — G.  C. 
Arvin. 

The  Nervous  Mechanism,  of  Angina  Pectoris — 
Donald  Duncan. 

Report  on  Parathormone  in  Menstrual  Bleeding — 
H.  C.  Goldthorpe. 

Effect  of  Hormones  on  the  Sympathetic  Nervous 
System — R.  M.  Tandowsky. 

Pathological  Embryology — Orin  Ogilvie. 

Bovine  Skin  Tuberculosis — L.  L.  Daines. 

* * * 

The  following  resolution  of  regret  was  presented  by 
the  Necrology  Committee,  J.  U.  Giesy,  chairman: 

In  Memoriam — George  L.  Smart 

Whereas,  Our  fellow  member,  Dr.  George  L.  Smart, 
has  been  called  upon  to  answer  that  summons  to 
which  we,  one  and  all,  must  in  due  course  respond; 
and 

Whereas,  We  his  comrades  shall  miss  him  from 
our  ranks  with  feelings  of  deep  regret;  therefore  be  it 

Resolved,  That  we  of  the  Salt  Lake  County  Medi- 
cal Society  take  this  means  of  formally  expressing 
our  sympathy  to  his  relatives  in  their  bereavement, 
so  necessarily  coupled  with  our  own  sense  of  loss; 
that  a copy  of  this  resolution  be  spread  upon  the 
minutes  of  our  organization,  and  a copy  sent  to  the 
immediate  family  of  the  deceased. 

* * * 

The  following  report  of  the  board  of  censors  upon 
the  letter  of  B.  I.  Burns,  regarding  forming  an  as- 
sociate membership  for  members  of  the  medical  de- 
partment of  the  University  of  Utah  who  are  not 
physicians,  was  read  by  William  F.  Beer: 

“The  committee  unanimously  recommends  that  the 
society  change  the  constitution  and  by-laws  so  that 
members  of  the  medical  department  of  the  University 
of  Utah  who  are  not  physicians  may  be  accepted  as 
associate  members  by  the  Salt  Lake  County  Medical 
Society.” 

E.  F.  Root  moved  that  the  report  be  accepted. 
Seconded  and  carried. 

S.  G.  Kahn  moved  that  the  board  of  censors  be 
asked  to  frame  a change  in  the  Constitution  and  By- 
Laws  of  the  Salt  Lake  County  Medical  Society  to 
show  that  an  associate  membership  is  permissible. 
Seconded  and  carried. 

A communication  from  the  Salt  Lake  County  Com- 
missioners was  read  asking  that  the  society  members 
examine  old-age  pension  applicants  free  of  charge. 
L.  J.  Paul  moved  that  the  secretary  instruct  the  Salt 


Lake  County  Commissioners  that  it  has  always  been 
the  policy  of  the  society  to  render  aid  in  any  worth- 
while charitable  cause,  and  that  it  would  do  so  in  the 
present  instance.  Seconded  and  carried. 

The  applications  for  membership  of  E.  F.  Wight 
and  F.  W.  Schaffer  were  read.  T.  A.  Clawson,  Jr.,  a 
transfer  from  the  Olmstead  County  Medical  Society, 
and  George  W.  Buchanon  were  unanimously  elected 
members  of  the  society. 

The  meeting  was  adjourned  at  10:15  o’clock. 

* * * 

The  regular  semiannual  business  meeting  of  the 
Salt  Lake  County  Medical  Society  was  held  at  the 
Newhouse  Hotel,  Salt  Lake  City,  Monday,  Decem- 
ber 9,  at  8 p.  m. 

The  meeting  was  called  to  order  at  8:05  o’clock  by 
President  C.  M.  Benedict.  Eighty  members  were 
present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted  without  correction. 

G.  H.  Pace  spoke  briefly  about  the  need  of  a psy- 
chopathic ward  in  the  County  Hospital,  and  stated 
that  the  county  commissioners  were  willing  to  create 
such  a department  if  the  medical  profession  so  de- 
sired. M.  M.  Nielson  moved  that  the  society  go  on 
record  as  being  in  favor  of  the  psychopathic  ward  to 
be  built  at  the  Salt  Lake  County  Hospital,  and  sug- 
gested that  the  county  commissioners  be  notified  to 
this  effect. 

G.  G.  Richards  read  a communication  from  Presi- 
dent Thayer  of  the  American  Medical  Association 
regarding  a memorial  to  Professor  Widal.  B.  Rees 
suggested  that  this  should  be  an  individual  contribu- 
tion, and  F.  Stauffer  moved  that  the  chair  appoint  a 
committee  of  three  to  solicit  funds  for  the  Widal 
Memorial,  with  G.  Richards  as  chairman.  Seconded 
and  carried.  The  following  committee  wras  appointed 
by  President  Benedict:  G.  Richards,  chairman;  W.  R. 
Tyndale  and  W.  G.  Schulte. 

B.  E.  Bonar  read  the  secretary’s  report.  W.  F. 
Beer  moved  that  the  report  be  accepted  and  filed. 
Motion  seconded  and  carried. 

Clark  Young  read  the  report  of  the  treasurer. 
W.  H.  Rothwell  moved  that  the  report  be  accepted 
and  filed.  Seconded  and  carried. 

C.  M.  Benedict  reported  for  the  Program  Com- 
mittee. F.  M.  McHugh  moved  that  the  report  be 
accepted  and  filed.  Motion  seconded  and  carried. 

A.  C.  Callister  gave  a verbal  report  for  the  Com- 
mittee on  Public  Health  and  Legislation.  W.  F.  Beer 
moved  that  the  report  be  accepted.  Seconded  and 
carried. 

J.  C.  Landenberger  read  a report  of  the  Medico- 
Legal  Committee.  This  was  discussed  by  J.  Z.  Brown 
and  P.  G.  Snow.  G.  H.  Pace  moved  that  the  report 
be  accepted  and  filed.  Motion  seconded  and  carried. 

W R.  Tyndale  read  the  report  of  the  Library  Com- 
mittee, and  stated  that  henceforth  none  except  phy- 
sicians would  be  allowed  the  privilege  of  the  stacks. 
This  report  was  discussed  by  B.  I.  Burns  and  W.  T. 
Ward.  G.  Richards  moved  that  the  report  be  accepted 
and  filed.  ^ 

W.  R.  Tyndale  moved  that  W.  T.  Cannon  be  given 
a vote  of  thanks  for  the  donation  of  his  medical 
library  to  the  Salt  Lake  County  Medical  Library,  and 
that  a letter  of  thanks  be  sent  to  him  by  the  secre- 
tary. Seconded  and  carried. 

Sol  G.  Kahn  read  the  report  of  the  Committee 
on  Reduction  of  Medical  Meetings.  The  committee 
recommended  that  the  regular  monthly  clinical  meet- 
ings at  the  various  hospitals  be  discontinued,  and  that 
the  Salt  Lake  County  Medical  Society  substitute  two 
yearly  clinical  meetings  at  each  hospital  in  their  place. 
F,  M.  McHugh  moved  the  adoption  of  this  report. 
Seconded  and  carried. 

J.  P.  Kerby  reported  for  the  Fee  Schedule  Com- 
mittee. This  committee  reiterated  the  recommenda- 


January,  1930 


STATE  MEDICAL  ASSOCIATIONS 


65 


tions  of  its  last  report,  and  recommended  that  per- 
sistent failure  to  follow  the  fee  schedule  be  regarded 
as  grounds  for  loss  of  membership;  and  finally  recom- 
mended that  some  action  be  taken  by  the  society  to 
carry  out  these  recommendations,  or  that  the  com- 
mittee be  discharged  and  their  function  discontinued. 
This  was  discussed  by  G.  G.  Richards,  F.  Stauffer, 
G.  H.  Pace,  J.  E.  Jack,  L.  N.  Ossman,  A.  C.  Callister, 
and  W.  F.  Beer.  W.  R.  Tyndale  moved  that  this 
committee  present  to  the  society  a new  fee  schedule 
for  adoption.  J.  P.  Kerby  amended  this  motion  to 
the  effect  that  a special  meeting  of  the  society  be 
called  to  consider  the  new  fee  schedule.  This  amend- 
ment was  accepted  by  W.  R.  Tyndale,  and  the  motion 
and  amendment  were  seconded  and  carried. 

F.  H.  Raley,  chairman  of  the  board  of  censors, 
presented  a revision  of  the  Constitution  and  By-Laws 
regarding  the  formation  of  an  associate  member- 
ship. This  report  was  discussed  by  G.  G.  Richards, 
F.  Stauffer,  F.  H.  Raley,  W.  F.  Beer,  H.  P.  Kirtley, 
B.  I.  Burns,  and  J.  Z.  Brown. 

L.  J.  Paul  read  the  report  of  the  Boy  Scouts  Com- 
mittee. W.  Rich  moved  that  the  report  be  accepted 
and  filed. 

The  report  of  the  Necrology  Committee,  J.  W. 
Giesy,  chairman,  was  read  by  the  secretary.  G.  FI. 
Pace  moved  that  the  report  be  accepted  and  filed. 

D.  G.  Edmunds  read  the  report  of  the  Committee 
on  Irregular  Practices.  Sol  G.  Kahn  moved  that  the 
report  be  accepted  and  filed,  and  that  the  committee 
be  continued  for  next  year.  Seconded  and  carried. 

J.  C.  Landenberger  read  the  report  of  the  Special 
Committee  to  Investigate  the  new  policy  of  the 
United  States  Fidelity  and  Guaranty  Company.  The 
committee  recommended  the  adoption  of  the  new 
policy  by  those  members  who  wish  to  insure  them- 
selves with  this  company.  This  report,  however,  was 
not  meant  to  recommend  that  the  policy  of  this  com- 
pany was  preferable  to  the  policy  of  any  other  com- 
pany. This  was  discussed  by  Sol  G.  Kahn,  A.  C. 
Callister,  and  G.  A.  Cochran.  W.  R.  Tyndale  moved 
that  the  report  be  accepted  and  filed.  Seconded  and 
carried. 

Earl  F.  Wight  was  elected  to  membership  by  sixty- 
one  yeas,  and  one  no. 

The  society  then  proceeded  to  elect  officers  for  the 
coming  year.  Sol  G.  Kahn  nominated  M.  M.  Nielson 
for  president.  W.  F.  Beer  moved  that  the  nomina- 
tion be  made  unanimous,  and  that  the  secretary  be 
instructed  to  cast  the  ballot.  Seconded  and  carried. 
W.  F.  Beer  nominated  F.  M.  McHugh  for  vice-presi- 
dent and  J.  Z.  Brown  nominated  R.  Groesbeck  for 
vice-president.  L.  N.  Ossman  moved  that  the  nomi- 
nation be  closed.  Seconded  and  carried.  F.  M.  Mc- 
Hugh was  voted  vice-president  by  a vote  of  44  to  30. 
J.  Z.  Brown  moved  that  the  election  of  F.  M.  Mc- 
Hugh be  made  unanimous.  Seconded  and  carried. 
A.  C.  Callister  moved  that  B.  E.  Bonar  be  elected 
secretary  by  acclamation.  Seconded  and  carried. 
W.  F.  Beer  moved  that  Clark  Young  be  elected  treas- 
urer by  acclamation.  Seconded  and  carried. 

W.  G.  Schulte  moved  that  the  tradition  of  electing 
the  retiring  president  a member  of  the  board  of  cen- 
sors be  continued,  and  that  the  secretary  be  instructed 
to  cast  a unanimous  ballot  for  C.  M.  Benedict.  Sec- 
onded and  carried. 

President  C.  M.  Benedict  gave  his  address  as  retir- 
ing president.  He  mentioned  that  his  mother,  in  the 
early  eighties,  gave  a dinner  to  a group  of  Salt  Lake 
City  physicians,  and  this  group  later  formed  the 
nucleus  for  the  Salt  Lake  County  Medical  Society. 
He  stated  that  it  had  been  a great  honor  to  him  to 
be  president  of  the  society  with  which  his  family  had 
been  so  intimately  associated.  President  C.  M.  Bene- 
dict asked  _ Spencer  Wright  and  W.  G.  Schulte  to 
escort  the  incoming  president,  M.  M.  Nielson,  to  the 
chair.  M.  M.  Nielson  made  a few  remarks. 

W.  R.  Tyndale  moved  that  the  society  extend  a 
vote  of  thanks  to  the  passing  officers  for  their  year’s 
work.  Seconded  and  carried. 


Clark  Young  announced  that  the  dues  for  1930  were 
payable  now,  and  that  the  usual  fine  would  be  insti- 
tuted for  those  whose  dues  were  not  received  by 
February  1. 

The  meeting  adjourned  at  10:05  o’clock. 

Barnet  E.  Bonar,  Secretary. 

UTAH  COUNTY 

The  Utah  County  Medical  Society  met  October  23. 
The  principal  paper  of  the  evening  was  by  Doctor 
Curtis,  of  Salt  Lake  City,  on  “General  Aspects  of 
Psychiatry  of  Interest  to  the  General  Practitioner.’’ 
Following  this  paper,  Doctor  Ossman  of  Salt  Lake 
gave  an  interesting  talk  on  “A  Newer  Conception  of 
the  Treatment  of  Osteomyelitis.” 

The  meeting  of  November  20  was  marked  by  a 
paper  on  “X-ray  Diagnosis  of  Right-Sided  Enterop- 
tosis,”  with  x-ray  illustrations,  by  Dr.  Robert  Tyndale 
of  Salt  Lake.  Dr.  George  E.  Bryan  of  Hollywood, 
California,  was  present  at  this  meeting  as  a guest. 

The  Utah  County  Dental  Society  invited  the  mem- 
bers of  the  Utah  County  Medical  Society  to  meet 
with  them  jointly  on  November  25.  At  this  time, 
Doctor  Wherry  of  Salt  Lake  spoke  on  “Mouth  Infec- 
tions.” Doctor  Bergstrom  of  Salt  Lake  discussed  the 
same  topic,  and  the  president-elect  of  the  Utah  Dental 
Society  gave  a short  talk  on  “A  Plea  for  Better 
Cooperation  between  the  Physician  and  Dentist.” 

Dr.  A.  E.  Robison  has  recently  returned  from  Chi- 
cago where  he  has  been  pursuing  postgraduate  work, 
with  especial  attention  to  physical  therapy.  He  at- 
tended the  annual  convention  of  the  American  Col- 
lege of  Physical  Therapy  while  in  the  East. 

Dr.  Walter  Hastier  has  recently  returned  from  The 
Mayo  Clinic  where  he  has  been  for  some  time,  both 
as  a patient  and  a student. 

J.  L.  Aird,  Secretary. 

* 

WEBER  COUNTY 

The  meeting  of  the  Weber  County  Medical  Society 
was  held  November  22  at  the  Hotel  Bigelow,  Presi- 
dent A.  H.  Aland  presiding. 

Election  of  officers  of  the  medical  society  for  1930 
follows:  Henry  W.  Nelson,  president;  W.  H.  Budge, 
vice-president;  Conrad  Jensen,  secretary;  S.  W. 
Badcon,  treasurer. 

The  society  has  an  excess  of  funds  in  the  bank, 
and  Dr.  E.  R.  Dumke  moved  that  the  fund  be  left 
in  the  bank  at  4 per  cent  interest.  This  was  seconded 
by  Dr.  L.  S.  Merrill  and  passed. 

The  paper  for  the  evening  was  given  by  Dr.  Conrad 
Jensen  on  “Postgraduate  Work  in  Europe.”  This 
paper  was  very  interesting.  Discussion  was  opened 
by  Doctors  E.  C.  Rich,  L.  R.  Jenkins,  and  A.  H. 
Aland. 

The  meeting  adjourned. 

George  M.  Fister,  Secretary. 


UTAH  NEWS 

The  regular  meetings  of  the  Academy  of  Medicine 
were  resumed  the  evening  of  December  5,  after  hav- 
ing been  suspended  during  the  last  week  of  November. 

The  program  given  the  first  meeting  of  December 
is  as  follows:  Coronary  Occlusion  (slides),  Dr.  Van 
Scoyoc;  Personal  Experiences  with  Amytal  and 
Spinal  Anesthesia,  Dr.  H.  T.  Anderson;  Presentation 
of  Chest  Case  (with  pictures),  Dr.  Jellison. 

* * * 

The  regular  meeting  of  the  Holy  Cross  Hospital 
Clinical  Association  was  held  the  evening  of  Novem- 
ber 18,  in  the  lecture  room  of  the  hospital.  The 
following  program  was  presented:  A “Nephroma”  1-B 
Carcinoma  of  the  Prostate  with  Metastasis  to  Pelvic 
Bones,  Dr.  W.  G.  Schulte;  Severe  Burn  of  Hand, 
Dr.  Sol  G.  Kahn;  Suppurative  Arthritis  of  Knee,  Dr. 
John  Sugden;  and  Encephalitis,  Drs.  B.  E.  Bonar  and 
D.  E.  Hansen. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  depart- 
ment are  grouped:  Comment  on  Current  and  Recent  Articles  in  the  Journal;  News;  Medical  Economics; 
Correspondence;  Department  of  Public  Health;  California  Board  of  Medical  Examiners;  and  Twenty-Five 
Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 


NEWS 


Western  Surgical  Association. — At  the  thirty-ninth 
annual  meeting  of  the  Western  Surgical  Association, 
held  at  Del  Monte  December  12,  13  and  14,  1929, 
Dr.  Carl  E.  Black  of  Jacksonville,  Illinois,  was  elected 
president;  Dr.  Frank  R.  Teachenor,  secretary;  and 
Dr.  Thomas  G.  Orr  of  Kansas  City,  Missouri, 
treasurer. 

The  next  meeting  of  the  association  will  be  held  at 
Kansas  City,  December  11,  12  and  13,  1930. 


The  Increase  in  Subscription. — At  its  recent  meet- 
ing, the  board  of  trustees  of  the  American  Medical 
Association  voted  to  increase  the  price  of  the  journal, 
including  fellowship  dues,  to  $7.  The  action  was 
taken  in  accordance  with  authorization  by  the  House 
of  Delegates  at  the  annual  session  in  Portland.  The 
advisability  of  the  increase  should  be  apparent  to  all 
subscribers  and  to  Fellows  of  the  Association.  The 
expansion  of  the  work  of  the  association,  and  par- 
ticularly the  extension  of  service  rendered  to  Fellows 
and  subscribers  during  the  last  ten  years,  is  widely 
recognized.  The  publication  of  the  special  periodicals 
and  of  the  Quarterly  Cumulative  Index  Medicus  are 
drains  on  the  finances  of  the  association  well  worth 
while  for  the  advancement  of  medical  science.  The 
special  committees  making  grants  for  scientific  re- 
search and  therapeutic  research,  the  Councils  on 
Medical  Education,  on  Pharmacy  and  Chemistry,  on 
Physical  Therapy  and  on  Scientific  Assembly  func- 
tion for  the  good  of  medicine  and  for  the  public  health 
without  asking  any  financial  return  from  the  medical 
profession  or  the  public.  The  Bureaus  of  Health  and 
Public  Instruction,  of  Investigation  and  of  Legal 
Medicine  and  Legislation  answer  thousands  of  ques- 
tions from  physicians  and  from  the  public  and  repre- 
sent medicine  in  many  phases  of  professional  and 
public  life.  The  package  library  and  the  reference  and 
periodical  lending  services  aid  physicians  everywhere, 
but  particularly  in  smaller  communities,  to  keep 
abreast  of  scientific  progress.  Indeed,  space  is  not 
available  to  enumerate  all  of  the  various  activities  and 
plans,  which  are,  no  doubt,  well  known  to  those  who 
have  followed  carefully  the  annual  reports  of  the 
board  of  trustees.  Even  if  it  were  not  for  all  these 
projects,  the  price  of  subscription  to  the  journal  is 
still  comparatively  far  below  the  subscription  prices 
of  other  similar  periodicals  published  both  in  this 
country  and  abroad.  The  Journal  of  the  American 
Medical  Association  supplies  some  four  thousand  read- 
ing pages  annually,  as  compared  with  from  1152  to 
2736  reading  pages  supplied  by  leading  weekly  medi- 
cal publications  in  other  countries.  The  new  subscrip- 
tion price  of  $7  may  be  compared  with  prices  varying 
from  $10  to  $17  charged  by  similar  publications 
abroad.  The  plans  of  the  board  of  trustees  contem- 
plate new  buildings,  a national  scientific  exhibit,  ex- 
tension of  library  and  bibliographic  services,  and  a 
wider  extension  of  the  help  that  the  association  can 
render  to  the  individual  practitioner. 


Warning  to  Physicians. — Recently  there  has  been 
active  among  physicians  in  New  York  and  Boston 
an  impostor  who  on  two  occasions  has  represented 
himself  to  be  the  son  of  .Dr.  Otis  B.  Wight  of  Port- 
land, Oregon.  The  impostor  is  about  five  feet  eight 
inches  in  height,  with  dark  hair,  and  with  eyes  so 
dark  that,  except  in  a good  light,  his  pupils  cannot 
be  distinguished.  His  face  is  rather  long  and  narrow 
with  well  developed  nose  and  chin,  lips  slightly  full, 

66 


skin  pale  and  fairly  clear;  well  dressed,  wearing  a 
fraternity  pin  prominently  (not  identified,  but  claimed 
by  the  wTearer  to  be  Sigma  Chi),  pleasant  manners 
and  address.  When  last  seen  he  had  on  a light  gray 
felt  hat,  light  brownish  gray  topcoat,  dark  blue  suit, 
tan  shoes,  and  rubbers.  He  claimed  to  have  been  at 
Johns  Hopkins  Medical  School  two  years  and  to  be 
now  at  Western  Reserve  University  in  the  fourth 
year  of  medical  school.  His  name  and  story  will 
probably  be  different  when  next  heard  from,  but  a 
description  of  him  has  been  given  to  the  Boston  police 
department.  Doctor  Wight  is  interested  in  his  identi- 
fication.   

University  of  California  Medical  School. — The  Uni- 
versity of  California  Medical  School  announces  the 
organization  of  new  activities  in  the  field  of  medical 
history  and  bibliography,  which  includes  instruction 
and  research  in  these  subjects  and  supervision  of  the 
development  of  the  Medical  School  library. 

Dr.  LeRoy  Crummer  has  accepted  an  appointment 
as  clinical  professor  of  medical  history  and  bibliog- 
raphy, effective  January  1,  1930,  and  Dr.  Sanford 
Larkey  is  to  be  assistant  professor  of  medical  history 
and  bibliography,  effective  July  1,  1930. 


The  New  Shrine. — The  hope  for  a miracle — a doubt- 
ing faith  in  miracles- — -is  eternal  in  the  human  mind. 
Born  into  suffering  as  the  sparks  fly  upward  man  is 
ever  in  search  of  the  short  cut  that  will  relieve  him 
of  his  pain  and  release  him  forever  from  the  necessity 
of  patience  in  working  out  his  destiny.  It  is  inborn 
in  us,  this  desire  to  cut  at  one  stroke  the  Gordian 
knot,  to  throw  off  our  mortal  burdens  and  to  stand 
forth  free. 

Miracles  furnish  the  glamor  of  the  Testaments,  and 
the  lapse  of  nineteen  hundred  years  has  rid  us  of  the 
necessity  of  trying  to  interpet  them  on  a rational 
basis.  So  many  centuries  are  piled  up  upon  them  that 
it  is  futile  for  us  to  try  and  apply  to  them  the  measure 
of  scientific  accuracy. 

New  miracles  have  been  quoted  and  new  shrines 
have  been  established,  however,  through  all  the  ages. 
We  now,  in  this  mechanical  age,  have  before  us  the 
spectacle  of  hundreds  of  thousands  of  afflicted  be- 
lievers— and  of  idle  curiosity  seekers — flocking  to  the 
near-by  grave  of  a youthful  priest  who  died  almost 
sixty  years  ago. 

Modern  miracles  of  healing  generally  resolve  them- 
selves into  two  classes — the  healing  of  those  who 
had  only  an  imaginary  disease  to  begin  with,  and 
the  imaginary  cure  of  those  afflicted  with  organic 
disease.  The  permanency  of  either  of  these  cures  may 
be  speculated  on;  presumably  the  first  may  occasion- 
ally be  of  lasting  value,  although  one  is  reminded  of 
Billy  Sunday’s  reference  to  the  bath — its  value  is 
not  wholly  destroyed  by  the  fact  that  it  needs  an 
occasional  repetition. 

Will  the  grave  of  this  holy  youth  become  a shrine 
which  will  permanently  grip  the  imagination  of  the 
emotional  masses  and  stimulate  their  belief  for  years 
to  come?  Will  he  become  another  St.  Ann  de 
Beaupre?  This  we  cannot  answer  except  to  say  that 
the  emotional  masses  are  fickle,  and  that  today,  as 
little  as  at  any  time,  are  we  building  on  permanent 
foundations. 

The  amazing  thing  is  to  realize  what  a little  dis- 
tance the  human  mind  has  traveled  since  the  mysti- 
cism of  the  Middle  Ages;  what  a short  step  it  is  back 
to  the  days  of  Salem  witchcraft.  One  can  almost 
believe  that  the  terror  of  that  period  might  be  re- 
peated today. — The  New  England  Journal  of  Medicine, 
November  1929. 


January,  193U 


MISCELLANY 


67 


MEDICAL  ECONOMICS 


The  Physician’s  Income  Tax — 1929. — The  taxpayer 

who  is  required  to  make  a return  must  do  so  on  or 
before  March  IS,  unless  an  extension  of  time  for  filing 
the  return  has  been  granted.  For  cause  shown,  the 
collector  of  internal  revenue  for  the  district  in  which 
the  taxpayer  files  his  return  may  grant  such  an  exten- 
sion, on  application  filed  with  him  by  the  taxpayer. 
This  application  must  contain  a full  recital  of  the 
causes  for  the  delay.  Failure  to  make  a return  may 
subject  the  taxpayer  to  a penalty  of  25  per  cent  of 
the  amount  of  the  tax  due. 

The  normal  rate  of  tax  on  individual  citizens  or 
residents  of  the  United  States,  under  the  Revenue  Act 
of  1928,  is  1.5  per  cent  on  the  first  $4000  of  net  income 
in  excess  of  the  exemptions  and  credits,  3 per  cent 
on  the  next  $4000,  and  5 per  cent  on  the  remainder. 

WHO  MUST  FILE  RETURNS 

1.  Returns  must  be  filed  by  every  person  having  a 
gross  income  of  $5000  or  more,  regardless  of  the 
amount  of  his  net  income  or  his  marital  status.  If 
the  aggregate  gross  income  of  husband  and  wife,  liv- 
ing together,  was  $5000  or  more,  they  must  file  a joint 
return  or  separate  returns,  regardless  of  the  amounts 
of  their  joint  or  individual  net  incomes. 

2.  If  gross  income  was  less  than  $5000,  returns  must 
be  filed  (a)  by  every  unmarried  person,  and  by  every 
person  married  but  not  living  with  husband  or  wife, 
whose  net  income  was  $1500  or  more,  and  (b)  by 
every  married  person,  living  with  husband  or  wife, 
whose  net  income  was  $3,500  or  more.  If  the  aggre- 
gate net  income  of  husband  and  wife,  living  together, 
was  $3500  or  more,  each  may  make  a return  or  both 
unite  in  a joint  return. 

If  the  marital  status  of  a taxpayer  changed  during 
the  tax  year,  the  amount  of  income  necessary  to  bring 
him  within  the  class  required  to  make  returns  should 
be  ascertained  by  inquiry  of  the  local  collector  of 
internal  revenue. 

As  a matter  of  courtesy  only,  blanks  for  returns 
are  sent  to  taxpayers  by  the  collectors  of  internal 
revenue,  without  request.  Failure  to  receive  a blank 
does  not  excuse  anyone  from  making  a return;  the 
taxpayer  should  obtain  one  from  the  local  collector 
of  internal  revenue. 

The  following  discussion  covers  matters  relating 
specifically  to  the  physician.  Full  information  con- 
cerning questions  of  general  interest  may  be  obtained 
from  the  official  return  blank  or  from  the  collectors 
of  internal  revenue. 

GROSS  AND  NET  INCOMES WHAT  THEY  ARE 

Gross  Income. — A physician’s  gross  income  is  the 
total  amount  of  money  received  by  him  during  the 
year  from  professional  work,  regardless  of  the  time 
when  the  services  were  rendered  for  which  the  money 
was  paid,  plus  such  money  as  he  has  received  as 
profits  from  investments  and  speculation,  and  as  com- 
pensation and  profits  from  other  sources. 

Net  Income. — Certain  professional  expenses  and  the 
expenses  of  carrying  on  any  enterprise  in  which 
the  physician  may  be  engaged  for  gain  may  be  sub- 
tracted as  “deductions”  from  the  gross  income,  to 
determine  the  net  income  on  which  the  tax  is  to  be 
paid.  An  “exemption”  is  allowed,  the  amount  depend- 
ing on  the  taxpayer’s  marital  status  during  the  tax 
year,  as  stated  before.  These  matters  are  fully  cov- 
ered in  the  instructions  on  the  tax  return  blanks. 

Earned  Income. — In  view  of  the  credit  of  25  per  cent 
allowed  on  earned  net  income,  the  physician  should 
state  accurately  the  amount  of  such  income  as  distin- 
guished from  his  receipts  from  other  sources.  Earned 
income  means  professional  fees,  salaries  and  wages 
received  as  compensation  for  personal  services  ren- 
dered. From  this,  in  the  computation  of  the  tax,  must 
be  subtracted  certain  “earned  income  deductions.” 
The  difference  is  the  “earned  net  income.” 


1 he  first  $5000  of  an  individual’s  net  income  from 
all  sources _ may  be  claimed,  without  proof,  to  be 
earned  net  income,  whether  it  was  or  was  not  in  fact 
earned  within  the  meaning  set  forth  in  the  preceding 
paragraph.  Net  income  in  excess  of  $5000  may  be 
claimed  as  earned  if  it  in  fact  comes  within  that 
category.  However,  a taxpayer  may  not  claim,  as 
earned,  net  income  in  excess  of  $30,000. 

The  conditions  relating  to  the  computation  of  the 
tax  on  earned  income  are  too  elaborate  to  be  stated 
here.  In  case  of  doubt,  physicians  should  consult 
collectors  of  internal  revenue. 

DEDUCTIONS  FOR  PROFESSIONAL  EXPENSES 

A physician  is  entitled  to  deduct  all  current  ex- 
penses necessary  in  carrying  on  his  practice.  The 
following  statement  shows  what  such  deductible  ex- 
penses are  and  how  they  are  to  be  computed: 

Office  Rent. — Office  rent  is  deductible.  If  a physician 
rents  an  office  for  professional  purposes  alone,  the 
entire  rent  may  be  deducted.  If  he  rents  a building  or 
apartment  for  use  as  a residence  as  well  as  for  office 
purposes,  he  may  deduct  a part  of  the  rental  fairly 
proportionate  to  the  amount  of  space  used  for  pro- 
fessional purposes.  If  the  physician  occasionally  sees 
a patient  in  his  dwelling  house  or  apartment,  he  may 
not,  however,  deduct  any  part  of  the  rent  of  such 
house  or  apartment  as  professional  expense;  to  entitle 
him  to  such  a deduction  he  must  have  an  office  there, 
with  regular  office  hours.  If  a physician  owns  the 
building  in  which  his  office  is  located,  he  cannot 
charge  himself  with  “rent”  and  deduct  the  amount  so 
charged. 

Office  Maintenance. — Expenditures  for  office  mainte- 
nance, as  for  heating,  lighting,  telephone  service  and 
the  services  of  attendants  are  deductible. 

Supplies. — Payments  for  supplies  for  professional 
use  are  deductible.  Supplies  may  be  fairly  described 
as  articles  consumed  in  the  using;  for  instance,  dress- 
ings, clinical  thermometers,  drugs  and  chemicals. 
Professional  journals  may  be  classified  as  supplies, 
and  the  subscription  price  deducted.  Amounts  cur- 
rently expended  for  books,  furniture  and  professional 
instruments  and  equipment,  “the  useful  life  of  which 
is  short,”  may  be  deducted;  but  if  such  articles  have 
a more  or  less  permanent  value,  their  purchase  price 
is  a.  capital  expenditure  and  is  not  deductible. 

Equipment. — Equipment  comprises  property  of  more 
or  less  permanent  value.  It  may  ultimately  be  used 
up,  deteriorate  or  become  obsolete,  but  it  is  not  in 
the  ordinary  sense  of  the  word  “consumed  in  the 
using”;  rather,  it  wears  out. 

Payments  for  equipment  or  nonexpendable  prop- 
erty for  professional  use  cannot  be  deducted.  As 
property  of  this  class  may  be  named  automobiles, 
office  furniture,  medical,  surgical  and  laboratory  equip- 
ment of  permanent  value,  and  instruments  and  appli- 
ances constituting  a part  of  the  physician’s  pro- 
fessional outfit  and  to  be  used  over  a considerable 
period  of  time.  Books  of  more  or  less  permanent 
value  are  regarded  as  equipment,  and  the  purchase 
price  is  therefore  not  deductible. 

Although  payments  for  equipment  or  nonexpend- 
able articles  cannot  be  deducted,  yet  from  year  to  year 
there  may  be  charged  off  against  them  reasonable 
amounts  as  depreciation.  The  amounts  so  charged  off 
should  be  sufficient  only  to  cover  the  lessened  value 
of  such  property  through  obsolescence,  ordinary  year 
and  tear,  or  accidental  injury.  If  improvement  to  off- 
set obsolescence  and  wear  and  tear  or  injury  has  been 
made,  and  deduction  for  the  cost  claimed  elsewhere  in 
the  return,  claim  should  not  be  made  for  depreciation. 

A hard  and  fast  rule  cannot  be  laid  down  as  to  the 
amount  deductible  each  year  as  depreciation.  Every- 
thing depends  on  the  nature  and  extent  of  the  prop- 
erty and  on  the  use  to  which  it  is  put.  Five  per  cent 
a year  has  been  suggested  as  a fair  amount  for  de- 
preciation on  an  ordinary  medical  library.  Deprecia- 
tion on  an  automobile  would  obviously  be  much 
greater.  The  proper  allowance  for  depreciation  of 
any  property  is  that  amount  which  should  be  set  aside 
for  the  tax  year  in  accordance  with  a reasonably  con- 


68 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


sistent  plan,  not  necessarily  at  a uniform  rate,  whereby 
the  aggregate  of  the  amounts  so  set  aside,  plus  the 
salvage  value,  will  at  the  end  of  the  useful  life  of  the 
property  in  the  business  equal  the  purchase  price  of 
the  property  or,  if  purchased  before  March  1913,  its 
estimated  value  as  of  that  date  or  its  original  cost, 
which  ever  may  be  the  greater.  The  physician  must 
in  good  faith  use  his  best  judgment  and  make  such 
allowance  for  depreciation  as  the  facts  justify.  Phy- 
sicians who,  from  year  to  year,  claim  deductions  for 
depreciation  on  nonexpendable  property  will  do  well 
to  make  annual  inventories,  as  of  January  1,  each 
year. 

Medical  Dues. — Dues  paid  to  societies  of  a strictly 
professional  character  are  deductible.  Dues  paid  to 
social  organizations,  even  though  their  membership 
is  limited  to  physicians,  are  personal  expenses  and 
not  deductible. 

Postgraduate  Study. — The  Commissioner  of  Internal 
Revenue  holds  that  the  expense  of  postgraduate  study 
is  not  deductible. 

Traveling  Expenses. — Traveling  expenses  necessary 
for  professional  visits  to  patients  are  deductible.  The 
board  of  tax  appeals  has  held  that  traveling  expenses 
incurred  in  attending  medical  meetings  are  deductible 
(Cecil  M.  Jack  v.  Commissioner,  13  B.  T.  A.  726; 
J.  Bentley  Squier,  13  B.  T.  A.  1223).  Such  expenses 
include  only  those  necessarily  incurred  in  attendance 
at  a professional  meeting  for  a professional  purpose. 
The  taxpayer  is  advised  to  make  no  claim  for  the 
deduction  of  such  expenses  unless  he  is  prepared  to 
establish  the  fact  of  expenditure.  In  the  future  accu- 
rate itemized  records  should  be  kept  of  such  expenses 
and  substantiating  evidence,  such  as  Pullman  and 
railroad  receipts,  hotel  bills  and  so  on,  should  be 
carefully  preserved. 


compensated  by  insurance  or  otherwise  recoverable, 
may  be  computed  as  a business  expense,  and  is  de- 
ductible, provided  evidence  of  such  loss  or  damage 
can  be  produced.  Such  loss  or  damage  is  deductible, 
however,  only  to  the  extent  it  has  not  been  made 
good  by  repair  and  the  cost  of  repair  claimed  as  a 
deduction. 

Insurance  Premiums. — Premiums  paid  for  insurance 
against  professional  losses  are  deductible.  This  in- 
cludes insurance  against  damages  for  alleged  mal- 
practice, against  liability  for  injuries  by  a physician’s 
automobile  while  in  use  for  professional  purposes, 
and  against  loss  from  theft  of  professional  equipment, 
and  damage  to  or  loss  of  professional  equipment  by 
fire  or  otherwise.  Under  professional  equipment  is 
to  be  included  any  automobile  belonging  to  the  phy- 
sician and  used  for  strictly  professional  purposes. 

Expense  in  Defending  Malpractice  Suits. — Expenses 
incurred  in  the  defense  of  a suit  for  malpractice  are 
deductible  as  business  expense.  Expenses  incurred  in 
the  defense  of  a criminal  action,  however,  are  not 
deductible. 

Sale  of  Spectacles. — Oculists  who  furnish  spectacles, 
etc.,  may  charge  as  income  money  received  from  such 
sales  and  deduct  as  an  expense  the  cost  of  the  article 
sold.  Entries  on  the  physician’s  account  books  should 
in  such  cases  show  charges  for  services  separate  and 
apart  from  charges  for  spectacles,  etc. — Jour.  A.  M.  A., 
January  5,  1929. 


CORRESPONDENCE  * 


Subject  of  Following  Letter:  “Mrs.  Eddy,  The 
Biography  of  a Virginal  Mind” 


AUTOMOBILES 

Payment  for  an  automobile  is  a payment  for  perma- 
nent equipment,  and  is  not  deductible.  The  cost  of 
operation  and  repair,  and  loss  through  depreciation, 
are  deductible.  The  cost  of  operation  and  repair  in- 
cludes the  cost  of  gasoline,  oil,  tires,  insurance,  re- 
pairs, garage  rental  (when  the  garage  is  not  owned 
by  the  physician),  chauffeurs’  wages,  etc. 

Deductible  loss  through  depreciation  is  the  actual 
diminution  in  value  resulting  from  obsolescence  and 
use,  and  from  accidental  injury  against  which  the 
physician  is  not  insured.  If  depreciation  is  computed 
on  the  basis  of  the  average  loss  during  a series  of 
years,  the  series  must  extend  over  the  entire  esti- 
mated life  of  the  car,  not  merely  over  the  period  in 
which  the  car  is  in  the  possession  of  the  present  tax- 
payer. 

If  the  automobile  is  used  for  professional  and  also 
for  personal  purposes — as  when  used  by  the  physician 
for  recreation,  or  used  by  his  family — only  so  much 
of  the  expense  as  arises  out  of  the  use  for  professional 
purposes  may  be  deducted.  A physician  doing  an 
exclusive  office  practice  and  using  his  car  merely  to 
go  to  and  from  his  office  cannot  deduct  depreciation 
or  operating  expenses;  he  is  regarded  as  using  his 
car  for  his  personal  convenience  and  not  as  a means 
of  gaining  a livelihood. 

What  has  been  said  with  respect  to  automobiles 
applies  with  equal  force  to  horses  and  vehicles  and 
the  equipment  incident  to  their  use. 

MISCELLANEOUS 

Laboratory  Expenses. — The  deductibility  of  the  ex- 
penses of  establishing  and  maintaining  laboratories 
is  determined  by  the  same  principles  that  determine 
the  deductibility  of  other  corresponding  professional 
expenses.  Laboratory  rental  and  the  expenses  of 
laboratory  equipment  and  supplies  and  of  laboratory 
assistants  are  deductible  when  under  corresponding 
circumstances  they  would  be  deductible  if  they  related 
to  a physician’s  office. 

Losses  by  Fire,  etc. — Loss  of  and  damage  to  a phy- 
sician's equipment  by  fire,  theft  or  other  cause,  not 


Los  Angeles, 

December  20,  1929. 

To  the  Editors, 

California  and  Western  Medicine: 

The  following  advertisement  appeared  as  a display 
advertisement  in  the  Los  Angeles  Times  of  recent 
date : 


“We  have  been  forced  to  take  off  our  tables  all 
copies  of  ‘Mrs.  Eddy’  by  Edwin  Franden  Dakin.” 

This  is  from  a bookseller  who  writes  also  that, 
because  of  pressure  from  individuals  who  are 
trying  to  smother  this  biography,  he  has  been 
obliged  to  return  his  stock  of  copies  and  com- 
pelled to  write  a letter  of  apology  to  “two  agen- 
cies” in  his  city.  Personally  this  bookseller 
endorses  the  book. 

This  is  a sample  of  many  similar  letters  which 
come  to  us  from  coast  to  coast.  The  result  is  a 
situation  almost  incredible  in  a free  country.  . . . 

Throughout  almost  eighty-five  years  of  pub- 
lishing, we  have  been  able  to  say  of  our  books, 
“On  sale  at  all  book  stores.”  We  regret  that'  in 
this  one' case,  we  must  qualify  this  statement. 

If  you  can’t  get  a copy  of  “Mrs.  Eddy:  The 
Biography  of  a Virginal  Mind,”  from  any  avail- 
able bookseller,  we  will  mail  you  a copy  postpaid 
to  any  part  of  the  United  States  on  receipt  of  $5. 


Charles  Scribner’s  Sons, 

597  Fifth  Avenue,  New  York  City. 


•The  undersigned  had  read  this  book  and  had  found 
it  to  be  even  kinder  to  the  memory  of  the  late, 
lamented  Mrs.  Mary  Baker  Glover  Patterson  Eddy 
and  the  Christian  Science  Church  than  have  been 
Georgine  Milmine  or  Peabody  or  others  who  have 
dissected  this  life  and  organization,  and  therefore  he 
was  astonished  to  know  that  the  central  organization 

* California  and  Western  Medicine  in  printing  letters  in 
the  Correspondence  column  does  so  without  committing 
the  California  Medical  Association  or  the  journal  to  any 
issues  that  are  discussed,  and  prints  such  communica- 
tions without  prejudice. 


January,  1930 


MISCELLANY 


69 


of  the  higher  powers  of  the  Christian  Science  Church 
was  attempting  to  suppress  free  speech,  free  reading, 
and  free  thought  in  Los  Angeles,  and  presumably  in 
other  cities  of  California  and  of  the  United  States. 

Inquiry  by  him  elicited  the  fact  that  booksellers  in 
Los  Angeles  had  been  requested,  and  either  by  direc- 
tion, or  innuendo,  had  been  threatened  or  urged  to 
suppress  the  sale  of  this  book. 

The  writer  was  informed  that  C.  C.  Parker,  520 
West  Sixth  Street,  was  the  only  bookseller  in  the 
city  who  had  continued  a window  display  in  defiance 
of  the  demands  of  the  Christian  Scientists.  The  writer 
was  also  informed  that  a window  display  made  by 
the  book  department  of  Bullock’s  was  removed  within 
three  hours  of  its  opening  by  reason  of  a storm  of 
protests  from  followers  of  Mrs.  Alary  B.  G.  P.  Eddy. 

This  was  so  interesting  that  visits  were  made  to  a 
number  of  stores  to  ascertain  the  facts.  At  the  book 
department  of  the  Broadway  Department  Store  the 
book  was  on  sale  and  in  evidence.  At  Bullock’s  the 
writer  purchased  a copy,  but  it  was  under  the  counter. 
At  the  Jones  book  store,  426  West  Sixth  Street,  it 
had  been  on  sale,  but  there  were  none  in  stock.  The 
assistant  manager  stated  that  there  had  been  much 
controversy  about  the  book,  and  he  did  not  know 
what  the  policy  of  the  firm  would  be.  The  writer's 
card  was  left,  with  a request  for  information.  None 
came.  A visit  to  this  store  on  December  10  elicited 
the  fact  that  there  were  none  in  stock,  but  that  it 
could  be  ordered. 

At  Parker’s,  520  West  Sixth  Street,  the  book  was 
on  display,  in  stock,  and  more  coming.  The  manager 
of  the  book  department  of  the  J.  W.  Robinson  de- 
partment store  stated  that  the  book  was  not  on  sale, 
would  not  be  on  sale  and  could  not  be  ordered 
through  this  firm.  An  hour  later  the  writer  was  in- 
formed over  the  phone  by  Air.  Rhodes,  secretary  of 
the  firm,  who  was  present  during  my  conversation 
with  the  manager  of  the  book  department,  that  they 
would  take  an  order  for  the  book. 

On  December  11  my  wife  called  at  the  May  de- 
partment store  book  department  and  was  curtly  told 
that  they  did  not  sell  the  book,  would  not  sell  the 
book  by  order  or  otherwise. 

Fowler  Brothers  book  store,  747  South  Broadway, 
have  the  book  on  display  and  have  sold  it  from  the 
start. 

The  feature  of  this  affair  that  is  most  interesting 
to  the  writer  is  that  the  subtle  influence  of  the  Chris- 
tian Science  committee  can  in  a large  measure 
throttle  the  speech,  the  reading,  the  thought  of  a 
million  and  a half  of  Los  Angeles  people  who  are  in 
no  way  in  sympathy  with  them.  There  are  some 
thirty  Christian  Science  churches  in  Los  Angeles.  It 
is  not  probable  that  their  average  membership  is  five 
hundred,  and  I am  informed  by  a former  Christian 
Scientist  that  it  is  less  than  three  hundred.  No  doubt 
there  are  hundreds  of  thousands  of  Catholics,  Jews, 
and  Protestants  who  would  like  to  know  this  story. 
Why  not  let  them  have  it? 

The  book  itself  has  received  the  highest  praise  as 
a work  of  real  unbiased  biography  by  the  best  re- 
viewers in  the  country,  such  as  the  New  York  World, 
Springfield  Republican,  Saturday  Review,  The  Nation, 
Boston  Herald,  The  Carnegie  Library  Magazine — the 
unmuzzled  press. 

The  medical  profession  does  not  wish  to  interfere 
with  Christian  Scientists  in  their  religion  or  in  the 
care  of  their  own  personal  bodies.  It  should  be  vitally 
concerned,  however,  when  the  Christian  Science  or- 
ganization or  any  other  organization  attempts  to  in- 
terfere with  the  sanitary  or  health  control  of  the 
community  as  such,  or  when  it  attempts  to  interfere 
with  the  free  speech,  free  thought,  or  free  reading  of 
the  people  of  a country  such  as  the  United  States  of 
America.  William  Duffield,  M.  D. 


TWENTY-FIVE  YEARS  AGO* 


EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  1,  January  1905 

From  some  editorial  notes: 

. . . Another  New  Year. — The  Journal  enters  upon 
its  third  year  of  life  with  hope  and  confidence  and 
is  cheerful  of  the  future.  We  speak  of  it  in  this  per- 
sonal sense  for,  to  your  Publication  Committee,  the 
Journal  seems  a living,  growing  entity;  our  child. 
The  condition  of  the  society  is  excellent;  county 
societies,  almost  without  exception,  are  in  a flourish- 
ing condition  and  are  growing  at  a healthy  rate.  A 
number  of  counties  where  no  societies  now  exist  are 
ready  for  organization.  On  every  important  question 
confronting  the  medical  proiession  of  California  there 
is  harmonious  agreement.  Judging  from  the  kindly 
expressions  of  opinion  that  come  to  us  from  every 
county  society  and  from  individuals  in  all  parts  of 
the  country,  the  Journal’s  policy  in  regard  to  not  only 
a passive  but  an  active  part  in  the  fight  for  clean 
advertising,  is  heartily  approved.  . . . 

. . . Tuberculosis  Sanatoria. — A question  which  should 
receive  the  careful  consideration  of  all  members  of 
the  society,  and  their  thoughtful  expression,  is  the 
proposed  establishment  of  state  sanatoria  for  the 
tuberculous  poor.  . . . 

. . . What  direction  shall  state  or  municipal  aid 
take?  Shall  it  be  out-patient  dispensaries,  or  shall  it 
be  sanatoria,  or  both?  Judging  from  the  general  tone 
of  discussion,  not  only  here  in  California  but  in  other 
parts  of  the  United  States,  both  projects  are  con- 
sidered desirable  and  necessary.  . . . 

. . . Just  Keep  Hammering. — During  the  past  few 
months  the  Journal  has  devoted  considerable  space 
to  editorial  discussion  of  the  advertising  question  and 
to  occasional  criticism  of  the  American  Medical  As- 
sociation, or  rather  of  its  trustees,  in  connection  wdth 
that  important  subject.  It  is  possible  that  at  times 
this  may  be  a little  monotonous  to  some  of  our 
readers;  at  times  it  is  somewhat  tiresome  even  to  the 
Publication  Committee.  But  we  must  crave  your  in- 
dulgence yet  a little  while.  An  official  of  the  Ameri- 
can Aledical  Association,  who  has  gone  over  the 
ground  very  carefully,  said  to  a member  of  the  com- 
mittee: “You  are  unquestionably  right,  and  you  are 
doing  the  only  thing  that  can  possibly  bring  results; 
you  are  constantly  hammering.  Keep  it  up,  for  if  you 
stop  and  the  subject  is  dropped,  it  will  sink  into 
oblivion.  Keep  hammering  and  you  will  see  that  the 
question  will  have  to  be  taken  up  and  settled  right.” 
For  that  reason  we  shall  “keep  hammering.”  . . . 

...  The  Pity  of  It  All. — Contrast  the  downright 
honesty  of  the  Japanese  commissariat,  the  fine  wool 
blankets  combining  warmth  with  lightness;  the  lamb’s 
wool  toe  socks  for  extreme  cold  weather;  the  beauti- 
fully woven  underwear;  the  rice  and  other  foodstuffs, 
of  which  only  the  best  is  accepted:  compare  these 
with  our  own  embalmed  beef,  our  actually  rotten  and 
rotting  tinned  pork  and  beans,  our  poor  shoddy  cloth, 
our  glove  scandal,  the  thousand  and  one  instances  of 
“graft,  graft,  graft.”  The  existence  of  surprise  is  in- 
dicative of  a widespread  demoralization  that  is  appall- 
ing in  its  tragic  significance.  So  accustomed  are  we 
to  corruption  that  simple  honesty  excites  our  surprise; 
graft  we  look  upon  as  naturally  to  be  expected.  . . . 

. . . Registration  of  Nurses.— The  California  State 
Nurses’  Association  has  had  prepared  a bill  which 
is  to  be  introduced  in  the  legislature  providing  for 
registration  of  graduate  and  qualified  nurses.  The 
text  of  the  bill  has  been  submitted  to  a number  of 
attorneys  and  prominent  physicians  and  has  received 
their  approval.  . . . 

* This  column  aims  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


70 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


From  an  article  entitled  “My  Son,  Make  Money; 
Honestly,  If  You  Can,  But — Make  Money”: 

. . . Let  us  once  more  glance  at  the  financial  state- 
ment made  by  the  trustees  of  the  American  Medical 
Association  at  the  last  meeting  and  see  whether 
further  understanding  may  have  come  from  reflec- 
tion. . . . 

...  It  is  difficult  to  see,  from  the  figures  which 
the  trustees  give,  why  it  would  not  be  possible  for 
them  to  conduct  The  Journal  of  the  American  Medical 
Association  in  accordance  with  the  Principles  of  Ethics, 
do  all  the  work  the  association  is  now  doing,  and  still 
make  money.  And  the  dollars  thus  made  would  be 
good,  clean,  wholesome  dollars,  without  taint  or 
stench.  It  is  true  that  the  reserve  fund  would  grow 
the  more  slowly,  but  it  would  grow,  and  in  the  end 
be  a monument  to  good  business  sense  as  well  as  to 
good  ethics,  instead  of  being  an  apparent  illustration 
that  the  accumulation  of  wealth  will  counterbalance 
disregard  of  ethical  principles.  . . . 


From  an  article  on  “Second  and  Fourth  Positions  of 
the  Vertex ” by  Henry  Gibbons,  Jr.,  M.  D.,  San  Francisco: 

I have  long  been  impressed  with  the  want  of  agree- 
ment of  the  textbooks  on  obstetrics  in  regard  to  the 
occurrence  and  the  frequency  of  second  and  fourth 
positions  of  the  vertex.  Until  recently  little  more 
than  the  possibility  of  the  occurrence  of  the  left 
occipitoposterior  position  has  been  admitted.  . . . 


From  an  article  on  “Appendicitis — Some  Points  in  Its 
Diagnoses  and  Treatment  from  the  Viewpoint  That  Its 
Cause  Is  a Strangulation  Produced  by  Distention  Behind 
a Ball-Valve”  by  C.  Van  Zwalenburg,  M.D.,  Riverside : 

I wish  to  acknowledge  my  indebtedness  to  Doctors 
Black  and  Leonard  of  the  Hendryx  Laboratory  of  the 
College  of  Medicine  of  the  University  of  Southern 
California,  by  whose  courtesy  that  institution  was 
used  for  most  of  the  work.  The  specimens  of  in- 
flamed appendices  of  dogs  are  the  result  of  some 
experiments  undertaken  to  demonstrate  that  strangu- 
lation from  overdistention  of  the  appendix  will  pro- 
duce appendicitis.  . . . 


From  an  article  on  “Chronic  Otorrhea  as  Viewed  by 
the  Life  Insurance  Companies  and  the  Medical  Recruit- 
ing Officer”  by  A.  Barkan,  M.D.,  San  Francisco: 

Motto:  As  long  as  a discharge  from  the  ear  exists, 
we  are  never  able  to  say  how,  when  or  where  it  may 
end,  nor  to  what  it  may  lead. — Wilde. 

The  running  ear,  having  been  considered  harmless, 
nay,  a benefit  to  the  general  economy  of  the  body, 
by  many  from  time  immemorial,  has  ceased  to  be  a 
noli  me  tangere.  The  last  twenty  years  have  brought 
about  a change  so  radical  in  the  understanding  of 
this  malady  that  radical  operative  measures  have  been 
adopted  to  fight  it.  . . . 


From  a letter  on  the  subject  of  “Wood-Alcohol  Poisoning: 

To  the  Editor  of  the  State  Journal:  A few  days 
since,  by  presenting  to  the  San  Francisco  County 
Medical  Society  a case  of  wood-alcohol  poisoning,  I 
have  tried  to  draw  local  attention  to  a matter  of  public 
moment,  as  evinced  by  the  attitude  of  the  American 
Medical  Association  regarding  the  same,  and  the  pub- 
licity it  has  received  more  recently  still  in  the  daily 
press  on  the  occasion  of  the  deaths  of  several  persons 
in  New  York  from  the  same  poison.  . . . 

From  medical  society  reports: 

Association  of  South  Side  Physicians. 

The  Association  of  South  Side  Physicians  held  its 
regular  bimonthly  meeting  Friday  evening,  October 
28,  at  Dr.  W.  F.  Barbat’s  office,  1310  Folsom  Street, 
with  the  president,  Dr.  A.  Eichler,  in  the  chair.  . . . 

. . . Dr.  A.  B.  Spalding,  who  had  been  invited  to 
attend  the  meeting,  explained  the  purposes  and 
methods  of  conducting  the  San  Francisco  Maternity 
Hospital  at  1217  Harrison  Street,  as  there  had  been 
some  misapprehension  of  the  objects  of  the  insti- 
tution. . . . 


DEPARTMENT  OF  PUBLIC 
HEALTH 


By  W.  M.  Dickie,  Director 

Epidemic  Meningitis. — The  incidence  curve  of  epi- 
demic meningitis  in  California  by  years  and  months 
from  1920  to  the  end  of  July  1929,  shows  that  there 
was  relatively  a high  incidence  of  the  disease  in  1920 
and  1921,  but  thereafter,  for  a period  of  four  years, 
there  were  few  cases  and  few  deaths.  In  December 
1925,  there  was  a definite  rise  in  incidence  which 
marked  the  beginning  of  a series  of  three  annual 
peaks  which  occurred  in  the  winter  and  spring  months 
of  1926,  1927,  and  1928.  The  peak  of  1928  was  lower 
than  those  of  1926  and  1927,  and  during  the  late 
summer  and  autumn  months  of  1928  the  incidence 
curve  appeared  to  be  approaching  the  normal  level 
of  1922-1925.  However,  in  November  1928,  the  case 
incidence  began  to  increase  and  continued  to  rise 
rapidly,  month  by  month,  until  the  peak  of  112vcases 
was  reached  in  March  1929.  A high  incidence  was 
maintained  during  April  and  May,  but  in  June  and 
July  the  number  of  new  cases  had  dropped  to  about 
one-half,  although  this  still  was  relatively  a high  case 
incidence.  There  has  been  a further  decline  during 
the  past  few  weeks,  but,  bearing  in  mind  that  the 
normal  seasonal  incidence  is  greater  in  the  winter  and 
spring  months,  one  can  but  speculate  whether  we 
have  passed  through  the  worst  of  this  epidemic  or 
whether  there  is  more  to  follow. 

An  interesting,  though  not  surprising  fact  is  that, 
coincident  with  the  marked  increase  in  the  number  of 
cases,  there  has  been  an  increase  in  the  case  mortality 
rate.  From  1922  to  1925,  inclusive,  the  case  mortality 
rate  was  36.6  per  cent;  in  1928  it  was  44.4  per  cent; 
and  during  the  first  six  months  of  1929  it  was  50.8 
per  cent.  The  number  of  reported  cases  during  this 
six-month  period  was  521,  and  the  number  of  deaths 
was  265. 

An  editorial  in  The  Journal  of  the  American  Medical 
Association  of  June  15,  1929,  might  lead  one  to  believe 
that  the  epidemic  meningitis  situation  on  the  Pacific 
Coast  was  particularly  alarming,  but  no  such  con- 
clusion is  justifiable.  This  has  been  a meningitis  year, 
not  only  in  the  West  but  elsewhere  in  the  United 
States,  and  the  situation  has  been  sufficiently  acute 
to  justify  monthly  bulletins  in  the  public  health  re- 
ports. On  January  11  it  was  reported  that,  although 
the  incidence  of  epidemic  meningitis  in  the  United 
States  had  been  unusually  low  during  the  first  week 
in  November  1928,  a sharp  rise  became  apparent  dur- 
ing the  remainder  of  the  month  and  that  during  the 
three  weeks  ending  December  1,  258  cases  had  been 
reported  as  compared  with  139  cases  during  the  cor- 
responding period  of  1927.  On  February  1 it  was 
reported  that  there  was  an  increase  during  December 
in  nearly  all  the  states,  and  on  March  1 it  was  stated 
that  in  January  1929,  the  incidence  of  the  disease  in 
the  United  States  was  the  highest  since  1918,  with  a 
general  tendency  toward  an  increase  in  all  sections  of 
the  country.  Finally,  on  July  5,  1929,  McCoy  re- 
ported that  one  must  go  back  to  1905  to  find  the  last 
comparable  prevalence  of  the  disease,  and  it  is  an 
interesting  fact  that  the  beginning  of  the  epidemic 
was  at  approximately  the  same  time  in  all  sections  of 
the  country. — Ernest  C.  Dickson,  M.  D.,  Department 
of  Public  Health  and  Preventive  Medicine,  Stanford 
University  Medical  School. 


Examine  Thirteen  Thousand  Children  of  Preschool 
Age. — Nearly  thirteen  thousand  California  children, 
who  entered  school  for  the  first  time  this  fall,  were 
given  physical  examinations  by  the  Bureau  of  Child 
Hygiene  of  the  State  Department  of  Public  Health, 


January,  1930 


MISCELLANY 


71 


in  cooperation  with  the  California  Congress  of  Par- 
ents and  Teachers.  Most  of  these  children  live  in  the 
rural  districts  of  the  state,  where  organized  facilities 
for  child  care  are  not  available.  Forty-eight  counties 
of  the  state  were  covered  in  the  campaign.  Exami- 
nations were  conducted  by  competent  physicians, 
many  of  whom  donated  their  services.  The  examin- 
ing physicians  noted  the  condition  of  the  heart,  lungs, 
eyes,  ears,  nose,  throat,  teeth,  and  the  weight  and 
posture  of  the  children.  They  recorded  conditions 
which  were  necessary  for  correction  and  advised  the 
parents  to  secure  such  corrections  from  local  phy- 
sicians before  the  child  was  permitted  to  enter  school. 
The  most  commonly  encountered  defect  was  decayed 
teeth.  The  next  most  common  defect  encountered 
was  diseased  throat  and  nose.  A large  number  of  the 
children  were  found  to  be  underweight  and  faulty 
posture  was  a commonly  found  defect. 


Doctor  Tenent  Is  Stanislaus  County  Health  Officer. 

The  board  of  supervisors  of  Stanislaus  County  estab- 
lished a full-time  health  unit  recently  and  Dr.  C.  H. 
Tenent  of  Memphis,  Tennessee,  has  been  selected  as 
county  health  officer.  Stanislaus  County  is  the  thir- 
teenth county  of  the  state  to  establish  its  health  de- 
partment upon  a full-time  basis.  The  county  has  an 
estimated  population  of  64,000.  Modesto,  the  county 
seat,  is  one  of  the  most  rapidly  growing  cities  in  the 
state.  Other  incorporated  towns  within  the  county 
are  Turlock,  Newman,  Patterson,  Ceres,  Oakdale,  and 
Riverbank.  Stanislaus  County  is  in  a rich  agricul- 
tural section  and  offers  an  ideal  field  for  unified  public 
health  administration. 


Tularemia — First  Known  Case  in  California. — It  is 

interesting  to  learn  that  the  first  known  case  of  tulare- 
mia occurred  in  California  as  long  ago  as  1904.  This 
fact  developed  through  information  contained  in  a 
letter  written  on  June  6,  1928,  by  Dr.  T.  F.  Johnson, 
for  many  years  health  officer  of  National  City,  to 
Dr.  Edward  Francis  of  the  United  States  Public 
Health  Service.  Doctor  Johnson  stated  that  his  son 
contracted  an  infection  from  wild  rabbits  in  1904. 
According  to  the  history,  the  boy,  then  fifteen  years 
of  age,  residing  in  National  City,  San  Diego  County, 
when  hunting  on  May  30,  1904,  shot  and  dressed 
twelve  rabbits  at  Sweetwater  Dam.  At  about  the 
same  time  he  punctured  his  hand  with  what  apoeared 
to  be  a “sliver.”  On  June  4,  he  was  taken  ill,  and 
the  illness  was  accompanied  by  swelling  of  the  hand, 
enlarged  epitrochlear  and  axillary  glands.  His  tem- 
perature reached  104  degrees  F.  The  blood  serum 
collected  from  Doctor  Johnson’s  son  June  6,  1928, 
twenty-four  years  after  this  illness,  agglutinated 
B.  tularense  in  all  dilutions  from  1/10  to  1/160,  con- 
firming the  diagnosis  of  tularemia  after  a lapse  of 
twenty-four  years.  This  information  was  submitted 
to  the  California  State  Department  of  Public  Health 
by  Surgeon  Francis,  together  with  the  following 
statement: 

“What  I believe  to  be  the  very  first  reference  on 
record  to  tularemia  in  rabbits  or  in  man  in  the  United 
States  is  contained  in  a letter  written  in  1904  by  the 
patient,  a boy  fifteen  years  of  age,  to  his  sister,  in 
which,  while  still  sick,  he  relates  the  source  of  his 
infection,  his  symptoms  and  the  treatment  which  he 
received  at  the  hands  of  his  father.  Dr.  Theodore  F. 
Johnson,  of  National  City,  California.” 

Cases  of  tularemia  were  not  recognized  as  such  in 
California  until  1927.  The  disease  was  made  report- 
able  June  2,  1928.  A total  of  thirty-seven  cases  have 
been  recorded  in  California.  Three  of  these  cases 
occurred  in  laboratory  workers  prior  to  1927.  Two 
cases  occurred  in  1927  in  patients  who  handled  jack- 
rabbits.  Sixteen  cases  occurred  in  1928,  and  fifteen 
cases  have  been  reported  so  far  this  year. — Weekly 
Bulletin,  California  Department  of  Public  Health. 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 


By  C.  B.  Pinkham,  M.  D. 

Secretary  of  the  Board 

News  Items,  January  1930 

Results  of  October  1929  Examination — Board  of 
Medical  Examiners,  State  of  California. — Charles  B. 
Pinkham,  M.  D.,  secretary  of  the  Board  of  Medical 
Examiners  of  the  State  of  California,  reports  the 
written  examination  held  in  Sacramento,  October  22 
to  24,  1929.  The  examination  covered  nine  subjects, 
and  included  ninety  questions.  An  average  of  75  per 
cent  was  required  to  pass.  An  allowance  of  one  per 
cent  for  years  of  practice  was  added  to  the  general 
average  of  four  applicants  who  had  not  received  less 
than  60  per  cent  in  more  than  one  subject.  Fifty-six 
applicants  were  examined.  Fifty-one  passed,  and  five 
failed.  The  following  colleges  were  represented: 


I.  PASSED 

Year 

College  Grad. 

Boston  University (1928) 

College  of  Medical  Evangelists (1927) 

College  of  Medical  Evangelists (1928) 

College  of  Medical  Evangelists (1929) 

College  of  Medical  Evangelists (1929) 

College  of  Medical  Evangelists (1929) 

College  of  Medical  Evangelists (1929) 

College  of  Medical  Evangelists (1929) 

College  of  Medical  Evangelists (1929) 

Creighton  University  School  of  Medicine.. (1929) 
Creighton  University  School  of  Medicine. .(1929) 
Creighton  University  School  of  Medicine. .(1929) 
Creighton  University  School  of  Medicine.. (1929) 

Harvard  University  Medical  School (1924) 

Harvard  University  Medical  School -.(1925) 

Harvard  University  Medical  School. (1929) 

Jefferson  Medical  College. (1929) 

Johns  Hopkins  University  School  of  Medi- 
cine   (1928) 

Johns  Hopkins  University  School  of  Medi- 
cine   (1929) 

McGill  University  Faculty  of  Medicine....(1920) 
McGill  University  Faculty  of  Medicine....(1926) 
McGill  University  Faculty  of  Medicine....(1929) 
Northwestern  University  Medical  School..  (1927) 
Northwestern  University  Medical  School  . (1927) 
Northwestern  University  Medical  School..(1929) 

Ohio  State  University (1926) 

Rush  Medical  College (1929) 

Rush  Medical  College (1929) 

Rush  Medical  College (1929) 

Rush  Medical  College (1929) 

Stanford  University  Medical  School (1928) 

Stanford  University  Medical  School ..(1929) 

Stanford  University  Medical  School... (1929) 

St.  Louis  University  School  of  Medicine....(1929) 
St.  Louis  University  School  of  Medicine....(1929) 
University  of  Buffalo  School  of  Medicine..  (1928) 
University  of  California  Medical  School.,.. (1928) 
University  of  California  Medical  School....(1929) 
University  of  California  Medical  School....(1929) 
University  of  Colorado  School  of  Medi- 
cine   (1929) 

University  of  Illinois  College  of  Medicine.. (1922) 
University  of  Illinois  College  of  Medicine..(1922) 
University  of  Illinois  College  of  Medicine  . (1924) 
University  of  Illinois  College  of  Medicine..(1929) 
University  of  Iowa,  Medical  Department.. (1928) 
University  of  Louisville  School  of  Medi- 
cine   (1927) 

University  of  Minnesota  Medical  School. .(1929) 
University  of  Pennsylvania  School  of 

Medicine  ....(1929) 

Washington  University  School  of  Medi- 
cine   (1929) 

Washington  University  School  of  Medi- 
cine   ; (1929) 

Yale  University  School  of  Medicine (1926) 


Per 

Cent 

78  5/9 

82  2/9 
90  7/9 

83  4/9 

77  7/9 
76  6/9 
89  8/9 

87  2/9 
83  8/9 

81  6/9 

83  1/9 

79  7/9 

82  5/9 

86  5/9 

88 

78  5/9 

82  8/9 

87  8/9 

78  1/9 

(a)  93  5/9 

(b)  83 

80 

78  8/9 
86  8/9 
81  4/9 

84  5/9 
89  1/9 

83  5/9 
78  6/9 

85  4/9 
89 

81  8/9 

86  3/9 
81 

78  2/9 
89  7/9 

75  5/9 

82  5/9 
82  8/9 

84  1/9 

(c)  86 

85  5/9 

(d)  88  6/9 

76  8/9 

87  2/9 

82  4/9 

81  7/9 
80  3/9 

86  1/9 

83  4/9 


(a)  Was  given  5 per  cent  credit  for  years  of  practice. 

(b)  Was  given  2 per  cent  credit  for  years  of  practice. 

(c)  Was  given  7 per  cent  credit  for  years  of  practice. 

(d)  Was  given  5 per  cent  credit  for  years  of  practice. 


II.  FAILED 

Year  Per 

College  Grad.  Cent 

College  of  Physicians  and  Surgeons, 

Boston  (1916)  66  3/9 

Creighton  University  School  of  Medicine  . (1929)  73  5/9 

Creighton  University  School  of  Medicine.. (1929)  73  8/9 

University  of  Prague,  Czechoslovakia (1921)  57 

University  of  Guadalajara,  Mexico (1928)  25  4/9 


72 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  1 


Democrito  R.  Gonzales,  mentioned  in  December 
“News  Items”  as  having  practiced  in  Los  Angeles 
with  fraudulent  diplomas  and  state  license,  was  on 
December  10,  1929,  reported  sentenced  in  the  Superior 
Court  of  Los  Angeles  to  San  Quentin  for  the  term 
prescribed  by  law.  Gonzales  was  charged  under  Cali- 
fornia’s diploma  mill  law — Chapter  79,  Statutes  1927, 
which  makes  the  use  of  fraudulent  credentials  a 
felony.  Gonzales  had  the  following  three  fraudulent 
documents,  which  were  seized  at  the  time  of  his 
arrest:  (1)  Cambridge  University  diploma  conferring 
on  him  the  degree  Doctor  of  Medicine;  (2)  Columbia 
University  College  of  Physicians  and  Surgeons  (New 
York)  diploma  conferring  on  him  the  degree  Doctor 
of  Philosophy;  (3)  a farcical  California  license;  and 
was  reported  as  carrying  on  a lucrative  practice 
among  the  Filipinos  in  Los  Angeles. 


According  to  The  Journal  of  the  American  Medical 
A ssociation  of  November  16,  1929,  William  T.  Con- 
well,  Philadelphia  druggist,  was  assessed  $8000  dam- 
ages as  a result  of  his  alleged  treatment  of  a diabetic 
who  lost  his  leg  as  a result. 


Dr.  Joseph  Cornell,  128  West  Main  Street,  Haw- 
thorne, late  yesterday  was  arrested  and  charged  with 
violation  of  the  Harrison  Narcotic  Act,  following  the 
asserted  sale  of  fifty  grains  of  morphin  to  an  under- 
cover agent.  (Los  Angeles  Daily  News,  November  14, 
1929.) 


Because  he  was  too  busy  to  appear  as  a witness  in 
a criminal  case,  Dr.  Frank  Chase,  medical  examiner 
for  the  New  York  Life  Insurance  Company,  yester- 
day was  ordered  to  serve  one  day  in  jail  today  by 
Municipal  Judge  Charles  D.  Ballard  for  contempt  of 
court.  The  physician  neglected  to  appear  yesterday 
morning  as  a witness  against  Harry  Meyers,  accused 
of  grand  theft  and  forgery.  When  he  was  brought 
into  court  late  on  a bench  warrant,  Doctor  Chase 
explained  that  it  was  too  much  “bother”  to  leave  his 
work  to  make  the  court  appearance.  (Los  Angeles 
Daily  News,  November  30,  1929.) 


Dr.  George  E.  Darrow  of  Azusa  today  was  sen- 
tenced to  five  years  to  life  imprisonment,  following 
his  conviction  by  a jury  who  heard  his  trial  on  a 
charge  of  second  degree  murder  based  on  the  death 
of  Jennie  Peterson,  twenty-three,  following  an  illegal 
operation.  Superior  Judge  Emmet  Wilson  pronounced 
sentence  after  denying  the  motion  for  probation  . . . 
(Los  Angeles  Herald,  December  2,  1929.) 


Hugh  H.  Slocumb,  M.  D.,  on  coming  to  California 
seemingly  did  not  consider  it  necessary  to  obtain  a 
license  before  commencing  practice,  our  investigator 
reporting  that  he  had  found  185  prescriptions  written 
by  Doctor  Slocumb  within  the  ninety  days  prior  to 
his  arrest  on  December  3 on  a charge  of  violation 
of  the  Medical  Practice  Act. 


On  October  25  the  State  Board  of  Medical  Exami- 
ners filed  a complaint  against  John  O.  Varian  of 
Halcyon  in  Judge  W.  H.  Dowell’s  court  in  this  city, 
charging  him  with  practicing  a system  or  mode  of 
treating  the  sick  and  afflicted  without  having  a state 
license.  He  was  arraigned  before  Judge  Dowell  and 
pleaded  guilty,  whereupon  he  was  sentenced  to  spend 
sixty  days  in  the  county  jail,  the  sentence  being  sus- 
pended on  condition  that  he  does  not  again  violate 
the  Medical  Practice  Act.  (Aurora  Grande  Herald- 
Recorder,  November  8,  1929.) 


According  to  the  San  Francisco  Examiner  of  No- 
vember 24,  1929,  Dr.  William  V.  Whitmore,  former 
chancellor  of  the  University  of  Arizona  and  licensed 
to  practice  in  California  in  1890,  was  on  November  23' 
found  guilty  in  Tucson,  Arizon,  of  conspiracy  to  vio- 
late the  Federal  Narcotic  Laws.  Doctor  Whitmore 
was  reported  later  sentenced  to  fifteen  months  in  the 
federal  penitentiary  and  a $500  fine. 


Margaret  Smyth,  surgeon  and  psychiatrist,  will 
serve  indefinitely  as  acting  superintendent  of  the 
Stockton  State  Hospital  for  Insane,  Earl  E.  Jensen, 
director  of  institutions,  announced  here  today.  Doctor 
Smyth  served  as  first  assistant  to  the  late  Dr.  Fred 
P.  Clark  from  1917  until  the  latter’s  death  last  Sun- 
day. . . . (Oakland  Tribune,  November  23,  1929). 


Announcement  has  been  made  that  Dr.  J.  C.  John- 
stone, formerly  of  the  Sonoma  State  Home  at  El- 
dridge,  has  recently  been  named  as  acting  medical 
superintendent  of  the  Pacific  State  Home  at  Spadra 
and  that  Dr.  Charles  Ritchie,  who  has  been  at  Spadra 
for  about  a year,  has  been  transferred  to  the  state 
institution  for  the  insane  in  Mendoccino  County. 


Mr.  Richard  M.  Lyman,  Jr.,  of  San  Francisco  has 
been  appointed  chief  counsel  of  the  Board  of  Medical 
Examiners,  vice  Bradford  M.  Melvin,  who  resigned 
to  accept  a lucrative  offer  from  the  Richfield  Oil 
Company. 


Colonel  W.  H.  H.  Miller,  head  of  the  State  De- 
partment of  Registration  and  Education  under  Ex- 
Governor  Small,  was  convicted  of  conspiracy  to  issue 
fraudulent  medical  and  dental  licenses  last  night  by 
a criminal  court  jury  before  Judge  Jacob  M.  Hopkins. 
The  jury,  which  deliberated  four  hours,  fixed  Miller’s 
sentence  at  seven  months  and  a day  in  the  county 
jail  and  a fine  of  $2000.  ...  At  one  time  H.  Mitchell 
Blaine,  alleged  conspirator,  submitted  a list  of  five 
hundred  unqualified  persons  to  whom  Miller  planned 
to  issue  licenses  at  a price  of  $2000  each.  . . . State’s 
Attorney  Samuel  G.  Clawsen  cited  evidence  that  the 
diploma  ring  had  agents  in  St.  Louis,  New  York,  and 
other  cities  soliciting  hospital  orderlies,  quacks,  and 
laymen  with  no  medical  knowledge,  to  come  to  Illi- 
nois, purchase  licenses  through  Miller’s  office  and 
engage  in  practice  for  which  they  were  utterly  un- 
qualified. . . . The  state  paraded  before  the  jury  wit- 
nesses who  testified  to  having  made  payment  to 
Miller  for  spurious  licenses  (Chicago  Tribune,  De- 
cember 11,  1929).  Comment:  Illinois  might  well  pass 
a law  similar  to  California’s  so-called  diploma  mill 
law. 


Irked  by  his  chosen  occupation  as  a Petaluma 
chicken  raiser,  Willie  Carlos  Barrington  (colored) 
ventured  into  the  realm  of  medicine.  His  procedure 
was  to  ask  a druggist  what  was  good  for  a certain 
complaint,  then  have  the  druggist  write  the  direc- 
tions on  the  container,  which  Barrington  is  asserted 
to  have  signed  and  sold  to  his  various  patients.  On 
November  30  Barrington  was  sentenced  on  each  of 
two  counts  for  violation  of  the  Medical  Practice  Act 
to  pay  a fine  of  $300  or  serve  one  day  in  the  county 
jail  of  Sonoma  County  for  each  $2  unpaid. 

Francis  J.  Bold,  Whittier  physician,  acquitted  No- 
vember 25  on  a second  degree  murder  charge  re- 
sulting from  the  death  of  Mrs.  Carmellita  Wilhite, 
Englewood,  alleged  to  have  died  following  an  illegal 
operation,  has  been  cited  to  appear  before  the  Board 
of  Medical  Examiners  at  the  meeting  which  opens  in 
Los  Angeles,  February  3,  1930. 


Walter  E.  Kuhn,  an  alleged  graduate  of  a Kansas 
City,  Missouri,  medical  school  not  approved  by  the 
California  board,  was  arrested  December  12  on  a 
charge  of  violation  of  the  Medical  Practice  Act.  On 
the  same  day  he  pleaded  guilty  in  the  police  court  at 
Chico  and  was  sentenced  to  pay  a fine  of  $600,  which 
was  paid,  and  to  serve  six  months  in  the  county  jail 
of  Butte  County,  from  which  jail  sentence  he  was 
granted  probation,  with  the  provision  that  he  leave 
the  state  within  ten  days.  Investigation  disclosed 
that  Doctor  Kuhn  had  carried  on  an  extensive  prac- 
tice in  and  about  Chico,  our  investigator  finding 
approximately  one  hundred  prescriptions  written  by 
Doctor  Kuhn  between  the  period  of  June  1 and  No- 
vember 11,  1929. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


Headquarters  for 

Modern  Office  Equipment 

Visit  Our  Large  Sales  Room 
MANY  BARGAINS  NOW  ON  DISPLAY 


Agents 


TRAVERS  SURGICAL  CO. 

Physicians’  and  Hospital  Supplies 


FRESNO 
933  Van  Ness 


SAN  FRANCISCO 
429  Sutter  Street 


CALIFORNIA’S  LEADING  SURGICAL  SUPPLY  HOUSE 


vmiisa 


A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER. 


U 

■ Looks  like  a dress  silk  stocking.  A new  German 

V invention.  Gives  compression  when  drawn  up  at 

the  top.  Tightness  regulated  in  direct  relation  to 
■■■■■■■■a  vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treatment  of  varicose  veins 
and  swollen  limbs.  Neat  and  comfortable. 

Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 


PRICES 

Length  as  illustrated  $ 7.00 

Half  thigh  length  9.00 

Full  length  10.00 


In  ordering  give  patient’s 
calf  measurement. 


SOLD  AND  FITTED  BY 


323  W.  6TH  STREET 


Phone  MUtual  8081 


LOS  ANGELES,  CALIF. 


34 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Pain — 

Burning — 

Frequency 

Are  relieved,  and  in  most  cases  complete  disinfection  of 
the  urinary  tract  is  established  by  the  prompt  use  of 

CAPROKOL 

(Hexylresorcinol,  S & D) 

Its  analgesic  action  on  the  urinary  mucosa  often  brings  im- 
mediate comfort , and  its  continuous  germicidal  actio?i  in  the  urine 
has  produced  astonishing  results  in  urinary  tract  infections. 


In  Capsules  for  Adults 

R 

Capsules  Caprokol  50  or  100 
Sig. — Two  Capsules  after  meals 
increasing  as  directed. 


In  Solution  for  Children 

R 

Solution  Caprokol  4 ozs. 

Sig. — Teaspoonful  q.  4 h. 
increasing  as  directed. 


Diuretics  and  increased  fluids  should  be  avoided  during  treatment 


SHARP  8c  DOHME 

BALTIMORE 

Quality  First  Since  1860 

New  York  Chicago  New  Orleans  St.  Louis  Atlanta  Philadelphia 
Kansas  City  San  Francisco  Boston  Dallas 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


THE  IHPCCTANCE 
CE  X DAL4NCEE  DIET 

WITH 


Mai  t i n e 

WITH  COD  LIVER  OIL 


No  matter  how  carefully  you  plan  a diet,  you 
cannot  obtain  best  results  when  your  patient 
lacks  appetite.  Today,  we  know  that  Vitamin 
B plays  an  important  part  in  stimulating  appe- 
tite.  Research  workers  are  emphasizing  its  im- 
portance in  the  diet. 

It  has  long  been  known  that  the  regimen 
must  be  balanced  in  its  content  of  proteins, 
fats,  sugars  and  minerals.  It  is  now  recognized 
that  the  vitamin  content  must  be  evenly  bal- 
anced. And  when  Maltine  With  Cod  Liver 
Oil  is  prescribed  not  only  do  you  supply  a 
generous  quantity  of  Vitamin  B but  also  Vita- 
mins A and  D.  Since  orange  juice  contains 
Vitamin  C,  this  combus- 
tion gives  an  abundance 
of  these  four  vitamins. 


A leading  biological  chemist  has  definitely 
established  the  presence  of  these  four  essential 
vitamins  in  this  palatable  combination  of  Mai- 
tine  With  Cod  Liver  Oil  and  orange  juice. 
Therefore,  Maltine  With  Cod  Liver  Oil,  taken 
in  orange  juice,  provides  adequate  assurance 
that  your  patient  secures  them  in  his  diet. 

Clinical  tests  prove  that  Maltine  With  Cod 
Liver  Oil  is  much  more  palatable  than  plain 
cod  liver  oil  no  matter  how  much  the  latter  is 
disguised.  It  is  easily  administered  and  readily 
digested  even  by  infants.  It  is  a preparation 
accepted  by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical  Association. 

Maltine  Company, 
Vesey  St.,  New  York. 
Established  1875. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


36 


Rainier  Pure  Grain  Alcohol 

USP 

The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRAIN  ONLY 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 

RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calif. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  30) 

salicylate  or  mercuric  chlorid  in  that  they  do  not 
cause  severe  cramps  or  sloughing  if  accidentally  in- 
jected outside  the  veins.  Solution  of  invert  sugar 
(Lilly)  is  marketed  in  ampoules  containing  5 grams, 
6 grams,  and  7.5  grams,  respectively,  in  10  cubic  centi- 
meters. Eli  Lilly  & Company,  Indianapolis. 

Sulpharsphenamin  (De  Pree),  0.5  Gram  Ampoules. 
Each  ampoule  contains  sulpharsphenamin — De  Pree 
(New  and  Nonofficial  Remedies,  1929,  p.  71),  0.5 
gram.  De  Pree  Chemical  Company,  Holland,  Mich. 

Sulpharsphenamin  (De  Pree),  0.9  Gram  Ampoules. 
Each  ampoule  contains  sulpharsphenamin — De  Pree 
(New  and  Nonofficial  Remedies,  1929,  p.  71),  0.9 
gram.  De  Pree  Chemical  Company,  Holland,  Mich. — 
Jour.  A.  M.  A.,  November  23,  1929,  p.  1649. 

PROPAGANDA  FOR  REFORM 
Toxogon  Not  Acceptable  for  New  and  Nonofficial 
Remedies.— Toxogon  is  the  therapeutically  suggestive 
name  applied  by  the  Von  Winkler  Laboratories,  Inc., 
Chicago,  to  a preparation  proposed  for  the  treatment 
of  infectious  diseases,  particularly  gonorrhea.  The 
Council  on  Pharmacy  and  Chemistry  found  Toxogon 
unacceptable  for  New  and  Nonofficial  Remedies  be- 
cause its  composition  was  not  adequately  declared; 
because  no  evidence  was  available  to  indicate  that 
the  composition  and  uniformity  of  the  product  was 
controlled;  because  the  claims  advanced  for  it  were 
unwarranted  in  the  light  of  the  available  evidence; 
and  because  it  is  marketed  under  a therapeutically 
suggestive  name.  When  the  Council’s  report  was 
submitted  to  the  Von  Winkler  Laboratories,  a reply 
was  received  which  submitted  further  information  hut 
which  did  not  permit  a revision  of  the  rejection  of 
Toxogon. — Jour.  A.  M.  A.,  November  2,  1929,  p.  1383. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the 
(Continued  on  Page  38) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


Tycos  Surgical  Unit 

For  Blood  Pressure  Determina- 
tion in  the  Operating  Room 

For  the  convenience  of  anaesthetists  and 
surgeons,  who  are  finding  that  accurate 
blood  pressure  readings  are  invaluable 
during  anaesthesia  and  surgery,  we  have 
designed  this  Tycos  Surgical  Unit. 

It  consists  of  a large  easy  reading  type 
Tycos  Sphygmomanometer  and  a uni- 
versal clamp.  The  clamp  enables  the 
Sphygmomanometer  to  be  adjusted  to 
any  position  convenient  for  the  anaes- 
thetist and  out  of  the  way  of  the  sur- 
geons and  assistants.  The  adjustments 
can  be  made  instantly,  but  once  made 
the  instrument  is  firm  as  the  table  itself. 

If  it  is  inconvenient  to  have  the  instru- 
ment attached  to  the  table,  the  clamp 
will  accommodate  it  to  the  anaesthesia 
equipment  or  instrument  stand. 

Modern  trends  make  it  extremely  impor- 
tant for  hospitals  to  include  the  Tycos 
Surgical  Unit  in  their  operating  room 
equipment. 

Your  dealer  can  supply  you  with  this 
equipment.  Complete  unit  $52.50. 
Clamp  only  $15.00.  Write  today  for 
additional  information. 

Taylor  Instrument  Companies 

ROCHESTER,  N.  Y„  U.  S.  A. 

CANADIAN  PLANT  MANUFACTURING  DISTRIBUTORS 
TYCOS  BUILDING  IN  GREAT  BRITAIN 

TORONTO  SHORT  &.  MASON,  LTD.,  LONDON 


d 


One  of 
America’s 
Leading  Hos- 
pital Supply 
Houses— 

Manufacturers  of  "Porcello” 
Aseptic  Steel  Furniture 


Reid 

Bros. 

Factory  at 
Irvington, 
California 


OFFICES 

91  Drumm  Street  San  Francisco.  Calif. 
Phone  Douglas  1381 

1417  Fourth  Avenue,  Seattle,  Washington 


..a,.**., 


/H4LLDCX 


Physicians  who  inoculate  a small 
area  when  vaccinatmg  cause  the  least 
inconvenience. 

The  multiple  puncture  method  of  vaccination  com- 
mends itself  because: — 

It  is  easily  performed. 

Causes  no  pain. 

Confines  vaccination  to  small  area. 

Leaves  no  abraded  surface  to  suggest 
need  of  protection. 

The  resultant  scar  is  inconspicuous. 

Vaccine  Virus  (Lederle)  is  a highly  potent  con- 
centrated vaccine  virus.  It  is  supplied  in  glass  capillary 
tubes  with  a rubber  bulb  to  expel  the  virus  and  a ster- 
ile needle. 

Illustrated  booklet  on  request 

Lederle  Antitoxin  laboratories 

NEW  YORK 


'V'V'T'V'V'T' 


sS  CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Analyzed  and  Certified  Products 

NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 
INTRAMUSCULAR  MEDICATIONS 
PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  36) 

Food,  Drug  and  Insecticide  Administration  of  the 
United  States  Department  of  Agriculture,  which  en- 
forces the  Federal  Food  and  Drugs  Act:  Acid  Iron 
Mineral  Compound  (A-I-M)  (Acid  Iron  Mineral  Per- 
colating Corporation)  consisting  essentially  of  a 
brownish-colored,  slightly  acid  solution  of  iron,  alumi- 
num and  magnesium  sulphates,  with  a small  amount 
of  phosphates.  Allenrhu  (Alle-Rhume  Remedy  Com- 
pany) consisting  essentially  of  sodium  phosphate  and 
sodium  sulphate,  with  small  amounts  of  sodium  sali- 
cylate and  colchicine,  some  free  acid,  in  a mixture  of 
glycerin  and  water)  flavored  with  licorice  and  winter- 
green.  Nozol  (Nozol  Company,  Inc.)  consisting  of 
a heavy  petroleum  oil,  containing  menthol  and  cam- 
phor, colored  with  a red  dye.  Lane’s  Cold  Tablets 
(Kemp  and  Lane,  Inc.),  consisting  essentially  of 
acetanilid,  with  small  amounts  of  quinin  sulphate,, 
camphor  and  aloin.  Asceine  (Serra,  Garabis  & Com- 
pany), consisting  essentially  of  caffein,  phenacetin 
(acetphenetidin)  and  aspirin  (acetylsalicylic  acid).. 
Zonite  (The  Zonite  Products  Company),  consisting 
essentially  of  a solution  of  sodium  hypochlorite,  yield- 
ing approximately  one  per  cent  of  available  chlorin. 
Fildrysin  (Drug  Company),  consisting  essentially  of 
iodids  of  potassium  and  sodium  with  small  amounts 
of  compounds  of  arsenic  and  mercury,  a trace  of  ber- 
berin,  glycerin,  alcohol,  and  water.  Jayzon’s  Laxa- 
tive Cold  Tablets  (D.  C.  Leo  & Company,  Inc.), 
consisting  essentially  of  acetanilid,  with  a small 
amount  of  cinchona  alkaloids  and  certain  extracts  of 
plant  drugs,  such  as  aloe,  podophyllum  and  capsicum. 
Jour.  A.  M.  A.,  November  2,  1929,  p.  1404. 

Quicamphol  (Transpulmin)  Not  Acceptable  for 
New  and  Nonofficial  Remedies. — In  1927  the  Council 
on  Pharmacy  and  Chemistry  considered  Transpulmin,. 
offered  by  the  Chemisch-Pharmazeutische  A.-G.,  Bad 
Homburg,  Germany,  “for  the  painless  parenteral 


STATE  BOARD  REVIEW 

Preparation  for  State  Board 
Examination 

WRITTEN  OR  ORAL 

DR.  MORRIS  STARK 

4405  So.  Broadway 
LOS  ANGELES,  CALIFORNIA 


Creating  Joy 

Qreate  joy  for  yourself  and  others 
by  sending  flowers 


Telephone:  Sutter  6200 
SAN  FRANCISCO 


I 


RAXTER’C 

JprtlL 


CErtifiED 


CALIFORNIA  ANL)  WESTERN  MEDICINE  ADVERTISER 


39 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 
NEW  YORK,  NEW  YORK 
FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  having  an  addict  problem  is 
invited  to  write  for  *' Hospital  Treatment  for 
Alcohol  and  Drug  Addiction  ** 


FRANK  F.  WEDEKIND  CO. 

SURGICAL  SUPPLY  CENTER 
First  Floor,  Medical  Building 
Opposite  St.  Francis  Hospital 

BUSH  AND  HYDE  STREETS 
TELEPHONE  GRAYSTONE  9210 

Main  Store  and  Fitting  Rooms 

2004-06  SUTTER  STREET  WEST  6322 

Corsets  < Surgical  Appliances  * Storm  Binders 
Orthopedic  Appliances  4 Elastic  Hosiery  t Trusses 
California  Manufacturing  Agents  for 

The  '’Storm  Binder”  and  Abdominal  Supporter 

(Patented) 


quinin  therapy  in  inflammatory  affections  of  the  lower 
air  passages.”  The  Council  found  the  preparation 
unacceptable  and  submitted  its  findings  to  the  Ger- 
man firm.  The  firm  adopted  the  name  Quicamphol 
for  the  preparation  and  took  other  measures  in  an 
effort  to  make  the  product  acceptable.  Quicamphol 
is  now  sold  in  the  United  States  by  Spicer  & Com- 
pany, which  firm  offers  it  “For  intramuscular  injec- 
tion in  bronchitis,  pneumonia,  and  pulmonary  infec- 
tions generally.”  The  Council  declared  Quicamphol 
(Transpulmin)  unacceptable  for  New  and  Nonofficial 
Remedies  because  the  claims  for  the  value  of  the 
preparation  in  the  treatment  of  lobar  pneumonia,  in- 
fluenza, etc.,  are  unsupported  by  satisfactory  clinical 
evidence. — Jour.  A.  M.  A.,  November  9,  1929,  p.  1471. 

Undulant  Fever. — A specific  treatment  of  undulant 
fever  is  not  yet  available.  The  use  of  serums  has 
proved  disappointing.  Vaccines  have  given  more  en- 
couraging results  according  to  recent  reports  from 
the  Continent.  In  particular,  an  antigen  prepared 
from  dried  Brucella  abortus  has  seemed  efficacious  in 
a small  number  of  cases.  In  this  country  the  use  of 
acriflavin  hydrochlorid  has  been  suggested  to  shorten 
the  duration  of  the  disease. — Jour.  A.  M.  A.,  Novem- 
ber 9,  1929,  p.  1475. 

The  D.  A.  Williams  Quackery. — The  Dr.  D.  A. 

Williams  Company  of  East  Hampton,  Conn.,  has 
been  operating  a piece  of  mail-order  quackery  for 
many  years.  More  than  ten  years  ago  the  Bureau  of 
Investigation  of  the  American  Medical  Association 
reviewed  the  history  of  the  concern  and  brought  out 
that  the  business  had  become  so  extensive  that  it  had 
given  the  little  village  of  East  Hampton,  with  a popu- 
lation of  less  than  1500  people,  a postoffice  of  the 
second  class!  At  the  time,  form-letters  sent  out  by 
the  D.  A.  Williams  concern  were  signed,  variously, 
“Theodore  Flaacks,  President,”  “J.  M.  Stearns,  Man- 
ager,” and,  occasionally,  “Dr.  E.  E.  Williams,  Medical 
Advisor.”  It  was  also  shown  that  the  Dr.  D.  A. 

(Continued  on  Next  Page) 


SAVE  MONEY  ON  — 

YOUR  X-RAY  SUPPLIES 


We  Save  You  from  10%  to  25% 

GET  OUR  PRICE  LIST  AND  DISCOUNTS 


Insures  finest  radiographs  on  heavy  parts,  such  as 
kidney,  spine,  gall-bladder  or  heads. 

Curved  top  style — up  to  17  i 17  size  cassettes ^?52'22 

Flat  top  style  for  11  x 14  size IIS ‘22 

Flat  top  style  for  14  x 17  size 260.00 

X-RAY  FILM — Buck  Silver  Brand  or  Eastman  Super- 
speed Duplitized  Film.  Heavy  discounts  on  carton 
quantities.  Buck,  Eastman  and  Justrite  Dental  Films. 
BARIUM  SULPHATE— for  stomach  work,  purest 
grade.  Also  BARI-SUSP  MEAL.  Low  Prices. 
DEVELOPING  TANKS—  4,  5 & 6 compartment 
soapstone,  EBONITE  2 J4,  5 & 10  gallon  sizes. 
Enamel  Steel  and  Hard  Rubber  Tanks. 
COOLIDGE  X-RAY  TUBES— 7 styles.  Gas  Tubes. 
INTENSIFYING  SCREENS  & CASSETTES  for 
reducing  exposures.  Special  low  prices. 

JONES  BASAL  METABOLISM  UNITS, 
Most  accurate,  reliable,  portable — $235.00. 

If  you  have  a machine  Geo.  W.  Brady  & Co. 

have  us  put  your  name  781  s.  w««tern  Ave. 

on  our  mailing  list.  Chicago  - - - Illinoi* 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


40 


Medico  - Dental 

Professional  Service 

AGREEMENTS 

FINANCED  BY  OUR  ORGANIZATION  OFFER  MANY 
ADVANTAGES  TO  BOTH  DOCTOR  AND  PATIENT 

Organized  for  the  purpose  of  financing  the  installment  purchase  of 

Medical  and  Dental  services 
EXCLUSIVELY 

Our  service  takes  care  of  your  installment-paying  patient  in  a 
scientific  and  dignified  manner — whereby  the  doctor  is  paid  cash 
for  his  services , allowing  the  patient  to  pay  over  a period  of  months 
without  additional  cost. 

NO  INVESTMENT  REQUIRED  TO  USE  OUR  SERVICE 

For  Further  Information  Address 

Medico-Dental  Finance  Co. 

Russ  Building  Kearny  6250  San  Francisco 

OAKLAND  SACRAMENTO 


Thu  Business  Formerly  Conducted  Under  the  Name  United  Commercial  Securities  Corporation 


Johnston-Wickett 

Clinic 

ANAHEIM,  CALIFORNIA 

Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 

Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 

Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Previous  Page) 

Williams  concern  had  made  a practice  of  selling  to 
letter  brokers  the  original  letters  that  had  been  sent 
to  it  by  prospective  victims.  It  was  shown,  too,  that 
the  preparation  sent  out  by  the  company  for  the 
alleged  cure  of  all  “uric  acid  troubles”  was  essentially 
a solution  of  potassium  acetate,  colored  and  flavored 
with  wintergreen.  Examination  of  a specimen  sent 
out  by  the  D.  A.  Williams  concern  in  October  1929, 
indicates  that  the  composition  of  the  nostrum  has  not 
changed.  Recently  the  National  Better  Business 
Bureau  investigated  the  concern.  With  the  assistance 
of  the  Medical  Information  Bureau  of  the  New  York 
Academy  of  Medicine,  four  report  blanks  were  filled 
out  and  sent  to  the  Williams  Company  from  different 
parts  of  the  country  to  determine  whether  the  com- 
pany declined  to  sell  its  product  to  those  who  were 
suffering  from  serious  ailments.  Due  to  the  fact  that 
diagnosis  by  mail  is  declared  to  be  unscientific  and 
untrustworthy  by  medical  authorities,  pronounced 
symptoms  were  indicated.  In  reply  a diagnosis  and 
prescription  were  returned  under  the  signature  of  Dr. 
Wilson  Powell,  New  Haven,  Conn. — Jour.  A.  M.  A., 
November  9,  1929,  p.  1493. 

Potency  of  Arsphenamin.  — There  is  no  official 
standard  for  therapeutic  potency  of  arsphenamin 
preparations.  According  to  reports  of  the  United 
States  Public  Health  Service  Hygienic  Laboratory,  no 
one  brand  has  been  definitely  established  as  superior 
to  others  when  considered  from  the  point  of  view  of 
clinical  efficiency.  In  some  foreign  countries,  every 
preparation  of  arsphenamin  and  neoarsphenamin  is 
tested  on  mice  for  therapeutic  efficiency  before  being 
used. — Jour.  A.  M.  A.,  November  9,  1929,  p.  1495. 

Antiustio  Not  Acceptable  for  New  and  Nonofficial 
Remedies. — The  Council  on  Pharmacy  and  Chemis- 
try reports  that  Antiustio  is  claimed  by  the  manu- 
(Continued  on  Page  49) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


41 


CALSO  WATER 

PALATABLE  ALKALINE  SPARKLING 


Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Galso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Galso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Los  Angeles 


dlonilu 

(An  Antiseptic  Liquid ) 

SxcEMLDe  c4omfii±  JfeAivfiiMiiou 


r Physician’s  samples 
sent  without  cost 
or  obligation. 


THE  NONSP1  COMPANY 
2652  WALNUT  STREET 
KANSAS  CITY,  MISSOURI 

Name 
Street. 

City 


Send  free  NONSPI 
samples  to: 

isiipyi 


’fiOlV...  A World  Mart 
of  Surgical  Supplies 

Brought  to  You  . . . 
... IN  LOS  ANGELES 

For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 

Send  for  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 

KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Boiled  Milk  . . . 


BOILED  milk  for  infant  feeding  has  many  advan- 
tages— yet  it  has  many  objectionable  character- 
istics, too. 

Klim,  powdered  whole  milk,  possesses  all  the 
favorable  attributes  of  boiled  milk — yet  has  none 
of  its  disadvantages. 

For,  first  of  all,  Klim  is  safe,  due  to  the  absence  of 
pathogens;  yet  not  sterile.  Its  curd  is  soft  and 
friable.  Furthermore,  at  no  stage  in  its  making 
has  it  been  subjected  to  temperatures  higher  than 
that  of  pasteurization  (145  degrees  F.).  Klim, 
therefore,  is  as  safe  and  as  digestible  as  boiled  milk, 
and,  as  it  has  not  been  oxidized,  is  the  biological 
equal  of  ordinary  raw  milk. 

It  is  more  convenient  for  the  mother  to  use,  is 
more  uniform  and  can  be  taken  on  trips  or  fed 
under  any  circumstances  or  conditions. 

Literature  and  samples  including  special  feeding 
calculator  sent  on  request.  Ask  for  Booklet  710. 

Merrell-Soule  Co.,  Inc.,  350  Madison  Ave.,  New  York 


(Recognizing 
the  importance 
of  scien  t ific 
control,  allcon- 
tact with  the 
laity  is  predi- 
cated on  the 
po  1 i cy  that 
KLIM  and  its 
allied  products 
be  used  in  in- 
fant feeding 
only  according 
to  a physician’s 
formula.) 


Merrell-Soule  Powdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 


B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 


Training  School  for 
Nurses 


For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


ST.  JOSEPH’S  HOSPITAL  SAN  FRANCISCO, 

J CALIFORNIA 

Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


44 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Banning  Sanatorium  Foarndtif 


Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
Treatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


LIVERMORE  SANITARIUM 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
^nd  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 


GENERAL  FEATURES 


1.  Climatic  advantages  not  excelled  in  United  States. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge 
Department. 

3.  A resident  medical  staff.  A large  and  well  trained 
individual  attention. 

Information  and  circulars  upon  request 
Address:  CLIFFORD  W.  MACK,  M.  D. 

Medical  Director 
Livermore,  California 
Telephone  7-J 


Beautiful  grounds  and  attractive  surrounding  country 
of  an  athletic  director.  An  excellent  Occupational 

nursing  staff  so  that  each  patient  is  given  careful 

CITY  OFFICES: 

San  Francisco  Oakland 

450  Sutter  Street  1624  Franklin  Street 

KEarnv  6434  GLencourt  5989 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


. 


( Ultraviolet 
indicated^ 


SggtaJHII 


Kps 

asSgSs 


mmm 


bm m 


. 

- ■’  : , 

• : ~ 

„ • 

' 

' • '' 

c- 

,'J  y y'tjff’it  • »vf  - 

■V  & 

" ' ■ ■ 


THE  unfortunate  part  of  the  widespread  publicity 
that  ultraviolet  radiation  has  enjoyed  is  that  it 
has  unwittingly  impressed  many  with  the  idea  that 
this  form  of  energy  is  a panacea  for  human  ills. 

Because  of  this  situation  many  physicians  have  become 
lukewarm  on  the  subject  of  ultraviolet  therapy.  But  they 
fail  to  appreciate  the  fact  that  the  public  is  quickly  learn- 
ing the  folly  of  self-treatment  for  any  abnormal  condition. 
The  physician  is  still  the  only  recognized  authority  who 
can  determine  whether  ultraviolet  is  indicated  or  contra- 
indicated in  a given  condition,  and  what  constitutes  cor- 
rect dosage.  For  those  reasons,  the  thinking  man  still  turns 
to  his  physician  for  advice  and  treatment  based  on  a 
knowledge  of  what  medical  science  has  established. 

Are  you  equipped  for  ultraviolet  therapy ? May  we  tell 
you  about  the  most  powerful  source  known  for  artificially 
produced  ultraviolet  radiations,  to  the  exclusion  of  infra- 
red? In  other  words,  ultraviolet  radiation  for  ultraviolet 
therapy. 

Victor  Quartz  Lamps  are  designed  for  use  by  the  medical 
profession  exclusively.  They  are  so  powerful  in  ultraviolet 
output  that  promiscuous  use  of  them  would  be  dangerous. 
A given  dosage  is  administered  in  a small  fraction  of  the 
time  required  with  other  types  of  apparatus.  Thus,  not 
only  is  the  physician’s  time  and  that  of  his  patient  con- 
served, but  the  opportunity  of  accomplishing  desired 
clinical  results  is  greatly  enhanced. 

There  is  a goodly  number  of  models  of  the  Victor 
Quartz  Lamp.  Send  for  our  new  complete  catalog,  which 
will  help  you  in  making  a selection  of  the  outfit  best  suited 
to  your  particular  requirements. 


■!  V . <*.  ■ >'•  • 

■ 


VICTOR  X-RAY  CORPORATION 

Manufacturers  of  the  Coolidge  Tube  (All  Physical  Therapy  Apparatus,  Electro* 

and  complete  line  of  X-Ray  Apparatus  I cardiographs,  and  other  Specialties 

2012  Jackson  Boulevard  Branches  in  all  Principal  Cllies  Chicago,  111.,  U.S.  A* 


VoT* 

A GENERAL  ELECTRIC  1 

m 

1 ORGANIZATION 

46 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


San  Francisco  Home  for 
Incurables,  Aged  and  Sick 

2750  Geary  Street,  N.  E.  corner  Wood  Street 
Telephone  WEst  5700 

A non-profit  institution  for  the  service  of  persons  of 
limited  means.  Two  large  courts  with  gardens; 
solariums,  roof  garden  and  sun  room. 

Day  and  night  nursing  care — Staff  Physician  in  at- 
tendance— Private  Physician  if  desired. 

Convalescent  patients  received. 

No  mental,  alcoholic  or  contagious  cases  accepted. 
Formal  application  required  before  admission. 

DR.  GEO.  W.  COX 
(Johns  Hopkins)  Attending  Physician 
MISS  MARY  A.  TAUTPHAUS,  R.N.,  Superintendent 


Medical-Surgical  Institute 

OF  SOUTHERN  CALIFORNIA 

R.  B.  JENKINS.,  M.  D. 

CONSULTATION 

DIAGNOSIS 

TREATMENT 

Organized  and  operated  not  for  profit 
Washington  at  Trinity  Los  Angeles,  Calif. 


DIATHERMY  GALVANIC  SINE  WAVE  X-RAY 

Dewar  & Hare  Electric  Co» 

386  Seventeenth  Street  i Oakland,  California 

\ 

THE  "THERMOTAX” 

A high  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 

THE  "ELECTROTAX” 

A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 

Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


Thousands  of  Physicians  Say 

"Yes” 

PRESCRIBE  DRYCO 


When  it  is  a case  of  convalescence! 

When  it  is  a case  of  debility  from  overwork! 
When  it  is  a case  of  infant  feeding! 

When  it  is  a case  requiring  calcium  ingestion! 
When  it  is  a case  of  fever! 

When  it  is  a case  of  neurasthenia! 


Avoid  milk-borne  infection  . . . prescribe  a milk  ~- 
‘ 1 which  is  free  from  pathogenic  bacteria!  Dryco  is 

easily  digested;  always  fresh;  requires  no  refrig-  -A 
eration ; contains  the  vitamins  unimpaired  and  is 
~ free  from  pathogenic  bacteria! J 

❖ 

LET  US  SEND  CLINICAL  DATA  AND  DRYCO  SAMPLES  FOR  TRIAL 

For  convenience,  pin  this  to  your  R x blank  or  letterhead  and  mail 

THE  DRY  MILK  COMPANY,  INC.  / 15  PARK  ROW,  NEW  YORK,  N.  Y. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


48 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 


FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  i Excellent  Cuisine 


DR.  MAX  ROTHSCHILD  DR.  HARRY  C.  WARREN 

Medical  Director  Asst.  Medical  Director 

Rates  and  Prospectus  on  Request 

San  Francisco  Office  Address:  BELMONT,  CALIF. 

384  Post  Street  Phone  BELMONT  100 

Phone  DAVENPORT  4466  (3  Trunk  Lines) 


No.  611 — 16"  Physician’s  Bag,  in  Black  or 
Brown,  Price  $13.00 


Bischoff’s  Surgical  House 

THE  HOUSE  OF  SERVICE 

427  20th  Street,  Elks  Bldg.,  Oakland,  Calif. 

Branch,  68  So.  1st,  San  Jose,  Calif. 

A COMPLETE  LINE  OF  PHYSICIANS’, 
HOSPITAL  AND  SICKROOM  SUPPLIES 


Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


Baft'*  " jfl 

Health  First 

SPRING  WATER 

Delivered 

to  Offices  and  Homes 

Entire  Bay  District 

tear! 

Purity  Spring  Water  Co. 

t 

/!  \ 

2050  Kearny  Street 

San  Francisco 

^ Phone  Davenport  2197 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


For  Impaired  Hearing 
THE  AUDIPHONE 

is  a new  principle  hearing  device  which  magnifies 
sound  waves  in  a perfectly  natural  way  without 
harshness  or  "grating.”  The  receiver  is  small  and 
fits  into  the  ear  and  is  hardly  noticeable.  Developed 
in  the  laboratories  of  the  Bell  Telephone  Company. 

The  Port-O-Phone 

is  another  hearing  device  of  great  merit.  One  or 
the  other  of  these  new  instruments  should  prove 
satisfactory  to  your  patients  who  are  hard  of  hear- 
ing. Write  us  for  full  information  regarding 
demonstration  and  trial. 


/ : J • \ \ \ \ \ \ 

ESTABLISHED  -1888  . 


177-181  Post  Street  San  Francisco 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  40) 

facturer,  Frederick  Laboratory,  Toledo,  Ohio,  to  be 
“The  greatest  Burn  Remedy  in  Existence.”  A circu- 
lar. contains  the  following  indefinite  and  nonquanti- 
tative  statement  of  composition:  “Formula,  Solvent 
Solution  of  Plumbic  Materials  Subnitrate  of  Bis- 
muth Zinc  Sulphate  and  Iodid  of  Lead  combined 
with  mineral  waxes.”  From  this  and  other  statements 
it  would  appear  that  Antiustio  is  a petrolatum-paraffin 
mixture  claimed  to  contain  five  per  vent  of  bismuth 
subnitrate  along  with  small  but  undeclared  amounts 
of  zinc  sulphate  and  lead  iodid.  The  Council  found 
Antiustio  unacceptable  for  New  and  Nonofficial 
Remedies  because  it  is  an  unscientific  preparation 
marketed  with  an  inadequate  statement  of  composi- 
tion,- under  a name  which  is  not  descriptive  of  its 
composition  and  with  claims  that  are  exaggerated 
and  unwarranted. — Jour.  A.  M.  A.,  November  16,  1929 
p.  1559. 

Unguentum  Carbonis  Compound  (Hilf)  Not  Ac- 
ceptable for  New  and  Nonofficial  Remedies. — The 

Council  on  Pharmacy  and  Chemistry  reports  that 
Unguentum  Carbonis  Compound  (Hilf)  is  marketed 
by  the  Hilf  Products  Company,  Brooklyn,  and  that 
it  is  claimed  to  contain  an  alcoholic  extract  of  crude 
coal  tar,  representing  from  2 to  2.5  per  cent  of  “its 
active  constituents”  menthol  and  thymol,  each  two 
and  one-half  grains  to  the  ounce;  eucalyptol,  five 
minims  to  the  ounce;  salicylic  acid,  two  per  cent; 
in  a base  consisting  of  kaolin  and  “boroglyceride” 
(equivalent  to  10  per  cent  of  boric  acid).  The  Council 
declared  Unguentum  Carbonis  Compound  .(Hilf)  un- 
acceptable for  New  and  Nonofficial  Remedies  because 
it  is  a needlessly  complex  and,  therefore,  unscientific 
mixture  which  is  marketed  with  unwarranted  thera- 
peutic claims  and  under  a name  which  is  insufficiently 
(Continued  on  Page  54) 


EVERY  DOCTOR 

needs  our  Professional  Liability  In- 
surance— to  protect  him  with  as- 
sured certainty  against  damage  suits 
in  his  practice. 


EVERY  HOSPITAL 

and  every  doctor  employed  by  or 
otherwise  interested  in  a hospital 
needs  the  same  adequate  protection 
and  service  provided  by  our  Hos- 
pital Liability  Insurance. 

Over  $70,000,000  in  Resources 

We  insure  only  ethical  practitioners  and 
hospitals 


UNITED  STATES  FIDELITY 
AND  GUARANTY  COMPANY 

BALTIMORE,  MARYLAND 

BRANCH  OFFICES 

340  Pine  Street,  San  Francisco,  Calif. 

1404  Franklin  Street,  Oakland,  Calif. 

724  South  Spring  Street,  Los  Angeles,  Calif. 

602  San  Diego  Trust  8C  Savings  Building 
San  Diego,  Calif. 

Continental  Nat’l  Bank  Bldg.,  Salt  Lake  City,  Utah 


50 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19  3 0 

Will  R eward  Progress 


1879 


The  law  of  compen-  In  terms  of  progress,  the  second 
sation,  as  applied  half-century  will  be  of  short  dura- 
to  present-day  business  is  as  re-  tion.  The  year  1929  marked  the 
warding  as  it  is  ruthless,  depending  greatest  advance  in  the  history  of 
entirely  upon  the  principles,  stand-  this  business.  New  publications 
ards  and  practices  followed.  The  and  an  increase  of  general  print- 

survival  and  progress  of  any  busi-  inS  orders  forced  us  t0  extend  our 
ness  is  dependent  upon  and  meas-  facilities,  to  double  our  floor  ca- 

ured  by  its  consistent  conduct,  its  pacity,  necessitating  the  addition 
policy  and  faithkeeping.  That  of  many  units  of  modern  high 
which  deserves  to  live — LIVES.  speed  equipment. 

The  James  H.  Barry  Com-  lAJ'  Our  organization  of  highly 
PANY  has  no  greater  eulogist  than  technical  craftsmen  has  also  been 
TIME.  Over  fifty  years  of  steady  greatly  augmented  during  the  past 
progress  ...  in  a highly  competi-  year. 

tive  business  . . . from  the  nucleus  As  a result,  the  quality,  the 
of  a one-man  print  shop  in  1879,  efficiency  and  the  service  in  our 
to  the  foremost  publication  plant  plant  have  been  considerably  en- 
in  Northern  California  in  1930,  is  hanced  and  we  sire  now  able  to 
an  achievement  which  discounts  a serve  our  present  and  prospective 
need  for  bluster.  We  make  the  customers  better  'll 

, IVJO 


years  count. 


than  ever  before. 


[ 


California  and  Western 
Medicine  is  a product 
of  our  craftsmanship. 


} 


THE  JAMES  H.  BARRY  CO. 

PRINTERS  AND  PUBLISHERS 
1122  MISSION  STREET  *•  SAN  FRANCISCO 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


51 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  275  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newdy  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


Experienced  Technicians  in  Clinical  Laboratory 
and  Physiotherapy  Departments.  Electrocardio- 
graphic and  Basal  Metabolic  determinations  made. 


The 

Santa  Barbara  Clinic 

1421  State  Street 

SANTA  BARBARA,  CALIFORNIA 

General  Surgery 

Rexwald  Brown,  M.  D. 

Irving  Wills,  M.  D. 

Internal  Medicine 

Hilmar  O.  Koefod,  M.  D. 

H.  E.  Henderson,  M.  D. 

Wm.  M.  Moffat,  M.  D. 

Neville  T.  Ussher,  M.  D. 
Obstetrics  and  Gynecology 

Benjamin  Bakewell,  M.  D. 
Lawrence  F.  Eder,  M.  D. 

Diseases  of  Children 

Howard  L.  Eder,  M.  D. 

Ear,  Nose  and  Throat 

H.  J.  Profant,  M.  D. 

Wm.  R.  Hunt,  M.  D. 

U rology 

Irving  Wills,  M.  D. 

Orthopedics 

Rodney  F.  Atsatt,  M.  D. 

Eye 

F.  J.  Hombach,  M.  D. 
Roentgenology 

M.  J.  Geyman,  M.  D.,  Consultant 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


IRIPLEX  for  efficient 

B ^ — Bucky 

Radiography 

AND 

Vertical 
Fluoroscopy 

at  minimum  investment 
in  space  and  dollars 


We  shall  be  glad  to  mail 
you  a booklet,  telling  what 
hundreds  of  successful 
physicians  the  country  over 
haye  to  say  about  the  effi- 
cient TripleX  Unit. 


THE  TripleX  Unit  is  a remarkably 
efficient,  self-contained  X-Ray 
plant,  particularly  designed  for  the  office 
of  the  physician  who  recognizes  the 
tremendous  importance  of  the  use  of 
X-Ray  in  routine  diagnosis. 

It  consists  of  an  oil-immersed  transform- 
er with  an  instrument  panel  of  striking 
simplicity  and  accuracy,  demanding  no 
special  training  for  its  successful  opera- 
tion. The  improved  American  Flat  Pot- 
ter-Bucky  Diaphragm  is  mounted  on  a 
special  track  in  the  sturdy,  beautifully 
finished  X-Ray  Table,  to  permit  the  mak- 
ing of  radiographs  of  any  part  of  the 
body  without  having  to  move  the  pa- 
tient. The  radiographic  tube  carriage 
can  be  quickly  connected  to  the  finely 
counter-balanced  fluoroscopic  screen, 
which  has  ample  range  for  all  forms  of 
vertical  fluoroscopy. 

t 

We  have  prepared  interesting  literature 
fully  illustrating  and  describing  the  effi- 
cient TripleX  Unit.  May  we  send  it  to  you? 


Americak"X^T?ay  (Corporation 


AMERICAN  X-RAY  CORPORATION, 

714  West  Lake  Street,  Chicago,  U.  S.  A. 


Name„ 


Gentlemen:  Please  send  me  — without  obligation  to  myself  — lit- 
erature illustrating  and  describing  the  TripleX  Unit  for  Bucky  Radio- 
graphy and  Vertical  Fluoroscopy. 

Please  tell  me  something  about  your  special  payment  plan. 


Address . 


City 


.State- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 


Los  Angeles  Office 
WILSHIRE  MEDICAL  BLDG. 
1930  Wilshire  Blvd. 


For  particulars  address: 

POTTENGER  SANATORIUM 

Monrovia,  California 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


The  Scripps 
Metabolic  Clinic 

For  the  treatment  and  investigation  of: 

Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


A Thoroughly  Equipped 

We  solicit  correspondence  from  physicians 

PHYSICAL  THERAPY 

regarding  pharmaceutical  and  proprietary 

LABORATORY 

preparations. 

Available  to  patients  under  prescription  of 
licensed  physicians. 

-o- 

DELMER  J.  FRAZIER 

LENGFELD’S  PHARMACY 

426-427  Dalziel  Building 

216  Stockton  Street  San  Francisco,  Calif. 

OAKLAND 

Telephone  Sutter  0080 

PHONE  LAKESIDE  5659 

5/ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ST.  MARY’S  HOSPITAL  San  Francisco 

Conducted  by  Sisters  of  Mercy 

Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.  A.  C.  S. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,#  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Burns,  M.  D. 


Obstetrics 

Philip  H.  Amot,  M.  D. 
Medicine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 

Stephen  Cleary,  M.  D. 

T.  T.  Shea,  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M.  D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M.  D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Chas.  C.  Mohun,  M.  D. 

Randolph  G.  Flood,  M.  D. 

Heart 
Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 
Dentistry 

Thos.  Morris,  D.  D.  S. 
Francis  L.  Meagher,  D.  D.  S. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  49) 

descriptive  of  its  composition. — Jour.  A.  M.  A.,  No- 
vember 23,  1929,  p.  1649. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the 
Food,  Drug  and  Insecticide  Administration  of  the 
United  States  Department  of  Agriculture  which  en- 
forces the  Federal  Food  and  Drugs  Act:  Day’s 
Asthma  Powder  (William  D.  Day  & Company)  con- 
sisting essentially  of  a mixture  of  stramonium  leaves 
and  potassium  nitrate.  Munyon’s  Grippe  Remedy 
(The  Munyon  Remedy  Company)  consisting  essen- 
tially of  sugar,  with  a trace  of  arsenic.  P.  and  R. 
Chlorin  Bombs  (The  National  Research  Corporation), 
each  ampoule  (“bomb”)  containing  about  one-third 
gram  of  chlorin.  Bronchuletts  (The  International 
Laboratories),  each  tablet  containing  about  one  grain 
of  acetanilid  and  four-tenths  grain  of  quinin  sulphate, 
together  with  camphor  and  laxative  plant  drug  ex- 
tractives. Thompson’s  Grippe  and  Cold  Tablets  (The 
Owl  Drug  Company),  each  tablet  containing  about 
one-fourth  grain  of  quinin  with  camphor,  licorice,  and 
sugar.  Meyer  Red  Diamond  Salve  (The  Meyer  Bros. 
Drug  Company),  consisting  essentially  of  petrolatum 
and  wool  fat,  with  oil  of  turpentine  and  menthol. 
Si-Nok  (The  Si-Nok  Company),  consisting  essentially 
of  a mineral  oil  containing  turpentine,  eucalyptus, 
sassafras,  menthol,  and  camphor.  Eagle  Menthol  In- 
haler (The  Eagle  Druggists  Supply  Company),  each 
tube  containing  approximately  two  and  one-half  grains 
of  menthol.  Cre  Sot  Rub  (The  Drain  Chemical  Com- 
pany), an  ointment  containing  creosote,  eucalyptol, 
turpentine,  and  camphor.  Nox-Mal-A  (The  Savodine 
Company),  consisting  essentially  of  Epsom  salt,  a 
quinin  salt  and  water. — -Jour.  A.  M.  A.,  November  23, 
1929,  p.  1669. 

Further  Misbranded  Nostrums.  — The  following 
products  have  been  the  subject  of  nrosecution  by  the 
(Continued  on  Page  56) 


Trademark  H MU  Trademark 

Registered  _|  (JKIV1  Registered 

Binder  and  Abdominal  Supporter 


"Type  A”  "Type  N” 


The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-IIiac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 

Katherine  L.  Storm,  M.  D. 

Originator,  Owner  and  Maker 
1701  Diamond  St.,  Philadelphia,  Pa.,  U.  S.  A. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

•F 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Year  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


J oslin’s  Sanatorium 

For  Treatment  of 

Nervous  and  Mental 
Disorders 

Home  for  Aged  and 
Infirm 

A quiet,  secluded  place  in  the  country 

RATES  REASONABLE 

Lincoln,  Calif. 


DOCTOR : 

CASH  PAID 

or  large  "trade-in”  allowances  made  on  out- 
fits or  apparatus  turned  in  on  purchases  of 
NEW  or  RENEWED  EQUIPMENT. 

Authorized  agents  and  distributors  for  all 
standard  makes  of  new  furniture,  surgical  in- 
struments, electro-therapy  and  X-ray  appa- 
ratus, supplies  and  accessories. 

We  carry  EVERYTHING  for  the  doctor  at 
just  the  price  he  wants  to  pay. 

Liberal  discounts  given  or  convenient  terms 
arranged. 

Telephone  SUTTER  5314 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Bldg. 

391  Sutter  Street  San  Francisco 


Phone  118F2 


56 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


NEW!  KOMPAK  MODEL 


SIZE 

l%"x3%"xll  Ya 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . . and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


Demonstration,  or  Sent  for  Inspection  Upon  Request 

RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


Quick  Results 

ON  ALL  COLLECTION  MATTERS 


'WE  GET  THE  COIN ’ 


'WE  PAY’ 


BITTLESTON  COLLECTION  AGENCY,  Inc. 


1211  Citizens  National  Bank  Bldg. 


LOS  ANGELES 


TRinity  6861 


SUGARMAN  CLINICAL  LABORATORY 


SUITE  1439 


450  Sutter  Street 

Telephone : DAvenport  0342 


San  Francisco,  Calif. 

Emergency:  WEst  1400 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  54) 

Food,  Drug  and  Insecticide  Administration  of  the 
United  States  Department  of  Agriculture  which  en- 
forces the  Federal  Food  and  Drugs  Act:  Rising  Mist 
Salve  (Wynn’s  Rising  Mist  Company),  essentially 
petrolatum  with  small  amounts  of  menthol,  camphor, 
and  oils  of  wintergreen  and  eucalyptus.  Grains  of 
Health  (Grains  of  Health  Products  Company),  con- 
sisting essentially  of  roasted  coffee,  with  chicory  and 
some  starchy  material.  Taylor’s  Laxative  Cold  Tab- 
lets (C.  E.  Jamieson  & Company),  containing  about 
one  grain  of  acetanilid  and  one-tenth  grain  of  cin- 
chonin  salicylate,  with  camphor,  red  pepper,  and  some 
laxative  plant  drug  extractives.  Uterine  Catholicon 
(The  Graefenberg  Company),  a liquid  containing  over 


11  per  cent  of  alcohol,  together  with  potassium  sul- 
phate and  extracts  of  plant  drugs,  including  aloe. 
Hermance’s  Asthma  and  Hay  Fever  Medicine  (C.  A. 
Bell),  consisting  of  potassium  iodid  with  extracts  of 
plant  material,  including  licorice  and  the  alkaloids  of 
lobelia,  all  in  alcohol  and  water.  Draper’s  Rub  (The 
Memphis  Chemical  Company),  an  ointment  having 
a fatty  base,  containing  menthol,  camphor,  turpentine 
and  wintergreen.  Laxa-Pirin  (The  Hoosier  Remedy 
Company),  each  tablet  containing  about  one  grain 
of  phenacetin,  two  grains  of  aspirin,  a small  amount 
of  caffein,  a trace  of  aconite  alkaloids,  and  some  laxa- 
tive plant  drug  extractives.  Nash’s  Croup  and  Pneu- 
monia Salve  (Nash  Bros.  Drug  Company),  consist- 
ing essentially  of  petrolatum,  with  the  usual  amounts 
of  menthol,  camphor,  sassafras,  and  turpentine. — 
Jour.  A.  M.  A.,  November  30,  1929,  p.  1751. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  An  Approved 

Clinical  Laboratory 

Definition 

“*  * * A clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application 
of  one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and 
methods,  for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in 
the  human  body." 

“Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  person- 
nel and  records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed 
ms  approved." 

“The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to 
be  properly  carried  out." 

The  Director 

“The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college 
or  university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have 
specialized  in  clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for 
at  least  three  years.  He  must  be  a man  of  good  standing  in  his  profession." 

“The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major 
part  of  his  time  to  the  supervision  of  the  laboratory  work." 

" The  director  may  make  diagnoses  only  when  he  is  a licensed  graduate  of  medicine,  has  special- 
ized in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of 
disease  in  the  patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports." 

“ The  director  may  have  assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hemato- 
logic, biochemical,  serologic  and  pathologic  should  be  made  to  the  director." 

Records 

“Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  labora- 
tory should  have  appended  pertinent  clinical  data." 

Publicity 

“Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bul- 
letins or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the 
name,  address,  telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel, 
Gelds  of  work  covered,  office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain 
misleading  statements.  Only  the  names  of  those  rendering  regular  service  to  the  laboratory  should 
appear  on  letter-heads  or  other  form  of  publicity." 

Fees 

“*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director 
and  any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism,  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


5» 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Fourteenth  Annual  Clinical  Session 

of  the 

American  College  of  Physicians 

Minneapolis,  Minn.,  February  10-14,  1930 

A POSTGRADUATE  WEEK  DEVOTED  TO  INTERNAL  MEDICINE  AND  AFFIL- 
IATED SPECIALTIES,  led  by  eminent  national  authorities.  The  program  consists  of 
formal  addresses,  symposia,  demonstrations,  clinics  and  ward-walks,  arranged  through  the 
cooperation  of  Minneapolis  hospitals,  societies  and  the  University  of  Minnesota. 

Specially  Planned  Addresses  or  Demonstrations 

will  be  made  by  the  following  (partial  list): 


A.  W.  Adson,  Rochester 
John  Alexander,  Ann  Arbor 
Walter  C.  Alvarez,  Rochester 
James  Burns  Amberson,  Loomis 
J.  A.  Bargen,  Rochester 
John  V.  Barrow,  Los  Angeles 
E.  T.  Bell,  Minneapolis 
Hilding  Berglund,  Minneapolis 
William  B.  Breed,  Boston 
Clyde  Brooks,  University,  Alabama 
A.  B.  Brower,  Dayton 
George  E.  Brown,  Rochester 
Philip  King  Brown,  San  Francisco 
J.  T.  Christison,  St.  Paul 
Benjamin  J.  Clawson,  Minneapolis 
Logan  Clendening,  Kansas  City 
Lotus  Delta  Coffman,  Minneapolis 
Hal  Downey,  Minneapolis 
Frederick  Epplen,  Seattle 
George  Fahr,  Minneapolis 
Walter  Freeman,  Washington 

E.  L.  Gardner,  Minneapolis 
Ross  A.  Gortner,  Minneapolis 

J.  Edward  Harbinson,  Woodland 
Seale  Harris,  Birmingham 
James  B.  Herrick,  Chicago 
Julius  H.  Hess,  Chicago 

F.  J.  Hirschboeck,  Duluth 


A.  C.  Ivy,  Chicago 

Noble  Wiley  Jones,  Portland 
Elliott  P.  Joslin,  Boston 
Norman  M.  Keith,  Rochester 
James  W.  Kernohan,  Rochester 
Olaf  Larsell,  Portland 
Samuel  A.  Levine,  Boston 
Leo  Loeb,  St.  Louis 
Frederick  T.  Lord,  Boston 
Elias  P.  Lyon,  Minneapolis 
Ralph  C.  Matson,  Portland 
James  S.  McLester,  Birmingham 
James  H.  Means,  Boston 
Joseph  L.  Miller,  Chicago 
John  H.  Musser,  New  Orleans 

B.  I.  Phillips,  Portland 
Lewis  J.  Pollock,  Chicago 
Francis  M.  Pottenger,  Monrovia 
Leonard  G.  Rowntree,  Rochester 
Walter  M.  Simpson,  Dayton 
Alfred  Stengel,  Philadelphia 
Edward  L.  Tuohy,  Duluth 
Henry  P.  Wagener,  Rochester 
Aldred  Scott  Warthin,  Ann  Arbor 
Gerald  Webb,  Colorado  Springs 
H.  Gideon  Wells,  Chicago 
Francis  Carter  Wood,  New  York 
Bernard  L.  Wyatt,  Tucson 


Program  now  ready  for  distribution.  Non-members  of  the  College  may  attend  by  paying  the 
prescribed  registration  fee.  Consult  the  Executive  Secretary  concerning  details. 

Railroad  transportation  has  been  arranged  on  the  Certificate  Plan  of  reduced  fares. 


General  Headquarters:  Minneapolis  Auditorium.  Hotel  Headquarters:  The  Curtis  Hotel. 
Program,  list  of  hotels  and  other  details  furnished  upon  request  to  the  Executive  Secretary. 

JOHN  H.  MUSSER,  M.  D.,  President  S.  MARX  WHITE,  M.  D.,  Chairman 

New  Orleans,  La.  Minneapolis,  Minn. 

E.  R.  LOVELAND,  Executive  Secretary 

133-135  S.  36th  Street,  Philadelphia,  Pa. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 

BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 
Consultants: 

Walter  F.  Schaller,  M.  D. 

Walter  B.  Coffey,  M.  D. 

Charles  Miner  Cooper,  M.  D. 

Walter  W.  Boardman,  M.  D. 

Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


Kenilworth  Sanitarium 

KENILWORTH,  ILLINOIS 
(Northern  Suburb  of  Chicago) 


Founded  by  Sanger  Brown,  M.  D.,  1905 

Built  and  equipped  for  treatment  of  mental  and 
nervous  diseases.  Over  ten  acres  of  well-parked 
and  landscaped  grounds.  Supervised  occupational 
and  recreational  activities.  Handicraft.  Elegant 
appointments.  Bathrooms  en  suite. 


James  M.  Robbins,  M.  D.,  Medical  Director 

John  G.  Henson,  M.  D.  Christy  Brown 

Assistant  Physician  Business 

PETER  BASSOE,  M.  D.,  Consulting  Physician 


All  correspondence  should  be  addressed  to 
Kenilworth  Sanitarium,  Kenilworth,  111. 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSCH  & LOMB  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 

Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty-fourth  Avenue,  Oakland,  Calif. 
Telephone  Fruitvale  488 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


LA  VIDA 

Minera  1 Water 

LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  $ 2.00  per  case  (4  gal.) 
Carbonated : $ 2.00  per  dozen 

(12  oz.)  bottles 

Tonic  Ginger  Ale:  $ 2.25  per  doz. 

(12  oz.)  bottles 


^CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

Grains  per  gallon 

LABORATORIES 

Celestins 
LA  VICHY 
VIDA  of  France 
3.74  43.28 

0.98 

5.00 

Sodium  Bicarbonate 

.252.6 

205.53 

94.0 

21.94 

Iron  Oxide 

0.07 

0.13 

Trace 

6.42 

2.63 

0.001 

14.97 

TOTAL 

357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


oAs  in  human  milk 
. . . the  only  fat  in 
Lactogen  is  milk  fat 


“YOU  SEE  .HENRY. 
EVER  5INCE.  THE 
SCIENCE  OF  PEDI- 
ATRICS CAME  INTO 
EXISTENCE. SCIEN- 
TISTS HAVE  ALWAYS. 
CONSIDERED  NATURES 
FORMULA,  WOMANS 
MILK.  AS  THE  6E5T  , 


GUIDE  FOR  .SUB- 
STITUTE FEEDING 
OF  INFANTS." 


the  infant  a generous  amount  of  fat,  offers 
presumptive  evidence  of  the  value  of  a 
liberal  fat  intake.” — McLean  and  Fales, 
“Scientific  Nutrition  in  Infancy,”  Page  1 16. 

Proof:  “Infants  receiving  an  insufficient 
amount  of  fat  in  their  diet  show  an  increas- 
ing tendency  to  local  and  general  infection, 
thereby  giving  evidence  of  lowered  immun- 
ity.”— Julius  H.  Hess,  “Infant  Feeding,” 
Page  97  (1923  ed.). 

“Calcium  and  other  mineral  substances 
are  ordinarily  stored  more  readily  in  the 
body  when  the  fat  intake  is  adequate.” — 
— Charles  Gilmore  Kerley,  “Practice  of 
Pediatrics,”  Page  20. 

hactogen,  diluted  for  feeding,  contains  3.12%  milk 
fat — approximately  the  same  amount  as  in  normal 
human  milk  and  about  twice  as  much  as  in  modifi- 
cations from  ordinary  cow’s  milk.  Literature  and 

samples  for  clinical  trial  gladly  sent  free  or 
charge  on  receipt  of  your  professional  blank. 


Lactogen  Dept. 

Nestle’s  Food  Co. 

2 Lafayette  Street,  Dept.  25-L-l,  New  York  City 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


6t 


MINER  AL  OIE  has  its  therapeutic  indications 
The  same  is  true  of  MIUK.  OF  MAGAESIA 

The  former  is  a lubricant,  the  latter  is  laxative  and  antacid.  Hence, 
a uniform,  permanent,  unflavored  emulsion  of  Milk  of  Magnesia 
and  Mineral  Oil  deserves  consideration  and  secures  results. 


Magnesia-Mineral  (f|il  <-’s) 

HALEY 

formerly  HALEY’S  M-O,  Magnesia  Oil, 

has  been  accepted  for  N.  N.  R.  by  the  A.  M.  A.,  Council  on 
Pharmacy  and  Chemistry;  is  being  prescribed  and  has  been 
and  is  endorsed  by  thousands  of  discriminating  physicians. 

Indicated  in  gastro-intestinal  hyperacidity  and  fermentation, 
gastric  or  duodenal  ulcer,  intestinal  stasis,  autotoxemia,  con- 
stipation, colitis,  hemorrhoids,  before  and  after  operation, 
during  pregnancy  and  maternity,  in  infancy  and  childhood. 

It  is  also  an  effective  antacid  mouth  wash. 

Liberal  sample  and  literature  sent  on  request. 

THE  HALEY  M-O  COMPANY,  INC.,  GENEVA,  N.Y. 


Illinois  Death  Rate  1,219.5  Per  100,000. — The  De- 
partment of  Commerce  announced  October  30  that 
the  1928  death  rate  for  Illinois  was  1,219.5  per  100,000 
population  as  compared  with  1,135.5  in  1927.  The 
announcement  follows  in  full  text: 

Increases  in  rates  (per  100,000  population)  from 
those  of  the  preceding  year  were  from  the  following 
principal  causes:  diseases  of  the  heart  (217.8  to  239.3), 
nephritis  (110.6  to  117.4),  cerebral  hemorrhage  and 
softening  (72.8  to  78.6),  diabetes  mellitus  (20.3  to 
23.5),  and  cancer  (106.4  to  107).  Increases  were 
shown  also  for  pneumonia  all  forms  (74.3  to  102.4), 
influenza  (14.2  to  34.8),  appendicitis  and  typhlitis 
(17.1  to  18.4),  meningococcus  meningitis  (1.8  to  3), 
lethargic  encephalitis  (0.9  to  1),  and  syphilis  (14.6 
to  15.1). 

The  death  rate  from  all  accidental  causes  increased 
from  78.1  to  80.6,  the  types  of  accidents  showing  the 
greatest  increases  being  automobile  accidents  (exclud- 
ing collisions  with  railroad  trains  and  street  cars) 
(20.7  to  23.6).  accidental  falls  (12.9  to  13.4),  and  mine 
accidents  (1.6  to  1.9). 

Significant  among  the  decreases  in  rates  from  1927 
to  1928  were  those  from  tuberculosis,  all  forms  (75.3 
to  74.1),  congenital  malformations  and  diseases  of 
early  infancy  (64.8  to  61),  diarrhea  and  enteritis  under 
two  years  (19.5  to  17.3),  measles  (4.1  to  1.2),  whoop- 
ing-cough (4.2  to  3.7),  and  acute  anterior  poliomyelitis 
(1.5  to  0.5). 

The  death  rate  from  burns  (conflagration  excepted) 
decreased  from  4.8  to  4.2,  and  from  drowning  5.8 
to  5.2. 

The  estimated  population  for  1928  was  7,396,000 
and  for  1927  was  7,296,000. — United  States  Daily. 


Kept  It  to  Themselves 

Professor:  What  have  you  found  out  about  the  sali- 
vary glands? 

Student:  Not  a thing.  They’re  so  secretive.” 

— Shaft. 


The  chest  piece  is  fitted  at  one  side  with  a 
phonendoscope  disk  for  general  use,  and  at 
the  other  side  with  a small  ebonite  bell  for  in- 
tercostal spaces.  The  instrument  also  forms 
a very  effective  differential  stethoscope  be- 
cause the  volume  of  sound  can  be  graduated 
at  will  by  revolving  chest  piece  to  certain 
angles. 

WALTERS 

SURGICAL  COMPANY 
Phone  DOUGLAS  4017 

521  Sutter  Street  San  Francisco 


FORMULA 

Each  Tablespoonful 
Contains  Magma 
Mag.  (U.S.P.)  3 iii. 
Petrolat.  Liq.  (U. 
S.  P.)  3 i. 


62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Cj'VAINLEs^ 


Surgeon’s 


flNCHVR 

I 


/, 


Needles 


BRflNP 


MADE  IN  USA 


\ Needle 

You  can  depend  on! 

Made  of  American  ST  Al  N LESS  Steel,  it  will 
of  course,  never  rust,  tarnish  or  corrode. 

But  what  is  even  more  important, 
ANCHOR  NEEDLES  are  tougher,  sharper 
and  safer  than  any  you  ever  used  before. 

You  will  use  it  with  full  confidence  that  it 
will  perform  its  functions  smoothly,  easily 
and  always  safely.  It  will  never  break  or 
bend  in  use.  Write  for 


Free  Trial  Sample 


Special  Introductory  Offer 

2 Dozen  Anchor  Needles  *3.00 

with  Fine  Nickel  Plated  Case  FREE. 

S.  DONIGER  &>  CO.  Inc. 


Makers  of  KROME  PLATE  Surgical  Instruments,  'X-ACTO 
Syringes  and  sole  distributors  of  ANCHOR  NEEDLES. 


S.  DONIGER  & CO.  Inc. 

23  East  21st  Street,  New  York  City 

Send  me  your  special  2 doz.  needles  in  case  for  which  I 

enclose  $ or  Q bill  thru  my  dealer.  Q Free  Sample. 

Doctor 

Address 

Dealer’s  Name — 

Please  give  dealer’s  name  in  either  case 


Four  Fifty 

I Sutter 

San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


The  Power  of  Suggestion. — The  story  is  told  that 
the  manager  of  a New  York  hotel  recently  engaged 
a clipping  bureau  to  send  him  everything  they  found 
concerning  mice  jumping  out  of  teapots  at  fashion- 
able afternoon  affairs.  He  later  explained  his  reason 
for  this  unusual  request.  He  said  that  a lady  of  some 
social  position,  but  little  means,  had  engaged  a room 
in  his  hotel.  After  a few  weeks  her  bill  ran  so  large 
that  he  became  afraid  it  would  not  be  paid.  On  the 
last  day  of  her  visit  she  entertained  in  her  room  and 
ordered,  among  other  things,  a pot  of  tea.  As  she 
opened  the  pot  of  tea,  a mouse  jumped  out  of  it.  In 
order  to  keep  down  the  unpleasant  publicity  that 
might  have  resulted,  the  hotel  manager  allowed  the 
lady  to  depart  without  paying  her  hotel  bill.  On  en- 
gaging the  services  of  the  clipping  bureau,  he  merely 
was  interested  to  know  whether  or  not  the  lady  would 
work  the  same  trick  on  someone  else. 

The  same  trick  may  or  may  not  have  been  worked 
again  in  New  York,  but  a situation  somewhat  similar 
has  arisen  in  our  own  state  within  the  past  few  weeks. 
The  situation  in  West  Virginia  involves  hot-water 
burns  rather  than  mice  jumping  out  of  teapots. 

Several  months  ago  a lady  was  admitted  to  a well- 
known  West  Virginia  hospital  with  a gangrenous 
appendix.  She  was  operated  upon  and  the  operation 
was  successful.  A short  time  after  the  lady  left  the 
hospital  she  brought  suit  to  recover  $5000  for  injuries 
she  claimed  to  have  received  from  the  application  of 
a hot-water  bottle  immediately  after  the  operation. 
Time  went  on;  the  case  was  brought  to  trial  in  Octo- 
ber, and  the  lady  was  given  a judgment  for  $2000 
against  the  hospital. 

On  the  day  after  the  judgment  for  $2000  was  re- 
turned in  favor  of  the  lady,  a second  suit  was  entered 
by  an  entirely  different  party  against  the  same  hospi- 
tal, “to  recover  for  burns  received  from  the  appli- 
cation of  a hot-water  bottle  immediately  after  an 
operation.” — The  JVest  Virginia  Medical  Journal,  De- 
cember, 1929. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


63 


Colfax  School  for  the 
Tuberculous 

Qoljaxy  Qalifornia 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


v 

ft 


~i  Patients  are  given  individ- 

* ual  care  by  experienced 

tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 
individual  needs. 

Patients  are  taught  how  to 
secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 

aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4  The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5  Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  [Medical  "Director 

Colfax , California 


ft 

V 

ft 


v« 

ft 


Ift 

V 
ft 

v> 

ft 

V 
ft 

v 

V 


v« 

ft 

V 
ft 
V« 
ft 

V 


ft 

V 

ft 

v« 

ft 

v« 

ft 

v 

ft 

IV 

ft 


ft 


64 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


In  pneumonia 

Optochin  Base 

For  the  specific  treatment  of  pneumonia  give 
2 tablets  of  Optochin  Base  every  5 hours, 
day  and  night  for  3 days.  Give  milk  with 
every  dose  but  no  other  food  or  drink. 
Start  treatment  early 


Literature  on  request 


MERCK  & CO*  Inc. 


Rahway,  N.  J* 


Research  Fund  for  Cancer  Study  Will  Be  Doubled 
at  the  University  of  California. — At  the  regular  De- 
cember meeting  of  the  regents  of  the  University  of 
California,  President  W.  W.  Campbell  reported  that 
an  anonymous  gift  of  §100,000  from  a friend  of  the 
university  has  been  received  for  the  support  of  re- 
search in  cancer  and  allied  subjects  by  the  Medical 
School  and  Hooper  Foundation  for  Medical  Research. 

With  the  addition  of  this  fund  the  university  will 
have  a total  endowment  of  §200,000  for  research  in 
this  field,  as  Mr.  and  Mrs.  George  H.  Roos  of  San 
Francisco  recently  turned  over  §100,000  to  the  regents 
for  research  in  thoracic  surgery  and  cancer,  and  later 
added  §5000  for  the  equipment  of  a clinic  and  research 
laboratory  to  carry  on  this  work. 

The  latest  gift  of  §100,000  was  received  by  Presi- 
dent Campbell  following  a short  correspondence  with 
the  donor  concerning  research  projects  needing  sup- 
port. In  the  letter  accompanying  the  gift,  the  donor 
said: 

“I  note  that  research  work  for  cancer  has  already 
been  established,  and  therefore  it  will  be  agreeable 
to  me  that  the  donation  be  added  to  the  amount 
already  in  hand. 

“I  am  enclosing  my  check  for  §100,000,  and  sin- 
cerely trust  it  will  be  of  benefit  in  this  humanitarian 
work  in  which  the  University  of  California  is  en- 
gaged.” 

The  work  of  fitting  out  a clinic  and  laboratory  in 
which  this  research  will  be  carried  on,  has  already 
been  started,  and  allotments  of  space  have  been  made 
both  in  the  University  Hospital  and  in  the  adjoining 
building  of  the  Hooper  Foundation  for  Medical  Re- 
search which  is  also  a part  of  the  university.  A com- 
mittee consisting  of  Dr.  Langley  Porter,  dean  of  the 
Medical  School,  Dr.  H.  Morrow,  clinical  professor 
of  dermatology,  and  Dr1.  Harold  Brunn,  clinical  pro- 
fessor of  surgery,  is  administering  the  plans.  To  date 
two  men  have  been  appointed  on  ‘he  research  staff: 
Dr.  William  Faulkner,  assistant  clinical  professor  of 
surgery,  and  Dr.  Selling  Brill. — University  of  California 
Clip  Sheet. 


I-  s* 


€v6T  SinC©  1914^  when  S.  M.  A.  was  first  developed  as  a 
diet  compound  adapted  to  breast  milk,  it  has  always  contained 
enough  cod-liver  oil  to  make  it  anti-rachitic  and  anti-spasmophilic. 
The  kind  of  food  constituents  and  their  correlation  also  contri- 
bute to  prevent  rickets  and  spasmophilia. 


IN  ADDITION  S.  M.  A.  HAS  THESE  FEATURES: 

Only  milk  from  tuberculin  tested  cows,  from 
dairy  farms  that  have  fulfilled  the  sanitary  require-  cjga 
ments  of  the  City  of  Cleveland  Board  of  Health,  U 
is  used  as  a basis  for  the  production  of  S.  M.  A. 


No  modification  is  necessary  for  normal  full  term 
infants. 


Resembles  breast  milk  both  physically  and  chemically. 

Simple  for  the  mother  to  prepare. 

It  gives  excellent  nutritional  results  in  most  cases, 
and  these  results  are  obtained  more  simply  and 
more  quickly. 


MAY  WE  SEND  YOU  SAMPLES? 


S.  M.  A.  was  developed  at  the  Babies  and  Childrens  Hospital 
at  Cleveland,  and  is  produced  by  its  permission  exclusively  by 

HE  LABORATORY  PRODUCTS  COMPANY  <•  <.  CLEVELAND,  OHIO 

est  of  Rockies:  437-8-9  Phelan  Bldg.,  San  Francisco,  Cal.  ©lpc  In  Canada:  64  Gerrard  St.,  East,  Toronto 


Conquering 
Pneumonia 
With  Vaccine 


The  combined  statistics  of  Lambert,  Sutton,  Tice  and  Wynn  show  the  very  marked 
influence  which  the  early  administration  of  vaccines  has  upon  the  fatality  rate. 


Cases  Coming  to  Treatment 

Within  48  hours  of  onset 

Within  72  hours  of  onset 

After  72  hours  from  onset  ... 


Vaccine  Treated 

Per  Cent 
No.  Cases  Deaths 
76  7.9 

171  8.8 

386  30.4 


Control  Cases 

Per  Cent 
Deaths 
47.5 
42.1 
40.0 


No.  Cases 
101 
171 
369 


Sutton,  111.  Med.  Jo.,  1928-53-280 
In  all  cases  a stock  vaccine  was  used 


CUTTER  offers  Western  physicians  an  excellent  formula  (essentially  that  of  Sutton)  in  a 
vaccine  prepared  from  Western  strains. 

The  Cutter  Laboratory 

Established  1897 

Berkeley,  California 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 
E.  A.  TRENKLE,  Manager  Phone  GRAYSTONE  1200 


Annual  Session  California  Medical  Association,  Del  Monte,  April  28-May  1,  1930 
Annual  Session  American  Medical  Association,  Detroit,  Michigan,  June  23-27,  1930 
Annual  Session  Nevada  State  Medical  Association,  September  9-11,  1930 
Annual  Session  Utah  State  Medical  Association,  September  26-27,  1930 


5X 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and  Published  ^Monthly  by  the  California  ^Medical  c Association 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUME  XXXII 
NUMBER  2 


FEBRUARY  . 1930 


50  CENTS  A COPY 
85.00  A YEAR 


CONTENTS  AND  SUBJECT  INDEX 


SPECIAL  ARTICLES: 

The  Cost  of  Medical  Care  and  Hospi- 
talization. By  A.  B.  Cooke,  Los 

Angeles  73 

Acute  Upper  Respiratory  Tract  Infec- 
tions in  Children.  By  Clifford  Sweet, 
Oakland  74 

Discussion  by  Donald  K.  Woods,  San  Diego; 
Andrew  J.  Thornton,  San  Diego ; Harold  K. 
Faber,  San  Francisco. 

Heart  Disease — Its  Modern  Diagnosis. 

By  L.  E.  Viko,  Salt  Lake  City,  Utah  78 

The  Blood  Picture  in  Hodgkin’s  Disease. 

By  Ernest  H.  Falconer,  San  Francisco  83 

Discussion  by  Ernest  S.  du  Bray,  San  Fran- 
cisco; John  J.  Sampson,  San  Francisco; 
Munford  Smith,  Los  Angeles. 

Systemic  Blastomycosis.  By  George  D. 
Maner  and  Roy  W.  Hammack,  Los 
Angeles  87 

Discussion  by  W.  T.  Cummins,  San  Fran- 
cisco; H.  A.  Wyckoff,  San  Francisco;  Newton 
Evans,  South  Pasadena. 

A Tuberculosis  Clinic  for  Children.  By 

Lloyd  B.  Dickey,  San  Francisco 90 

Anesthesia  for  Children.  By  James  Ray- 
mond Martin,  Los  Angeles 93 

Carcinoma  of  the  Uterus — Its  Treatment 
by  Radiation.  By  Albert  Soiland  and 
William  E.  Costolow,  Los  Angeles....  95 

Discussion  by  R.  R.  Newell,  San  Francisco; 
Lyell  Cary  Kinney,  San  Diego ; H.  J.  Ullmann, 
Santa  Barbara. 

Stenosing  Tendovaginitis  of  De  Quer- 
vain.  By  James  T.  Watkins  and 

Horace  C.  Pitkin,  San  Francisco 101 

Hemochromatosis.  By  Milo  K.  Ted- 

strom,  Anaheim 102 

Foreign  Bodies  in  the  Ureter.  By 
William  E.  Stevens,  San  Francisco. ...104 

Discussion  by  Charles  P.  Mathe,  San  Fran- 
cisco ; W.  W.  Cross,  Oakland ; Robert  V.  Day, 

Los  Angeles. 

A Note  on  the  Medical  Books  of  Famous 
Printers  (Part  II) — The  Lure  of 
Medical  History.  By  Chauncey  D. 

Leake,  San  Francisco 106 

CLINICAL  NOTES  AND  CASE  REPORTS: 

Toxic  Amblyopia.  By  Earle  L.  Crevel- 

ing,  Reno,  Nevada 110 

Rupture  of  the  Uterus.  By  W.  J. 
Blevins,  Woodland Ill 


Phenobarbital — Rash  and  Other  Toxic 
Effects.  By  Suren  H.  Babington, 
Berkeley  114 

BEDSIDE  MEDICINE: 

The  Lump  in  the  Breast 115 

Discussion  by  Alson  Kilgore.  San  Francisco; 
Edwin  I.  Bartlett,  San  Francisco;  M.  T.  Bur- 
rows, Pasadena. 

EDITORIALS: 

Does  Los  Angeles  County  Hospital  Ex- 
tension into  Private  Hospitals  Consti- 
tute a Menace  to  Medical  Practice?... .1 17 
Difficulties  Met  With  in  Trying  to  Edu- 
cate Citizens  Concerning  Quackery.... 1 19 
The  “Cost  of  Medical  Care” — As  Dis- 
cussed in  Some  Recent  Lay  Journals.. 121 

MEDICINE  TODAY: 

Parenteral  Infections  and  Infantile  Diarrhea.  By 

Phillip  E.  Rothman,  Los  Angeles 123 

Synthetic  Diphtheria  Antitoxin.  By  W.  H.  Man- 

waring,  Stanford  University 124 

The  Present  Status  of  Liver  Function  Tests. 

(Part  II.)  By  T.  L.  Althausen,  San  Francisco  124 
Acute  Articular  Rheumatism  an  Allergic  Mani- 
festation. By  F.  M.  Pottenger,  Monrovia 125 

STATE  MEDICAL  ASSOCIATIONS: 

California  Medical  Association 126 

Woman’s  Auxiliarv 131 

Utah  State  Medical  Association 131 

MISCELLANY: 

News  132 

Medical  Economics 133 

Correspondence  — 134 

Descartes  Was  Right 135 

Serio-Lighter  Vein 140 

“As  Others  See  Us” 141 

Twenty-Five  Years  Ago 142 

Department  of  Public  Health 143 

California  Board  of  Medical  Examiners. .144 
Directory  of  Officers,  Sections,  and 
County  Units  of  the  California  Medi- 
cal Association Adv.  page  2 

Book  Reviews Adv.  page  11 

Books  Received Adv.  page  12 

Truth  About  Medicines Adv.  page  12 

ADVERTISEMENTS— INDEX: 

Adv.  page  8 


"Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


G R E E N S’ 

EYE  HOSPITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


Resident  Staff 

Aaron  S.  Green,  M.  D. 
Louis  D.  Green,  M.  D. 
Martin  lcove  Green,  M.  H. 
Einar  V.  Blak,  M.  D. 


THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in 
the  A.M.  A.  Facilities  are  especially  designed  for  Ophthal- 
mology and  include  X-Ray,  Radium,  Physio-Therapy  and 
Clinical  Laboratories. 

A private  out  patient  department  is  conducted  daily  be- 
tween the  hours  of  9 a.  m.  and  5 p.  m.  A report  of  findings 
and  recommendations  for  treatment  are  returned  with  the 
patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for 
patients  of  limited  income.  Examination  fees  in  the  clinic 
are  $2. 50  for  the  first  visit  and  $1. 50  for  subsequent  visits. 
Moderate  fees  for  drugs,  laboratory  work,  X-Rays.  Oper- 
ating fees  are  arranged  according  to  the  circumstances  cf 
each  individual. 


Bush  at  Octavia  Street  ♦ Telephone  WE  st  4300  ♦ San  Francisco,  California 

Address  communications  to  Superintendent L> 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


yk 

14 


14 


u a Ij 


Patronize  Your  Home  Firm 

Because  We  Are  Progressive 

We  represent  the  following  firms  on  the  Pacific  Coast 

McIntosh  Electrical  Corp.  The  Burdick  Corporation 


INDIRECT  LIGHTED 
VIEWING  BOX 


VERTICAL 

FLUOROSCOPE 


ACME-INTERNATIONAL 

ROENTGEN 

ACCESSORIES 


One  of  the  essential  requirements  for  the  manu- 
facturer of  Roentgen  apparatus  is  a thorough 
familiarity  with  the  technique  employed  in  Radiog- 
raphy and  Fluoroscopy. 

The  Acme  International  organization  consists  of 
men  identified  with  the  X-Ray  industry  almost  from 
its  inception,  whose  years  of  experience  in  supply- 
ing the  profession  with  apparatus  suitable  for  its 
needs  have  enabled  them  to  present  a line  of 
Roentgen  accessories  unsurpassed  in  design,  con- 
struction and  adaptability. 

Continual  striving  for  mechanical  perfection  has 
resulted  in  a general  refinement  throughout,  ob- 
vious upon  even  the  most  casual  inspection,  and 
making  the  manipulation  of  the  apparatus  an 
absolute  pleasure. 

Illustrated  bulletins  are  available  describing 
any  of  this  apparatus  in  detail 


INDIRECT  LIGHTED 
STEREOSCOPE 


X.  R.  V. 


COMBINATION 
RADIOGRAPHIC  AND 
FLUOROSCOPIC  TABLE 


HORIZONTAL 
RADIOGRAPHIC  AND 
FLUOROSCOPIC  TABLE 


We  handle  a complete  line  of  Medical  Electrical  Equipment 

BUSH  ELECTRIC  CORPORATION 


334  Sutter  Street 

San  Francisco,  Calif. 
SUtter  6088 


1207  West  Sixth  Street 

Los  Angeles,  Calif. 
MUtual  6324 


7t 

14 


yi 

K4 


^ ll  si] 


2 


Officers  of  the  California  Medical  Association 


General  Officers 


President — Morton  R.  Gibbons,  515  Union 
Square  Building,  350  Post  Street,  San 
Francisco. 

President-Elect — Lyell  C.  Kinney,  510  Med- 
ico-Dental Building,  233  A Street,  San 
Diego. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

Vice-Speaker  of  House  of  Delegates — John 


H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw  Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 


Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 


Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  5th  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam Duffield  (1930),  516  Auditorium 

Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1930),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Cruz. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Junius  B.  Harris  (1930), 
Medico-Dental  Building,  1127  Eleventh 
Street,  Sacramento. 


Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 
lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1930),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large — T.  Henshaw  Kelly  (1930),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Robert  A.  Peers  (1931),  Colfax. 


Standing  Committees 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker  of  the  House 
of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair- 
man of  the  Auditing  Committee.  (Committee  Chairman,  T. 
Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego 1932 

William  Bowman  (Chairman),  Los  Angeles 1931 

George  H.  Kress,  Los  Angeles 1930 

Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach 1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands.  1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco 1932 

William  T.  McArthur,  Los  Angeles.. 1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education'and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 

Committee  on  Medical  Defense 

George  G.  Reinle  (Chairman),  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Mott  H.  Arnold,  San  Diego 1930 


Committee  on  Membership  and  Organization 


Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks  (Chairman),  San  Francisco 1931 

Jesse  W.  Barnes,  Stockton 1930 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Charles  D.  Ball  (Chairman),  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

Emmet  Rixford,  San  Francisco 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 1932 

Percy  T.  Magan  (Chairman),  Los  Angeles 1931 

Frederick  F.  Gundrum,  Sacramento 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

Joseph  Catton,  San  Francisco 1930 

The  President Ex-officio 

The  President-Elect Ex-officio 

Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland 1931 

Robert  V.  Day,  Los  Angeles 1930 

Ernest  H.  Falconer,  Sec’y  Sect.  Med.,  San  Francisco 1930 

Sumner  Everingham,  Sec'y  Sect.  Surg.,  Oakland 1930 


Committee  on  Arrangements 

1930  Annual  Session — Del  Monte,  April  28  to  May  1,  1930 

T.  Henshaw  Kelly  (Chairman),  San  Francisco. 

Joseph  Catton,  San  Francisco. 

Martin  McAulay,  Monterey. 

Garth  Parker,  Salinas. 

William  H.  Bingaman,  Salinas. 

Alfred  Phillips,  Santa  Cruz. 

The  Secretary Ex-officio 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland (1930-1931) 

Albert  Soiland,  Los  Angeles (1930-1931) 

Fitch  C.  E.  Mattison,  Pasadena (1930-1931) 

Victor  Vecki,  San  Francisco (1929-1930) 

Percy  T.  Magan,  Los  Angeles (1929-1930) 

Junius  B.  Harris,  Sacramento (1929-1930) 


ALTERNATES 

Joseph  Catton,  San  Francisco 

William  H.  Gilbert,  Los  Angeles 

James  F.  Percy,  Los  Angeles 

William  E.  Stevens,  San  Francisco 

Charles  D.  Lockwood,  Pasadena 

John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


Special  Motorcycle  Service 

HOURS:  Week  Days,  8 A.  M.  to  9 P.  M.;  Sundays,  9-1,  6-8  Phones:  GArfield  4417-4418-4419 

For  Emergencies  Only — Phone  WEST  1400 

DIGITALIS 

FOR  YOUR  USE  WE  ARE  DISPENSING 

DIGITALIS  FOLIA  ELECT 
Selected  Digitalis  Leaves  (Allen’s)  in  One  Grain  Capsules 

These  are  selected  leaves  of  Digitalis  purpurea  collected  only  from  plants  grown  in  England. 
The  fresh  leaves  are  dried  at  a low  temperature  under  conditions  calculated  to  retain  the 
potent  glucosides  of  Digitalis  unimpaired.  POTENCY  CERTIFICATION — According  to 
Stafford  Allen  8C  Sons,  Ltd.,  0.84  gramme  of  this  Digitalis  Leaf  is  equivalent  in  activity  to 
1.0  gramme  of  the  International  Standard  Digitalis  Powder,  as  determined  by  a biological  test 
carried  out  by  the  Pharmaceutical  Society  of  Great  Britain.  The  high  potency  should  be  taken 
into  account  by  the  prescriber. 

Available  at 

Broemmel’s  Prescription  Pharmacy 

SERUMS  VACCINES  ANTITOXINS 

Free  Delivery 

Fitzhugh  Building,  Rooms  201-202-203  Post  and  Powell  Streets,  San  Francisco,  Calif. 


Radium  and  Oncologic  Institute 

1052  West  Sixth  Street,  Los  Angeles 


An  institution  providing  adequate  facilities  for  the  scientific  study,  diagnosis, 
and  treatment  of  cancer  and  other  neoplastic  diseases. 

Recognized  therapeutic  measures  for  the  treatment  of  cancer  are  radium, 
high  voltaige  x-ray  and  surgery. 

Results  in  cancer  therapy  are  entirely  dependent  upon  early  diagnosis, 
thorough  study  and  proper  application  of  such  of  the  above  methods  of 
treatment,  either  alone  or  in  combination,  as  each  case  may  indicate. 

We  desire  to  confer  and  cooperate  with  the  medical  profession  in  the 
diagnosis  and  treatment  of  cancer  and  other  neoplastic  diseases. 

DR.  REX  DUNCAN  DR.  H.  H.  HATTERY 

AND  STAFF 

Office  Hours:  10  a.m.  to  4 p.m.  TRinity  3683 
1052  West  Sixth  Street  Los  Angeles 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  Lorruli  A.  Rethwilm,  2217  Web- 
ster Street,  San  Francisco. 

Secretary,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 

Chairman  of  Section  Program  Committee 

Q.  O.  Gilbert,  301  Medical  Building,  1904 
Franklin  Street,  Oakland. 

Pathology  and  Bacteriology 

Chairman,  W.  T.  Cummins,  Southern  Pacific 
Hospital,  San  Francisco. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
H.  A.  Thompson,  907  Medico-Dental 
Building,  233  A Street,  San  Diego. 

General  Surgery 

Chairman,  Clarence  G.  Toland,  902  Wilshire 
Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Secretary,  Northern  Division,  Sumner  Ever- 
ingham,  400  29th  St.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Dermatology  and  Syphilology 
Chairman,  Samuel  Ayres,  Jr.,  517  Westlake 
Professional  Building,  2007  Wilshire 
Boulevard,  Los  Angeles. 

Vice-Chairman,  Stuart  C.  Way,  320  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  George  F.  Koetter,  812  Medical 
Office  Bldg.,  1136  W.  6th  St.,  Los  Angeles. 
Vice-Secretary,  Merlin  T.  Maynard,  408 
Medico-Dental  Building,  San  Jose. 

Pediatrics 

Chairman,  Guy  L.  Bliss,  1723  East  First 
Street,  Long  Beach. 

Secretary,  Donald  K.  Woods,  5th  and 
Laurel  Streets,  San  Diego. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Industrial  Medicine  and  Surgery 
Chairman,  Charles  A.  Dukes,  601  Wakefield 
Building,  426  17th  Street,  Oakland. 
Secretary,  Edmund  J.  Morrissey,  201  Med- 
ical Bldg.,  909  Hyde  St.,  San  Francisco. 
Chairman  of  Program  Committee,  Arthur  L. 
Fisher,  212  Medical  Building,  909  Hyde 
Street,  San  Francisco. 

Eye,  Ear,  Nose  and  Throat 
Chairman,  Barton  J.  Powell,  510  Medico- 
Dental  Building,  Stockton. 

Vice-Chairman,  Frederick  C.  Cordes,  817 
Fitzhugh  Building,  384  Post  Street,  San 
Francisco. 

Secretary,  Andrew  B.  Wessels,  1305  Medico- 
Dental  Building,  233  A Street,  San  Diego. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Irving  S.  Ingber,  321  Medico- 
Dental  Building,  490  Post  Street,  San 
Francisco. 

Secretary,  William  H.  Sargent,  Franklin 
Building,  1624  Franklin  Street,  Oakland. 
Chairman  of  Section  Program  Committee, 
W.  E.  Chamberlain,  Stanford  Hospital, 
San  Francisco. 

N europsychiatry 

Chairman,  Thomas  G.  Inman,  2000  Van  Ness 
Avenue,  San  Francisco. 

Secretary,  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

General  Medicine 

Chairman,  Walter  P.  Bliss,  407  Professional 
Bldg.,  65  North  Madison  Ave.,  Pasadena. 
Secretary,  Ernest  H.  Falconer,  316  Fitzhugh 
Building,  384  Post  Street,  San  Francisco. 

Obstetrics  and  Gynecology 

Chairman,  Karl  L.  Schaupp,  835  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  Clarence  A.  De  Puy,  Strad  Build- 
ing, 230  Grand  Avenue,  Oakland. 

Urology 

Chairman,  Charles  P.  Mathe,  Room  1831, 
450  Sutter  Street,  San  Francisco. 

Secretary,  Harry  W.  Martin,  1U10  Quinby 
Building,  650  S.  Grand  Ave.,  Los  Angeles. 

Officers  of  County  Medical  Associations 

Alameda  County  Medical  Association 

2404  Broadway,  Oakland 

President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Monterey  County  Medical  Society 
President,  William  H.  Bingaman,  Mercan- 
tile Building,  Salinas. 

Secretary,  H.  J.  Koenecke,  246  Main  Street, 
Salinas. 

San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Santa  Barbara  County  Medical  Society 

President,  Hugh  F.  Freidell,  1525  State 
St.,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment, Santa  Barbara. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Secretary,  J.  O.  Chiapella,  Chiapella  Build- 
ing, Chico. 

Orange  County  Medical  Society 
President,  H.  Miller  Robertson,  212  Medical 
Bldg.,  Santa  Ana. 

Secretary,  Harry  G.  Huffman,  615  First 
National  Bank  Bldg.,  Santa  Ana. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building,  San  Jose. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 

Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary.  C.  J.  Durand,  Colfax. 

Santa  Cruz  County  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldir..  Santa  Cruz. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son Building,  Fresno. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block, 
Riverside. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Glenn  County  Medical  Society 
President,  Etta  S.  Lund,  143  North  Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Siskiyou  County  Medical  Society 
President, 

Secretary,  Ruth  C.  Hart,  Fort  Jones. 

Sacramento  Society  for  Medical 
Improvement 

President,  Wm.  H.  Pope,  503  California 
State  Life  Building,  Sacramento. 

Secretary,  Frank  W.  Lee,  510  Physicians 
Bldg.,  1027  Tenth  St.,  Sacramento. 

Humboldt  County  Medical  Society 
President,  Charles  C.  Falk,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street. 
Vallejo. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol. 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Ey  tinge,  47  East  Vine 
Street,  Redlands. 

Kern  County  Medical  Society 
President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

Stanislaus  County  Medical  Society 
President,  R.  S.  Hiatt,  Beaty  Bldg.,  1024 
J Street,  Modesto. 

Secretary,  Donald  L.  Robertson,  1003  12th 
Street,  Modesto. 

Lassen-Plumas  County  Medical  Society 
President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

San  Diego  County  Medical  Society 

Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 

President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey.  Red  Bluff. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 

1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 
Street,  Los  Angeles. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

San  Francisco  County  Medical  Society 

2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street,  San  Francisco. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary,  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  D.  G.  Clark,  130  N Tenth  St., 
Santa  Paula. 

Secretary,  C.  A.  Smolt,  23  S.  California  St., 

Ventura. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary,  L.  L.  Robinson,  Larkspur. 

San  Joaquin  County  Medical  Society 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Mendocino  County  Medical  Society 
President,  L.  K.  Van  Allen,  Ukiah. 

Secretary,  Paul  J.  Bowman,  Fort  Bragg. 

Yolo-Colusa  County  Medical  Society 
President,  Ney  M.  Salter,  Williams. 
Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Merced  County  Medical  Society 
President,  Chester  A.  Moyle,  6 Bank  of 
Italy  Bldg.,  Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building, 
Merced. 

San  Luis  Obispo  County  Medical  Society 
President,  Gifford  L.  Sobey,  214  Bank  of 
Italy  Building,  Paso  Robles. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 

Yuba-Sutter  County  Medical  Society 
President,  Philip  Hoffman,  404  D Street, 
Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 


THE  INDIANS 
TAUGHT  US  THE  VALUE 
OF  THE  SACRED  HERB 


The  western  Indians  employed  a de' 
coction  of  yerba  santa  for  colds  and 
coughs.  Pioneers  of  covered'wagon 
days  adopted  this  simple  and  effective 
remedy.  Today,  it  (eryodictyon)  has 
been  accepted  by  the  U.  S.  Phar' 
macopoeia. 

But  the  very  resinoids  to  which  this 
herb  owes  its  therapeutic  efficiency  are 
unpleasant  to  the  taste.  Moreover,  they 
precipitate  speedily,  making  the  dosage 
uncertain. 

By  combining  yerba  santa  with  Mah 
tine,  these  disadvantages  have  been 
overcome.  The  Maltine  not  only  acts 
as  an  agreeable  vehicle,  and,  at  the  same 
time,  retains  the  yerba  santa  in  susperv 
sion,  but  it  also  possesses  valuable 
medicinal  properties  of 
its  own. 

Maltine,  a concen- 
trated  extract  of  the 


Accepted  by  the  Council  on 
Pharmacy  and  Chemistry  of 
the  American  Medical 
Association. 


nourishing  elements  of  malted  barley, 
wheat  and  oats,  is  rich  in  the  appetite' 
stimulating  Vitamin  B.  Maltine 
promotes  and  improves  nutrition, 
and  aids  assimilation. 

MaltO'Yerbine  is  more  effective  than 
extracts  of  yerba  santa  taken  alone. 
As  an  expectorant  it  is  preferred  above 
cough  mixtures  containing  opiates.  The 
latter  lead  to  depression,  and  interfere 
with  the  expulsion  of  bronchial  mucus. 

MaltO'Yerbine  is  recommended  as 
a stimulating  expectorant  in  influenza, 
coughs  due  to  phthisis,  pertussis,  brorn 
chial  asthma,  and  other  respiratory 
affections.  It  is  particularly  valuable 
for  children.  Each  fluid  ounce  contains 
the  extract  of  30  grains  of  yerba  santa. 

Samples  to  physicians  on 
request.  The  Maltine 
Company,  20  Vesey  St., 
New  York.  Est.  1875. 


6 


Miscellaneous  California  Medical  Organizations 


State  Board  of  Health 
San  Francisco,  337  State  Building 
Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.  Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 


State  Board  of  Medical  Examiners 
San  Francisco,  623  State  Building 
Los  Angeles,  821  Associated  Realty  Bldg., 
510  West  Sixth  Street 
Sacramento,  908  Forum  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 


Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 

Southern  California  Medical  Association 
President,  Paul  E.  Simonds,  Riverside. 
Secretary.  Carl  R.  Howson,  711  Merritt 
Building,  307  West  8th  Street,  Los 
Angeles. 

California  Northern  District  Medical  Society 
President,  J.  D.  Lawson,  Woodland  Clinic, 
Woodland. 

Vice-President,  Dan  H.  Moulton,  Chico. 


Secretary,  Albert  K.  Dunlap,  Sacramento 
Hospital,  Sacramento. 

Treasurer,  Walter  E.  Bates,  Davis. 

Better  Health  Foundation 
President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 


Nevada  State  Medical  Association 


W.  A.  SHAW,  Elko President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 


HORACE  J.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 

Place  of  next  meeting Reno,  September  26-27,  1930 


Utah.  State  Medical  Association 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY,  701  Medical  Arts  Building, 


Salt  Lake  City Associate  Editor  for  Utah 

Place  of  next  meeting Salt  Lake  City,  September  9-11,  1930 


Hospitals  and  Samatoriums 

The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 

Belmont,  Calif. 

FRANKLIN  HOSPITAL 

Limited  General  Hospital 

Fourteenth  and  Noe  Streets,  San  Francisco 

SAN  FRANCISCO  HOME  FOR 
INCURABLES,  AGED  AND  SICK 

2750  Geary  Street,  San  Francisco 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 

San  Jose,  California 

GREENS’  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  of 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

ANDERSON  SANATORIUM 

Mental  and  Nervous  Diseases 

2535  Twenty-fourth  Avenue 

Oakland,  Calif. 

JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

JOSLIN’S  SANATORIUM 

Nervous  and  Mental 

Lincoln,  Calif. 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

BANNING  SANATORIUM 

Treatment  of  Tuberculosis  and  Throat 
Diseases 

Banning,  Calif. 

ENCINAS  SANITARIUM 

Nervous  and  General  Diseases 

Las  Encinas,  Pasadena,  Calif. 

ST.  FRANCIS  HOSPITAL 

Limited  General  Hospital 

Bush  and  Hyde  Streets,  San  Francisco 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Belmont,  San  Mateo  County,  Calif. 

LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 

ST.  JOSEPH’S  HOSPITAL 

Limited  General  Hospital 

Buena  Vista  and  Park  Hill  Avenues 

San  Francisco,  Calif. 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 

ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 

27th  and  Valencia  Streets,  San  Francisco 

CHILDREN’S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Los  Gatos,  Calif. 

ST.  MARY’S  HOSPITAL 

General  Hospital 

2200  Hayes  Street,  San  Francisco,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

POTTENGER  SANATORIUM 

AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

DANTE  SANATORIUM 

Limited  General  Hospital 

Van  Ness  and  Broadway,  San  Francisco 

RADIUM  AND  ONCOLOGIC 
INSTITUTE 

Diagnosis  and  Treatment  of  Neoplastic 
Diseases 

1052  West  Sixth  Street,  Los  Angeles,  Calif. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


BOTH 

Vitamins 

Definitely 

Measured 


Illustrating  "Jfine  Test”  method  of  standardizing  Vitamin  D content. 
At  left,  the  leg  bone  of  a rachitic  rat  showing  induced  decalcif  cation 
area{X}.  At  right,  healing  has  begun,  as  evidenced 
by  initiation  of  recalcification  at  dark  line  (Y). 


How  can  vitamins 
be  “measured?”  What  is 
meant  by  “standardized” 
when  applied  to  Cod-liver 
Oil?  Here,  briefly,  is  the 
method  followed  in  determ- 
ining the  vitamin  content 
of  Parke-Davis  Standardized  Cod-liver  Oil: 

To  test  for  vitamin  A potency  the  oil  is  given 
orally  to  young  albino  rats  which  have  been  fed 
on  a diet  free  from  vitamin  A.  We  ascertain 
how  much  oil  is  needed  daily  to  correct  the 
induced  typical  eye  condition  (xerophthalmia) 
and  to  institute  a specified  rate  of  growth.  The 
daily  minimum  amount  of  oil  required 
to  bring  about  this  change  constitutes 
one  vitamin  A unit. 

Every  lot  of  Parke-Davis  Standard- 
ized Cod-liver  Oil  must  contain  not  less 
than  13,500  units  of  vitamin  A in  each 
fluid  ounce. 

In  determining  vitamin  D potency  we 
use  our  quantitative  adaptation  of  the 
“line  test”  technique  of  McCollum, 
Simmonds,  Shipley,  and  Park.  The 
oil  is  fed  to  young  rats  in  which  rickets 
has  been  induced.  We  measure  the 
minimum  amount  of  oil  required  per  day  over  a 
period  of  ten  days  to  initiate  recalcification  in 
the  leg  bones.  This  amount  represents  one 
vitamin  D unit.  Each  fluid  ounce  of  Parke- 
Davis  Standardized  Cod-liver  Oil  contains  not 
less  than  3000  vitamin  D units. 


Parke,  Davis  & Company  was  the  first 
commercial  laboratory  to  assay  Cod-liver  Oil 
for  both  vitamins  A and  D.  Parke-Davis 
Standardized  Cod-liver  Oil  is  backed  by  years 
of  research  work  in  various  phases  of  nutrition 
chemistry.  Quite  aside  from  its  vitamin 
richness,  this  product  has  other  dis- 
tinguishing features  which  will  appeal 
to  you.  It  is  clear,  bland,  and  as  nearly 
tasteless  and  odorless  as  a pure  Cod- 
liver  Oil  can  be.  May  we  suggest  that 
in  prescribing  Cod-liver  Oil  for  your 
patients  you  specify  the  Parke-Davis 
product? 

Send  for  stock  package 

To  any  physician  who  is  personally  unacquainted 
with  Parke-Davis  Standardized  Cod-liver  Oil  we 
will  gladly  send  a 4-ounce  bottle  for  free  trial. 


PARKE,  DAVIS  & COMPANY 

DETROIT,  MICHIGAN 

NEW  YORK  KANSAS  CITY  CHICAGO  BALTIMORE  NEW  ORLEANS 
ST.  LOUIS  MINNEAPOLIS  SEATTLE 

In  Canada:  walkerville  Montreal  Winnipeg 


PARKE-DAVIS  STANDARDIZED 

COD-LIVER  OIL 


s 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 


Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 


HA 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

American  Laundry  Mach.  Co 29 

Anderson  Sanatorium,  The 59 

Approved  Clinical  Laboratories  57 

Banning  Sanatorium  44 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  and  Rackerby — 58 

Benjamin,  M.  J 33 

Bischoff’s  Surgical  House...  48 

Bittleston’s  56 

Brady  & Co.,  George  W 39 

Broemmel’s  Prescription  Phar- 
macy   3 

Brown  Press  52 

Bush  Electric  Corporation 1 

Butler  Building  16 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co 41 

Camp  & Co.,  S.  H 36 

Canyon  Sanatorium  18 

Certified  Laboratory  Products.  ..  38 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 

Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co 36 

Dante  Sanatorium 4 Cover 

Dewar  & Hare 46 

Doctors’  Business  Bureau 19 

Doniger  & Co.,  Inc.,  S 62 

Dry  Milk  Co.,  The 47 

Pour  Fifty  Sutter 62 

Franklin  Hospital  43 

Frazier,  Delmer  J 53 

Furscott,  Hazel  E.  24 

Golden  State  Milk  Products  Co.  30 
Graduate  School  of  Medicine, 
Tulane  University  of  La 14 

Greens’  Eye  Hospital... 2 Cover 

Gunn,  Herbert,  Stool  Examina- 
tion Laboratory  24 


Page 


Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Haley  M-O  Company  61 

Hexol,  Inc 51 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H 10 

Hoffmann-La  Roche,  Inc 13 

Holland-Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning.  11 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic  40 

Joslin’s  Sanatorium  31 

Keniston-Root  Corporation  41 

Knox  Gelatin  Laboratories.... 25 

Laboratory  Products  Co 3 Cover 

Las  Encinas  Sanitarium 58 

La  Vida  Mineral  Water  Co 60 

Lederle  Antitoxin  Laboratories..  23 

Lengfeld’s  Pharmacy  53 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 14 

Livermore  Sanitarium  44 

Maltbie  Chemical  Co.,  The 28 

Maltine  Company,  The 5 

Mead  Johnson  & Co 21 

Medical  Protective  Co 15 

Medico-Dental  Finance  Co 40 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc 42 

Monrovia  Clinic  43 

National  Ice  Cream  and  Cold 

Storage  Co.  12 

New  York  Polyclinic  Medical 

School  and  Hospital  9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital  12 

Nichols  Nasal  Syphon 14 

Nonspi  Company  28 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 
ical Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 

O’Keeffe  & Co 16 

Park  Sanitarium  24 

Parke,  Davis  & Co 7 


Page 


Podesta  and  Baldoccbi  38 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 52 

Radium  and  Oncologic  Institute  3 

Rainier  Brewing  Co 36 

Reid  Bros 37 

Richter  & Druhe 56 

Riggs  Optical  Company. 31 

San  Francisco  Home  for  Incur- 
ables, Aged,  and  Sick ...  46 

Santa  Barbara  Clinic,  The 52 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  18 

Sharp  & Dohme 34 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription 

Pharmacies  24 

Soiland  (Albert,  Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stark,  Dr.  Morris,  State  Board 

Review  38 

St.  Francis  Hospital 26 

St.  Joseph’s  Hospital 16 

St.  Luke’s  Hospital 23 

St.  Mary’s  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugarman  Clinical  Laboratory.  ..  56 
Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies.  ..  37 

Towns  Hospital,  Charles  B 39 

Trainer-Parsons  Optical  Co 26 

Travers’  Surgical  Co 33 

Troy  Laundry  Machinery  Co 20 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Victor  X-Ray  Corporation 45 

Vita  Fruit  Products,  Inc 35 

Vitalait  Laboratory  64 

Wallace,  Sidney  J 55 

Walters  Surgical  Company 35 

Wedekind,  Frank  F 39 

White,  Arthur  H.,  Quiz  Course..  24 
Wilson  Laboratories,  The 60 


mm lev 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


0 


The  Oaks  Sanitarium  Los  Qatos , California 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 

WILLIAM  C.  VOORSANGER,  M.  D.  PAUL  C.  ALEXANDER,  M.  D. 

Medical  Director  Asst.  Medical  Director 

San  Francisco  Office  490  Post  Street 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 

COMPTON,  CALIF. 

30  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  bed  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 
P.  J.  Cunnane,  M.  D.  J.  F.  Vavasour,  M.  D. 
Office:  1052  West  6th  St.,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

(Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 

INTERNAL  MEDICINE— A Combined  Course  Comprising 

DIAGNOSIS  DERMATOLOGY  and  SYPHILOLOGY  STOMATOLOGY 

CARDIOLOGY  GASTROENTEROLOGY  PATHOLOGY 

DIABETES  GYNECOLOGY  (MEDICAL)  ROENTGENOLOGY 

PEDIATRICS  NEUROLOGY  PHYSICAL  THERAPY 


For  information  address  MEDICAL  EXECUTIVE  OFFICER:  345  W.  50th  St.,  New  York  City 


Ten  Acres  of  Beautiful  Grounds 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Improved  Suprapubic 
Drainage  Appliance 

For  temporary 
or  permanent 
drainage  of 
bladder  after 
operation.  Now 
fitted  with  double 
belt  to  prevent 
shifting.  Has 
large  pure-gum 
pouch  and  in- 
flating ring  in 
rear  of  alumi- 
num plate  which 
forms  tight  seal 
against  body. 

NEXT  MONTH 

We  will  make  an  important  announcement  of  our 
newest  development — a collecting  apparatus  to  be 
used  in  cases  of  ureterostomy  of  the  skin. 

SEND  FOR  CATALOGUE  AND 
MEASURING  BLANK 

C.  H.  HITTENBERGER  CO. 

1115  Market  Street  460  Post  Street 

Market  4244 


BISMUTH 

in  the  Treatment  of  Vincent’s 
A ngina 

It  is  characteristic  of  bismuth  that,  when  in- 
jected intramuscularly,  it  is  carried  by  the  blood 
stream  and  largely  deposited  in  the  salivary  glands 
and  the  gums. 

In  1929,  Rigby  reported  that  bismuth  is  quicker 
in  its  action  than  neosalvarsan  intravenously  and 
takes  less  local  treatment  than  does  neosalvarsan 
to  bring  about  a cure. 

Bismuth  Sodium  Tartrate  (Searle)  is  a water- 
soluble  bismuth  complex  which  is  administered  in 
aqueous  solution.  Its  toxicity  is  very  low.  It  is 
superior  to  bismuth  preparations  in  oil  suspension 
in  that  it  is  rapidly  and  uniformly  absorbed,  in 
that  it  is  not  irritating  and  does  not  cause  pain 
when  intramuscularly  injected  and  in  that  there  is 
no  tendency  toward  nodule  formation  when  thus 
used.  Rapid  absorption  is  necessary  for  prompt 
action. 

Bismuth  Sodium  Tartrate  (Searle)  is  supplied 
in  2 c.  c.  ampuls  of  the  aqueous  solution  for  intra- 
muscular administration. 

Also  supplied  in  15  c.  c.  bottles  of  a glycerine 
solution  for  topical  application. 

LITERATURE  ON  REQUEST 
San  Francisco  Distributor 

C.  CCDCLPli  GUTH 

BIOLOGICS  Si.  THERAPEUTIC  SPECIALTIES 
WILLIAM  H.  BANKS,  M.  D.,  Medical  Director 

Phone  KEarny  3644 

811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

Prates  a Lovotti,  Professional  Pharmacists 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less; 
additional  words  5 cents  each. 


MEDICAL  PRACTICE,  HOUSE  AND  DOUBLE  GARAGE 

and  office  supplies  for  sale.  20  miles  from  Sacramento.  Ma- 
sonic fraternity  preferred.  Price,  $4500.  Leaving  for  New  York. 
Address  Box  210,  California  and  Western  Medicine. 


FOR  SALE  IN  CENTRAL  SOUTHERN  CALIFORNIA— 

General  medical  and  surgical  practice.  Thirty  thousand  yearly 
collections.  Fine  opportunity  for  making  money  from  the  start. 
Price  $6,000  with  equipment.  Will  introduce.  Address  Box  1110, 
California  and  Western  Medicine. 


EDITORIAL  ASSISTANCE— MEDICAL  PAPERS  EDITED 

and  revised,  for  society  meetings  and  publication,  by  physician 
now  engaged  in  medical  editorial  work  and  member  of  American 
Medical  Editors’  Association.  Address  Box  506,  Hagerstown, 
Maryland. 


FOR  SALE— GENERAL  AND  SURGICAL  PRACTICE  IN 

Central  California.  Well  established  in  live  community  of 
15,000.  Fine  location.  Sale  includes  office  furniture  and  equip- 
ment complete  of  the  late  Dr.  Mott.  Good  hospital  facilities. 
Fine  opening  if  taken  promptly.  Priced  reasonably.  Mrs.  G.  H. 
Mott,  624  Forest  Ave.,  Pacific  Grove,  California. 


SITUATIONS  WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 


INTERNIST  DESIRES  ASSOCIATION  WHERE  PRAC- 

tice  can  be  limited  strictly  to  internal  medicine  or  internal  medi- 
cine and  clinical  pathology.  32  years,  married,  Gentile.  Graduate 
Johns  Hopkins,  4 years’  hospital  experience  in  internal  medicine, 
3 years’  private  practice.  Licensed  in  California.  References. 
Write  full  details  first  letter.  Address  Box  200,  California  and 
Western  Medicine. 


FOR  SALE— MEDICAL  PRACTICE  AND  SMALL  DRUG 

store  in  rich  dairy  community,  San  Joaquin  Valley.  Nearest 
competition  seven  miles.  No  other  drug  store.  Very  low  over- 
head. Collections  absolutely  one  hundred  per  cent.  Good  crop 
outlook.  Drug  store,  office  and  living  quarters  combined.  Income 
nine  thousand.  Increase  with  surgery.  Twelve  hundred  cash 
for  improvements.  Stock  optional  at  invoice.  Address,  Box  220, 
California  and  Western  Medicine. 


EXTERNSHIP  IN  DERMATOLOGY  AND  SYPHILOLOGY 

— Stanford  University  Medical  School.  On  March  15,  1930,  an 
appointment  to  this  position  will  be  made  for  the  year  1930-31 
(starting  April  1st).  The  salary  is  $50  per  month  (increasing 
later).  About  300  syphilitics  per  week  and  an  average  of  30 
dermatological  cases  per  day  are  treated.  There  are  good  oppor- 
tunities and  facilities  for  research.  Applications  must  be  filed 
before  March  1st,  stating  age  and  education  qualifications  of  can- 
didate. 


TO  LET— COMPLETELY  FURNISHED  CONSULTATION 

room  and  adjoining  treatment  room  with  use  of  phone,  reception 
room  and  receptionist  in  450  Sutter  Building.  Phone  Daven- 
port 3523. 


The  Practice  of  Medicine  by  Corporations  and  Or- 
ganizations, was  given  particular  attention.  A reso- 
lution was  adopted,  introduced  by  Past  President 
Doctor  Pusey,  calling  upon  the  Judicial  Council  to 
prepare  for  the  next  annual  meeting  of  the  House  of 
Delegates  a comprehensive  statement  concerning  such 
practices,  for  the  guidance  of  the  medical  profession 
of  America.  Objection  has  been  growing  more  and 
more  emphatic  as  the  practice  has  increased,  and  it 
has  increased  by  leaps  and  bounds  of  late.  There 
seems  to  be  a determination  on  the  part  of  our  leaders 
to  not  permit  medicine  to  be  thus  commercialized, 
bought  wholesale  by  shrewd  business  men  and  re- 
tailed to  the  consumer  on  a chain-store  basis.  An 
executive  meeting  of  the  House  of  Delegates  was  held 
for  the  purpose  of  discussing  the  problem,  and  we 
desire  to  state  that  it  was  thoroughly  discussed.  It 
is,  indeed,  a serious  situation.  As  it  happens,  we  are 
not  bothered  so  much  in  Texas  as  in  other  parts  of 
the  country,  but  it  is  here  and  it  will  grow  on  us, 
insidiously,  and  by  offering  advantages  that  we  find  it 
hard  to  forego,  a firm  foundation  will  be  laid  for  the 
continuation  of  the  system  and  its  establishment  as 
a regular  thing,  unless  something  is  done  about  it, 
and  soon. — Editorial,  Texas  State  Journal  of  Medicine, 
September  1929. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


BOOK  REVIEWS 


The  Nutrition  of  Healthy  and  Sick  Infants  and  Children 
for  Physicians  and  Students.  By  E.  Nobel,  C.  Pirquet 
and  R.  Wagner.  Second  edition.  Illustrated.  Author- 
ized translation  by  Benjamin  M.  Gasul.  Philadel- 
phia: F.  A.  Davis  Company.  1929. 

An  English  version  of  the  above  work  is  interesting 
and  stimulating.  The  book  is  a brief  rdsumS  of  nutri- 
tional disorders  in  infancy  and  childhood  with  discussions 
of  treatment.  Professor  Pirquet’s  "nem”  system  is  ex- 
plained and  rather  extensive  tables  of  diets  are  included. 

H.  E.  T. 


Outline  of  Preventive  Medicine  for  Medical  Practitioners 
and  Students.  Prepared  under  the  auspices  of  the 
Committee  on  Public  Health  Relations,  New  York 
Academy  of  Medicine.  (Twenty-one  contributors.) 
Editorial  Committee:  Frederic  E.  Sondern,  Charles 
Gordon  Heyd,  E.  H.  L.  Corwin.  New  York:  Paul  B. 
Hoeber,  Inc.  1929. 

This  volume  of  three  hundred  and  ninety-eight  pages 
consists  of  twenty-one  chapters,  each  of  which  deals  with 
some  branch  of  preventive  medicine.  It  was  written  in 
response  to  “repeated  requests  for  an  outline  of  the 
practical  features  in  the  prevention  of  disease”  and  each 
contributor  has  confined  his  attention  to  preventive  medi- 
cine as  it  affects  his  own  specialty. 

There  is  not  sufficient  detail  for  a book  of  reference 
or  a textbook,  but  a general  survey  of  preventive  medi- 
cine is  presented  in  readable  form.  It  should  serve  a 
valuable  purpose  in  stimulating  greater  interest  in  the 
prevention  aspect  of  medical  responsibility.  E.  C.  D. 


Applied  Electrocardiography — An  Introduction  to  Electro- 
cardiography for  Physicians  and  Students.  By  Aaron 
E.  Parsonnet  and  Albert  S.  Hyman,  with  a foreword 
by  Harlow  Brooks.  Pp.  206.  Illustrated.  New  York: 
The  Macmillan  Company.  1929. 

There  are  so  many  treatises  on  electrocardiography, 
beginning  with  Lewis’  excellent  little  book,  that  a new 
volume  is  necessarily  subjected  to  comparison.  The  work 
here  reviewed  is  by  two  men  concerned  with  the  clinical 
value  of  this  recording  method,  and  it  is  remarkable  only 
in  that  many  of  the  records  include  radial  pulse  tracings, 
so  that  one  clinical  feature  is  thus  graphically  compared 
with  the  electrical  record.  It  contains  detailed  descrip- 
tions of  several  instruments  with  judicious  remarks  on 
their  comparative  value.  The  text  and  illustrations  are 
fairly  full  in  most  sections,  but  the  chapter  on  coronary 
artery  disease  is  extremely  meager. 

There  are  other  omissions  of  less  importance  to  the 
practitioner.  The  book  is  brief,  clearly  written,  and  con- 
tains the  following  novel  statement,  “Very  recently  a 
study  of  T-wave  inversion  of  the  third  lead,  made  by  the 
authors,  has  shown  a certain  interesting  correlation  be- 
tween such  T-wave  changes  and  habitual  constipation.” 

W.  D. 


Rickets,  Including  Osteomalacia  and  Tetany.  By  Alfred  F. 
Hess.  Pp.  4S5.  Illustrated.  Philadelphia:  Lea  and 
Febiger.  1929.  Price,  $5.50. 

This  is  the  first  monographic  work  on  rickets  done  in 
the  light  of  our  present  knowledge,  and  most  physicians 
would  have  wished  Doctor  Hess  to  write  it.  By  virtue 
of  his  unusual  experience  in  teaching  and  in  research, 
the  author  is  particularly  well  fitted  to  prepare  a work 
helpful  in  these  rather  diverse  phases  of  the  subject. 

The  text  is  treated  throughout  in  a scholarly  fashion 
and  is  concisely  but  not  ponderously  written.  There  are 
fifteen  chapters  in  all,  the  book  beginning  with  a brief 
and  interesting  account  of  the  history  of  rickets.  The 
next  six  chapters  deal  with  the  etiology  and  pathology 
of  the  disease,  and  the  rest  of  the  book  with  the  more 
strictly  clinical  side,  the  last  chapter  with  the  treatment. 
The  entire  text  is  well  outlined  and  each  chapter  would 
make  interesting  reading  even  though  the  rest  of  the 
book  were  not  seen.  There  is  a good  bibliography  at  the 
end,  arranged  according  to  chapters,  and  the  index  is 
excellent. 

As  Doctor  Hess  says  in  his  preface,  “The  book  is  writ- 
ten for  the  practitioner  of  medicine  as  well  as  for  the 
nutritional  worker.”  An  interesting  book,  exceptionally 
easy  to  read,  and  written  about  a rapidly  disappearing 
disease,  it  will  be  a volume  for  the  physician’s  library, 
rather  than  for  his  desk.  L.  b.  D. 


The  Treatment  of  Diabetes  Mellitus  With  Higher  Carbo- 
hydrate Diets.  A textbook  for  physicians  and  patients. 
By  William  David  Sansum,  Percival  Allen  Gray,  and 
Ruth  Bowden.  Pp.  309.  New  York  and  London: 
Harper  and  Brothers.  1929.  Price,  $2.50. 

It  is  remarkable  that  so  many  handbooks  for  patients 
should  be  published,  when  one  considers  that  their  con- 
(Continued  on  Next  Page) 


Exclusively 

PHYSICIANS  r SURGEONS  *-  DENTISTS 


350  Post  Street,  Facing  Union  Square 

GAr  field  1014 


As  a General  Antiseptic 


in  place  of 

TINCTURE  OF  IODINE 


Try 

Mercurochrome  - 220  Soluble 

( Dibrom-oxymercuri- fluorescein.) 

2%  Solution 


It  stains,  it  penetrates,  and  it 
furnishes  a deposit  of  the  germ- 
icidal agent  in  the  desired  field. 

It  does  not  burn,  irritate  or  injure 
tissue  in  any  way. 

Hynson,  Westcott  & Dunning 

Baltimore , Maryland 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


New  York  Post-Graduate  Medical  School  and  Hospital 


□ MEDICINE  □ SURGERY  □ ORTHOPEDIC  SURGERY  L OPHTHALMOLOGY 

□ PEDIATRICS  □ UROLOGY  □ TRAUMATIC  SURGERY  □ CHEMISTRY 

□ NEUROLOGY  □ GYNECOLOGY  □ PLASTIC  SURGERY  □ PATHOLOGY 

□ DERMATOLOGY  □ PROCTOLOGY  □ OTOLOGY  □ ROENTGENOLOGY 

□ SYPHILOLOGY  □ ANESTHESIA  □ LARYNGOLOGY 

Name Address 

Check  the  subject  which  interests  you  and  return  with  your  name  and  address  to 

THE  DEAN  i 313  East  Twentieth  Street  r New  York  City 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 
tents  consist  so  largely  of  nearly  identical  directions  for 
calculating  diets,  measuring  food  items,  administering 
insulin,  hygiene,  and  the  like.  That  by  Joslin,  who  is 
frequently  quoted  whenever  an  appeal  to  authority  seems 
appropriate,  remains  the  best.  Characteristic  contentions 
of  the  present  book  are  shown  in  the  following  quota- 
tions: 

"An  acid-ash  type  of  acidosis,  in  contradistinction  to 
the  acetone  type,  has  served  as  a valuable  working  hy- 
pothesis.” "The  average  individual  who  is  constipated 
requires  two  pounds  of  cellulose-containing  foods  daily.” 
“The  diabetic  should  . . . produce  at  least  2000  cubic 
centimeters  of  urine  each  day.”  "Upon  admission  . . . 
usually  at  least  forty  units  of  insulin  per  day,  ...  in 
more  severe  cases  . . . eighty  units  daily,  . . . average 
69  units.”  "We  found  that  a U-100  strength  was  a very 
convenient  form.”  “In  table  IX  is  shown  the  division  of 
dosage  when  the  daily  amount  of  insulin  is  increased  to 
two  hundred  units.”  "We  have  some  cases  where  even 
with  arteriosclerotic  changes  (in  the  retina),  vision  has 
apparently  improved  when  alkaline-ash  diets  were  used.” 
"Occasionally  indigestion  arises  from  a lack  of  an  ade- 
quate amount  of  hydrochloric  acid  in  the  stomach.  This 
defect  can  apparently  be  overcome  by  the  use  of  citric 
acid,  . . . especially  lemon  or  grapefruit.” 

“A  diabetic  may  expect  to  experience  an  improvement 
in  tolerance  following  the  use  of  a high  carbohydrate 
formula  even  in  spite  of  an  inability  to  keep  constantly 
sugar  free  or  in  spite  of  certain  complications.”  “It  has 
been  a source  of  no  little  pleasure  to  us  to  witness  our 
diet  principle,  clothed  in  slightly  different  garb  to  be 
sure,  work  so  efficiently  abroad.” 

In  sum,  the  reviewer's  judgment  is  that  most  of  the 
above  practices  require  considerable  proof,  that  some  of 
them  are  positively  objectionable  to  students  of  diabetes 
in  general,  and  that  none  of  them  is  responsible  for  the 
authors’  success  with  patients.  The  essence  has  been, 
as  with  other  physicians,  the  ability  to  win  patients’ 
faith,  and  faithfulness  to  principles  generally  accepted. 

H.  G. 


BOOKS  RECEIVED 


Bacteriology  for  Nurses.  By  Harry  W.  Carey,  A.  B., 
M.  D.,  Assistant  Bacteriologist,  Bender  Hygienic  Labora- 
tory, Albany,  New  York.  Third  revised  and  enlarged 
edition.  Cloth.  Pp.  282,  illustrated  with  forty-three  en- 
gravings and  one  colored  plate.  Price,  $2.25  net.  Phila- 
delphia: P.  A.  Davis  Company,  1930. 


United  States  Naval  Medical  Bulletin.  Published  quar- 
terly for  the  information  of  the  Medical  Department  of 
the  Navy.  Issued  by  the  Bureau  of  Medicine  and  Sur- 
gery, Navy  Department,  Division  of  Planning  and  Publi- 
cations, Captain  W.  Chambers,  Medical  Corps,  United 
States  Navy,  in  charge.  Edited  by  Lieutenant  Com- 
mander Robert  P.  Parsons,  Medical  Corps,  United  States 
Navy.,  Compiled  and  published  under  the  authority  of 
Naval  Appropriation  Act  for  1930,  approved  March  2,  1929. 
Washington,  United  States  Government  Printing  'office! 


The  Medical  Museum.  Modern  Developments,  Organi 
zation  and  Technical  Methods  Based  on  a New  Syster 
of  Visual  Teaching.  By  S.  H.  Daukes,  O.  B.  E.,  M D 
D.  P.  H.,  D.  T.  M.  and  H.,  Director  of  the  Wellcom 
Museum  of  Medical  Science,  affiliated  to  the  Bureau  o 
Scientific  Research.  An  amplification  of  a thesis  read  fo 
degree  of  M D. .,  Cambridge.  Cloth.  Pp.  183.  London 
The  Wellcome  Foundation,  Ltd.,  1929. 


Methods  and  Problems  of  Medical  Education  Fifteenth 
series.  Paper.  Pp.  72.  New  York:  The  Rockefeller  Foun- 
dation, 1929. 


TRUTH  ABOUT  MEDICINES 
New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

Note. — These  do  not  represent  all  of  the  actions  of  the  Council, 
but  they  do  represent  those  remedies  manufactured  by  firms  who 
cooperate  with  California  and  Western  Medicine  in  its  advertising 
columns,  and  thereby  with  the  physicians  in  California. 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

E.  Bilhuber,  Inc. — Lenigallol — Zinc  Ointment. 

Cutter  Laboratory. — Scarlet  Fever  Streptococcus 
Antitoxin  (Cutter). 

Mead  Johnson  & Company. — Mead’s  Viosterol  in 
Oil  100  D. 

H.  K.  Mulford  Company. — Ampoules  Sodium  Caco- 
dylate  (Mulford),  three-fourth  grain,  one  cubic  centi- 
meter; Ampoules  Sodium  Cacodylate  (Mulford),  three 
grains,  one  cubic  centimeter;  Ampoules  Sodium  Caco- 
dylate (Mulford),  five  grains,  one  cubic  centimeter. 

Winthrop  Chemical  Company,  Inc. — Tablets  Tuto- 
cain  No.  6. 

The  following  article  has  been  exempted  and  in- 
cluded with  the  List  of  Exempted  Nonmedicinal  Arti- 
(Continued  on  Page  14) 

"TnnrrinrvinnnnnnrTnnnnrBim 


For  Medicinal,  Industrial  and  Drinking  Purposes 


Gall-Bladder  Disease.  Roentgen  Interpretation  anc 
Diagnosis.  By  David  S.  Beilin,  B.  S.,  M.  D.,  Roentgenolo- 
gist, Augustana  Hospital,  Chicago.  Cloth.  Pp  65  St 
Paul:  Bruce  Publishing  Company,  1929. 


it  1 1 ui  it  i 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


13 


case  has  been  to  the  jury- 


What  a jury!  Not  twelve  men,  but  thousands 
and  thousands  of  physicians  all  over  the 
world — experts  on  the  subject,  rich  in  expe- 
rience,  fit  to  judge  . . * They  have  rendered 
their  verdict  . . . Digalen  has  been  found  to 
be  a satisfactory  digitalis  preparation 


€J  Why  do  so  many  members  of  the  profession  everywhere  come  out 
definitely  in  favor  of  this  remedy? 

€J  During  long  years  of  investigation  with  digitalis  why  have  over  sixteen 
hundred  men  so  frankly  expressed  their  preference  for  Digalen  in  articles 
published  in  reputable  medical  journals? 

•I  Why  do  so  many  institutions  everywhere  make  Digalen  their  digitalis 
remedy  of  choice  to  such  an  extent  that  the  hospital  consumption  of 
Digalen  in  both  vial  and  ampul  is  enormous? 

<1  The  answer  is  simple.  The  value  of  Digalen  has  been  definitely  proven. 
How?  By  the  one  criterion  that  really  counts — twenty-five  years  of  satisfac- 
tory clinical  results.  Is  it  any  wonder  that  those  who  know  Digalen  swear 
by  it,  in  view  of  the  fact  that,  according  to  clinical  reports,  time  and  time 
again  it  has  saved  a life? 

Vials:  of  lice,  liquid;  hospital  packages  of  25 
and  100.  Ampuls:  of  l.lcc.  sterile,  for  injection; 
cartons  of  6 and  12;  packages  of  100  for  hospital 
use.  Oral  tablets:  vials  of  25,  each  representing 
f,cc.  liquid.  Hypodermic  tablets:  tubes  of  15, 
each  representing  lcc.  liquid 


0? 


X)( 


COUNCIL 

ACCEPTED 


. 1 1 to  2cc‘ 

, .Cl  f'0”1 ‘ uiniect’0”1  g rad<ja“( case  re4u,r 

y hours  \lVu ludl  ca> 

■ °L2uithi  p“lil  ,s 


J DlGAlij 


igalM 


H of Fm  an  n - La  Ro  ch  e .Inc. 

^Makerx  of^iedicines  of  Rare  Quality 

NUTLEY  NEW  JERSEY 


A trial  vial  of  Digalen 
(regular  trade  package) 
will  be  sent  to  physi- 
cians on  request ...» 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 
Telephone  Main  7676 

Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


Graduate  School  of  Medicine 

The  Tulane  University  of  Louisiana 

Approved  by  the  Council  on  Medical  Education 
of  the  A.  M.  A. 

Post-graduate  instruction  offered  in  all  branches  of 
medicine.  Courses  leading  to  a higher  degree  have 
also  been  instituted. 

For  bulletin  furnishing  detailed  information 
apply  to  the 

DEAN 

Graduate  School  of  Medicine 
1551  Canal  Street  New  Orleans,  La. 


*°<fa 
¥ 


*/isters 

CAS  E IfM  - PALMNUT 


Dietetic  Flour 

Starch-free  Diabetic  Foods  that  are  ap- 
petizing are  easily  made  in  the  patient’s 
home  from  Listers  Flour.  It  is  self-rising. 
Ask  for  nearest  depot  or  order  direct. 

LISTER  BROS.  Inc.,  41  East  42nd  St.,  NEW  YORK 


ELASTIC  HOSIERY 

Seamed  or  Seamless 


Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  12) 

cles  (New  and  Nonofficial  Remedies,  1929,  p.  485): 

Child  Welfare  Guild,  Inc.  Bite-X. 

Gelatin  Compound  Phenolized  (Mulford). — A mix- 
ture composed  of  gelatin,  zinc  oxid,  glycerin,  and 
water,  containing  1.5  per  cent  of  phenol.  It  is  used 
in  the  preparation  of  bandages  to  cover  chronic  ulcers, 
unhealed  secondary  burns,  and  the  preparation  of 
pressure  bandages  for  varicose  veins  when  surgical 
treatment  is  not  necessary.  H.  K.  Mulford  Company, 
Philadelphia. 

Diphtheria  Toxoid  (Mulford),  Thirty  Cubic  Centi- 
meter Vial.— Diphtheria  Toxoid  (Mulford)  (New  and 
Nonofficial  Remedies,  1929,  p.  369),  is  also  marketed 
in  packages  of  one  thirty  cubic  centimeter  vial.  H.  K. 
Mulford  Company,  Philadelphia. 

Typhoid-Paratyphoid  Prophylactic,  Hospital  Pack- 
ages.— Typhoid  paratyphoid  prophylactic  (New  and 
(Continued  on  Page  16) 


Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  r TRUSSES  r ELASTIC  WEAR 

Clark-Gandion  Go.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
522  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


NICHOLT  POWDER 


Get  this  Nasal  Powder* 

J FREE/ 

We  want  every  physician  to 
try  Nichols  Nasal  Syphon 
Powdei'-lt's  new  and  unusual- 
ly fine  for  use  with  the  Nichols 
Nasal  Syphon-  or  wherever 
nasal  cleansing  is  indicated/ 

NICHOL/ 

N A/Al  CYPHON  INC. 

159  East  34'tSI.-  N.Y.C. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Whether  it  be  in  the  construction  of  a building,  in  the  pre- 
scribing or  administering  of  drugs  and  medicines,  in  the  care 
and  construction  of  teeth,  or  in  the  defense  of  malpractice 
suits  against  professional  men,  inferior  materials  or  methods 
lead  to  inferior  results. 

The  Medical  Protective  Company’s  standard  of  professional 
protection  continues  to  be  that  by  which  all  others  are 
measured.  It  assures  the  broadest  and  finest  protective  agree- 
ment devisable,  local  legal  counsel  to  execute  it  which  in 
many  cases  would  be  beyond  the  reach  of  the  average  prac- 
titioner, and  expert  supervision  by  a central  advisory  board 
of  malpractice  legal  specialists  with  an  experience  of  thirty-one 
years  in  this  field  — a combination  of  coverage  and  service  which 
makes  the  first  cost  the  last. 


There  is  no  substitute 
for  specialized  service 
in  professional  protection 


r7S£)G  Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Boulevard  t Chicago,  Illinois 


MEDICAL  PROTECTIVE  CO. 
360  North  Michigan  Blvd. 
Chicago,  111. 

Address 

Kindly  send  details  on  your  plan  of 
Complete  Professional  Protection 

r.iry 

2-30 

i6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ANNOUNCEMENT 

OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION,  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION,  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FULGURATION  OF  BLADDER  TUMORS,  ETC., 
WILL  BE  GIVEN. 

FOURTEENTH  FLOOR-FOUR-FIFTY 

LOUIS  CLI\  E JACOBS,  M.  D.,  Urologist  san  FRANcnscof  California 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  DAvenport  7322 


CABLE  WARP  * 

f O’KEEFFE  & COMPANY  1 

TOWELS 

Incorporated 

Telephones 

WHOLESALE  DEALERS 

Sutter  7599 

W estinghouse 

BEDDING  * BED  LINENS  < CURTAINS 

MAZDA  LAMPS 

Carpets  i Towels  i Table  Linens  i Furniture 

Sutter  3458 

i*  788  Mission  Street  San  Francisco  ** 

ft 

ST.  JOSEPH’S  HOSPITAL  SAN  FRANCISCO, 

J CALIFORNIA 


Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  14) 

Nonofficial  Remedies,  1929,  p.  379),  is  also  marketed 
in  hospital  size  packages  containing  ten  complete 
immunizations.  The  Cutter  Laboratory,  Berkeley, 
California. 

Ampoule  Solution  Silver  Nitrate  One  Per  Cent 
(Cutter). — Solution  silver  nitrate  one  per  cent,  ap- 
proximately 0.2  cubic  centimeter,  contained  in  am- 
poules composed  of  beeswax.  They  are  used  for  the 
prevention  of  ophthalmia  neonatorum.  Cutter  Lab- 
oratory, Berkeley,  California. 

Merthiolate — Sodium  Ethylmercuri  Thiosalicylate. 
Merthiolate  contains  from  49.15  to  49.65  per  cent  of 
mercury  in  organic  combination.  Merthiolate  is  a 
potent  germicide  for  spore-bearing  and  nonspore- 
bearing bacteria.  It  is  used  for  sterilizing  tissue  sur- 


faces. It  does  not  precipitate  with  serum  proteins. 
Merthiolate  is  much  less  toxic  than  mercuric  chlorid. 
Merthiolate  is  supplied  in  the  form  of  merthiolate 
solution  1:1000,  containing  one  grant  of  merthiolate 
in  1000  cubic  centimeters  of  water,  buffered  with  1.4 
gram  of  sodium  borate  in  1000  cubic  centimeters  and 
containing  sodium  chlorid  to  make  the  solution  ap- 
proximately isotonic.  Eli  Lilly  & Company,  Indian- 
apolis.— Jour.  A.  M.  A.,  December  7,  1929,  p.  1809. 

Polyanaerobic  Antitoxin. — An  anaerobic  antitoxin 
(New  and  Nonofficial  Remedies,  1929,  p.  346),  pre- 
pared by  immunizing  horses  with  the  toxins  of 
B.  tetani,  B.  ‘welchii,  Vibrion  septique  and  B.  edematiens. 
It  is  marketed  in  bottles  containing  100  cubic  centi- 
meters, each  100  cubic  centimeters  containing  at  least 
5000  units  of  tetanus  antitoxin,  75  units  of  Welch 
bacillus  antitoxin,  and  sufficient  antitoxin  to  neutralize 
(Continued  on  Page  18) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


CIBA  COMPANY,  INC.,  NEW  YORK  CITY 


And  Now — 

THE  COST  IS  HALVED! 


DIGIFOLINE,  “CIBA”  Liquid 

is  now  supplied  in  one  ounce  bottles  to  replace 
the  former  15  c.c.  or  one-lialf  ounce  size.  The 
price  remains  the  same.  When  liquid  medi- 
cation is  indicated  in  the  administration  of 
digitalis,  be  sure  to  specify  Digifoline,  “Ciba” 
Liquid  in  the  new  one  ounce  bottle. 

Samples  and  literature  will  be  gladly  sent 
to  you  upon  request 


mm* 


“COUNCIL 

ACCEPTED” 


i8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


CANYON  SANATORIUM  the  Treatment  of  Tuberculosis 

REDWOOD  CITY,  CALIFORNIA 


NESTLED  IN  THE  FOOTHILLS 


For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  Douglas  4486 


The  Scripps 
Metabolic  Clinic 

For  the  treatment  and  investigation  of: 

Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  16) 

50,000  minimum  lethal  doses  of  Vibrion  septique  toxin 
and  100,000  minimum  lethal  doses  of  B.  edematiens 
toxin.  Cutter  Laboratory,  Berkeley,  California. 

Normal  Horse  Serum  Without  Preservative. — A 
normal  horse  serum  (New  and  Nonofficial  Remedies, 
1929,  p.  344),  marketed  in  packages  of  one  vial  con- 
taining 100  cubic  centimeters.  H.  K.  Mulford  Com- 
pany, Philadelphia. 

Pollen  Extracts  (Mulford). — The  following  pollen 
extracts  (Mulford)  (New  and  Nonofficial  Remedies, 
1929,  p.  33),  have  been  accepted:  Alder  Pollen  Ex- 
tract (Mulford);  Alfalfa  Pollen  Extract  (Mulford); 
Annual  Sage  Pollen  Extract  (Mulford);  Apple  Pollen 
Extract  (Mulford);  Aster  Pollen  Extract  (Mulford); 
Blue  Beech  Pollen  Extract  (Mulford);  Boneset  Pollen 
Extract  (Mulford);  Brown  Grass  Pollen  Extract 
(Mulford);  Burning  Bush  Pollen  Extract  (Mulford); 


Burweed  Marsh  Elder  Pollen  Extract  (Mulford); 
Buttercup  Pollen  Extract  (Mulford);  California  Mug- 
wort  Pollen  Extract  (Mulford);  Careless  Weed  Pollen 
Extract  (Mulford);  Cedar  Tree  Pollen  Extract  (Mul- 
ford); Clover  Pollen  Extract  (Mulford);  Crab  Grass 
Pollen  Extract  (Mulford);  Dahlia  Pollen  Extract 
(Mulford);  Dragon  Sage  Pollen  Extract  (Mulford); 
Elm  Tree  Pollen  Extract  (Mulford);  English  Plan- 
tain Pollen  Extract  (Mulford);  Fescue  Pollen  Extract 
(Mulford);  Golden  Glow  Pollen  Extract  (Mulford); 
Hickory  Tree  Pollen  Extract  (Mulford);  Milo  Maize 
Pollen  Extract  (Mulford);  Mock  Orange  Pollen  Ex- 
tract (Mulford);  Oat  Pollen  Extract  (Mulford) ; Olive 
Pollen  Extract  (Mulford) ; Pecan  Tree  Pollen  Extract 
(Mulford);  Pine  Tree  Pollen  Extract  (Mulford); 
Poverty  Weed  Pollen  Extract  (Mulford);  Prairie 
Grass  Pollen  Extract  (Mulford);  Privet  Pollen  Ex- 
tract (Mulford);  Quack  Grass  Pollen  Extract  (Mul- 
ford); Rabbitt  Brush  Pollen  Extract  (Mulford);  Rose 
Pollen  Extract  (Mulford);  Salt  Bush  Pollen  Extract 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19 


A GCLD  MINE 

in  your  back  yard  would  certainly  not  be  neglected. 

Let  us  work  the  gold  mine  you  now  have  in  your  office — the  delinquent  and  bad  accounts 
due  you  for  services. 

The  collector  for  "the  butcher,  the  baker,  etc.,”  obviously  cannot  handle  doctors’  accounts 
as  efficiently  or  satisfactorily  as  The  Bureau’s  Collection  Department. 

Nearly  two  thousand  members  of  the  California  Medical  Association,  now  using  our 
service,  testify  to  our  efficiency.  They  are  receiving  through  this  service  an  average  of 
almost  a quarter  of  a million  dollars  annually. 

The  Bureau’s  advertisement  appearing  in  this,  YOUR  official  professional  Journal  con- 
tinuously  for  more  than  three  years,  should  be  sufficient  recommendation  and  proof  of 
efficiency  and  reliability. 

PHONE  OR  WRITE  FOR  DETAILED  INFORMATION 

The  Doctors  Business  Bureau 

Balboa  Building,  GArfield  0460  Brockman  Building,  TRinity  1252 

San  Francisco  Los  Angeles 

The  Only  Business  Service  Exclusively  for  Doctors 
BONDED  Established  in  1916  LICENSED 


(Mulford);  Shad  Scale  Pollen  Extract  (Mulford) ; 
Sheep  Sorrel  Pollen  Extract  (Mulford);  Slender 
Ragweed  Pollen  Extract  (Mulford);  Spring  Ama- 
ranth Pollen  Extract  (Mulford);  Sudan  Grass  Pollen 
Extract  (Mulford);  Velvet  Grass  Pollen  Extract 

(Mulford);  Western  Giant  Ragweed  Pollen  Extract 

(Mulford);  Wheat  Pollen  Extract  (Mulford);  Wild 
Oats  Pollen  Extract  (Mulford);  Willow  Tree  Pollen 
Extract  (Mulford);  Winter  Grass  Pollen  Extract 

(Mulford);  Yellow  Foxtail  Grass  Pollen  Extract 

(Mulford).  These  pollen  extracts  are  marketed  in  five 
cubic  centimeter  vials  containing  500  units  per  cubic 
centimeter.  H.  K.  Mulford  Company,  Philadelphia. 

Thompson’s  Maltose  and  Dextrin. — A mixture  con- 
taining maltose,  51  per  cent;  dextrins,  45  per  cent; 
sodium  chlorid,  2 per  cent;  and  moisture,  2 per  cent. 
On  the  claim  that  maltose  is  more  readily  assimilated 
than  other  forms  of  sugar,  Thompson’s  maltose  and 
dextrin  is  proposed  to  supplement  the  carbohydrate 
of  cow’s  milk  or  of  water  modifications  of  cow’s  milk. 
Thompson’s  Malted  Milk  Company,  Inc.,  Waukesha, 
Wisconsin. — Jour.  A.  M.  A.,  December  21,  1929,  p. 
1971. 

PROPAGANDA  FOR  REFORM 


Alum  Rock  Sanatorium 


Intramuscular  Iron  Arsenic  Compound  (No.  201) 
and  (Intravenous)  Iron,  Cacodylate  and  Glycerophos- 
phate (No.  202)  Not  Acceptable  for  New  and  Non- 
official Remedies. — The  Council  on  Pharmacy  and 
Chemistry  reports  that  a circular  with  the  caption 
“Formulas  of  Definite  Therapeutic  Value”  issued  by 
Sci-Medico,  Inc.,  New  York,  lists  an  extensive  line 
of  preparations  marketed  in  the  form  of  ampoules  and 
intended  for  intramuscular  and  intravenous  adminis- 
tration and  includes  the  following  as  having  “proved 
useful  in  the  treatment  of  anemia,  nervous  debility, 
neurasthenia,  chlorosis,  and  wherever  a general  tonic 
is  indicated”:  (Intramuscular)  Iron,  Arsenic  Com- 
pound (No.  201),  each  five  cubic  centimeter  ampoule 
being  stated  to  contain  Iron  Cacodylate  1/4  grain, 
(Continued  on  Page  23) 


TUBERCULOSIS 


Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 

RATES  AND  FOLDER  ON  APPLICATION 


Consultants  : 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


UNLIKE  the  cupboard  of  childhood  rhyme,  this  cupboard 
is  full.  It  invariably  is ....  in  hospitals  served  by  a 
Troy-equipped  laundry. 

Hospitals  look  to  Troy  laundry  machinery  to  keep  closets 
stocked  with  ample  supplies  of  fresh,  clean  linen.  By  increas- 
ing the  rapidity  of  the  laundering  service,  Troy  equipment 
aids  in  enabling  the  institution  to  operate  on  a minimum 
supply  of  textiles. 

Without  charge  or  obligation,  TROY  HOSPITAL  AD- 
VISORY SERVICE  will  help  draw  plans  and  prepare 
specifications  for  any  type  or  size  of  laundry.  Feel  free  to 
consult  Troy  engineers  at  any  time. 

TROY  LAUNDRY  MACHINERY  CO.,  INC. 

Chicago-*- New  York  City^San  Francisco  -"-Seattle-*-  Boston  Los  Angeles 
JAMES  ARMSTRONG  & CO.,  Ltd.,  Europeat i Agents : London  -+■  Paris  Amsterdam  Oslo. 
Factories:  Fast  Moline,  111., 

TROY 

LAUNDRY  MACHINERY 


SINCE  1879  . . . THE  WORLD’S  PIONEER  MANUFACTURER  OF  LAUNDRY  MACHINERY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


....  '1^  • a 


C 


very  day  that 
Dextri-Maltose  is  manufactured,  control  samples 
for  bacteriological  analyses  are  secured  from 
certain  points  in  the  process  which  experience 
has  shown  give  an  accurate  picture  of  the 
bacteriological  condition  of  the  product  in 
the  different  steps  of  its  manufacture.  As  a 
result  of  experiment  and  experience,  it  has 
been  demonstrated  that  by  exercising  cer- 
tain strict  sanitary  control  measures  and 
precautions,  the  bacteria  count  can  be  re- 
duced to  the  point  where  the  finished  pro- 
duct approaches  practical  sterility.  The 
Petri-dish  at  right  shows  a plate  count  of  only 
40  bacteria  per  gram,  obtained  from  a package 
of  Dextri-Maltose  selected  at  random. 


The  Reality 


Of  The  Unseen 


The  things  unseen  determine  the  cleanliness,  uni- 
formity and  safety  of  Dextri-Maltose.  From  years 
of  study  and  experience,  we  know  how  to  produce 
the  bacteriologically  clean  product  indicated  above. 


Q, 


n the  other  hand, 
the  Petri-dish  at  the  left  visualizes  the  potential  danger 
that  may  accompany  lack  of  experience.  At  37°  C., 
this  sample  (bought  in  the  open  market)  showed  a 
bacteria  count  of  420,000  per  gram  (compared  with  40 
per  gram  in  Dextri-Maltose,  as  mentioned  above). 
Every  physician  is  deeply  concerned  about  the  pas- 
teurization, certification,  etc.,  of  the  cow’s  milk  his 
babies  are  fed  on,  but  even  sterile  milk  would  give  the 
infant  over  seventeen  million  bacteria  per  daily  feeding 
when  “modified”  with  a carbohydrate  such  as  is  repre- 
sented by  the  Petri-dish  at  the  left. 


Mead  Johnson  & Company,  evansville,  Indiana,  u.  s.  a.5 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 
by  mouth.” 


ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 

ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


ALQUA  WATER — In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 

To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 


Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 


The  Shasta  Water  Company 

Bottlers  and  Controlling  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 


At  All  Druggists 


SOUTHERN  SIERRAS  SANATORIUM 

For  Tuberculosis  and  Allied  Affections 

BANNING,  CALIFORNIA 

Climate  Favorable  Throughout  The  Year 


Many  aids  for  comfort  and  convenience. 
Simmons’  Beautyrest  mattresses  throughout. 
Radio  connection  in  each  apartment. 


Tempting,  tasteful  foods  prepared  by  a woman  cook. 
Special  dietaries  when  required. 

A spot  of  beauty  in  an  atmosphere  of  contentment. 


RATES  WITHIN  THE  MEANS  OF  THE  AVERAGE  PATIENT 
A REPUTATION  FOR  SERVICE  AND  SATISFACTION 

Charles  E.  Atkinson,  M.  D. 

Medical  Director 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


23 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


BENJAMIN  H.  DIBBLEE 
President 


I.  C.  KNOWLTON 
Secretary 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 

W.  G.  Moore,  M.D. 

Harold  P.  Hill,  M.D. 

Geo.  D.  Lyman,  M.D. 

Howard  H.  Johnson, 
M.  D.,  Med.  Dir. 
Secretary,  Executive 
Committee. 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  19) 

Sodium  Cacodylate  3/8  grain,  Sodium  Hypophosphite 
3/16  grain,  Manganese  Hypophosphite  1/24  grain, 
Sodium  Citrate  5/8  grain,  and  (Intravenous)  Iron, 
Cacodylate  and  Glycerophosphate  (No.  202)  each  five 
cubic  centimeter  ampoule  being  stated  to  contain 
“Iron  Cacodylate  (Colloidal)”  one  grain,  Sodium 
Cacodylate  four  grains,  Sodium  Glycerophosphate 
one  and  one-half  grains.  The  Council  declared  these 
preparations  unacceptable  for  New  and  Nonofficial 
Remedies  because  they  are  irrational  mixtures  mar- 
keted with  unwarranted  therapeutic  claims.  — Jour. 
A.  M.  A.,  December  7,  1929,  p.  1809. 

Tucker’s  Asthma  Specific. — The  continued  exploita- 
tion of  this  cocain  mixture  is  a standing  disgrace  to 
the  federal  authorities.  The  nostrum  carries  a label 
admitting  the  presence  of  five  grains  of  cocain  to 
the  fluidounce.  When  the  Commissioner  of  Internal 
Revenue  was  asked  in  1922  how  such  a product  could 
be  sent  without  violating  the  Harrison  Narcotic  Law, 
his  reply  was  that  the  cocain  in  the  remedy  became 
hydrolyzed  before  it  reached  the  public,  and  that 
when  used  there  was  either  no  cocain  or  a very  small 
quantity.  This  commissioner,  at  the  same  time,  also 
gave  a fulsome  puff  for  the  nostrum  expressing  the 
opinion  that  the  mail-order  distribution  of  this  prod- 
uct served  “a  great  humanitarian  cause”  and,  for  that 
reason,  the  Treasury  Department  was  taking  no 
action.  This  in  spite  of  the  fact  that  the  product 
obviously  violates  the  Harrison  Narcotic  Law,  for  if 
it  does  not  actually  contain  cocain  it  admittedly  con- 
tains a derivative  of  cocain,  to  which  the  law  also 
applies.  Furthermore,  if  the  product  does  not  contain 
five  grains  of  cocain  to  the  ounce,  then  it  violates 
the  National  Food  and  Drugs  Act. — Jour.  A.  M.  A., 
December  7,  1929,  p.  1829. 

(Continued  on  Page  26) 


ERy/IPEU/ 

ANTITOXIN 


£ec/er/e 


I HE  outstanding  advantages  of  the  treatment  of 
erysipelas  with  Erysipelas  Streptococcus  Antitoxin, 
Refined  and  Concentrated,  are: 

The  patient’s  period  of  disability  is  reduced 
over  50  per  cent. 

In  hospitals,  the  personnel  of  the  nursing 
staff  can  be  reduced  about  60  per  cent. 

Saves  bed  linen  and  sleeping  garments  by 
eliminating  the  destructive  effects  of  local 
remedies. 

Marks  an  advance,  the  results  of  which  are 
comparable  to  those  obtained  in  the  treat' 
ment  of  diphtheria. 

Erysipelas  Streptococcus  Antitoxin  ( Lederle ) 
Refined  and  Concentrated  is  supplied  in  syringe  pack' 
ages  containing  one  therapeutic  dose. 

Literature  upon  request 

Lederle  Antitoxin  Laboratories 

NEW  YORK 


24- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  MArket  0331 


Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with 
especial  reference  to  parasites. 

Containers  will  be  fur- 
nished upon  request. 

HERBERT  GUNN,  M.  D. 

2000  Van  Ness  Avenue 
San  Francisco  Telephone:  GRaystone  1027 


Hazel  E.  Furscott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  DOuglas  9124  380  Post  St. 

San  Francisco,  California 


THE  HILL- YOUNG  SCHOOL 
OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi- 
culty. Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child’s 
physician.  Testimonials  from  physicians. 

School  Publications — $2.00  each:  ’'Overcoming  Cleft 
Palate  Speech,”  "Help  for  You  Who  Stutter.” 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 
2809-15  South  Hoover  Street  WEstmore  0512 


Shumate’s 

PRESCRIPTION  PHARMACIES 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 

Refrigerated  Biologies  Prescription 
Technique 

Catering  to  the  Medical  Profession  Since  1890 
SAN  FRANCISCO 


QUIZ  COURSE, 

Preparation  For  Medical  Boards, 
Post-Graduate  Medical  Lectures. 

ARTHUR  H.  WHITE,  M.  D. 

1005  Market  Street  San  Francisco 

Phone  Market  3362 


HOLLAND-RANTOS 
COMPANY,  Inc. 


Gynecological  and  Obstetrical 
Specialties 


Descriptive  Leaflets,  Reports  and  Price  List 
Sent  on  Request 

156  FIFTH  AVENUE  NEW  YORK  CITY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


DIET  QUESTIONS  have  GELATINE  ANSWERS 


HOW  CAN  A PATIENT 
LOSE  WEIGHT  WITHOUT 
LOSING  HEALTH? 


KIM  OX 

is  the  real 

GELATINE 


When  you  prescribe  a weight-reducing  diet— you 
need  your  patient’s  co-operation.  And  you  will  be 
sure  of  that  co-operation  if  your  diet  satisfies  the  hun- 
ger for  bulk  and  the  longing  for  “something  good”. 

Here’s  where  Knox  Sparkling  Gelatine  plays  an 
important  part  in  the  weight-reducing  regime.  Being 
a pure,  plain  gelatine — it  is  a form  of  protein  which  may 
be  used  more  freely  with  less  danger  to  the  kidneys 
than  some  other  forms  of  protein. 

It  is  free  from  sugar  or  coloring  matter,  and  may  be 
combined  in  delightful  variety  with  foods  of  low  cal- 
orific value  — giving  the  necessary  appetite-satisfying 
bulk  without  supplying  the  fat-producing  calories  and 
conforming  to  the  fundamental  principles  of  nutrition. 
In  the  Knox  weight-reducing  menu  are  found  many 
salads,  desserts  and  other  dishes  which  are  well- 
balanced  dietetically  but  low  in  calorific  value. 

The  physician  should  exercise  care,  however,  to 
prescribe  pure  gelatine — Knox  Gelatine — for  most  of 
the  gelatine  preparations  now  on  the  market  are  heavily 
sugared  and  flavored.  Knox  Gelatine  is  the  real  gelatine. 

We  shall  be  pleased  to  send  you  a number  of  dietary 
booklets  prepared  by  an  eminent  dietitian  on  the  sub- 
ject of  gelatine  in  foods.  The  coupon  below  describes 
them— please  fill  it  out  and  mail  it  today. 


KNOX  GELATINE  LABORATORIES 
417  Knox  Avenue,  Johnstown,  N.  Y. 

Please  send  me,  without  obligation  or  expense,  the  booklets  which  I have 
marked.  Also  register  my  name  for  future  reports  on  clinical  gelatine  tests 
as  they  are  issued. 

□ Varying  the  Monotony  of  Liquid  and  Soft  Diets.  □ Recipes  for  Anemia. 

□ Diet  in  the  Treatment  of  Diabetes.  □ Reducing  Diet. 

□ Value  of  Gelatine  in  Infant  and  Child  Feeding. 

Name .. 

Address 

City - .. 

State 


26 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SAINT  FRANCIS  HOSPITAL 


A GENERAL 
HOSPITAL 
WITH 

ACCOMMODATIONS 
FOR  THREE 
HUNDRED 
PATIENTS 


Taltphona 

PROSPECT 

7600 


AND 

SCHOOL  OF  NURSING 


% 

1 

— » 

a i!  1 

MI 

t > t 

fTHBllS 

1 • --  MTr 

t UI 

y 

-Li 

DIRECTORS 


JOHN  GALLWEY, 
M.  D. 

W.  B.  COFFEY, 

M.  D. 

THOS.  E.  SHUMATE, 
M.  D. 

W.  W.  WYMORE, 
M.  D. 

JOHN  H.  GRAVES, 
M.  D. 

M.  O.  AUSTIN, 

M.  D. 

J.  H.  O’CONNOR, 
M.  D. 

B.  A.  MARDIS, 

M.  D. 

H.  E.  MANWARING 


Mantling  Diractor 
L.  B.  ROGERS, 
M.  D. 


Address  Communications 


SAINT  FRANCIS  HOSPITAL 

Bush  and  Hyde  Streets 


San  Francisco 


CARL  ZEISS,  JENA 

MICROSCOPES 

Represent  the  finest  possible  craftsmanship,  opti- 
cally and  mechanically,  in  the  microscope  field. 
Priced  from  #128.00  up.  Terms  if  desired. 

Trainer-Parsons  Optical  Co. 

228  POST  STREET  SAN  FRANCISCO 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  23) 

Zonite  Declared  Misbranded. — Zonite  is  another  of 
the  many  hypochlorite  preparations  which  arose  from 
the  work  of  Carrel  and  Dakin  during  the  war.  It  has 
been  advertised  like  a typical  “patent  medicine”  under 
the  firm  name  of  the  Zonite  Products  Co.  The  propa- 
ganda for  Zonite  is,  in  effect,  capitalization  on  the 
work  of  Carrel,  Dakin,  and  others,  and  the  method 
of  exploitation  has  been  that  typical  of  the  nostrum 
business.  Chemically,  Zonite,  after  dilution  with  equal 
parts  of  water,  is  claimed  to  be  essentially  the  same 
as  surgical  solution  of  chlorinated  soda.  According 
to  a recent  notice  of  judgment,  Zonite  was  declared 
misbranded  in  that  certain  statements  were  false  and 
misleading.  Zonite  has  been  exploited  to  both  the 
physician  and  the  public.  It  goes  without  saying  that 
it  has  not  been  accepted  by  the  Council  on  Pharmacy 
and  Chemistry  for  inclusion  in  New  and  Nonofficial 
Remedies. — Jour.  A.  M.  A.,  December  7,  1929,  p.  1830. 

Treparsol. — Treparsol  differs  from  the  better  known 
acetarsone  in  that  it  has  a formyl  group  in  place  of 
the  acetyl  group  of  acetarsone.  Its  oral  use,  as  with 
acetarsone,  in  the  treatment  of  syphilis  is  not  sup- 
ported by  adequate  evidence.  Treparsol  has  not  been 
accepted  by  the  Council  on  Pharmacy  and  Chemistry. 
Jour.  A.  M.  A.,  December  7,  1929,  p.  1830. 

Uviol-Jena  Ultraviolet  Transmitting  Glass  Accept- 
able.— The  Council  on  Physical  Therapy  reports  that 
the  window  glass  known  as  Uviol-Jena,  manufac- 
tured by  Schott  and  Gen.,  Jena,  Germany,  and  sub- 
mitted to  the  Council  by  the  Fish-Schurman  Corpo- 
ration, New  York,  is  stated  to  be  “a  glass  which 
transmits  the  biological  ultraviolet  rays  of  the  sun’r 
and  “in  a thickness  of  two  millimeters  transmits  at 
the  time  of  installation  about  60  per  cent  of  the  ultra- 
violet rays  of  a wave  length  of  302  millimicrons”  and 
“even  after  ‘solarization’  it  still  transmits  about  48  to 
(Continued  on  Page  28) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


EVERY  PHYSICIAN 

should  be  familiar  with  these  two 

SQUIBB  ANTITOXINS 

Erysipelas  Streptococcus 


Antitoxin  Squibb 

As  erysipelas  antitoxin  is  being  more  and 
more  widely  used  its  value  in  erysipelas  is 
being  recognized. 

Erysipelas  Streptococcus  Antitoxin 
Squibb  is  accepted  by  the  Council  on 
Pharmacy  and  Chemistry  of  the  American 
Medical  Association.  It  is  prepared  ac- 
cording to  the  principles  developed  by 
Dr.  Konrad  E.  Birkhaug.  Its  early  admin- 
istration ensures  a prompt  reduction  in 
temperature  and  toxicosis,  clearing  the 
lesions  and  effecting  uncomplicated  recov- 
ery. 

Erysipelas  Streptococcus  Antitoxin 
Squibb  is  distributed  only  in  concentrated 
form  in  syringes  containing  one  average 
therapeutic  dose. 


Tetanus  Antitoxin  Squibb 

Every  wound  in  which  skin  continuity  is 
destroyed  is  a possible  route  of  tetanus 
infection.  Just  as  routine  practice  of  in- 
jecting anti-tetanic  serum  during  the  World 
War  practically  eradicated  tetanus  so  in 
civil  practice  this  disease  might  be  stamped 
out  by  the  same  routine  practice. 

Tetanus  Antitoxin  Squibb  is  small  in 
bulk,  high  in  potency,  low  in  total  solids, 
yet  of  a fluidity  that  permits  rapid  absorp- 
tion. It  is  remarkably  free  from  serum- 
reaction  producing  proteins. 

Tetanus  Antitoxin  Squibb  is  supplied  in 
vials  or  syringes  containing  an  immunizing 
dose  of  1500  units.  Curative  doses  are 
marketed  in  syringes  containing  3,000, 
5.000,  10,000  and  20,000  units. 


( Write  to  the  Professional  Service  Department  for  Literature) 

E RiSoyiBB  &.  Sons,  New  York 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858. 


28 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Compound  S 
of  Cal 


yrup 


creose 


Available  for  the  lesser  ailments  of  the 
respiratory  tract  ...  a tasty,  effective 
cough  syrup  that  does  not  nauseate 
. . . each  fluid  ounce  representing  Cal- 
creose  Solution,  160  minims;  Alcohol, 
24  minims;  Chloroform,  approximately 
3 minims;  Wild  Cherry  Bark,  20  grains; 
Peppermint,  Aromatics  and  Syrup  q.  s. 


Tablets  Cal  creose 
four  grains 

Each  Tablet  Calcreose  4 grains,  con- 
tains 2 grains  pure  creosote  combined 
with  hydrated  calcium  oxide.  The  full 
expectorant  action  of  creosote  is  pro- 
vided in  a form  which  patients  will 
tolerate. 

THE  MALTBIE  CHEMICAL  CO. 
Newark,  New  Jersey 


MALTBIE 

Calcreose 


We  would  like  to 
have  you  try 


I 


OTIAU 


( An  Antiseptic  Liquid) 


c&^6|xiACLtL0ri 


NONSPI  destroys  armpit  odor 
and  removes  the  cause — exces- 
sive perspiration. 

This  same  perspiration,  excreted 
elsewhere  through  the  skin 
pores,  gives  no  offense  because 
of  better  evaporation. 

W>e  will  gladly  mail  you 
Physician's  testing  samples. 


THE  NONSPI  COMPANY  Send  free  NONSPI 

2652  WALNUT  STREET  ' . j , 

Kansas  city,  Missouri  samples  to: 

. ' 

Name -------  — • — • — 

s -pP-i 

City 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  26) 

45  per  cent  of  these  same  rays.”  The  Council  reports 
that  acceptable  evidence  in  favor  of  these  claims  was 
submitted  and  hence  declares  it  acceptable  for  in- 
clusion in  its  list  of  accepted  devices  for  physical 
therapy. — Jour.  A.  M.  A.,  December  14,  1929,  p.  1887. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the 
Food,  Drug  and  Insecticide  Administration  of  the 
United  States  Department  of  Agriculture  which  en- 
forces the  Federal  Food  and  Drugs  Act:  Flu-Zone 
(R.  B.  Pettijohn  Company)  consisting  essentially  of 
ammonium  chlorid,  ammonium  carbonate,  menthol, 
chloroform  and  traces  of  plant  drug  extractives,  with 
alcohol,  sugar  and  water.  Optolactin  Tablets  (Fair- 
child  Bros,  and  Foster)  containing  an  insufficient 
number  of  organisms  ( Bacillus  bulgaricus  and  Bacillus 
acidophilus).  Adamson’s  Botanic  Cough  Balsam  (F.  W. 
Kinsman  Company)  consisting  essentially  of  a syrup 
containing  red  pepper,  tartar  emetic,  guaiac  and  other 
resinous  material,  a trace  of  alkaloids,  water,  and  a 
small  amount  of  alcohol.  Inflammacine  (Math-Ol 
Inflammacine  Company)  an  ointment  having  a petro- 
latum base  and  containing  the  usual  menthol,  cam- 
phor, oil  of  wintergreen  and  volatile  oils,  including 
spearmint  and  eucalyptus.  Haywood’s  Cold  and 
Grippe  Tablets  (W.  R.  Warner  and  Company,  Inc.) 
containing  the  alkaloids  of  cinchona,  gelsemium  and 
aconite,  together  with  camphor,  red  pepper  and  aloes. 
Lungremed  (W.  D.  Stokes)  consisting  essentially  of 
ammonium  and  potassium  salts,  carbonates,  iodids, 
and  creosote  flavored  with  oil  of  peppermint.  Iophen 
(The  Mayer  Brothers  Drug  Company)  consisting 
essentially  of  small  amounts  of  carbolic  acid,  iodids 
and  menthol  in  water.  Warren’s  Wonder  Workers 
(S.  Pfeiffer  Manufacturing  Company)  containing 
acetanilid,  quinin,  sodium  and  potassium  salts,  bro- 
(Continued  on  Page  30) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


29 


W^here  washroom  costs 

[already  low] 

were  brought  down 

even  lower ♦♦♦ 


At  Christ  Hospital , Cincinnati — the 
washroom  of  a year  ago. 


NOT  long  ago,  the  washroom  at  Christ  Hospital, 
Cincinnati,  favorably  known  for  its  high-quality, 
low-cost  work,  “had  its  picture  taken.”  You  see  it  at 
the  left.  Yet,  modern  and  efficient  as  this  department 
seemed  to  be  at  that  time,  it  has  since  been  com- 
pletely re-equipped — as  shown  by  the  photograph 
at  the  right. 

And  the  operating  costs — already  unusually  low — 
have  been  brought  down  even  lower  by  the  installa- 
tion of  the  American-Perry  Automatic  Washroom 
System.  Labor  costs  cut  almost  in  half — floor  space 
producing  twice  as  much!  Mass  economies  that  are 
automatic  and  continuous. 

Shall  we  tell  you  more  about  mass-production 
methods  for  the  modern  hospital  washroom? 

THE  AMERICAN  LAUNDRY  MACHINERY  CO. 

Norwood  Station,  Cincinnati,  Ohio 
SAN  FRANCISCO  LOS  ANGELES  SEATTLE 


Showing  the  American-Perry  Automatic 
Washroom  System  in  the  "American” 
laundry  at  Christ  Hospital.  The  goods 
are  loaded,  lifted  and  conveyed  auto- 
matically. Machinery  does  all  the  heavy 
work. 

TlETlG  & Lee,  Cincinnati , Architects 
FOSDICK  & HlLMER,  Consulting  Engineers 


3° 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Soiland  Clinic 

Drs.  Soiland,  Costolow  and 
Meland 


1407  South  Hope  Street,  Los  Angeles,  Calif. 
Telephone  WEstmore  1418 
HOURS:  9:00  to  4:00 


An  institution  fully  equipped  for  the  study, 
diagnosis  and  treatment  of  neoplastic  disease. 
Radiation  therapy  and  modern  electro- 
surgical  methods  featured. 


ALBERT  SOILAND,  M.  D. 
WM.  E.  COSTOLOW,  M.  D. 
ORVILLE  N.  MELAND,  M.  D. 
EGBERT  J.  BAILEY,  M.  D. 

A.  H.  WARNER,  Ph.  D.,  Physicist 


Supporting  Qarments 

p Remarkable  Results 
with  this  New 
Post- Operative  Support 

A new  Camp  garment  particularly 
designed  for  physiological  sup- 
port following  stomach  or  gall  bladder 
operations.  The  Camp  Patented  Adjust- 
ment provides  support  and  proper  uplift 
where  needed.  It  insures  diaphragm  con- 
trol without  restriction.  The  elastic 
insert  at  operative  point  supplies  the 
required  softness  without  loss  of  firm- 
ness, and  gives  satisfactory  sacro-iliac 
support.  Leading  physicians  and  sur- 
geons everywhere  endorse  the  garment 
as  a preventive  of  post-operative  compli- 
cations, and  praise  the  extreme  comfort 
it  affords  the  patient. 

Obtainable  in  all  of  the  better  surgical 
goods  houses,  drug  stores  and  depart- 
ment stores 

i Write  for  full  information 


S.  H.  CAMP  AND  COMPANY/' 

Manufacturers,  JACKSON,  MICHIGAN 


Dependability  Is  a Factor 
in  Dairy  Products 
Satisfaction 

— and  Golden  State  brand 
products  are  famed  for 
their  dependability. 

— Golden  State  plants  and 
branches  conveniently 
located  throughout  California  make  these 
quality  products  available  to  you  up  and 
down  the  state. 

Golden  State 
Milk  Products  Company 

MILK  / CREAM  / BUTTER 
ICE  CREAM  / COTTAGE  CHEESE 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  28) 

mids  and  aloes.  Owen’s  Oil  (The  Carolina  Chemical 
Company)  consisting  essentially  of  lard,  oil,  and  some 
other  fatty  substance  containing  a small  amount  of 
menthol.  Fluco  (The  Fluco  Laboratories,  Inc.),  a 
liquid  containing  glycerin  and  alcohol  together  with 
acetanilid,  ammonium  carbonate,  camphor  and  ben- 
zoic acid.  Buddies  (The  Buddies  Company),  con- 
sisting essentially  of  aspirin  (five  and  one-half  grains), 
caffein  (one-third  grain),  red  pepper,  and  salicylic 
acid. — Jour.  A.  M.  A.,  December  14,  1929,  p.  1908. 

Medical  Treatment  of  Cataract. — About  every  five 
years,  the  ophthalmic  world  is  thrilled  by  the  an- 
nouncement of  a new  medical  cure  for  senile  cata- 
ract. This  has  been  going  on  for  at  least  two  hundred 
years.  Boric  acid  and  glycerin,  ethylmorphin  hydro- 
chlorid,  subconjunctival  injections  of  mercuric  cyanid, 
radium,  antigenic  injections  of  lens  proteins,  mixed 
endocrine  glands,  sodium  iodid  in  all  possible  com- 
binations, and  so  on,  have  all  had  a trial.  Not  one 
of  them  has  been  scientifically  established  as  of  value 
and  more  cataracts  are  being  operated  on  than  ever 
before. — Jour.  A.  M.  A.,  December  14,  1929,  p.  1910. 

Bichloridol. — Bichloridol  is  a proprietary  prepara- 
tion of  corrosive  mercuric  chlorid  suspended  in  a 
“palmitin”  base,  intended  for  intramuscular  adminis- 
tration. It  is  sold  in  compressible  ampoules  called 
collapsules.  This  preparation  was  formerly  marketed 
by  the  H.  A.  Metz  Laboratories,  Inc.,  but  is  now 
marketed  by  the  Duke  Laboratories,  Inc.  In  1925 
the  Council  on  Pharmacy  and  Chemistry  rejected 
Bichloridol  because  it  was  marketed  with  indefinite 
statements  of  composition  and  under  a nondescriptive 
name.  The  American  Medical  Association  Chemical 
Laboratory  reports  that  it  analyzed  Bichloridol  be- 
cause of  inquiries  received,  one  inquirer  writing, 
“One-half  to  one  grain  a week  gives  practically  no 
reaction  and  likewise  mighty  little  therapeutic  effect.” 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


31 


GLARESTRAIN 


For  Maximum  Optical  Precision 
prescribe  Soft-Lite  in  Orthogon 


Comfort  and  Safety 

Come  with  Soft-Lite  Lenses  more  than  with  any 
other  optical  combination.  When  you  write  “Soft- 
Lite”  in  the  prescription  you  write  eye  ease  for  your 
patient  as  long  as  the  lenses  are  worn. 

Glare  is  an  irritant  to  all  eyes — both  young  and  old — 
especially  if  there  is  a refractive  or  muscular  error. 
Soft-Lite  Glare  Absorbing  Glass  is  the  result  of 
careful  study  and  experiment.  It  is  offered  in  three 
correct  grades  for  every  degree  of  eye  sensitivity. 
Your  patients  will  appreciate  the  comfort  of  Soft- 
Lite,  and  you  may  prescribe  it  with  the  assurance 
that  it  is  as  safe  as  it  is  effective. 

RIGGS 

Optical  Company 

OAKLAND  FRESNO  OGDEN 

SAN  FRANCISCO  RENO  SALT  LAKE  CITY 


Corrective  . . . . SOFT-LITE  . . . . Protective 


The  laboratory  found  the  preparation  to  contain  only 
from  one-fifth  to  one-tenth  of  the  mercuric  chlorid 
claimed.  The  laboratory  points  out  that  a discrepancy 
of  this  magnitude  is  inexcusable  and  comments  on 
the  desirability  of  physicians  confining  their  use  of 
proprietary  preparations  to  products  accepted  for 
New  and  Nonofficial  Remedies. — Jour.  A.  M.  A.,  De- 
cember 21,  1929,  p.  1971. 

The  Horovitz  Proteins  and  Lipoids  Again. — “Lipoi- 
dal  substances”  and  “protein  substances”  are  mar- 
keted under  various  names  by  variously  named  firms. 
Always,  apparently,  the  chemistry  is  performed  by 
and  the  claims  are  made  through  A.  S.  Horovitz.  In 
1915  it  was  an  alleged  cancer  cure,  “Autolysin,”  a 
poultice  or  extract  made  from  a number  of  herbs. 
Then  came  the  “Proteogens”  of  the  William  S.  Mer- 
rell  Company,  reported  on  unfavorably  by  the  Coun- 
cil on  Pharmacy  and  Chemistry  in  1918.  They  were 
numbered,  different  ones  being  for  the  treatment  of 
different  diseases.  These  mixtures  of  vegetable  pro- 
teins were  exploited  to  physicians  by  a sad  outpour- 
ing of  pseudoscience.  Next  Horovitz  became  identi- 
fied with  the  Horovitz  Biochemical  Laboratories,  with 
a line  of  “Protein  Substances”  similar  to  the  “Pro- 
teogens,” each  claimed  to  be  more  or  less  specific 
for  some  disease.  Now  the  successor  to  the  Horovitz 
Biochemical  Laboratories  is  the  Lipoidal  Labora- 
tories, Inc.,  and  a number  of  supply  houses  act  as 
agents  for  the  firm.  “Gonolin,”  “Luesol,”  “Osmogen,” 
“Arthritine,”  “Asthmazine,”  and  other  preparations 
similar  in  stated  composition  and  therapeutic  claims 
to  the  Proteogens  are  now  promoted  for  physicians 
who  think  that  the  “bosh”  in  the  circulars  is  good 
science  because  it  is  so  confusing  that  it  is  not  com- 
prehensible.— Jour.  A.  M.  A.,  December  21,  1929, 
p.  1975. 

The  Influenza  Discovery  (?).— With  little  if  any 
apparent  warrant,  it  is  again  announced,  for  at  least 
the  tenth  time  in  five  years,  that  the  causative  organ- 
(Continued  on  Page  35) 


J oslin’s  Sanatorium 

For  Treatment  of 

Nervous  and  Mental 
Disorders 

Home  for  Aged  and 
Infirm 

A quiet,  secluded  place  in  the  country 
RATES  REASONABLE 

Phone  118F2  Lincoln,  Calif. 


32 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


RESEARCH  FACILITIES 


qA  university  investigator  working  in 
the  Lilly  Laboratories  expressed  surprise 
at  the  resources  available  for  research. 
Practically  any  chemical  or  other  materi- 
al needed  was  obtainable  from  the  stock 
rooms,  the  apparatus  required  was  at 
hand,  the  Lilly  Library  afforded  the 
necessary  references. 


Iletin  ( Insulin , Lilly) 
Merthiolate 
Liver  Extract  T^o.  343 
Ephedrine  Products 
Pharmaceuticals 
Biologicals 


THE  problems  involved  in  the  develop- 
ment and  manufacture  of  Lilly  Pharma- 
ceuticals and  Biologicals  make  it  necessary 
to  maintain  an  extensive  and  varied  equip- 
ment for  research. 

The  Lilly  Research  Laboratories  have  the 
advantage  of  close  co-operation  with  the  Lilly 
Manufacturing  Laboratories  with  their  long 
experience  in  large-scale  production.  The  two 
laboratories  co-ordinate  exceptional  resources 
for  expediting  research  and  render  effective 
service  to  investigators  in  developing  scientific 
discoveries  and  adapting  them  to  medical  use. 


<rw 


ELI  LILLY  AND  COMPANY 

INDIANAPOLIS,  U.  S.  A. 


trv,1 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXII  FEBRUARY,  1930  No.  2 


THE  COST  OF  MEDICAL  CARE  AND 
HOSPITALIZATION* 

By  A.  B.  Cooke,  M.  D. 

Los  Angeles 

IN  order  to  get  a correct  idea  of  this  subject  it 
is  necessary  to  keep  in  mind  the  several  fac- 
tors involved.  The  patient  is  not  the  only  con- 
sideration. At  least  three  other  elements  of  the 
problem  must  be  recognized  and  properly  evalu- 
ated, namely,  the  hospital,  the  nurse,  and  the 
doctor.  The  mutual  interdependence  of  these  is 
self-evident.  But  it  is  well  to  remember  that  they 
are  not  equally  important.  Both  doctor  and  nurse 
existed  and  functioned  long  before  there  were 
hospitals — and  do  still  in  many  communities — and 
with  a fair  degree  of  success.  Also,  doctors  lived 
and  labored  before  the  professional  nurse  was 
even  dreamed  of  and,  again  we  may  say,  with 
a fair  degree  of  success. 

SOME  FACTS AS  THEY  ACTUALLY  ARE 

The  purpose  of  this  contribution  is  not  to  de- 
fend the  doctor — he  needs  no  defense — but  to 
say  openly  a few  things  which  have  too  long  been 
left  unsaid.  I hold  no  brief  for  my  profession, 
but  I believe  that  an  opportunity  like  this  should 
not  pass  without  an  earnest  and  emphatic  plea 
that  the  importance  and  the  interests  of  the  doctor 
be  not  lost  sight  of  in  the  hue  and  cry  which  has 
become  so  fashionable  on  this  question  of  the 
high  cost  of  sickness.  If  the  hospital  is  often 
hard  pressed  to  keep  its  head  above  the  waters 
of  financial  disaster,  if  the  nurse’s  claims  for 
more  pay  and  less  work  are  based  upon  sound 
principles  of  justice  and  fair  play — I charge  you 
to  remember  that  the  doctor,  the  pivotal  factor 
about  which  the  whole  machinery  revolves,  should 
also  be  taken  fully  into  account  in  any  right  think- 
ing upon  the  subject.  That  this  is  not  always  done 
is  a matter  of  common  knowledge.  Speaking  of 
the  prevalent  custom,  the  hospital  charges  are 
settled  in  full  v/hen  the  patient  is  dismissed,  and 
with  them,  usually  the  nurse’s  bill.  The  doctor 
comes  last.  By  the  time  he  arrives  the  pocket- 
book  is  empty,  and  fortunate  is  he  in  many  cases 
if,  after  prolonged  and  often  hectic  effort,  he 
succeeds  in  obtaining  even  a portion  of  what  is 
due  him.  Does  he  lack  the  courage  to  demand 

* Read  before  a joint  meeting-  of  the  Southern  Cali- 
fornia Medical  Association  and  the  Southern  California 
Hospital  Council,  Los  Angeles,  November  8,  1929. 


his  rights,  or  does  he  submit  because  his  concep- 
tion of  professional  ethics  (God  save  the  mark!) 
restrains  him  from  open  opposition  to  a vicious 
and  inequitable  system,  notwithstanding  that  his 
very  livelihood  is  at  stake? 

Prosperity  is  a grand  sounding  word,  and  the 
huge  gobs  of  it  we  are  said  to  be  enjoying  in 
America  at  the  present  time  form  the  subject  of 
smug  and  vociferous  comment  in  the  publicity 
media  of  the  business  world  from  day  to  day.  Let 
us,  the  members  of  the  medical  profession,  stop 
and  solemnly  ask  ourselves  to  what  extent  we  are 
participating  in  the  loudly  acclaimed  “good  times.” 

THE  PRACTICAL  WORLD  AND  THE  PHYSICIAN 

In  the  economic  world  the  physician  is  and 
always  has  been  a sorry  spectacle.  Immersed  in 
the  exacting  responsibilities  of  his  daily  work, 
beset  with  the  almost  insuperable  difficulties  of 
keeping  abreast  of  his  rapidly  developing  science, 
he  has  little  time  for  thought  of  material  gain. 
An  easy  mark  for  the  public,  he  is  exploited  with 
increasing  flagrance  by  national,  state,  county, 
and  municipal  governments.  As  for  his  position 
in  the  domain  of  industry  he  has  become  merely 
a cog  in  the  wheel,  a pawn  in  the  game  of  big 
business.  For  let  no  one  delude  himself  that  the 
interest  of  business  in  this  problem  of  the  cost 
of  sickness  is  in  any  sense  philanthropic  or  altru- 
istic. It  is  rather  a matter  of  the  actual  cash  sav- 
ings to  be  realized  by  the  wholesale  purchase  of 
medical  service.  And  the  doctor  apparently  takes 
no  heed  of  the  ignoble  position  in  which  he  places 
himself  or  the  discredit  he  brings  upon  his  pro- 
fession by  lending  his  aid  to  further  the  schemes 
of  cold-blooded  commercialism.  It  is  little  wonder 
that  the  individual  should  be  contaminated  by  the 
spirit  of  that  which  he  serves,  and  that  the  pro- 
fession as  a whole  should  find  itself  more  and 
more  on  the  defensive,  fighting  to  retain  the 
respect  and  esteem  which  constitute  its  honorable 
birthright. 

If  financial  gain  or  material  preferment  of  any 
kind  followed  the  operation  of  customs  and  con- 
ditions such  as  have  been  mentioned,  the  uncom- 
plaining acquiescence  of  the  doctor  in  these  and 
similar  abuses  would  not  be  so  hard  to  under- 
stand. In  this  connection  I have  only  to  remind 
you  of  what  we  all  know,  that  not  10  per  cent 
of  our  fellows  achieve  financial  success  from  their 
professional  labor  alone,  and  that  more  than 


74 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


50  per  cent  of  those  who  reach  old  age  are  entirely 
and  pitifully  dependent. 

The  idea  of  justice  to  the  doctor  is  so  seldom 
given  expression  that  it  will  possibly  sound  bold 
and  strange  to  many.  His  own  attitude  has 
always  been  that  of  dumb  and  spiritless  accept- 
ance of  things  as  they  are.  Result:  The  passing 
years  have  brought  economic  and  social  uplift  to 
all  but  him,  and,  sad  to  say,  little  promise  of  im- 
provement is  visible  on  the  horizon  of  tomorrow. 
Long-suffering  may  be  an  admirable  Christian 
virtue,  but  the  fact  remains  that  no  other  body 
of  equal  numbers  and  intelligence  would  even 
hesitate  to  promote  the  material  interests  of  its 
members  merely  because  of  sentimental  allegi- 
ance to  certain  hoary  and  outgrown  traditions. 

For  look  you ! The  attainment  of  happiness  is 
the  purpose  and  the  right  of  every  human  being, 
including  the  doctor.  Without  health,  happiness 
is  merely  an  idle  dream.  The  maintenance  of 
health,  then,  or  its  restoration  when  impaired, 
must  be  recognized  as  transcending  in  importance 
all  other  objects  of  human  desire  and  endeavor. 
To  these  ends  the  doctor  devotes  himself,  assum- 
ing responsibilities  of  incomparable  gravity  and 
rendering  services  of  incomparable  value.  Yet 
strange,  almost  passing  belief  is  the  attitude  of 
the  public  on  the  subject.  As  long  as  health  is 
a present  reality  the  contingencies,  nay  the  cer- 
tainties, of  the  future  remain  matters  of  little 
concern.  The  purchase,  usually  on  time,  of  auto- 
mobiles, radios,  and  similar  luxuries,  nightly 
attendance  at  the  movies  and  every  form  of  in- 
dulgence and  extravagance  constitute  the  routine 
life  of  the  average  citizen  today.  Only  when  the 
inevitable  sickness  or  calamity  comes,  do  the 
doctor  and  the  hospital  receive  more  than  passing 
thought.  Then  indeed  they  become  agencies  of 
supreme  importance.  And  then  what  happens? 
Either  the  doctor  is  called  and  his  services  re- 
munerated with  a specious  promise  to  pay  hencely, 
or,  more  likely,  the  good  offices  of  a free  clinic 
or  hospital  is  sought.  In  the  latter  event  the 
doctor  (simple  soul!)  perforce  becomes  the  agent 
of  service,  the  only  difference  being  that  now  he 
knows  he  will  receive  no  compensation.  The 
doctor  and  his  interests  are  lost  sight  of  in  the 
shuffle.  The  cards  are  stacked  against  him.  Glory 
and  a dribbling  of  half-hearted  gratitude  form 
a large  proportion  of  his  reward  for  a life  of 
arduous  and  self-sacrificing  devotion. 

HOSPITAL  STANDARDIZATION  BRINGS 
INCREASED  EXPENSE 

I cannot  let  the  occasion  pass  without  express- 
ing my  personal  appreciation  of  the  hospital  and 
my  sympathy  with  and  for  it  in  the  struggle  it 
daily  faces  to  make  ends  meet.  Standardization, 
desirable  as  it  is,  has  resulted  in  heavy  addition 
to  the  operating  cost,  and  the  many  exacting  de- 
mands of  the  times  we  live  in  continue  to  swell 
the  already  top-heavy  overhead.  And  I yield  to 
no  one  in  commendation  of  the  nurse,  and  in 
sympathy  for  her  and  her  aims  so  long  as  she 
refrains  from  employing  the  methods  of  trades- 
unionism  to  gain  ber  ends.  But  I insist  as  vigor- 
ously as  my  command  of  language  will  permit 


that  the  doctor,  too,  is  entitled  to  consideration 
in  any  fair  discussion  of  the  question  before  us. 

1 he  truth  is  that  the  time  has  fully  come  when 
we,  the  members  of  the  medical  profession,  can 
no  longer  afford  to  remain  passive.  Already  the 
drift  toward  state  medicine  has  set  in.  The  im- 
mediate future  is  full  of  ominous  menace.  Less 
compensation  and  more  work  under  the  direction 
of  bureaus  controlled  by  laymen,  utter  loss  both 
of  independence  and  dignity — these  are  a few  of 
the  dangers  I seem  to  see  lurking  just  around  the 
corner. 

What  of  the  outlook  for  young  physicians  just 
entering  upon  their  chosen  life  work? 

Brethren,  let  us  wake  up ! 

727  West  Seventh  Street. 


ACUTE  UPPER  RESPIRATORY  TRACT 
INFECTIONS  IN  CHILDREN* * 

By  Clifford  Sweet,  M.  D. 

Oakland 

Discussion  by  Donald  K.  Woods,  M.D.,  San  Diego; 
Andrew  J.  Thornton,  M.D.,  San  Diego;  Harold  K. 
Faber,  M.  D.,  San  Francisco. 

IN  all  fields  of  medicine  an  accurate  diagnosis 

should  precede  any  treatment  that  is  meant  to 
change  the  natural  course  of  disease.  This  is 
especially  true  when  the  patient  is  a child.  Often 
the  child  is  unable  to  give  an  exact,  detailed  his- 
tory, and  his  most  accurate  statements  are  all  too 
often  distorted  in  being  relayed  from  parent  to 
physician.  Likewise,  all  too  often  this  distortion 
is  multiplied  when  the  physician’s  mind  is  im- 
peded by  such  fixed  ideas  as : ( 1 ) Acute  illness 
in  childhood  is  usually  caused  by  improper  food. 
(2)  The  intestinal  tract  is  so  nearly,  if  not  al- 
ways, the  seat  of  the  pathological  process  that  a 
thorough  cleaning  out  may,  in  general,  precede 
other  diagnostic  endeavor. 

SIGNS  AND  SYMPTOMS  OF  ONCOMING 
INFECTIONS 

Loss  of  appetite  and  interest  in  play,  with 
unusual  irritability  and  otherwise  unexplained 
fatigue,  are  commonly  signs  of  approaching  ill- 
ness, rather  than  of  original  sin.  However,  the 
onset  of  an  infectious  process  in  the  child  is  fre- 
quently characterized  by  sharply  defined,  often 
alarming  symptoms. 

Fever. — Fever,  sudden  in  onset  and  of  high 
degree,  often  marks  the  beginning  of  illness 
which,  after  the  passage  of  a few  hours,  proves 
to  be  of  little  moment.  Not  infrequently  a fever 
of  104  degrees  has  fallen  to  a moderate  degree  or 
to  normal  the  next  day  and  only  a “head  cold”  is 
the  evident  diagnosis. 

Fever  is  evidence  of  infection,  with  two  excep- 
tions : the  dehydration  fever,  due  to  severe  water 
deprivation  or  loss,  and  the  allergic  fever  result- 
ing from  severe  anaphylactic  reaction  in  highly 

* From  the  Baby  Hospital,  Oakland. 

* Read  before  the  Pediatrics  Section  of  the  California 
Medical  Association  at  the  fifty-eighth  Annual  Session, 
Coronado,  May  6-9,  1929. 


February,  1930 


RESPIRATORY  INFECTIONS  IN  CHILDREN — SWEET 


75 


susceptible  individuals.  In  most  cases  infection 
is  the  cause  of  a febrile  response,  and  in  children 
the  area  most  often  invaded  is  the  upper  respira- 
tory tract. 

Vomiting. — Vomiting,  another  common  symp- 
tom of  infection  is  so  frequently  present  that  at- 
tention is  focused  on  the  digestive  tract.  With 
his  attention  so  directed,  the  physician  is  easily 
settled  into  a conviction  that  the  difficulty  lies  in 
the  alimentary  system.  Often  this  conviction  is 
evidently  confirmed  by  the  appearance  in  the 
vomitus  of  food  eaten  many  hours  previously,  and 
if,  in  addition,  the  not  infrequent  fall  in  tempera- 
ture mentioned  above  occurs  after  the  adminis- 
tration of  a cathartic,  the  case  for  the  digestive 
system  seems  to  be  so  evidently  won  that  further 
diagnostic  search  seems  to  be  wasted  effort. 

Vomiting  plays  so  prominent  a part  in  all  diffi- 
culties that  have  their  seat  within  the  digestive 
tract  that  one  does  well  to  use  all  skill  and  care 
in  the  detection  of  any  pathological  process  so 
situated.  One  who  fails  to  think  of  appendicitis, 
intussusception  and,  in  very  young  infants,  of 
congenital  pyloric  stenosis,  will  in  the  course  of 
years  commit  diagnostic  oversights  of  grave  or 
even  fatal  moment. 

Rectal  examination  whenever  palpation  of  the 
abdomen  has  aroused  even  slight  suspicion  should 
be  a common  diagnostic  procedure.  Only  fre- 
quent careful  rectal  examinations  bring  the  acu- 
men of  the  examiner  to  a highly  trustworthy  state 
of  perfection. 

Food  idiosyncrasy  on  an  allergic  basis  is  of 
sufficiently  frequent  occurrence  as  a cause  of 
vomiting  not  to  be  lost  sight  of.  The  presence  of 
or  history  of  other  allergic  signs  and  symptoms 
such  as  hives,  eczema,  asthma,  as  well  as  the  usual 
absence  of  fever,  are  of  considerable  value  as  evi- 
dence of  this  state. 

Still  more  rarely  actual  food  poisoning  from 
decayed  or  infected  foodstuffs  needs  to  be  given 
thought.  With  improved  inspection  and  care  of 
foods  this  is  a constantly  diminishing  cause  of 
illness. 

After  all  these  causes  for  vomiting  have  been 
summed  up  there  remains  by  far  the  most  fre- 
quent cause,  i.  e.,  the  vomiting  which  is  a part 
of  a systemic  response  to  a toxic  invasion  from 
a seat  of  infection  located  most  frequently  in  the 
upper  respiratory  system.  Urinary  tract  infec- 
tion, osteomyelitis,  or  other  infection  may,  of 
course,  produce  an  identical  response  to  the  ab- 
sorption of  bacterial  toxins.  The  mechanism  of 
this  response  may  well  be  explained  by  analogy. 
When  apomorphin  is  given  by  hypodermic  no 
anatomical  change  occurs  in  the  stomach,  but 
function  is  interfered  with  through  the  medium 
of  the  central  nervous  system. 

Acetonemic,  or  so-called  cyclic  vomiting,  is  in 
general  a response  to  the  invasion  of  bacterial 
toxins.  Since  the  upper  respiratory  tract  is,  in 
point  of  frequency,  by  far  the  most  usual  seat  of 
localized  infection,  here  again  it  plays  the  princi- 
pal role.  The  connection  between  the  respiratory 
tract  infection  and  the  onset  of  this  type  of  vomit- 


ing is  often  obscure.  The  infection  is  usually  of 
a low-grade  type,  producing  but  little  constitu- 
tional response  in  the  way  of  fever,  or  malaise, 
and  may  precede  or  follow  the  onset  of  vomiting 
by  such  a number  of  days  (often  two  or  three) 
that  the  direct  connection  between  the  two  is  lost 
sight  of.  However,  if  careful  observation  of  the 
upper  respiratory  tract  is  carried  out,  undoubted 
evidence  of  infection  of  the  pharynx,  middle  ears 
or  paranasal  sinuses  will  be  convincingly  ap- 
parent. Cessation  of  or  at  least  a marked  drop 
in  frequency  and  severity  of  attacks  of  aceto- 
nemic vomiting,  following  the  removal  of  tonsils 
and  adenoids  or  the  drainage  of  infected  antrums, 
is  also  strong  circumstantial  evidence  in  favor  of 
respiratory  tract  infection  being  the  chief  etio- 
logic  factor. 

In  acetonemic  vomiting  the  response  may  be 
in  part  an  anaphylactic  or  allergic  one,  at  least 
an  allergic  family  history  and  other  undoubted 
allergic  symptoms  are  sufficiently  often  present  to 
give  this  thought  a considerable  foundation. 

Diarrhea. — Diarrhea,  at  least  here  in  Califor- 
nia, is  also,  in  a large  majority  of  its  appearances, 
a functional  reaction  to  the  systemic  absorption 
of  bacterial  toxin.  In  considering  the  causes  of 
diarrhea,  one  must  remember : acute  pyogenic 
colitis  and  enteritis ; specific  infections,  such  as 
dysentery  and  typhoid,  which  localize  in  the  diges- 
tive tract ; food"  substances  which  act  as  irritants 
either  because  they  have  undergone  bacterial 
putrefaction  or  because  the  host  is  allergic  to 
them  or  because  they  are  unripe  or  otherwise  not 
properly  prepared  for  the  use  of  the  young  human 
being ; and  appendicitis,  which  may  cause  a pro- 
fuse watery  diarrhea,  especially  in  very  young 
children. 

After  giving  due  weight  to  all  other  causes, 
infection  outside  the  digestive  tract  remains  the 
most  frequent  cause  of  diarrhea  in  children,  as 
Marriott  and  Others  have  found. 

Convulsions. — Convulsions  not  infrequently  are 
a part  of  the  stormy  onset  of  acute  respiratory 
infection.  Here  the  bacterial  toxin  shows  the  re- 
sult of  its  attack  upon  the  central  nervous  system. 
The  question  arises,  is  the  convulsion  the  direct 
result  of  the  reaction  of  the  toxin  on  the  nervous 
system  or  does  the  toxin  so  disturb  the  heat 
regulatory  function  that  the  convulsion  is  pro- 
duced by  the  excessive  fever?  In  any  event  a 
high  degree  of  fever  usually  attends  convulsive 
attacks.  Reduction  of  the  fever  quiets  the  over- 
irritated nervous  system  and  the  most  certain 
method  of  preventing  the  onset  of  convulsions 
is  the  prompt  and  sufficient  use  of  hydrotherapy. 
Immersion  in  a deep,  warm  tub  bath  for  from 
twenty  to  thirty  minutes  or  the  use  of  a warm, 
wet  sheet  and  blanket  pack  for  one  hour  are  most 
useful.  The  fever  usually  falls  and  the  patient 
often  sleeps  quietly  for  hours.  That  these  meas- 
ures have  not  been  commonly  used  by  physicians 
is  indicated  by  the  surprise  and  fear  with  which 
their  recommendation  is  greeted  by  patients  who 
have  not  used  them  formerly.  An  ice  bag  on  the 
head  is  also  of  value  and,  in  extremely  high  fever. 


76 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


cold  sponging  may  be  necessary  in  order  to  reduce 
the  fever. 

A tendency  to  have  convulsions  is  more  marked 
in  some  individuals  than  in  others.  This  tendency 
is  not  infrequently  a familial  one,  following  the 
usually  observed  laws  of  heredity.  Again,  reason- 
ing by  analogy,  a certain  number  of  people  are 
susceptible  to  seasickness  while  others  succumb 
only  under  unusual  conditions.  However,  since 
the  degree  of  toxemia  necessary  to  produce  so 
marked  a reaction  as  convulsions  in  even  sus- 
ceptible individuals  must  be  considerable,  the 
digestive  tract  may  well  have  its  function  simul- 
taneously interfered  with.  Quite  often,  therefore, 
at  or  near  the  time  of  the  onset  of  convulsions, 
food  is  vomited  or  removed  from  the  stomach 
which  was  eaten  hours  previously.  Again  one  is 
tempted  to  ascribe  to  the  undigested  food  a causal 
role  in  relation  to  the  convulsion,  when,  in  reality, 
both  the  convulsion  and  the  failure  of  digestion 
to  make  its  normal  time  progress  are  the  result 
of  the  action  of  bacterial  toxins. 

The  contents  of  the  gastro-intestinal  tract  may 
become  infected  during  the  period  of  stagnation 
produced  by  bacterial  toxemia.  This  possibility  is 
lent  color  by  tbe  well-known  fact  that  urine,  held 
stagnant  within  the  urinary  tract  by  congenital  or 
induced  interference  with  normal  passage,  be- 
comes itself  the  seat  of  bacterial  growth  and 
reproduction.  While  this  possibility  must  be  ad- 
mitted, it  does  not  seem  to  deserve  too  great 
weight  in  one’s  search  for  the  cause  of  the  symp- 
toms under  consideration. 

In  the  first  place,  normal  peristaltic  progress 
is  interfered  with  strikingly  within  a short  period 
of  time.  That  bacterial  toxins  could  be  quickly 
produced  in  clean  food  materials  within  the  rela- 
tively sterile  upper  digestive  tract,  in  the  presence 
of  the  digestive  juices,  all  of  which  possess  con- 
siderable bactericidal  powers,  seems  very  improb- 
able. Secondly,  food  materials  that*  are  known  to 
be  infected  have  a very  marked  irritant  action,  on 
the  digestive  tract  producing,  not  stasis,  but  an 
unusually  severe  grade  of  vomiting  and  purging. 
Third,  the  mucosa  of  the  digestive  tract  and  its 
appendages  do  not  lend  themselves  readily  to 
generalized  bacterial  invasion,  and  when  localized 
infection  takes  place,  as  in  the  appendix,  symp- 
toms which  are  definite  and  unmistakable  arise. 
Likewise  when  an  inflammatory  or  ulcerative  coli- 
tis is  present,  evident  signs  of  its  presence  are 
seen  in  the  passage  of  mucus,  blood,  and  puru- 
lent material.  One  who  stands  often  at  the  post- 
mortem table  and  sees  the  healthy  appearance  of 
the  digestive  organs  and  the  frequent  presence  of 
pathologic  changes  in  the  upper  respiratory  pas- 
sages soon  learns  by  which  system  the  burden  of 
infection  has  been  borne.  In  addition,  the  most 
important  evidence,  lending  itself  to  objective 
demonstration,  if  careful  search  be  made,  is  the 
presence  of  localized  reaction  to  bacterial  invasion 
within  the  visible  portion  of  the  upper  respira- 
tory tract. 

Abdominal  Pain. — Abdominal  pain  is  a very 
common  symptom  of  upper  respiratory  tract  in- 
fection. Many  children  with  tonsillitis  make  no 


complaint  of  the  throat,  but  complain  insistently 
of  abdominal  pain  or  discomfort.  I have  no  exact 
explanation  to  offer  for  this  frequently  observed 
fact.  Brenneman  has  studied  this  symptom  and 
wisely  observes  that  its  cause  must  be  carefully 
worked  out  each  time  it  occurs  and  no  conclu- 
sion reached  by  snap  judgment. 

Allergic  Outbreaks. — The  careful  observer  of 
the  upper  respiratory  tract  cannot  long  doubt  that 
infection  in  this  region  is  a very  important  factor 
in  allergic  outbreaks  such  as  attacks  of  asthma, 
eczema,  hives,  and  urticaria.  The  mother  of  the 
asthmatic  child  volunteers  the  information  that 
attacks  are  ushered  in  by  a cold  almost  uniformly. 
The  upper  respiratory  tract  infection  in  this  in- 
stance is  not  the  cause  of  the  allergic  response, 
but  merely,  if  you  please,  “opens  the  door”  allow- 
ing a protein  invasion  to  overflow  or  break  down 
the  patient’s  threshold  of  allergic  resistance. 

IMPORTANCE  OF  RESPIRATORY  INFECTIONS 
IN  CHILDHOOD 

That  the  importance  of  upper  respiratory  tract 
infection  in  childrood  is  not  sufficiently  appreci- 
ated my  experience  teaches  me.  This  experience 
has  been  gathered : First,  in  an  active  practice 
extending  over  several  years  in  two  representative 
California  communities.  Second,  from  the  teach- 
ing of  interns  who  are  recent  graduates  of 
Class  A medical  schools  quite  representative  of 
the  entire  United  States.  These  young  physicians 
may  be  assumed  to  reflect,  without  too  great  dis- 
tortion, the  teachings  of  their  respective  schools. 
Third,  from  an  active  clinic  practice  which  is  the 
most  certain  measure  of  the  current  medical  ideas 
of  the  community  in  which  one  works,  as  the 
clinic  patients  come  out  of  the  practices  of  the 
entire  medical  fraternity,  reflecting,  in  the  mass, 
the  medical  teaching  to  which  they  have  been  sub- 
jected. Fourth,  from  a sustained  interest  in  the 
study  of  medicine  which  causes  me  to  exchange 
ideas  with  physicians  wherever  we  may  meet. 

My  experience  is  illustrated  by  the  family  phy- 
sician who,  during  the  course  of  taking  the  pa- 
tient’s history,  roundly  scolded  the  mother  for 
allowing  the  child  to  partake  of  ice  cream  and  a 
ripe  banana  (both  wholesome  foods)  several  days 
previously;  thereby  placing  the  entire  blame  for 
the  illness  upon  the  mother  and  the  child’s  gastro- 
intestinal tract.  The  demonstration  of  an  exten- 
sive bronchial  pneumonia  and  a bilateral  purulent 
otitis  media  made  it  difficult  to  maintain  the 
mother’s  confidence  in  that  physician.  Another 
physician  stated,  in  the  parents’  presence,  “We 
are  dealing  with  nothing  but  an  intestinal  infec- 
tion, and  during  each  of  the  past  fifteen  days  the 
fever  has  been  reduced  within  twelve  hours  by 
a dose  of  castor  oil  and  an  enema.”  The  presence 
of  a bronchial  pneumonia,  with  its  usual  tem- 
perature curve  made  some  embarrassing  moments 
for  all  of  us.  I hasten  to  add  that  both  these 
physicians  are  skillful,  reputable  members  of  our 
profession  whom  I hope  I possess  as  friends,  who 
bad  failed  in  making  a diagnosis  because  the 


February,  1930 


RESPIRATORY  INFECTIONS  IN  CHILDREN — SWEET 


77 


major  part  of  their  attention  had  been  focused 
upon  the  intestinal  tract. 

My  teaching  experience  with  interns  is  illus- 
trated by  the  frank  doubt  with  which  they,  one 
and  all,  first  receive  the  statement  that  the  gastro- 
intestinal upsets  of  children  are  nearly,  if  not  all, 
brought  about  by  demonstrable  localized  respira- 
tory tract  infection.  At  ward  rounds,  when  the 
question  is  asked  “Why  is  this  child  vomiting? 
Why  has  he  a diarrhea?  or  Why  has  he  had  con- 
vulsions ?”  the  answer  has  been,  “He  has  eaten 
something  which  has  disagreed  with  him  or  his 
mother  has  fed  him  wrongly.”  Only  after  many 
cases  have  been  studied  and  he  has  had  an  oppor- 
tunity to  see  develop  an  acute  follicular  tonsillitis, 
a pharyngitis,  a purulent  otitis  media,  or  a sinusi- 
tis, does  he  come  to  believe  that  food  does  not 
usually  cause  these  symptoms.  Then  in  tones  of 
self-confident  assurance  he  heads  his  list  of  causes 
with  “an  acute  infection,  usually  of  the  upper 
respiratory  tract.” 

The  acute  upper  respiratory  tract  infection  is 
overlooked  because  it  does  not  occupy  its  deserved 
place  of  importance  in  the  mind  of  the  physician. 

EXAMINATION  METHODS 

If  the  upper  respiratory  tract  is  to  be  exam- 
ined in  anything  like  sufficient  detail,  an  adequate 
source  of  light  must  be  used.  Only  under  un- 
usually favorable  circumstances  can  daylight  be 
used  for  examination  of  the  throat,  not  to  men- 
tion the  ear  and  nose.  Only  with  the  head  mirror 
or  especially  lighted  instruments  can  anyone  con- 
sistently make  the  detailed  examination  which  is 
necessary  for  accurate  diagnosis. 

The  sudden,  stormy  onset  of  infection  in  the 
child  causes  the  physician  to  be  called  early  in 
the  illness.  Therefore  the  patient  is  seen  before 
localized  pathologic  changes  have  taken  place. 
A throat  apparently  normal  today  will  have  the 
typical  and  unmistakable  appearance  of  a florid 
follicular  tonsillitis  tomorrow,  at  which  time  the 
temperature  may  be  normal  and  the  child  reported 
“much  better.”  The  follicles  of  the  tonsils  are 
outlined  by  and  filled  with  sloughed  material. 
Hours  are  necessary  for  the  organization  of  this 
slough. 

On  the  other  hand,  the  localizing  signs  may 
disappear  from  the  throat  long  before  the  other 
symptoms  have  subsided.  Rarely,  however,  is  tell- 
tale evidence  of  the  true  nature  of  the  difficulty 
lacking  if  the  throat,  nose,  and  especially  the  ears, 
are  carefully  examined.  The  ear-drums  often  re- 
main discolored  or  injected  for  days  after  an 
acute  infection  and  almost  always  become  injected 
before  its  course  is  run.  It  has  been  said  that 
“The  eye  is  the  window  of  the  soul.”  It  may  be 
said  with  more  abstract  truth  that  the  ear-drum 
is  the  screen  upon  which  is  pictured  the  state  of 
the  mucous  membranes  of  the  accessory  cavities 
of  the  upper  respiratory  system. 

Every  child  should  have  frequent  complete 
physical  examinations.  While  the  time-honored 
custom  of  emptying  his  digestive  tract  has  its 
place  in  therapeutic  procedure,  it  should  not  pre- 
cede the  examination  and  under  no  circumstance 


should  it  serve  as  a substitute  for  careful  physical 
examination. 

The  upset  stomach  is  a symptom  and  should 
not  be  elevated  to  the  dignified  level  of  a care- 
fully arrived  at  diagnosis.  The  Irishman  who  had 
never  seen  a horse  was  puzzled  which  to  put 
first — the  horse  or  the  cart.  Infection  is  the  horse, 
and  disturbed  function  of  the  digestive  tract,  or 
nervous  system,  is  the  cart  and  follows  after. 

SUMMARY 

Acute  infections,  the  area  of  invasion  being 
usually  within  the  upper  respiratory  tract,  are 
responsible  for  many  departures  from  a healthy 
state  in  children.  Loss  of  appetite,  fever,  vomit- 
ing, diarrhea,  abdominal  pain,  and  convulsions  are 
usual  symptoms  and  signs  of  such  acute  infec- 
tion. This  view,  kept  in  the  foreground  of  the 
physician’s  mind,  will  enable  him  to  practice 
medicine  more  successfully  and  so  make  his  com- 
munity a better  one  for  children  to  live  in. 

242  Moss  Avenue. 

DISCUSSION 

Donald  K.  Woods,  M.  D.  (El  Prado  Comercial, 
Fifth  and  Laurel,  San  Diego). — Doctor  Sweet’s  paper 
strikes  the  keynote  in  the  more  advanced  thought  in 
connection  with  disease  in  childhood.  In  talking  to 
any  group  interested  in  children,  it  would  seem  im- 
possible to  put  too  great  an  emphasis  on  the  symp- 
toms pointing  to  infections  of  the  respiratory  tract. 

Practically  all  disease  in  children,  as  we  see  it  in 
private  practice,  is  located  in  the  upper  respiratory 
or  gastro-intestinal  tract.  I believe  most  authorities 
today  feel  that  the  majority  of  gastro-intestinal  upsets 
are  due  primarily  to  upper  respiratory  infection,  thus 
leaving  upper  respiratory  tract  infections  as  the  out- 
standing source  of  practically  all  illness  in  childhood. 
Therefore  early  recognition  and  active  treatment  of 
these  infections,  particularly  those  of  a mild  nature, 
would  greatly  reduce  the  incidence  of  disease  in  child- 
hood. 

Discharging  nostrils,  especially  chronic,  often  mean 
an  infected  sinus  or  large  infected  adenoids.  The 
nonrecognition  or  disregard  of  these  mild  chronic 
or  subacute  symptoms  often  leads  to  more  serious 
troubles  in  sinuses,  cervical  glands,  mastoids,  lungs, 
heart,  kidneys,  or  colon.  Desire  for  fluids  is  often 
mistaken  for  desire  for  food  in  the  early  stages  of 
acute  respiratory  infections.  The  child  is,  therefore, 
often  overfed,  especially  with  milk,  and  the  gastro- 
intestinal indisposition  added  to  the  original  infection. 

Practically  all  children  who  die  of  different  affec- 
tions in  hospitals  or  foundling  asylums,  show  foci  of 
bronchopneumonia  in  the  lungs.  Most  of  these  fatal 
cases  possibly  started  with  mild  infections  which  were 
not  considered  important.  The  onset  of  the.  illness 
was  only  dated  from  the  time  when  the  condition  of 
the  patient  had  become  serious.  The  original  infec- 
tion in  most  of  these  cases  was  overlooked.  Many 
cases  such  as  these,  with  possibly  serious  or  fatal 
termination,  will  be  avoided  by  early  attention  to  mild 
symptoms  of  infection  in  the  upper  respiratory  tract. 

However,  we  must  not  entirely  overlook  the  possi- 
bility of  allergic  reactions.  I believe  that  the  lowered 
resistance  of  many  children,  due  to  varying  phases  of 
protein  sensitivity,  makes  it  possible  for  otherwise 
harmless  infections  to  develop. 

It  is  very  possible  that  many  cases  showing  symp- 
toms of  upper  respiratory  infection  were  primarily 
such,  but  I believe  a great  many  start  with  gastro- 
intestinal upsets  due  to  constant  contact  with  pro- 
teins to  which  the  individual  is  sensitized.  In  all  of 
these  cases  we  should  not  be  satisfied  with  the  symp- 
toms whether  they  apparently  arise  in  the  intestinal 
tract  or  the  upper  respiratory,  but,  as  Doctor  Sweet 


78 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


indicates,  we  'should  be  more  careful  in  our  search 
for  the  true  underlying  cause  of  the  symptoms  which 
present  themselves. 

* 

Andrew  J.  Thornton,  M.  D.  (3235  Fourth  Street, 
San  Diego). — This  paper  deals  with  the  practical  side 
of  our  everyday  practice. 

Doctor  Sweet  has  emphasized  many  times,  in  fact, 
the  whole  paper  seems  to  be  constructed  around  the 
idea  that  infection  is  the  great  cause  of  illness  in 
children,  and  as  a rule  not  errors  in  diet. 

We  have  all  been  told  many  times  that  the  vast 
majority  of  infections  in  children  begin  in  the  upper 
respiratory  tract.  But  we  need  to  be  reminded  of  this 
fact  frequently  lest  we  lapse  back  into  the  rut  of 
thinking  that  possibly  food  or  teeth  are  responsible 
for  the  stomach  upset  or  fever  in  a child. 

Mothers  and  fathers  like  to  hear  the  doctor  say 
that  food  has  upset  the  baby  because  that  is  what 
they  think  has  caused  the  trouble  and  they  are  pleased 
to  have  someone  agree  with  them. 

Diagnosis  in  children  requires  industry  and  alert- 
ness. One  does  not  often  get  by  with  a guessed  diag- 
nosis because  mothers  are  rapidly  becoming  accus- 
tomed to  thorough  examination  and  careful  attention 
to  every  detail  of  treatment  by  the  pediatrist  and  his 
efficient  office  force. 

If  the  cases  are  seen  early  there  may  be  very  little 
or  no  evidence  in  the  throat,  ears,  or  nose  of  the 
infection,  yet  if  the  child  has  fever  and  has  vomited, 
or  has  had  a convulsion,  the  doctor  knows  there  is 
an  infection  causing  the  trouble.  It  may  be  twenty- 
four  hours  or  even  more  before  the  throat  is  very  red 
or  the  tonsils  swollen. 

In  cases  of  pyelitis  in  babies  we  may  never  find 
any  other  symptom  than  fever,  yet  how  frequently  we 
see  such  patients  with  a history  of  repeated  attacks 
in  whom  so-called  biliousness  and  the  gastro-intestinal 
tract  were  blamed  for  the  whole  trouble. 

If  the  doctor  does  not  find  sufficient  evidence  for 
a definite  diagnosis  after  one  or  two  examinations, 
let  him  frankly  say  that  he  has  not  yet  found  the 
cause  of  the  symptoms  or,  if  he  feels  that  the  type  of 
parent  requires  a definite  statement,  let  him  place 
the  blame  on  the  upper  respiratory  tract  rather  than 
on  the  gastro-intestinal  tract  and  errors  in  diet. 

AL 

rtr 

Harold  K.  Faber,  M.  D.  (Stanford  University  Hos- 
pital, San  Francisco).- — Doctor  Sweet  is  right — and 
performs  a valuable  service  to  the  medical  profession 
in  calling  attention  to  the  fact — in  insisting  on  the 
relative  infrequency  of  primary  acute  digestive  dis- 
orders in  children  and  the  vastly  greater  frequency  of 
infections,  usually  upper  respiratory,  with  secondary 
digestive  symptoms.  The  fault — as  with  the  still  older 
and  now  less  tenaciously  held  fear  of  the  dangers  of 
teething — really  lies  with  the  pediatric  teaching  of  a 
generation  or  less  ago.  The  cornerstone  of  instruction 
in  children’s  diseases  up  to  comparatively  recent  times 
was  the  gastro-intestinal  tract,  which  was  firmly  be- 
lieved to  be  the  basis  of  most  juvenile  complaints.  It 
has  taken  pediatricians  a long  time  to  appreciate  that 
such  a view  is  not  in  consonance  with  the  facts. 
Meantime  it  has  become  firmly  fixed  in  the  lay  mind. 
The  medical  man,  therefore,  finds  it  only  too  easy  to 
satisfy  the  mother  with  the  diagnosis  of  “stomach 
upset”  and  a prescription  of  castor  oil,  and  is  himself 
too  apt  to  be  content  with  such  an  explanation  and 
treatment  of  symptoms. 

Doctor  Sweet's  paper  is  of  great  practical  impor- 
tance not  only  to  the  general  practitioner,  but  also 
to  those  who  are  responsible  for  the  education  of 
medical  students,  and  of  the  lay  public  in  medical 
matters. 


HEART  DISEASE — ITS  MODERN  DIAGNOSIS* 

By  L.  E.  Viko,  M.  D. 

Salt  Lake  City,  Utah 

HPHIS  paper  does  not  attempt  a complete  sum- 
^ mary  of  the  modern  diagnosis  of  heart  disease, 
but  rather  tries  to  evaluate  certain  of  the  means 
of  diagnosis,  to  suggest  sources  of  error  and  to 
indicate  some  of  the  differences  between  our  pres- 
ent ideas  and  those  of  the  past.  The  opinions 
expressed  are  based  partly  upon  observations 
made  in  some  American  and  European  clinics  and 
partly  upon  an  analysis  of  seven  hundred  of  our 
own  cases.  With  regard  to  the  latter  material,  I 
shall  avoid  statistics,  which  are  merely  one  means 
of  expressing  conclusions.  Such  a case  analysis 
justifies  itself  in  clarifying  one’s  own  ideas,  too 
often  based  on  a few  outstanding  cases,  forgetful 
of  the  many  others.  Also  it  calls  to  mind  errors 
made  in  diagnosis  or  prognosis — errors  revealed 
by  time  or  more  careful  examination,  errors  that 
one  subconsciously  wishes  to  forget. 

HISTORY  OF  DIAGNOSTIC  PROGRESS 

Today,  the  word  “diagnosis”  as  applied  to  heart 
disease  demands  much  more  than  formerly.  That 
we  may  better  appreciate  the  meaning  of  cardiac 
diagnosis,  let  me  digress  for  a moment  to  the 
development  of  our  present  knowledge  of  heart 
disease.  It  will  be  recalled  that  before  Galen,  in 
the  second  century  after  Christ,  little  was  known 
even  of  the  anatomy  of  the  heart  or  circulation; 
heart  disease  was  an  unknown  quantity.  From 
the  second  to  the  seventeenth  century,  great  anat- 
omists, such  as  Galen,  Vesalius,  Leonardo  da 
Vinci,  and  Eustachius,  dissected  the  human  body 
and  described  the  heart  and  blood  vessels.  But 
still,  heart  disease  remained  unknown  except  for 
an  occasional  description  by  the  anatomist,  of  ab- 
normalities observed  in  an  excised  heart.  The 
course  of  the  circulation,  too,  remained  unknown 
until  the  great  work  of  Harvey  in  1628.  With 
the  discovery  of  the  capillary  circulation  by  Mal- 
pighi and  Van  Leeuwenhoek  an  understanding  of 
the  circulation  was  possible.  Following  them 
came  the  age  of  the  pathologists  and  the  begin- 
nings of  cardiac  diagnosis.  At  autopsies  patholo- 
gists recognized  abnormalities  of  the  heart  muscle, 
cavities,  or  valves,  and  assumed  these  to  be  the 
cause  of  death.  With  the  discovery  of  percussion 
by  Auenbruggers  in  1750  and  of  auscultation  by 
Laennec  in  1819,  clinicians  secured  means  for 
recognizing  certain  physical  signs  in  their  patients 
and  correlating  these  with  the  autopsy  findings. 
But  still  the  diagnosis  was  entirely  an  anatomic 
one,  a prediction  of  the  pathologic  findings  ex- 
pected after  death.  Just  as  little  was  known  of 
the  physiology  of  the  normal  or  abnormal  heart 
or  circulation,  so  the  cardiac  diagnosis  failed  to 
express  the  functional  or  physiologic  capacity  of 
the  heart  of  the  living  patient. 

The  beginning  of  our  present  century  brought 
us  knowledge  of  the  mechanism  of  the  normal  and 


* Read  before  the  Utah  County  Medical  Society,  Octo- 
ber 9,  1929. 


February,  1930 


MODERN  DIAGNOSIS  OF  HEART  DISEASE — VIKO 


79 


abnormal  heart  and  the  physiology  of  the  circu- 
lation. The  work  of  Mackenzie,  Lewis,  Wencke- 
bach. Peabody,  and  others  taught  us  to  ask  first, 
not  “What  does  the  heart  look  like?”  but  “What 
is  the  heart  doing?”  We  began  to  understand 
cardiac  decompensation,  and  it  became  necessary 
to  include  in  our  diagnosis  heart  function  as  well 
as  anatomic  change. 

But  as  we  recognized  the  hopelessness  of  chang- 
ing the  stenosis  of  the  valve  or  reducing  hyper- 
trophy of  heart  muscle,  and  as  we  saw  the  inade- 
quacy of  our  therapeusis  to  restore  the  normal 
function  of  the  heart,  we  sought  clearer  knowl- 
edge of  the  causes  of  heart  disease,  hoping  to  find 
means  of  preventing  or  arresting  it. 

MODERN-DAY  DIAGNOSIS 

So  today  a complete  diagnosis  demands  a state- 
ment of  its  etiology,  the  structural  changes,  and 
the  physiology  and  function  of  the  heart.  How- 
ever incomplete  our  present  knowledge  of  the 
causes  of  heart  disease,  too  much  stress  cannot 
be  laid  upon  the  importance  of  such  etiology  as 
there  lies  our  best  hope  for  the  individual  patient 
and  the  advancement  of  cardiology. 

In  conformity  with  this  modern  concept  of  the 
proper  diagnosis  of  heart  disease,  the  American 
Heart  Association  has  adopted  a new  classifi- 
cation. With  minor  modifications  1 this  has  been 
accepted  by  most  cardiologists  and  cardiac  clinics 
in  the  United  States  and  by  the  medical  depart- 
ments of  the  Army  and  Navy.  Its  increasing  use 
has  aided  in  the  collection  of  data.  Its  various 
headings  need  little  explanation.  It  stresses  the 
inadequacy  of  such  diagnoses  as  “aortic  regurgi- 
tation” unless  the  cause  of  the  valve  defect  and 
the  function  of  the  heart  be  added  or  a diagnosis 
of  “cardiac  decompensation”  unless  the  etiology 
and  structural  changes  be  included.  It  is,  of 
course,  obvious  that  in  some  patients  more  than 
one  cause  may  be  operative,  as  in  the  patient  with 
rheumatic  mitral  stenosis  who  develops  hyperthy- 
roidism. The  structural  lesion  present  may  indi- 
cate the  etiology,  as  in  the  case  of  mitral  stenosis 
which  is  nearly  always  rheumatic  in  origin.  Or 
the  etiology  may  predict  the  structural  changes, 
as  in  the  syphilitic  type  of  disease.  The  group 
labeled  “etiology  unknown”  is  important  in  em- 
phasizing that  it  is  preferable  to  so  state  and  thus 
keep  searching  for  a cause  rather  than  to  simply 
note  the  anatomic  lesion  and  consider  the  case  a 
closed  book. 

The  group  of  cases  associated  with  general 
systemic  disease  includes  a number  of  more  or 
less  distinct  etiologic  types  corresponding  in  gen- 
eral to  the  old  term  “chronic  myocarditis.”  This 
latter  term  is  being  gradually  discarded  as  insuffi- 
ciently explanatory  and  pathologically  incorrect. 
As  Christian,  who  has  championed  the  phrase, 
points  out 2 there  may,  even  microscopically,  be 
no  inflammation  of  the  heart  muscle. 

The  relative  frequency  of  the  different  etiologic 
types  varies  in  different  parts  of  the  world  and 
even  in  different  sections  of  our  own  country.  In 
this  Rocky  Mountain  area,  as  in  most  of  the 


Table  1. — Etiology  of  Heart  Disease 


New 

Utah 

England 

Virginia 

700  cases  3000  cases 

300  cases 

Rheumatic  

42.27% 

31.8% 

21.98% 

Arteriosclerotic  

21.57% 

28.8% 

45.66% 

Hypertensive  

..  ..13.13% 

23.6% 

45.98% 

Hyperthyroid  

9.13% 

2.26% 

3.66% 

Syphilitic  

85% 

3.18% 

11.0% 

Unknown  etiology  

6.14% 

2.7% 

2.33% 

Hypothyroid  

....  .14% 

0.02% 

Subacute  bacterial  endocarditis  .28% 

1.5% 

Acute  bacterial  endocarditis. 

14% 

1.0% 

Congenital  

......  .86% 

1.2% 

Toxic  

43% 

.13% 

Anemic  

28% 

.05% 

9.33% 

Angina  pectoris  

S.4% 

11.7% 

Coronary  occlusion  

28% 

2.3% 

Auricular  fibrillation  

8.7% 

12.5% 

Not 

Cardiac  neurosis  

13.85% 

10.1%  considered 

Note:  Some  cases  in  each  group  have  more  than  one 
etiology. 

northern  United  States,  the  rheumatic  is  the  most 
numerous  group.  It  appears  from  my  figures  that 
it  is  even  more  frequent  than  in  Boston  or  Vir- 
ginia. In  such  a semi-southern  state  as  Virginia  3 
it  is  considerably  less  frequent  than  in  New  Eng- 
land,4 and  if  one  goes  about  the  wards  of  the 
Charite  Hospital  in  New  Orleans,  one  sees  a pre- 
ponderance of  syphilitic  cases  over  rheumatic.  In 
this  connection,  I was  told  by  a physician  prac- 
ticing in  Central  Africa  that  there  rheumatic 
fever  and  rheumatic  heart  disease  are  infrequent. 
In  this  Rocky  Mountain  area  it  appears  that  the 
thyroid  type  is  relatively  frequent  and  the  syphi- 
litic type  infrequent. 

PROCEDURES  IN  DIAGNOSIS 

In  discussing  the  method  of  diagnosis  of  a 
given  case,  I wish  to  consider  principally  those 
procedures  most  frequently  neglected  with  result- 
ant error  or  those  regarding  which  present-day 
opinion  differs  from  that  of  the  past.  For  sim- 
plicity’s sake  let  us  follow  the  patient  through  the 
logical  order  of  examination. 

In  the  first  place,  we  observe  the  approaching 
patient  and,  if  we  have  seeing  eyes,  can  learn 
much  before  a word  has  been  spoken.  Physicians 
of  the  older  generation  are  often  better  observers 
than  those  of  the  younger  generation  with  the 
overemphasis  in  their  training  of  laboratory  pro- 
cedures. There  is  the  unsmiling  type  who  carries 
the  weight  of  the  world  on  her  shoulders,  usu- 
ally a neurotic ; the  thyroid  type  whose  knees  are 
never  still,  the  hypertensive  type  who  sits  on  the 
edge  of  the  chair  and  moves  as  if  in  response  to 
a starter’s  gun.  Even  in  the  acutely  ill,  the  gen- 
eral appearance  may  give  valuable  evidence  for 
or  against  a specific  cardiac  diagnosis.  A short 
time  ago  I saw  a patient  complaining  of  extremely 
severe  precordial  and  substernal  pain  unrelieved 
by  a quarter  grain  of  morphin  given  an  hour  be- 
fore. Of  course  one  thought  of  angina  pectoris 
or  coronary  artery  occlusion,  but  when  one  noted 
that  he  writhed  around  in  bed  and  even  got  up 
on  his  hands  and  knees,  one  felt  fairly  certain 
that  neither  of  these  could  be  the  diagnosis,  since 
in  either  the  patient  tends  to  remain  quiet — to 
splint  himself.  The  true  diagnosis  proved  to  be 
tabetic  crisis.  I do  not  mean  to  advocate  “snap- 


80 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


shot”  diagnosis,  but  to  suggest  that  the  use  of 
instruments  of  precision  need  not  preclude  the 
use  of  the  eyes. 

Then,  as  the  patient  tells  us  of  his  symptoms, 
we  try  to  find  the  circumstances,  psychic,  physical 
or  infectious,  preceding  their  onset.  The  elicita- 
tion of  psychic  trauma  preceding  onset  is  most 
difficult  but  exceedingly  important,  not  only  in 
leading  to  a diagnosis,  but  later  in  determining 
treatment.  Among  the  present  series  was  one,  all 
of  whose  symptoms  dated  from  a doctor’s  exami- 
nation, one  from  the  first  knowledge  of  her  hus- 
band’s infidelity  and,  of  course,  the  usual  ones 
due  to  war  experience. 

If  cardiac  disease  is  suspected,  the  patient  is 
likely  to  complain  of  dyspnea,  palpitation,  or  pre- 
cordial pain.  Not  only  must  we  determine  the 
conditions  producing  these  symptoms,  but  must 
realize  that  one  or  all  of  these  may  be  symptoms 
either  of  organic  cardiac  disease,  of  cardiac  neu- 
rosis, or  of  disease  entirely  apart  from  the  heart 
such  as  tuberculosis  or  anemia.  According  to  our 
records,  patients  without  any  diagnosable  heart 
disease  admit  dyspnea  almost  as  frequently  as  the 
cardiacs. 

In  the  minds  of  the  laity,  dizziness,  fainting,  or 
numbness  are  considered  symptoms  of  heart  dis- 
ease. As  a matter  of  fact,  in  young  people  these 
symptoms  are  seldom  truly  cardiac  but  rather 
result  from  neurosis  or  extracardiac  disease.5  In 
older  persons,  however,  they  may  be  significant. 


Table  2. — Symptoms  in  Three  Groups  of  Cases 


Valvular 

and 

Symptom 

Valvular 

Neurosis 

Neurosis 

100  cases 

50  cases 

23  cases 

Dyspnea  - 

62% 

76% 

91% 

Palpitation  

44% 

86% 

91% 

Precordial  pain  

20% 

52% 

52% 

Dizziness  

7% 

40% 

74% 

Fainting  

3% 

26% 

34% 

Numbness  or  tingling  ... 

4% 

18% 

48% 

As  we  bring  out 

these  and 

other  symptoms, 

we  must  observe  whether  the  patient  puts  them 
together  in  a logical  manner.  There  was  a girl, 
for  example,  who  had  been  diagnosed  as  having 
valvular  heart  disease.  The  history  showed  that 
she  could  dance  all  evening  without  dyspnea  or 
palpitation,  yet  in  the  home  slight  exertion  was 
said  to  produce  both.  Such  illogical  combinations 
should  cast  doubt  upon  the  presence  or  signifi- 
cance of  organic  cardiac  disease. 

The  most  difficult  symptom  to  evaluate  is  pre- 
cordial pain  in  persons  over  forty  years  of  age. 
Even  in  mild  degree  or  in  the  atypical  types 
where  all  the  pain  is  abdominal  rather  than  pre- 
cordial, it  may  be  the  only  symptom  of  angina 
pectoris  and  may  predict  a sudden  death.  Or 
precordial  pain  may  be  unrelated  to  the  heart 
but  rather  the  result  of  gastric  disease  or  other 
pathology.  Only  the  most  careful  description  of 
the  pain  and  the  fitting  of  the  symptom  to  phy- 
sical and  instrumental  examination  may  serve  to 
determine  its  significance. 

After  securing  such  a history  of  the  present  ill- 
ness, we  delve  into  the  past  history,  searching 


particularly  for  a cause  for  possible  heart  dis- 
ease : rheumatic  fever,  thyroid  disease,  syphilis, 
past  hypertension,  etc.  The  history  of  such  dis- 
ease will  later  give  point  to  our  physical  exami- 
nation. Finally  we  bring  out  any  other  facts  about 
the  patient’s  past  or  present  health.  Even  seem- 
ingly remote  symptoms,  apparently  unrelated  to 
the  heart,  may  give  the  clue  to  a correct  diag- 
nosis. The  cardiologist  who  is  only  a cardiologist 
might  easily  err  through  not  realizing  this  point. 
Let  me  illustrate. 

A woman  of  forty-one  was  referred  to  me  for 
heart  examination  with  particular  request  for 
x-ray  and  electrocardiographic  studies,  as  ordi- 
nary examination  left  the  nature  of  the  condition 
in  doubt.  For  eight  to  ten  months  she  had  com- 
plained of  weakness,  shortness  of  breath,  and 
periodic  blueness  of  the  lips  and  cheeks.  Except 
for  headaches  there  were  no  other  complaints,  and 
the  history  revealed  none  of  the  usual  causes  for 
heart  disease.  She  denied  taking  any  medicines  or 
drugs.  Examination  of  the  heart  revealed  no  ab- 
normality; it  was  noted  that  the  patient  breathed 
rapidly  at  rest  and  that  the  lips  and  cheeks  were 
slightly  bluish  in  color.  Exercise  or  deep  breath- 
ing caused  this  cyanosis  to  disappear.  As  the  only 
other  presenting  symptom,  inquiry  was  directed 
to  her  headaches  and,  after  some  questioning,  it 
appeared  that  to  relieve  them  she  had  been  taking 
bromoseltzer  for  months,  averaging  the  equivalent 
daily  of  five  to  forty  grains  of  acetanilid.  This 
she  had  not  thought  of  as  a medicine  or  drug. 
X-ray  and  electrocardiogram  were  unnecessary; 
all  symptoms  disappeared  a few  weeks  after  dis- 
continuance of  the  bromoseltzer. 

PHYSICAL  EXAMINATION 

We  proceed  to  the  physical  examination.  Not 
long  ago,  as  a relic  of  the  period  of  overemphasis 
of  auscultatory  signs,  it  was  too  commonly  the 
custom  to  immediately  use  the  stethoscope,  often 
through  a small  opening  in  the  shirt  or  through 
a layer  or  two  of  clothing.  Fortunately  the  day 
of  such  “vest-button  diagnosis”  is  past.  We  get 
the  patient’s  chest  uncovered  and  use  our  eyes 
first.  We  look  for  the  apex  impulse  and  abnormal 
pulsations  or  retractions.  With  the  patient  reclin- 
ing, we  observe  the  degree  of  filling  of  the  veins 
of  the  neck,  a simple  and  valuable  indication  of 
the  function  of  the  right  ventricle.  As  I check 
over  some  of  my  own  and  others’  mistakes,  I find 
failure  to  do  these  things  is  a fairly  frequent 
source  of  avoidable  errors. 

A few  years  ago  a man  of  fifty-nine,  applying 
for  insurance,  was  referred  to  me  by  the  home 
office  for  examination.  He  had  been  passed  by 
a capable  medical  examiner  as  a first-class  risk, 
but  a nonmedical  report  to  the  company  had  cast 
doubt  on  this.  As  is  usual  in  insurance  exami- 
nations, the  man  denied  all  cardiovascular  symp- 
toms. The  apex  impulse  was  in  the  ordinary  posi- 
tion; an  ordinarily  careful  examination  revealed 
no  murmurs  anywhere  over  the  cardiac  area. 
Except  for  accentuation  of  the  aortic  second 


February,  1930 


MODERN  DIAGNOSIS  OF  HEART  DISEASE — VIKO 


81 


sound,  the  heart  tones  were  of  normal  quality. 
There  was  no  palpable  thrill,  but  inspection  re- 
vealed a visible  pulsation  in  the  first  and  second 
left  interspaces,  and  careful  percussion  increased 
supracardiac  dullness.  With  these  findings  as  an 
indication,  a faint  aortic  regurgitant  murmur  was 
discovered.  There  was  no  murmur  over  the  an- 
eurysm. X-ray  confirmed  the  diagnosis  of  aortic 
aneurysm.  In  this  case  several  of  the  cardinal 
symptoms  were  lacking  and  inspection  of  the  chest 
was  the  procedure  that  led  to  diagnosis. 

By  careful  palpation  and  percussion  of  the 
heart  in  patients  who  do  not  have  too  thick  a chest 
wall  it  is  possible  to  determine  heart  size  with 
fair  accuracy.  Through  haste  or  carelessness 
these  procedures  are  often  neglected  and  error 
follows.  In  one  of  my  cases,  a woman  with  indefi- 
nite cardiac  history  and  symptoms,  good  heart 
sounds  and  no  murmurs,  I failed  to  recognize  the 
presence  of  heart  disease  before  an  x-ray  exami- 
nation at  a later  date  revealed  the  trouble.  She 
was  one  of  those  women  who  are  resistant  to 
properly  uncovering  the  chest,  and  I had  per- 
cussed the  heart  outline  so  carelessly  I had  failed 
to  recognize  a considerable  degree  of  cardiac  en- 
largement. Not  long  ago  a young  man  was 
referred  as  having  an  acute  surgical  abdominal 
condition  because  the  physician  had  failed  to  out- 
line by  percussion  a massive  pericardial  effusion. 

At  last  our  magic  stethoscope  appears  and  we 
proceed  to  search  for  murmurs.  It  has  been  said 
that  the  invention  of  the  stethoscope  has  done 
more  harm  than  good  for  cardiac  diagnosis.  In 
watching  Sir  Thomas  Lewis  work  in  London  last 
year,  I noted  that  a large  percentage  of  his  diag- 
noses were  correctly  made  before  use  of  the 
stethoscope.  The  significance  of  the  various  mur- 
murs is  too  well  known  to  justify  discussion  here. 
Let  me,  however,  point  out  the  changing  attitude 
toward  systolic  murmurs  and  particularly  toward 
the  apical  so-called  mitral  systolic  murmur.  Sys- 
tolic murmurs  at  the  base  are  usually  functional. 
More  and  more  there  is  a tendency  to  disregard 
apical  systolic  murmurs  unless  associated  with 
the  diastolic  murmur  of  mitral  stenosis,  or  with 
enlargement  of  the  heart,  or  unless  they  follow 
recent  rheumatic  infection.  If  by  ignoring  many 
such  murmurs  we  miss  a few  cases  of  organic 
mitral  regurgitation,  such  lesions  are  usually  un- 
important and  we  do  not  do  as  much  harm  as  by 
producing  fear  disability  in  many  by  falsely  diag- 
nosing heart  disease  on  the  basis  only  of  a sys- 
tolic apical  murmur.  May  I illustrate  with  a case  ? 

A woman  of  thirty-five  had  been  helping  care 
for  a neighbor  suffering  from  heart  disease. 
Thinking  it  might  be  well  to  make  certain  of  her 
own  heart  she  went  to  a doctor  for  examination. 
Presumably  only  on  the  basis  of  a systolic  apical 
murmur,  she  was  informed  that  she  had  “leakage” 
and  was  advised  to  be  careful.  Following  this  she 
developed  dyspnea  and  palpitation  for  the  first 
time.  A month  or  so  later  the  neighbor  died  and 
the  patient’s  symptoms  became  more  pronounced. 
She  was  given  digitalis  without  improvement. 
Two  months  later  her  father  died  suddenly  of 
heart  disease.  The  patient  soon  became  so  dysp- 


neic  that  she  was  confined  to  bed.  At  the  time  I 
first  saw  her  she  was  certain  that  if  she  raised 
up  suddenly  in  bed  it  meant  sudden  death.  Each 
night  members  of  the  family  sat  up  with  her 
“waiting  for  the  end.”  She  had  no  organic  heart 
disease,  but  a cardiac  neurosis  suggested  by  a 
physician  and  accentuated  by  psychic  trauma.  She 
is  now  back  to  normal  activity. 

Richard  Cabot,  in  reviewing  1906  cardiac  cases 
found  at  autopsy,  reports  “seven  cases  of  that 
rare  condition,  mitral  regurgitation,6  emphasizing 
the  infrequency  of  this  lesion  as  an  isolated 
condition. 

From  the  contrary  point  of  view  many  patients 
with  serious  heart  disease  present  no  murmurs. 
In  Vienna  much  emphasis  is  still  laid  upon  auscul- 
tatory signs  and,  by  their  correlation  with  the 
abundant  autopsy  material,  surprisingly  accurate 
anatomic  diagnoses  are  made,  but  often  at  the 
expense  of  an  interest  in  the  more  important  func- 
tion of  the  heart. 

Finally,  we  do  a careful  general  physical  ex- 
amination to  make  sure  that  the  supposed  heart 
symptoms  are  not  due  to  some  condition  outside 
the  heart.  An  example  of  this  is  a recent  case, 
previously  diagnosed  as  heart  disease  unrelieved 
by  rest  and  digitalis.  Examination  showed  little 
or  no  evidence  of  heart  disease,  but  the  back  of 
the  lungs,  which  had  not  been  previously  exam- 
ined, showed  a massive  right  hydrothorax,  later 
proved  to  be  the  result  of  a mediastinal  tumor 
rather  than  heart  disease. 

OTHER  AIDS  IN  DIAGNOSIS 

Blood  pressure  and  urine  examinations  need  no 
comment.  But  our  diagnosis  may  still  be  in  doubt 
and  we  seek  the  aid  of  the  x-ray  and  electro- 
cardiograph. These  two  instrumental  aids  par- 
ticularly characterize  the  diagnostic  advancement 
of  our  own  century.  But,  like  all  instruments, 
they  may  be  misused  or  misinterpreted.  Of  course 
fewer  errors  would  be  made  if  all  cases  had  both 
x-ray  and  electrocardiographic  examination,  but 
in  general  practice  this  is  not  practical  because 
of  its  cost.  So  let  us  try  to  judge  just  what 
information  may  be  expected  from  these  pro- 
cedures. The  majority  of  cases  of  rheumatic 
valvular  heart  disease  can  be  sufficiently  accu- 
rately diagnosed  without  their  aid.  It  is  particu- 
larly in  heart  disease  of  doubtful  etiology  and  in 
heart  disease  associated  with  general  systemic  dis- 
ease— the  chronic  myocardial  type — that  these  in- 
struments are  of  value,  sometimes  indispensable. 

The  electrocardiograph,  like  most  instruments, 
has  gone  through  phases  of  overenthusiasm  and 
undervaluation,  and  is  only  gradually  assuming 
its  rightful  place.  It  records  the  electrical  phe- 
nomena associated  with  the  heart  beat.  It  deter- 
mines with  certainty  the  meaning  of  the  various 
types  of  abnormal  mechanism.  To  consider  only 
a few  of  its  practical  applications,  it  is  the  only 
certain  means  of  differentiating  between  such 
irregularities  as  auricular  fibrillation  from  pre- 
mature beats,  or  premature  beats  from  partial 
auriculoventricular  block  or  sinus  arrhythmia.  As 


82 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


the  treatment  is  different  in  these  different  irregu- 
larities and  the  prognostic  importance  of  each 
different,  their  distinction  is  an  important  and 
practical  one.  Likewise,  without  the  record,  it  is 
often  difficult  to  distinguish  between  the  three 
types  of  rapid  regular  hearts,  sino-auricular  tachy- 
cardia, auricular  flutter  and  paroxysmal  tachy- 
cardia, or  between  the  two  types  of  slow  regular 
hearts.  In  each  of  these  conditions  the  thera- 
peutic indication  is  different.  The  electrocardio- 
gram gives  useful  information  for  the  use  or 
avoidance  of  digitalis  and  serves  as  the  safest 
means  of  following  the  course  of  quinidin  ther- 
apy. Its  greatest  value,  however,  lies  in  the  evi- 
dence it  gives  of  myocardial  or  coronary  artery 
changes.  In  these  conditions  it  may  give  the 
first  or  only  evidence  of  disease  and  may  furnish 
valuable  prognostic  data.7  Intraventricular  block 
or  certain  T-wave  changes  have  a definite  sig- 
nificance. It  must,  however,  be  recalled  that  it 
is  possible  to  have  a normal  electrocardiogram 
despite  serious  heart  disease.  The  instrumental 
findings  are  not  a diagnosis  in  themselves,  but 
only  data  to  be  used  in  making  that  diagnosis. 

By  means  of  the  x-ray  we  may  determine  more 
accurately  the  size  and  shape  of  the  heart  outline 
and  get  reasonably  accurate  information  of  the 
relative  size  of  the  different  chambers  and  of  the 
aorta,  information  difficult  or  impossible  to  secure 
by  any  other  means.  Such  information  is  not 
often  necessary  in  rheumatic  valvular  disease  in 
persons  with  thin  chest  walls,  but  if  the  chest  wall 
is  thick,  or  if  aortic,  coronary  artery  or  myo- 
cardial disease  is  suspected,  the  x-ray  examina- 
tion may  be  indispensable.  Of  the  methods  of 
x-ray  examination,  fluoroscopy  is  the  most  valu- 
able. For  heart  measurements  it  should  be  supple- 
mented by  an  orthodiagram  or  a seven-foot  plate. 

When  all  our  data,  clinical  and  instrumental, 
have  been  assembled,  our  cardiac  diagnosis  will 
usually  be  evident.  Occasionally,  however,  despite 
every  possible  examination,  we  are  still  in  doubt 
whether  or  not  an  organic  lesion  of  the  heart 
exists.  In  such  cases  it  was  formerly  the  custom 
to  tell  the  patient  that  he  had  a slight  degree 
of  cardiac  disease,  consoling  ourselves  with  the 
thought  that  moderate  restriction  of  activity  would 
do  no  harm  if  it  did  no  good.  Today,  after  the 
Great  War  has  taught  us  the  frequency  and  dis- 
abling seriousness  of  cardiac  neurosis,  we  feel 
that  in  such  cases  it  is  better  to  keep  our  doubt 
to  ourselves  and  not  inform  the  patient  that  he 
has  heart  disease — to  give  the  heart  the  benefit  of 
our  diagnostic  doubt. 

Or  when  a positive  diagnosis  of  heart  disease 
has  been  made  we  should  ask  ourselves  if  this 
condition  explains  all  the  symptoms.  I recall  in 
this  connection  the  case  of  a woman  of  forty  who 
lay  in  bed  complaining  of  great  dypsnea,  extreme 
weakness  and  fear  of  imminent  death.  Exami- 
nation revealed  a markedly  enlarged  heart — heart 
disease  of  unknown  etiology,  but  there  was  no 
objective  evidence  of  congestive  or  anginal  failure. 
It  soon  became  apparent  that,  while  she  had  defi- 


nite organic  heart  disease,  most  of  her  symptoms 
were  due  to  a superimposed  anxiety  neurosis, 
which  fact  very  greatly  modified  the  treatment. 

Finally  we  come  to  the  question  of  the  func- 
tional capacity  of  the  heart  which  is  more  or  less 
synonymous  with  prognosis  and  upon  which  treat- 
ment depends  more  than  it  does  on  the  anatomic 
changes.  To  the  patient,  too,  the  outlook  is  of 
more  importance  than  is  some  valve  change  which 
he  does  not  understand. 

The  cause  of  the  heart  disease — the  etiologic 
type — has  great  bearing  on  the  prognosis.  Obvi- 
ously if  the  cause  can  be  removed,  as  in  thyroid 
heart  disease  or  certain  of  the  toxic  types,  the 
outlook  is  good.  Syphilitic  heart  disease  is  usually 
progressive  despite  antiluetic  treatment,  and  if 
congestive  failure  occurs,  it  is  not  likely  to  im- 
prove under  digitalization.  In  the  arteriosclerotic 
and  hypertensive  types  prognosis  depends  not 
only  upon  these  conditions,  but  upon  kidney  and 
blood-vessel  pathology. 

The  character  of  murmurs  seems  to  have  little 
bearing  on  function  or  prognosis.  Provided  that 
there  is  not  a thick  chest,  the  character  of  the 
heart  sounds  is  a fair  indication  of  prognosis. 
The  degree  of  cardiac  enlargement  is  perhaps  the 
most  valuable  single  clinical  sign  with  the  excep- 
tion of  the  arteriosclerotic  group,  where  enlarge- 
ment is  not  at  all  essential  for  a poor  outlook. 

Of  the  irregularities,  premature  beats,  as  re- 
cently shown  by  White  in  a large  series  of  cases, 
do  not  materially  modify  the  length  of  life  while 
auricular  fibrillation  definitely  shortens  life.  Ref- 
erence has  already  been  made  to  the  significance 
of  certain  types  of  heart  block  determined  by  the 
electrocard  iogram . 

Tests  of  function,  such  as  vital  capacity,  re- 
sponse of  blood  pressure  and  pulse  to  exercise, 
do  not  seem  as  useful  to  me  as  the  patient’s 
response  to  activities  more  nearly  approximating 
his  normal  mode  of  life. 

The  bearing  of  occupation  on  prognosis  is 
obvious. 

In  all  cardiacs  the  length  of  life  is  profoundly 
modified  by  acute  or  chronic  focal  infections  and 
his  ability  to  avoid  or  eliminate  them. 

Intermountain  Clinic. 

REFERENCES 

1.  Criteria  for  the  Classification  and  Diagnosis  of 
Heart  Disease.  Paul  B.  Hoeber,  1928. 

2.  Christian,  Henry:  Oxford  Monographs  on  Diag- 
nosis and  Treatment.  Volume  III.  Oxford  Univer- 
sity Press,  1928. 

3.  Wood,  T.  E.,  Jones,  T.  D.,  Kimbrough,  R.  D. : 
Am.  J.  M.  Sc.,  1926,  172,  185. 

4.  White,  P.  D.,  and  Jones,  T.  D.:  Am.  Heart.  J., 
1928,  3,  302. 

5.  Viko,  L.  E.:  Am.  Heart  J.,  1926,  1,  2. 

6.  Cabot,  Richard  C. : Facts  on  the  Heart,  1926. 
W.  B.  Saunders  Co. 

7.  White,  P.  D.,  and  Viko,  L.  E.:  Am.  J.  M.  Sc., 
1923,  165,  659. 


February,  1930 


BLOOD  PICTURE  IN  HODGKIN’S  DISEASE — FALCONER 


83 


TLIE  BLOOD  PICTURE  IN  HODGKIN’S 
DISEASE* * 

By  Ernest  H.  Falconer,  M.  D. 

San  Francisco 

Discussion  by  Ernest  S.  du  Bray,  M.D.,  San  Francisco ; 
John  J.  Sampson,  M.  D.,  San  Francisco;  Munford  Smith, 
M.D.,  Los  Angeles. 

QINCE  the  publication  of  Bunting’s  work  in 
^1911  1 and  1914, 2 analyzing  a series  of  blood 
counts  in  Hodgkin’s  disease,  our  interest  has  been 
directed  toward  the  importance  of  the  blood  pic- 
ture in  this  disease.  We  use  the  term  “Hodg- 
kin’s disease”  in  this  paper  instead  of  the  newer 
nomenclature  because  of  the  fact  that  long  usage 
distinguishes  this  disease  from  lymphosarcoma. 
Bunting’s  work  tended  to  show  that  it  is  possible 
to  divide  cases  of  Hodgkin’s  disease  into  two  dis- 
tinct groups,  according  to  the  differential  count 
of  the  leukocytes.  The  first  group,  consisting  of 
cases  of  one  year  or  less  duration,  showed  a 
normal  or  decreased  percentage  of  polymorpho- 
nuclear neutrophils.  The  second  group,  those 
cases  of  longer  than  one  year  duration,  showed 
a leukocytosis,  running  in  one  instance  to  100,000 
leukocytes  per  cubic  millimeter.  The  leukocytosis 
present  was  found  to  be  made  up  of  a neutro- 
philic percentage  between  72  and  90  per  cent. 
The  most  striking  feature  of  the  differential  count 
was  the  increase  in  the  transitional  leukocyte,  a 
large  mononuclear  cell  with  indented,  irregular 
nucleus  and  fine  azurophil  granulation  with 
Wright’s  stain.  These  cells  were  found  increased 
in  both  groups.  The  lymphocytes  might  be  in- 
creased in  the  very  early  cases,  but  tended  to  de- 
crease in  the  later  cases,  varying  from  7.6  to  3.4 
per  cent.  The  eosinophil  count  was  found  to  be 
variable,  never  high  except  in  rare  cases.  The 
basophils  were  increased  in  early  cases,  later 
tending  to  disappear  from  the  circulation.  Plate- 
lets were  always  increased  in  both  groups. 

The  analysis  in  this  report  is  patterned  after 
Bunting’s  analyses.  The  chief  reason  for  pub- 
lishing these  data  is  to  again  call  attention  to  the 
value  of  carefully  made  blood  counts  in  this  dis- 
ease and  to  emphasize  the  fact  that  an  increase 
in  the  eosinophilic  percentage  in  the  differential 
count  is  not  an  important  and  a constant  feature 
in  the  blood  picture.  Many  students  and  practi- 
tioners hold  this  idea,  apparently  having  been 
taught  it  at  some  time  in  their  careers.  There  are 
certain  exceptional  cases  of  Hodgkin’s  disease 
that  show  a remarkable  eosinophilia,  as,  for  ex- 
ample, the  following  case  from  the  male  medical 
ward  in  the  University  of  California  Hospital. 
An  average  of  ten  blood  counts  shows  this  com- 
posite leukocyte  and  differential  count : Red  cells, 
4,874,000 ; hemoglobin,  88.3  per  cent ; white  blood 
cells,  43,875;  polymorphonuclear  neutrophils,  14; 
polymorphonuclear  eosinophils,  65.5 ; polymor- 
phonuclear basophils,  1.2;  lymphocytes,  11.3;  and 

* From  the  Department  of  Medicine,  University  of  Cali- 
fornia Medical  School,  San  Francisco. 

* Read  before  the  General  Medicine  Section  of  the  Cali- 
fornia Medical  Association  at  the  fifty-eighth  annual 
session,  Coronado,  May  6-9,  1929. 


monocytes,  8.  One  or  two  of  the  differential 
counts  in  this  individual  showed  as  high  as  80  per 
cent  eosinophils.  There  was  an  extensive  eryth- 
ema and  infiltration  of  the  skin  in  this  patient. 

ANALYSIS  OF  TABLES 

An  analysis  of  Table  1 shows  twenty  cases  on 
whom  ninety-three  blood  counts  were  made. 
There  are  twenty-one  composite  counts  entered 
in  this  table,  but  Case  No.  26716  appears  twice, 
having  two  sets  of  blood  counts  in  two  different 
entries.  The  average  hemoglobin  and  average  red 
cell  count  for  the  group  shows  a moderate  second- 
ary anemia.  The  average  white  count  is  11,728, 
slightly  above  the  usual  normal,  but  still  within 
the  higher  limits  of  normal.  The  polymorphonu- 
clear eosinophil,  basophil,  and  lymphocyte  ratios 
are  within  normal  limits,  but  the  monocytes,  10.2 
per  cent,  are  increased.  The  large  mononuclear 
cell  and  the  transitional  are  grouped  together  in 
this  study  under  the  term  “monocytes.”  We  have 
been  unable  to  find  any  definite  criteria  to  differ- 
entiate between  these  two  types  of  cells,  so  we 
group  them  under  the  term  “monocyte.”  The 
normal  percentage  of  monocytes  is  taken  as  about 
6 to  8 per  cent  of  all  the  leukocytes. 

Table  2,  comprising  cases  of  more  than  one 
year’s  duration  and  up  to  thirteen  years,  in  one 
case  shows  an  average  white  cell  count  of  14,350 
white  cells  per  cubic  millimeter.  This  count  is  an 
average  of  eighty  counts  made  in  twenty  patients. 
In  this  group  it  will  be  noted  that  the  polymor- 
phonuclear ratio  averages  68.4  per  cent,  not  much 
higher  than  Table  1.  A few  cases  with  low  neu- 
trophil count  serve  to  bring  down  the  percentage. 
1 he  eosinophil  count  averages  2 per  cent,  the 
lymphocyte  count  20.7  per  cent,  and  monocytes 
8.5  per  cent.  The  monocyte  count  is  only  slightly 
increased  in  this  group. 

Table  3 is  composed  of  two  small  groups  di- 
vided as  to  time  limits  into  Group  “A,”  one  year 
or  less ; and  Group  “B,”  more  than  one  year. 
These  cases  have  had  very  carefully  performed 
white  blood  counts  with  the  differential  count 
checked  by  the  author.  These  groups  are  small, 
but  are  worth  recording  as  several  counts  have 
been  made  in  each  case  and  a composite  average 
recorded  in  the  table.  It  is  interesting  to  note 
that  in  Group  “A,”  of  one  year  or  less  duration, 
the  white  cell  count  and  differential  is  within 
normal  limits  with  the  exception  of  the  mono- 
cytes, which  are  increased.  In  Group  “B,”  cases 
of  more  than  one  year  duration,  the  white  cell 
count  averages  11,500,  a slight  increase  with  an 
increase  in  the  percentage  of  polymorphonuclear 
neutrophils  at  the  expense  of  a decrease  in  the 
lymphocyte  percentage.  The  monocyte  count  is 
10  per  cent,  the  same  as  Group  “A.”  The  plate- 
lets and  reticulated  cell  counts  have  been  recorded 
in  Table  3.  The  platelets  are  nor  particularly  in- 
creased in  the  averages  shown.  By  the  method 
used  3 300,000  falls  well  within  the  normal  range. 
The  reticulocyte  count  in  Group  “A”  indicates 
that  the  marrow  is  fairly  active  in  the  early  cases. 
In  Group  “B”  it  appears  to  indicate  some  “falling 


84 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


Table  1. — Cases  of  Apparent  Duration  Under  One  Year 


Sex  and 
Case  No. 

Age 

Diagnosis 
by  Biopsy 
or  Autopsy 

Apparent 
Duration 
of  Disease 

Number 
of  Blood 
Counts 

Hgb. 

Erythrocytes 

White 

Blood 

Cells 

N 

E 

Bas. 

L 

M 

Plates. 

M 

8127 

17 

B.  A. 

1 yr. 

4 

81 

3,630,000 

17,510 

82 

1.2 

.3 

9. 

7.4 

M 

2869 

33 

B. 

6 mos. 

2 

70 

5,200,000 

9,700 

85 

3. 

8 

4 

Number 
appears  normal 

F 

8950 

54 

B. 

8 mos. 

2 

85 

4,280,000 

9,300 

75 

1. 

.5 

19 

4.5 

M 

13876 

22 

B.  A. 

1 yr. 

9 

50 

3,600,000 

12,830 

20 

.7 

.5 

77.2 

1.6 

M 

18468 

42 

B. 

6 mos. 

6 

47 

3,130,000 

10,400 

80 

1. 

.1 

15.7 

3.2 

M 

12699 

50 

B. 

7 mos. 

3 

87 

4,960,000 

6,000 

52 

7. 

.7 

26.3 

14. 

M 

25746 

41 

B. 

8 mos. 

5 

71 

3,600,000 

6,100 

74 

1.2 

.2 

15. 

9.6 

M 

25751 

34 

B. 

5 mos. 

3 

90 

5,020,000 

7,150 

51 

2. 

.7 

37. 

9.3 

M 

22992 

40 

B. 

9 yrs. 

2 

75 

3,952,000 

9,150 

79 

2. 

0. 

14. 

5. 

M 

10851 

29 

B. 

4 mos. 

1 

85 

4,352,000 

13,800 

46 

14. 

0. 

.25. 

15. 

M 

33396 

23 

B.  A. 

3 mos. 

11 

62 

3,517,000 

17,400 

85.5 

0. 

. 1 

8.3 

6.1 

592,000 

F 

12909 

33 

B.  A. 

1 yr. 

2 

95 

4,760,000 

5,650 

75. 

1. 

0. 

19. 

5. 

M 

16599 

39 

B. 

10  mos. 

9 

76.5 

3,898,000 

7,000 

80. 

3. 1 

.2 

9. 

8.7 

F 

46234 

62 

B. 

9 mos. 

1 

80. 

4,430,000 

17,840 

85.6 

0. 

0. 

9. 

5.4 

F 

23656 

65 

B. 

6 mos. 

2 

94. 

5,420,000 

7,800 

67 

1. 

.7 

26. 

5.3 

M 

26716 

21 

B.  A. 

11  mos. 

5 

48.5 

3.724,000 

44,250 

88 

2.2 

.2 

4.2 

5.4 

M 

26716 

21 

B.  A. 

1 yr. 

4 

49 

3,095,000 

84,960 

89 

3.2 

0. 

4.5 

3.3 

M 

13760 

24 

B.  A. 

6 1/2  mos. 

11 

50 

4,080,000 

33,300 

89.2 

.2 

0. 

4.9 

5.7 

M 

43370 

47 

B.  A. 

4 mos. 

3 

89 

4,625,000 

5,640 

63.3 

2. 

.1 

23.3 

11.3 

M 

20334 

42 

B. 

5 mos. 

2 

83 

4,900,000 

5,400 

53 

4.5 

1. 

28 

12.5 

M 

8226 

22 

B. 

8 mos. 

6 

48 

3,549,000 

9,220 

65.2 

1.5 

.3 

24. 

9. 

93 

72 

4,200,000 

11,728 

60.4 

2.4 

.4 

26.6 

10.2 

B — Biopsy  A — Autopsy  N — Neutrophils  E — Eosinophils  Bas — Basophils 

L — Lymphocytes,  large  and  small  M — Monocytes  which  include  large  mononuclears  and  transitionals 


off”  in  the  regenerative  power  of  the  bone  mar- 
row in  those  cases  beyond  one  year  in  duration. 

SUMMARY 

The  results  of  our  blood  studies  in  Hodgkin’s 
disease  conform  in  a general  way  to  the  results 
and  conclusions  worked  out  by  Bunting  several 
years  ago.  In  our  results  it  is  difficult  to  be  sure 
of  the  duration  of  the  disease  from  the  history 
obtained  from  the  patient.  In  Table  1 there  are 
undoubtedly  some  inaccuracies  with  respect  to  the 
duration  of  the  disease,  as  the  onset  is  nearly 
always  insidious  and  the  patient  is  not  aware 
of  the  disease  until  it  has  been  progressing  for 
several  weeks.  It  is  very  important  to  realize  that 
occasionally  leukemia-like  blood  pictures  may 
occur  in  Hodgkin’s  disease,  as  seen  in  this  patient 
at  the  age  of  thirty-six  who,  entered  the  male 
medical  ward  at  the  University  of  California 


Hospital  from  the  medical  clinic  with  a leukocyte 
count  of  36,200;  polymorphonuclears,  14  per 
cent;  lymphocytes,  86  per  cent.  From  his  his- 
tory the  duration  appeared  to  be  about  eight 
months.  His  blood  count  after  entry  to  the 
hospital  was : hemoglobin,  75 ; red  blood  cells, 
4,460,000;  white  cells,  25,000;  polymorphonu- 
clears, 35 ; large  lymphocytes,  2 ; small  lympho- 
cytes, 60 ; and  monocytes,  3 per  cent.  This  patient 
had  a paraplegia,  and  an  x-ray  film  of  the  spine 
showed  nodules  in  one  of  the  lower  dorsal  ver- 
tebrae. 

CONCLUSIONS 

This  analysis  substantiates  the  idea  that  later 
in  the  disease,  beyond  the  first  year,  the  leuko- 
cyte count  tends  to  become  increased,  with  an  in- 
crease in  the  polymorphonuclear  leukocytes.  Also 
there  is  an  average  and  fairly  constant  increase 


February,  1930 


BLOOD  PICTURE  IN  HODGKIN’S  DISEASE — FALCONER 


85 


Table  2 — Cases  of  Apparent  Duration  of  One  Year  or  More 


Sex  and 
Case  No. 

Age 

Diagnosis 
by  Biopsy 
or  Autopsy 

Apparent 
Duration 
of  Disease 

Number 
of  Blood 
Counts 

Hgb. 

Erythrocytes 

White 

Blood 

Cells 

N 

E 

Bas. 

L 

M 

Plates. 

F 

21763 

54 

B.  A. 

3 % yrs. 

10 

50 

3,215,000 

11,196 

85 . 

2.7 

.9 

1.8 

10.6 

M 

23730 

22 

B. 

3 yrs. 

5 

60 

3,591,000 

5,240 

70. 

1. 

.0 

20.6 

8.4 

F 

47044 

45 

B. 

4 yrs. 

1 

79 

4,100,000 

8,680 

57. 

7. 

2. 

26. 

8. 

M 

47336 

26 

B. 

18  mos. 

1 

65 

4,010,000 

16,850 

16. 

4. 

0. 

72. 

8. 

M 

47322 

46 

B. 

14  mos. 

1 

80 

4,150,000 

9,400 

72. 

2. 

0. 

19. 

7. 

M 

24678 

10 

B.  A. 

18  mos. 

5 

83 

4,606,000 

15,740 

80. 

.7 

.3 

10. 

9. 

M 

14490 

24 

B.  A. 

14  mos. 

11 

50 

4,084,000 

33,000 

89. 

.2 

0. 

5. 

5.8 

F 

16034 

25 

B.  A. 

3 yrs. 

1 

65 

3,000,000 

10,600 

66. 

0. 

0. 

24. 

10. 

M 

38003 

15 

B.  A. 

6 yrs. 

1 

35 

2,240,000 

35,500 

89. 

0. 

0. 

5. 

6. 

M 

38427 

21 

B.  A. 

21  mos. 

2 

42 

2,943,000 

22,500 

82.5 

2.5 

0. 

10. 

5. 

F 

31786 

30 

B. 

8 yrs. 

5 

75 

4,010,000 

10,730 

81. 

2.5 

.2 

11. 

5.3 

M 

46455 

8 

B.  A. 

2 yrs. 

8 

37 

2,041,000 

5,600 

87. 

.4 

0. 

6.  ‘ 

6.6 

405,900 

M 

10391 

47 

B. 

2 yrs. 

5 

50 

3,141,000 

10,100 

66. 

4.6 

.6 

22. 

6.8 

F 

13704 

37 

B. 

16  mos. 

2 

65 

4,320,000 

15,900 

86.5 

.5 

.5 

9.5 

3. 

F 

1521 

27 

B. 

1 */2  yrs- 

1 

55 

4,488,000 

14,800 

60. 

1. 

0. 

30. 

10. 

F 

598 

52 

B. 

5 yrs. 

1 

90 

5,240,000 

12,000 

47. 

8. 

0. 

36. 

9. 

M 

33735 

40 

A. 

13  yrs. 

7 

61 

3,220,000 

20,900 

83. 

0. 

0. 

13.5 

3.5 

M 

25556 

43 

B. 

1 yr.  9 mos. 

10 

60 

3,200,000 

3,500 

57.6 

1.4 

1. 

25. 

15. 

432,000 

M 

16219 

22 

B. 

4 yrs. 

2 

90 

4,500,000 

11,300 

22.5 

.2 

. 5 

62. 

15. 

F 

16980 

35 

B. 

5 yrs. 

1 

75 

3,592,000 

13,500 

72. 

5. 

0. 

6. 

17. 

80 

63 

3,684,550 

14,350 

68.4 

2. 

.02 

20.7 

8.5 

B — Biopsy  A — Autopsy  N — Neutrophils  E — Eosinophils  Bas — Basophils 

L — Lymphocytes,  large  and  small  M — Monocytes  which  include  large  mononuclears  and  transitionals 


in  the  mononuclear  cells.  For  some  reason  our 
platelet  counts  are  not  high,  as  other  authors  have 
found  them.  This  is  a matter  for  further  investi- 
gation. The  eosinophil  count  averages  about  nor- 
mal or  below  but  may  occasionally  be  very  high, 
reaching  in  one  instance  80  per  cent  of  the  total 
leukocytes. 

384  Post  Street. 

REFERENCES 

1.  Bunting,  C.  H.:  The  Blood  Picture  in  Hodgkin’s 
Disease,  Johns  Hopkins  Hospital  Bulletin,  1911,  xxii, 
369. 

2.  Bunting,  C.  H.:  The  Blood  Picture  in  Hodgkin’s 
Disease.  Second  paper.  Johns  Hopkins  Hospital 
Bulletin,  1914,  xxv,  173. 

3.  Kristenson,  Anders:  Acta  Med.  Scandinav.,  1922 
lvii,  301. 

DISCUSSION 

Ernest  S.  du  Bray,  M.  D.  (490  Post  Street,  San 
Francisco). — I think  it  is  safe  to  say  that  Doctor 
Falconer  has  brought  together  in  the  foregoing  paper 


the  largest  and  most  completely  studied  group  of 
cases  of  Hodgkin’s  disease,  from  the  blood  stand- 
point, that  has  appeared  in  the  American  medical 
literature  since  the  classic  contributions  of  Bunting. 
It  is  rather  significant  that  this  study  confirms  Bunt- 
ting’s  work  in  the  chief  essentials.  Although  it  is 
true  the  blood  picture  alone  cannot  be  relied  upon 
absolutely  to  make  the  diagnosis  in  a border-line 
case,  nevertheless  it  is  of  value  in  -offering  strong 
corroborative  evidence  in  cases  of  general  glandular 
enlargement.  Such  conditions  as  lymphosarcoma, 
tuberculosis,  leukemia,  and  infectious  mononucleosis 
are  among  the  frequent  confusing  disturbances  that 
come  to  mind  in  the  differential  diagnoses  of  glandu- 
lar enlargement.  To  be  sure  the  biopsy  is  nowadays 
resorted  to  early,  but  at  times  even  the  pathologist 
hesitates  to  go  on  record  positively  from  a study  of 
the  gland  tissue. 

In  a general  way  it  can  be  said  that  Hodgkin’s  dis- 
ease usually  presents  a secondary  anemia  which  in- 
creases as  the  disease  progresses.  The  white  blood 
count  may  be  normal  early  in  the  course  of  the  ill- 
ness, but  later  a moderate  leukocytosis  between 
10,000  and  20,000  usually  appears.  The  polymorpho- 
nuclear neutrophils  gradually  increase  and  are  found 


86 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


Table  3. — Groupings  Based  on  Time  Limits* 


Sex  and 
Case  No. 

Apparent 
Duration 
of  Disease 

White 

Blood 

Count 

GROUP  “A” — Less  Than  One  Year 

N 

E 

B 

L 

M 

Plates. 

Retie. 

Reds 

F 

1 

1 yr. 

5,650 

73 

2 

0 

13 

10 

312,000 

2. 

F 

2 

10  mos. 

6,400 

50 

6 

1 

34 

9 

160,000 

1.2 

M 

6 

11  mos. 

7,850 

80 

1 

0 

12 

7 

420,000 

2.6 

M 

4 

1 yr. 

10,400 

77 

1 

0 

13 

9 

260,000 

4.4 

F 

8 

8 mos. 

9,000 

36 

2 

1 

44 

17 

268,000 

.8 

M 

9 

1 yr.  11  mos. 

6,600 

65 

3 

0 

20 

12 

368,000 

.6 

M 

13 

7 mos. 

9,550 

73 

1 

0 

23 

3 

480,000 

2. 

7,921 

65 

2 

.3 

23 

10 

324,000 

2.3 

M 

3 

18  mos. 

9,900 

GROUP  “B” — More  Than  One  Year 

80 

0 

0 

8 

12 

325,000 

.8 

M 

5 

2 yrs. 

6,350 

65 

1 

0 

10 

24 

184,000 

.2 

F 

7 

4 yrs.  ‘ 

9,450 

70 

2 

0 

22 

6 

310,000 

.4 

M 

10 

2 yrs. 

6,920 

70 

2 

0 

23 

5 

254,000 

1.2 

M 

12 

1 yr. 

32,000 

79 

3 

1 

10 

7 

532,000 

3.7 

M 

11 

3 yrs. 

9,600 

80 

3 

0 

10 

7 

164,000 

1.2 

M 

14 

1 yr.  4 mos. 

6,300 

72 

1 

0 

19 

8 

355,000 

.0 

11,503 

74 

2 

. 1 

15 

10 

303,428 

1.1 

*Special  counts  checked  by  author  done  in  the  Hematology  Clinic. 

N — Neutrophils  E — Eosinophils  Bas — Basophils  L — Lymphocytes,  large  and  small 

M — Monocytes  which  include  large  mononuclears  and  transitionals  Plates. — Platelets  Retie.  Reds — Reticulated  red  cells 


commonly  between  70  and  90  per  cent,  with  an  abso- 
lute increase  in  the  transitional  cell,  which  Doctor 
Falconer  includes  in  his  monocyte  group.  Bunting, 
it  will  be  recalled,  emphasized  the  absolute  increase 
in  the  transitional  cell  even  in  the  early  cases. 

Most  observers  have  noted  a definite  increase  in 
the  platelets,  but  as  the  exact  numerical  determina- 
tion of  platelets  depends  considerably  on  the  method 
used,  this  may  partially  account  for  this  apparent 
discrepancy  in  that  the  platelets  in  this  present  study 
appeared  about  within  normal  limits.  Another  feature, 
with  reference  to  the  platelets  that  some  observers 
have  noted,  was  the  conspicuous  presence  of  giant 
platelets  in  considerable  numbers.  The  presence  of 
marked  eosinophilia  has  undoubtedly  been  over- 
stressed as  an  important  feature  of  the  blood  picture. 
It  may  be  said,  however,  that  it  does  occur,  particu- 
larly with  either  one  of  two  conditions  existing,  viz.: 
widespread  skin  involvement  or  a necrosis  in  lymph 
glands. 

In  conclusion,  I would  like  to  compliment  Doctor 
Falconer  on  the  concise  and  yet  complete  way  the 
above  study  is  presented.  He  has  again  shown  that 
the  Oslerian  method  of  an  intense  study  of  a single 
phase  of  a well-known  disease  is  not  without  profit. 

"eC1 

John  J.  Sampson,  M.  D.  (490  Post  Street,  San  Fran- 
cisco).— Doctor  Falconer,  as  Doctor  du  Bray  has 
pointed  out,  has  rendered  a genuine  service  in  stabil- 
izing our  knowledge  of  the  changes  that  take  place 
in  the  blood  in  Hodgkin’s  disease. 


I believe  that  there  are  some  remarkable  variations 
in  morphology  that  are  worthy  of  mention,  in  addi- 
tion to  the  changes  in  total  and  relative  numbers  of 
blood  cells  that  Doctor  Falconer  summarizes.  The 
monocytes  (large  mononuclear  leukocytes  or  endo- 
thelial leukocytes),  in  my  experience  have  often  been 
found  to  assume  the  same  forms  frequently  seen  in 
subacute  bacterial  endocarditis,  namely,  increase  in 
size,  vacuolization,  and  definite  large  pseudopod  for- 
mation. 

The  platelets,  especially  during  the  phase  of  the 
disease  in  which  they  are  increased  in  number,  have 
been  observed  to  be  increased  in  size,  occasionally 
as  much  as  twenty  microns.  Such  platelets  are  more 
liable  to  be  elongated  along  a single  meridian. 

There  is  still  a difference  of  opinion  as  to  recogni- 
tion of  Hodgkin’s  disease  as  a separate  entity  in  con- 
trast to  its  possible  classification  in  a general  lympho- 
blastoma group.  Transitional  cases  occasionally  ap- 
pear which  seem  to  link  it  with  either  lymphosarcoma 
on  one  extreme  or  lymphatic  leukemia  on  the  other. 

I believe  it  is  wise  to  withhold  the  decision  as  to 
which  of  these  conclusions  may  be  correct,  and  there- 
fore still  reserve  the  possibility  of  interpreting  these 
blood  changes  in  another  light  than  that  they  may 
be  characteristic  of  Hodgkin’s  disease,  as  a distinct 
clinical  entity. 

* 

Munford  Smith,  M.  D.  (1105  Roosevelt  Building, 
Los  Angeles). — Doctor  Falconer  has  presented  a 
large,  interesting  group  of  cases  of  Hodgkin’s  dis- 


February,  1930 


BLASTOMYCOSIS — MANER  AND  HAMMACK 


87 


ease,  thoroughly  studied  from  the  standpoint  of  the 
blood  picture.  It  well  illustrates  that  there  is  a 
slightly  higher  white  cell  count  and  increased  poly- 
morphonuclear neutrophil  count  in  the  older  cases; 
also,  that  there  is  rarely  an  eosinophilia  in  Hodgkin’s 
disease,  which  is  an  incorrect  point  of  differentiation 
so  frequently  insisted  upon. 

At  the  time  that  this  paper  was  presented  to  me 
I was  particularly  interested  in  the  differentiation 
between  Hodgkin's  disease  and  tuberculous  adenitis, 
having  recently  seen  several  cases  where  a question 
had  arisen.  I had  made  a partial  survey  of  the  litera- 
ture, but  had  found  nothing  so  well  covered  as  in 
Doctor  Falconer’s  paper.  Biopsy  still  remains  the 
method  of  choice  to  differentiate  between  several 
conditions  which  may  be  confused  with  Hodgkin’s 
disease. 


SYSTEMIC  BLASTOMYCOSIS* 

REPORT  OF  CASES 

By  George  D.  Maner,  M.  D. 
and 

Roy  W.  Hammack,  M.  D. 

Los  Angeles 

Discussion  by  IV.  T.  Cummins,  M.D.,  San  Francisco ; 
H.  A.  IVyckoff,  M.D.,  San  Francisco;  Newton  Evans, 
M.  D.,  South  Pasadena. 

HPHE  term  “blastomycosis,”  in  its  broad  sense, 
^ includes  all  diseases  caused  by  yeast-like  fungi, 
that  is,  fungi  which  appear  in  the  lesions  as  round 
or  oval  cells,  sometimes  budding,  but  usually  with- 
out mycelium.  These  fungi  are  generally  called 
blastomycetes,  and  include  members  of  several 
genera. 

However,  in  this  country  the  tendency  has  been 
to  restrict  the  term  “blastomycosis”  to  infec- 
tion with  Blastomyces  dermatitidis  (Gilchrist  and 
Stokes)  and  there  seems  to  be  constant  effort 
to  designate  otherwise  infections  with  related 
but  distinct  organisms.  This  is  particularly  true 
in  California,  where  infection  with  Coccidioides 
immitis  is  so  frequently  seen.  While  several  cases 
of  coccidioidal  infection  have  been  reported  in 
the  literature  as  systemic  blastomycosis,  they  were 
so  reported  because  the  organisms  were  not  differ- 
entiated, and  the  true  nature  of  the  infection  was 
not  recognized. 

CASTELLANl’s  CLASSIFICATION  OF 
BUDDING  FUNGI 

Castellani 1 has  recently  proposed  a new  classi- 
fication of  the  yeast-like  or  budding  fungi,  based 
on  the  presence  or  absence  of  mycelium,  and  pres- 
ence or  absence  of  ascospores,  which  includes 
families  of  both  Ascomycetes  and  Fungi  imper- 
fecti. 

(a)  Family  Saccharomycetaceae,  with  budding 
cells,  asci  and  ascospores,  but  no  mycelium  in 
culture. 

( b ) Family  Endomycetaceae,  with  budding 
cells,  asci  and  ascospores  with  mycelium  in 
culture. 

(c)  Family  Cryptococcaceae,  with  budding  cells 
(blastospores),  no  asci  and  no  mycelium  in 
culture. 

* Read  before  the  Pathology  Section  of  the  California 
Medical  Association  at  the  fifty-eighth  annual  session, 
May  6-9,  1929. 


(d)  Family  Oosporaceae,  with  budding  cells, 
no  asci  but  mycelium  in  cultures. 

He  creates  a new  genus,  which  he  calls  Blasto- 
mycoides,  under  Family  Oosporaceae,  in  which  he 
places  three  species:  1.  Blastomycoides  derma- 
titidis, synonym — Blastomyces  dermatitidis  (Gil- 
christ and  Stokes).  2.  Blastomycoides  immitis, 
synonym — Coccidioides  immitis  (Rixford  and 
Gilchrist).  3.  Blastomycoides  tularensis  (Castel- 
lani). He  defines  the  genus  Blastomycoides  as: 
“Oosporaceae  appearing  in  the  lesions  as  large 
roundish  cells  from  eight  to  twenty  microns  in 
diameter,  or  larger,  with  the  protoplasm  contain- 
ing a number  of  well-marked  granules  or  spher- 
ules, and  with  a membrane  showing  a well-defined 
double  contour : in  dextrose  agar  cultures  a large 
amount  of  mycelium  is  present.”  There  are  slight 
cultural  differences  of  the  three  species  when 
grown  on  mannitol,  glucose,  lactose  and  galactose 
agar. 

In  justifying  his  reasons  for  placing  Coccidi- 
oides in  the  above  genus,  he  contends  that  “the 
spherules  found  in  the  large  round  cells  are  not 
ascospores,  but  are  protoplasmic  granules,  and 
that  in  culture,  when  one  of  the  organisms  pro- 
duces a bud,  which  later  becomes  a filament,  the 
same  granules  are  seen  in  the  mycelium.”  He 
also  states  that  Coccidioides  grows  in  cultures  as 
a saccharomyces  type  which  reproduces  by  bud- 
ding, and  a filamentous  type.2  He  moves  the  spe- 
cies Coccidioides  immitis,  genus  Coccidioides, 
family  Endomycetaceae,  class  Ascomycetes,  to 
genus  Blastomycoides,  species  Blastomycoides  im- 
mitis, family  Odsporaceae,  class  Fungi  imperfecti. 

Thus,  he  also  moves  Cryptococcus  dermati- 
tidis, synonym — Blastomyces  dermatitidis  (Gil- 
christ and  Stokes)  from  genus  Cryptococcus, 
family  Cryptococcaceae  to  family  Oosporaceae, 
genus  Blastomycoides,  species  Blastomycoides 
dermatitidis . 

We  agree  with  Castellani  on  the  value  of  a 
better  classification,  but  do  not  feel  that  the  spe- 
cies Coccidioides  immitis  should  be  grouped  in 
genus  Blastomycoides,  even  though  it  has  cultural 
characteristics  similar  to  others  of  this  genus. 
He  apparently  has  arrived  at  this  classification 
of  the  organism  wholly  upon  the  cultural  charac- 
teristics without  regard  for  the  generally  accepted 
ideas  of  the  morphology  of  the  organisms  in  the 
lesions,  that  is,  he  does  not  agree  with  other 
observers  on  the  method  of  reproduction  of  Coc- 
cidioides in  tissues,  viz.,  multiplication  by  endo- 
sporulation  with  complete  absence  of  budding. 

Therefore  we  feel  that  Coccidioides  immitis,  in 
spite  of  cultural  similarity,  is  not  sufficiently 
closely  related  to  Blastomyces  dermatitidis  to  be 
placed  in  the  same  genus. 

The  two  cases  which  we  report  as  "general- 
ized or  systemic  blastomycosis  are  caused  by 
organisms  of  the  species  Blastomyces  dermatitidis 
(Gilchrist  and  Stokes),  or  Blastomycoides  dcr- 
matitid is  ( Castellani ) . 

NATURE  OF  BLASTOMYCOSIS  INFECTION 

Little  is  known  of  the  source  and  manner  of 
infection.  In  some  cases  the  primary  focus  has 


88 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


apparently  been  the  lungs.  In  the  majority  of 
cases  the  disease  is  confined  to  the  skin,  but  may 
enter  the  system  from  that  location. 

The  lesion  of  cutaneous  blastomycosis  is  fairly 
typical.  It  begins  usually  as  a papulopustule 
which  slowly  enlarges,  flattens  down  and  forms 
crusts  over  the  center.  The  surface  becomes 
irregular  and  papillomatous,  the  edges  elevated, 
firm  and  deep  red.  Extension  may  be  in  one  or 
all  directions.  The  histologic  picture  is  charac- 
teristic. There  is  a large  amount  of  carcinoma- 
toid  overgrowth  of  epithelium,  numerous  intra- 
epithelial abscesses  and  abscesses  beneath  the  epi- 
thelium, as  well  as  granulomatous  lesions  which 
contain  the  organisms. 

In  systemic  infections  the  lesions  of  the  viscera 
resemble  greatly  those  of  miliary  tuberculosis, 
but  in  the  supporting  tissues  there  is  more  tend- 
ency to  suppuration  and  frequently  burrowing 
abscesses  are  formed.  The  lungs  are  always  in- 
volved, the  spleen  and  kidneys  usually,  other 
organs  less  frequently.  But  the  list  of  organs 
involved  in  the  sum  total  of  cases  includes  practi- 
cally every  tissue. 

The  microscopic  appearance  of  the  lesions 
closely  resembles  that  of  tuberculosis,  but  often 
differs  from  it  in  the  larger  numbers  of  poly- 
morphonuclear leukocytes  present,  and  in  the 
presence  of  the  parasite. 

Clinically  the  disease  may  resemble  tuberculosis 
in  being  a chronic  febrile  disease  with  pulmonary 
symptoms.  However,  its  clinical  manifestations 
are  as  variable  as  those  of  tuberculosis.  In  many 
cases  multiple  abscesses  have  appeared  in  various 
parts  of  the  body  with  the  symptoms  of  a chronic 
pyemia.  These  abscesses  may  rupture  forming 
ulcers  or  sinuses.  In  several  cases  subcutaneous 
nodules  were  the  first  external  manifestation  of 
the  disease,  and  followed  systemic  symptoms.  In 
others,  cutaneous  blastomycosis  has  existed  for 
some  time  before  systemic  symptoms  appeared. 
The  diagnosis  depends  upon  the  demonstration 
of  the  parasite  in  pus  or  tissues.  The  addition 
of  10  per  cent  sodium  hydrate  to  pus  tends  to 
cause  disintegration  of  the  leukocytes,  and  causes 
the  organisms  to  stand  out  clearly.  The  organisms 
have  been  found  in  the  sputum  and  have  been 
recovered  from  the  blood  stream. 

Treatment  of  the  systemic  cases  has  been  un- 
satisfactory. Many  therapeutic  agents  have  been 
used,  but  of  these  only  potassium  iodid  seems  to 
have  been  of  any  value.  Even  this  has  been  suc- 
cessful in  very  few  cases. 

REPORT  OF  CASES 

Case  1. — The  patient  was  a male,  white,  age  thirty- 
five,  an  electrician.  His  first  admission  to  the  Los 
Angeles  General  Hospital  was  on  January  13,  1920. 
He  was  first  on  the  service  of  Doctor  Lovejoy,  later 
under  Doctor  Scholtz.  Six  or  seven  months  before 
admission  a pustule  appeared  on  the  chin;  it  was 
somewhat  painful.  It  opened  after  being  poulticed 
with  “Denver  mud,”  but  continued  to  grow.  Soon 
after  the  appearance  of  the  first  lesion  others  ap- 
peared. He  was  treated  by  a physician  with  iodin, 
scarlet  red,  and  phenol  at  different  times,  but  the 
lesions  continued  to  grow. 


Fig.  1. — Cutaneous  lesions,  Case  1 

At  the  time  of  admission  examination  showed  a 
well-developed  man  with  no  abnormal  physical  find- 
ings other  than  the  lesions  of  the  skin.  There  were 
five  of  these,  one  on  the  chin,  one  on  the  left  eyelid, 
one  on  the  right  side  of  the  neck,  one  on  the  left 
shoulder,  and  one  on  the  fourth  toe  of  the  right  foot. 
The  lesion  on  the  eyelid  was  1.5  centimeter  in  diame- 
ter, elevated,  with  reddened  edges,  a small  area  of 
ulceration  in  the  center  covered  by  a crust.  Conjunc- 
tiva was  reddened  and  the  eye  somewhat  painful.  The 
other  lesions  were  3 to  4 centimeters  in  diameter,  oval, 
elevated  and  partially  covered  by  yellowish  crusts. 
The  edges  were  firm  and  reddish.  Beneath  the  crusts 
was  a little  pus;  the  surfaces  were  deep  red,  irregular 
and  somewhat  papillomatous.  A small  piece  of  tissue 
removed  from  one  of  the  lesions  showed  the  typical 
microscopic  picture  of  blastomycetic  dermatitis.  At- 
tempt to  culture  the  organism  was  unsuccessful.  The 
blood  Wassermann  was  negative. 

Three  days  after  admission  the  patient  left  the 
hospital  but  returned  thereafter  twice  weekly  for 
treatment.  Treatment  consisted  of  local  applications 
of  trichloracetic  acid,  x-ray,  and  potassium  iodid  by 
mouth. 

For  some  time  there  was  marked  improvement  in 
the  lesions.  The  lesion  of  the  eyelid  gave  the  most 
trouble,  as  it  was  hard  to  treat  and  was  often  painful. 

On  July  22  he  was  again  admitted  to  the  hospital 
complaining  of  general  malaise,  headache,  weakness, 
and  pain  in  left  eye.  Headaches  were  frequent,  but 
there  were  no  other  signs  suggesting  meningeal  irri- 
tation. The  pain  in  the  left  eye  was  constant  and 
later  had  to  be  controlled  by  morphin. 

The  day  after  admission  his  temperature  was  103 
degrees,  pulse  was  108,  and  respiration  was  20  at 
3 p.  m.  This  was  the  highest  temperature  recorded. 
It  averaged  about  99  in  the  mornings  and  101  degrees 
in  mid-afternoon.  Pulse  was  80  to  100.  He  became 
gradually  weaker  and  died  August  29,  1920.  On 
July  28  he  had  14,000  leukocytes,  57  per  cent  poly- 
morphonuclears,  37  per  cent  small  mononuclears,  4 
per  cent  large  mononuclears,  1 per  cent  eosinophils, 


February,  1930 


BLASTOMYCOSIS — MANER  AND  HAMMACK 


89 


and  1 per  cent  basophils.  A blood  culture  taken 
July  27  remained  sterile.  Urine  was  normal. 

Autopsy. — Autopsy  was  not  obtained  until  July  31, 
nearly  forty-eight  hours  after  death.  A summary  of 
the  report  is  as  follows: 

Body  emaciated,  postmortem  discoloration  of  ab- 
domen. Over  the  left  eye  are  crusts  and  pus,  the 
upper  lid  is  completely  destroyed,  as  also  the  median 
end  of  the  lower,  for  a distance  of  about  one  centi- 
meter. The  cornea  is  opaque.  On  the  left  side  of  the 
lower  jaw  is  a large  ulcerated  area  five  centimeters  in 
diameter,  extending  from  the  mouth  to  the  chin.  This 
is  covered  with  crusts  and  pus;  edges  are  slightly 
elevated,  the  base  fairly  smooth.  A thin  layer  of  epi- 
thelium extends  a short  distance  inward  from  the 
elevated  edge.  On  the  right  side  of  the  neck  is  a 
lesion  eight  by  four  centimeters;  on  the  front  of  the 
left  shoulder,  one  five  by  three  centimeters;  on  the 
right  fourth  toe,  one  covering  the  dorsum — all  similar 
to  the  one  described. 

The  left  lung  is  bound  by  numerous  fibrous  ad- 
hesions, the  right  is  free.  Palpation  of  the  left  lung 
revealed  many  shot-like  nodules  throughout.  Other- 
wise the  lung  is  soft.  Posterior  part  is  red,  but  not 
moist.  The  cut  surface  shows  many  small  gray 
nodules  two  to  three  millimeters  in  diameter.  Occa- 
sionally two  or  more  of  these  are  fused  to  form  a 
larger  nodule.  Th^re  appears  to  be  some  increase  in 
the  connective  tissue  about  the  nodules  where  they 
are  thickest,  especially  in  the  upper  lobe.  Bronchi 
contain  mucopurulent  exudate.  Right  lung  is  similar 
in  every  respect.  Peribronchial  lymph  nodes  are  not 
enlarged. 

No  lesions  are  found  in  other  organs. 

The  lung  picture  resembled  closely  a miliary  tuber- 
culosis. Cultures  were  made  from  the  lung  lesions, 
but  only  staphylococci  were  obtained.  Microscopic 
examination  of  sections  showed  tubercle-like  struc- 
tures containing  many  giant  cells.  In  these  structures 
were  found  the  parasites,  small  spherical  bodies  ten 
to  twelve  microns  in  diameter  with  double-contoured 
membranes.  Occasional  budding  forms  were  found. 
The  organisms  were  present  both  in  the  giant  cells 
and  lying  free  in  the  tissue. 

i i i 

Case  2. — Negro,  male,  age  thirty-four,  occupation 
freight  handler.  Residence  in  Los  Angeles  County 
seven  months.  Previous  residence,  Louisiana  and 
Arkansas. 

Illness  began  in  January  of  1925  with  chills  and 
fever,  weakness  and  progressive  loss  of  weight.  He 
had  daily  fever,  was  able  to  be  up  but  not  to  work. 
On  March  1 he  became  bedridden.  Loss  of  weight 


Fig.  2. — Section  from  lung  showing  organisms  in 
giant  cells 


continued.  On  April  1 he  noticed  abscesses  over  right 
leg  which  were  opened.  Was  admitted  to  hospital 
May  2,  1925. 

Examination  revealed  a greatly  emaciated,  acutely 
ill  patient,  with  temperature  101  degrees,  pulse  128, 
and  respiration  32.  There  was  a punched-out  ulcer  on 
inner  aspect  of  right  heel,  a discharging  sinus  in  the 
middle  third  of  inner  aspect  of  right  leg,  and  abscesses 
over  the  tuberosity  of  right  tibia  and  upper  third  of 
outer  surface  of  the  right  leg.  Several  healed  scars 
over  right  leg.  A large  abscess  over  left  shoulder. 
A verrucoid  lesion  on  the  bridge  of  nose  and  on  left 
cheek.  Physical  examination  of  chest  revealed  signs 
suggesting  both  active  and  fibroid  pulmonary  tuber- 
culosis. Pus  aspirated  from  abscess  of  left  leg  showed 
budding  blastomyces.  Cultures  of  this  gave  a heavy, 
white,  fluffy,  mycelial  growth.  Sputum  positive  on 
one  occasion  for  tubercle  bacilli.  Patient  was  given 
potassium  iodid  by  mouth  and  neoarsphenamin  intra- 
venously with  no  improvement.  He  died  June  19,  1925. 

Autopsy. — Emaciated  negro  male.  On  left  cheek  a 
raised,  encrusted  lesion  containing  creamy  gray  pus; 
the  scab  is  easily  removed,  leaving  a red,  granular 
and  verrucoid  surface.  Similar  lesion  on  bridge  of 
nose.  Irregular,  encrusted,  verrucous  lesions  over  left 
shoulder  and  scapula,  mid-portion  of  volar  surface  of 
left  forearm,  base  of  left  thumb,  and  dorsal  surface 
of  base  of  left  fifth  finger.  Small  subcutaneous  ab- 
scesses in  anterior  portion  of  left  temporal  region, 
medial  surface  of  right  forearm,  left  thigh  and  upper 
portion  of  left  leg.  Right  ankle  is  swollen  and  pre- 
sents several  sinuses  which  extend  into  the  joint.  Par- 
tial destruction  of  talo-tibial  joint  capsule,  and  erosion 
of  articular  cartilages.  Right  elbow  joint  distended 
with  fifty  cubic  centimeters  of  pus.  Articular  carti- 
lages eroded. 

Left  pleural  cavity  completely  obliterated  with 
dense  fibrous  adhesions.  Right,  few  adhesions  at  apex. 

Right  lung  weighs  1320  grams,  firm  and  diffusely 
nodular.  Pleura  presents  numerous  semitranslucent, 
miliary  nodules.  Hilar  nodes  enlarged,  black,  pig- 
mented, but  no  nodules.  The  cut  surface  shows  nu- 
merous small,  gray,  opaque  and  semitranslucent  mili- 
ary nodules,  more  numerous  in  lower  lobe.  Anterior 
portion  contains  pneumonic  patches.  No  cavities. 

Left  lung  weighs  720  grams.  Firm  and  nodular. 
Surface  roughened  with  fibrous  tags  and  miliary 
nodules.  Hilar  nodes  enlarged,  pigmented  but  no 
nodules.  At  the  apex  there  is  an  irregular,  outlined, 
solitary  cavity  four  centimeter  in  diameter  lined  by 
a thin,  fibrous  wall  and  filled  with  sanguinopurulent 
material.  Cut  surface  studded  with  nodules  which 
are  larger  and  more  opaque  than  those  in  the  right 
lung. 

Kidneys  are  slightly  enlarged.  The  surface,  after 
stripping  the  capsule,  is  studded  with  a few  small, 
yellow,  opaque,  miliary  nodules.  Organ  infiltrated 
with  amyloid. 

No  nodules  found  in  other  viscera. 

Microscopic. — The  lesions  in  the  skin  were  charac- 
teristic of  blastomycetic  dermatitis  with  carcinoid 
overgrowth  of  epithelium  and  numerous  intra-  and 
subepithelial  abscesses  containing  the  round  and  bud- 
ding organisms.  Tubercle-like  nodules  in  corium,  or- 
ganisms in  giant  cells  and  free  among  the  tissue  cells. 
Heavy  eosinophilic  infiltration. 

Lungs. — Numerous  tubercle-like  nodules  with  cen- 
tral necrosis  in  some.  Organisms  in  giant  cells  and 
free  among  the  tissue  cells.  The  lesions  closely  re- 
semble tubercles,  and,  in  absence  of  blastomyces, 
would  probably  be  considered  as  such.  Acid-fast 
stains  made  of  lung  lesions  but  no  tubercle  bacilli 
found.  In  the  pneumonic  areas  many  blastomyces, 
polynuclear  leukocytes,  and  large  mononuclear  cells 
were  found  in  the  alveoli.  Pus  from  elbow  and  ankle 


90 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


joints  contained  many  budding  organisms.  Cultures 
of  the  organism  were  obtained  from  this  pus  and  from 
lung  lesions. 

COMMENT 

In  Case  1 the  skin  lesions  preceded  the  develop- 
ment of  systemic  symptoms  by  several  months. 
In  Case  2 the  duration  of  the  skin  lesion  was 
not  definitely  ascertained  and  may  also  in  this 
case  have  preceded  systemic  involvement.  In 
Case  2 the  cavity  in  tire  lung  was  probably  of 
tuberculous  origin  since  acid-fast  bacilli  were 
found  in  the  sputum.  Lesions  in  the  bones,  joints 
and  subcutaneous  tissues  were  especially  striking 
in  Case  2 while  absent  in  Case  1.  The  treatment 
instituted  had  no  apparent  effect  on  the  disease 
in  either  case. 

SUMMARY 

It  seems  better  at  the  present  time  to  limit  the 
term  blastomycosis  to  infections  with  the  specific 
organism  Blastomyces  dermatitidis  ( Gilchrist  and 
Stokes). 

Two  cases  of  systemic  blastomycosis  with  au- 
topsy findings  are  reported.  These  illustrate  the 
variability  of  the  distribution  of  the  lesions  in 
different  cases. 

523  West  Sixth  Street. 

references' 

1.  American  Journal  of  Tropical  Medicine,  Vol.  viii, 
No.  5,  p.  379. 

2.  Fungi  and  Fungus  Diseases.  Aldo  Castellani, 
1926. 

DISCUSSION 

W.  T.  Cummins,  M.  D.  (Southern  Pacific  General 
Hospital,  San  Francisco). — The  debatable  matter  in 
this  publication  is  the  classification  proposed  by  Cas- 
tellani. We  agree  with  the  authors  that  the  organism 
causing  blastomycosis  must  not  be  of  the  same  genus 
as  Coccidiold.es  immitis,  for  we  believe  that  they  have 
different  methods  of  reproduction.  This  alone  seems 
to  be  a sufficient  reason  for  their  generic  differenti- 
ation. If  the  classification  of  Castellani  were  adopted, 
in  the  writer’s  opinion  it  might  promote  further  con- 
fusion in  the  differentiation  of  blastomycosis  and 
coccidioidal  granuloma.  Culturally  and  clinically  we 
know  well  that  the  diseases  closely  resemble  each 
other  and  that  either  may  be,  and  doubtless  frequently 
has  been,  diagnosed  as  tuberculosis. 

Potassium  iodid  failed  as  a therapeutic  agent  in 
each  of  the  patients.  It  is  unfortunate  that  a number 
of  blood  cultures  are  not  made  on  each  blastomycetic 
case  (as  well  as  coccidioidal),  for  it  seems  likely  that 
the  widely  disseminated  lesions  must  be  induced  at 
least  terminally  by  blood  vascular  transportation  of 
the  infectious  agent.  It  is  not  unlikely  that  we  shall 
find  that  the  coexistence  of  active  tuberculosis  and 
mycotic  disease  of  this  type  is  not  unusual. 

This  paper  is  of  timely  value  not  only  in  the  presen- 
tation of  data  for  the  clinician  and  pathologist,  but 
also  in  reminding  them  to  keep  alert  as  to  the  impor- 
tance of  mycotic  diseases,  their  careful  study  and 
differentiation. 

rtr 

H.  A.  Wyckoff,  M.  D.  (Lane  Hospital,  San  Fran- 
cisco).— The  two  cases  reported  in  this  paper  should 
prove  a valuable  addition  to  the  literature  of  mycotic 
diseases,  and  this  is  especially  true  in  view  of  the 
comparative  completeness  of  the  observations. 

While  a close  interrelationship  of  the  mycoses  is 
obvious  from  more  than  one  standpoint,  the  endeavor 
of  these  authors  to  maintain  a sharp  distinction  be- 


tween blastomycosis  and  coccidioidal  granuloma  is 
fully  justified. 

Recognizable  differences  in  the  clinical  course  in 
these  diseases  suggest  a difference  in  causative  organ- 
ism and,  even  though  the  fungi  show  similarity  when 
grown  upon  artificial  culture  media,  the  manner  of 
reproduction  in  the  tissues  is  quite  different  and  seem- 
ingly invariably  constant. 

Newton  Evans,  M.  D.  (710  Orange  Grove  Avenue, 
South  Pasadena). — The  authors’  contention  concern- 
ing the  classification  and  nomenclature  of  the  organ- 
ism studied  and  its  dissimilarity  to  the  parasite  of 
coccidioidal  granuloma  appears  to  me  to  be  well 
grounded. 

The  anatomical  findings  in  these  two  cases  are  quite 
similar  to  those  reported  in  others  of  systemic  blasto- 
mycosis. The  absence  of  distinct  blastomycotic  lesions 
of  lymph  nodes  is  like  the  majority  of  cases  described. 
It  would  have  been  of  interest  had  observations  been 
made  upon  the  brains,  or  at  least  mentioned  if  they 
were  included  in  the  examinations.  Rarely  are  brain 
lesions  found,  and  where  they  have  been  present  the 
lesions  were  in  the  brain  substance  rather  than  the 
meninges.  The  characteristic  subcutaneous  abscesses 
and  the  deep,  crusted  ulcers  which  were  a prominent 
feature  here  are  like  others  reported  and  in  con- 
trast to  the  more  superficial  lesions  of  “blastomycetic 
dermatitis.” 

The  geographical  distribution  of  this  mycotic  dis- 
ease as  compared  with  that  of  coccidioidal  granuloma 
is  a striking  feature.  One  of  these  patients  came  from 
the  southern  part  of  the  United  States  and  possibly 
brought  the  infection  with  him.  The  previous  places 
of  residence  are  not  mentioned  in  the  other  case.  If 
there  are  recorded  cases  of  blastomycosis  of  persons 
who  have  lived  only  in  California  they  must  be  very 
few.  The  great  majority  have  occurred  in  the  central 
and  southern  states.  In  contrast,  the  cases  of  cocci- 
dioidal granuloma  occurring  outside  of  California  are 
uncommon. 


A TUBERCULOSIS  CLINIC  FOR  CHILDREN* 

By  Lloyd  B.  Dickey,  M.  D. 

San  Francisco 

HPHE  results  of  educational  campaigns  directed 
^ against  tuberculosis  are  mirrored  in  ever  de- 
creasing mortality  rates  from  this  disease.  Early 
diagnosis  being  the  clue  to  early  and  permanent 
arrest,  campaign  slogans  have  continually  em- 
phasized the  nature  of  early  symptoms  in  adult 
pulmonary  tuberculosis.  Education  of  the  public 
has  taught  it  to  know  these  symptoms,  and  has 
contributed  largely  to  the  increasing  number  of 
cases  early  diagnosed.  There  has  followed,  in 
consequence,  the  removal  of  tuberculous  indi- 
viduals as  contacts  to  susceptible  children,  which 
probably  explains  the  recent  lessened  incidence  of 
tuberculous  disease  in  the  young. 

TUBERCULOSIS  SYMPTOMS  IN  CHILDREN 
DIFFERENT  FROM  ADULTS 

Most  children  who  come  to  the  physician  to 
be  examined  for  evidence  of  tuberculosis  do  so 
because  of  their  history  of  contact  with  an  open 
case  of  this  disease.  Probably  many  more  who 
should  come  fail  to  do  so  because  parents  or 
guardians  do  not  appreciate  that  significant  symp- 
toms in  children  are  not  the  same  as  those  for 

* From  the  Department  of  Pediatrics,  Stanford  Uni- 
versity Medical  School,  San  Francisco. 


February,  1930 


CHILDREN’S  TUBERCULOSIS  CLINIC — DICKEY 


91 


adults.  The  children  being  free  of  the  symptoms 
from  which  the  adults  suffer,  the  significance  of 
the  contact  is  not  appreciated.  Those  who  fre- 
quently see  tuberculous  disease  in  children  know 
how  seldom  hemoptysis,  productive  cough,  night 
sweats,  and  loss  of  weight  are  symptoms  of  early 
juvenile  tuberculosis  of  any  type.  They  also 
realize  how  seldom  a physical  examination  of  the 
chest  yields  any  information  valuable  in  diagnos- 
ing early  tuberculosis  in  children. 

Before  the  public  may  be  educated  to  and  ap- 
preciate the  difference  between  the  early  symp- 
toms of  adult  and  of  juvenile  tuberculosis,  it  is 
first  absolutely  necessary  that  physicians  and  other 
workers  in  tuberculosis  be  educated  to  this  differ- 
ence. Many  cases  could  be  cited  of  detailed  his- 
tories of  contact  children,  taken  by  tuberculosis 
nurses  and  other  workers,  where  a careful  in- 
quiry was  made  into  the  occurrence  of  night 
sweats  (properly  called  slumber  sweats),  hemop- 
tysis, cough  with  sputum,  loss  in  weight,  and 
other  symptoms  only  common  in  adult  pulmonary 
tuberculosis.  While  all  of  these  may  occur  in 
the  juvenile  type  of  the  disease  they  are  usually 
not  significant  in  early  cases. 

The  real  injustice  to  the  children  comes  from 
the  physician  in  the  tuberculosis  clinic,  who,  with 
a negative  history  of  the  above  symptoms,  exam- 
ines a child’s  chest,  elicits  no  signs,  and  dismisses 
it  as  undiseased.  Yet  such  things  happen,  and 
happen  in  clinics  conducted  especially  to  diagnose 
tuberculosis  in  its  incipiency. 

The  study  of  tuberculosis  in  childhood,  during 
which  time  most  individuals  contract  their  initial 
infection,  is  important  for  a proper  understand- 
ing of  the  evolution  of  the  disease.  It  is  probable 
that  the  course  of  the  infection  in  this  period 
determines  the  degree  of  resistance  in  adult  life, 
when  at  least  casual  exposure  to  this  ever  present 
disease  must  be  constant.  Realizing  that  to  con- 
trol any  disease  it  must  be  attacked  at  its  source, 
the  San  Francisco  Tuberculosis  Association  in 
1925  aided  in  establishing  a clinic  for  the  detec- 
tion of  tuberculosis  in  childhood  at  Stanford  Uni- 
versity Medical  School.  A similar  clinic  was  held 
at  the  University  of  California  Medical  School, 
although  the  methods  of  study  differed  in  minor 
details.  The  outline  of  the  work  presented  below 
is  that  initiated  at  Stanford. 

OUTLINE  OF  CLINIC  WORK  AT  STANFORD 

The  Clinic  Itself. — An  ideal  tuberculosis  clinic 
for  children  should  have  ample  funds  at  its  com- 
mand so  that  no  aid  in  diagnosis  need  be  omitted. 
The  item  of  roentgenographs  being  one  of  the 
most  important  from  a diagnostic  standpoint,  and 
the  expense  of  these  being  one  of  the  heaviest 
drains  on  the  funds  of  any  clinic  where  these 
must  be  paid  for,  funds  for  them  should  be  pro- 
vided before  any  attempts  at  diagnoses  be  made. 
In  our  clinic,  expenses  were  chiefly  financed  by 
the  San  Francisco  Tuberculosis  Association,  and 
at  no  time  during  the  three  years  the  clinic  has 
been  held  was  it  necessary  to  defer  or  omit  the 
taking  of  any  roentgenogram  essential  in  the  diag- 
nosis of  a single  case.  Expenses  were  also  con- 


siderably curtailed  because  of  the  courtesy  of  all 
members  of  the  department  of  roentgenology  of 
the  medical  school  in  giving  large  amounts  of 
their  time  in  consultation. 

The  clinic  should  be  an  integral  part  of  a gen- 
eral children’s  clinic,  which  in  turn  should  be  a 
part  of  a general  dispensary.  An  isolated  clinic 
for  suspected  tuberculous  individuals  would  seem 
at  a distinct  disadvantage  as  compared  with  one 
which  had  facilities  for  refers  and  consultations 
with  other  medical  workers. 

The  Medical  Staff. — Ideally  such  a staff  would 
consist  of  several  workers  interested  in  the  study 
of  tuberculosis,  the  number  depending  upon  the 
number  of  children  available  for  examination, 
and  would  consist  of  physicians  who  were  seeing 
at  the  same  time  large  numbers  of  normal  chil- 
dren, and  children  suffering  from  other  conditions 
not  allied  to  tuberculosis.  The  physicians  should 
have  an  adequate  knowledge  of  adult  tuberculosis, 
in  addition  to  a more  complete  knowledge  than 
the  average  physician  has  about  tuberculosis  in 
childhood.  A short  time  of  training  in  a tubercu- 
losis sanatorium  would  give  such  workers  a val- 
uable perspective,  and  an  appreciation  of  the 
differences  between  adult  and  juvenile  tuberculosis 
could  be  gained.  The  physicians  should  be  thor- 
oughly familiar  with  the  accepted  aids  in  diag- 
nosing juvenile  tuberculosis,  both  active  and 
latent ; and  after  the  gathering  of  data,  should 
know  how  properly  to  evaluate  the  history,  the 
physical  examination,  the  roentgenographs,  the 
tuberculin  tests,  and  the  laboratory  aids. 

The  Nursing  Staff. — The  duties  and  functions 
of  the  nursing  staff  should  be,  first,  taking  of 
most  of  the  histories,  the  performing  of  the  tuber- 
culin tests,  and  the  assembling  of  the  data  for 
diagnosis,  after  the  physician  has  performed  the 
physical  examination.  Upon  this  division  of  the 
staff  would  fall  the  burden  of  the  social  service 
work ; the  visiting  of  patients  who  failed  to  return 
for  tuberculin  readings ; home  visiting  to  prepare 
families  of  patients  for  the  institutionalizing  of 
their  children,  when  necessary;  and  the  comple- 
tion of  the  routine  necessary  for  placing  an  active 
patient  in  an  institution. 

The  ideal  nurse  for  such  a clinic  is  one  who 
knows  more  about  tuberculosis  than  does  the 
average  nurse.  She  should  be  able  to  do  tuber- 
culin testing  and  should  know  what  a positive  test 
means,  and  what  it  does  not  mean.  She  should  be 
able  to  explain  intelligently  to  a mother  the  sig- 
nificance of  a positive  test.  She  should  be  able 
to  take  a good  history,  and  should  therefore  know 
the  significant  symptoms  of  childhood  tubercu- 
losis. She  should  know  the  treatment  of  tubercu- 
losis, and  should  have  the  ability  to  explain  to  a 
family  the  necessity  of  the  proper  treatment,  and 
the  ability  to  reconcile  them  to  the  absence  of 
the  child  from  the  home  when  institutional  care 
is  necessary. 

With  an  equal  number  of  patients,  the  work 
of  a visiting  nurse  in  a children’s  clinic  for  tuber- 
culosis would  be  considerably  greater  than  in  a 
clinic  for  adult  patients.  As  compared  with  juve- 


92 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


nile  tuberculosis  the  adult  type  is  relatively  easier 
to  diagnose.  In  the  latter  often  a single  clinic 
visit  is  sufficient  for  diagnosis  if  a careful  his- 
tory be  taken,  a complete  physical  examination 
be  done,  with  roentgenological  and  sputum  exami- 
nations. Many  children  must  have  a rather  inten- 
sive period  of  observation  before  the  aids  at  our 
command  for  diagnosis  can  be  properly  evaluated, 
and  this  may  necessitate  many  “follow-up”  visits. 

Diagnosis  and  Disposition  of  Cases. — In  three 
years  time  over  2500  children  from  our  clinic 
were  tuberculin  tested,  approximately  700  react- 
ing positively,  and  the  latter  were  selected  as 
patients  for  this  clinic.  The  occasional  failure  of 
tuberculous  patients  to  react  to  intracutaneous 
tuberculin  is  relatively  unimportant, _ and  practi- 
cally never  occurs  in  ambulant  patients  report- 
ing to  an  out-patient  clinic.  Such  a phenomenon 
occasionally  occurs  in  patients  overwhelmed  with 
tuberculous  disease,  where  other  signs  and  symp- 
toms are  present  in  sufficient  number  to  diagnose 
tuberculosis  without  the  aid  of  the  skin  test.  We 
have  never  seen  a proved  case  of  tuberculous  dis- 
ease that  reacted  negatively  to  tuberculin  intra- 
cutaneously  with  a dose  of  one-tenth  milligram 
of  K.  O.  T. 

A record  was  started  for  all  patients  reacting 
positively.  Each  patient  had  of  course,  in  addi- 
tion, a clinic  chart  in  which  was  a record  of  the 
history  of  all  complaints,  diagnoses,  and  treat- 
ments at  the  children’s  clinic.  By  the  use  of  the 
signs  + and  — for  positive  and  negative  findings, 
the  entire  record  as  to  tuberculosis  is  condensed, 
and  the  data  assembled  on  a single  card.  Subse- 
quent findings  on  successive  visits  to  the  clinic 
could  be  tabulated  and  progress  noted  without 
hunting  through  masses  of  records.  The  reverse 
side  of  the  card  was  used  to  record  the  date,  size, 
and  area  of  the  tuberculin  test,  to  elaborate  on 
positive  findings  which  needed  further  descrip- 
tion, and  notes  as  to  final  disposition  or  outcome 
of  the  case.* 

After  the  evaluation  of  the  aids  in  diagnosis, 
the  history,  the  physical  examination,  the  roent- 
genograph, the  tuberculin  test,  and  the  laboratory 
findings,  a diagnosis  was  made  on  each  case. 
Then  came  the  problem  of  disposing  of  the  cases 
which  were  diagnosed  as  active,  suspected,  or 
latent  tuberculosis. 

Such  a clinic  should  have  access  ideally  to  sev- 
eral types  of  institutions.  Active  cases  should  be 
sent  to  a special  institution  for  tuberculous  chil- 
dren, thus  initiating  the  most  important  single 
step  in  the  treatment  of  juvenile  tuberculosis, 
which  is  the  removal  of  the  patient  from  the  con- 
tact. The  institution  should  be  one  where  the 
remainder  of  the  treatment  of  childhood  tubercu- 
losis, both  general  and  special  methods,  are  under- 
stood and  where  the  facilities  for  carrying  out 
this  treatment  are  adequate.  It  is  especially  im- 
portant that  facilities  for  natural  and  artificial 
heliotherapy  be  supplied,  and  that  special  surgi- 

*Copy of  the  Stanford  chart  used  for  filing  a condensed 
record  of  patient’s  condition  will  be  sent  on  application 
to  the  author. 


cal  procedures  can  be  carried  out  if  necessary. 
It  should  be  an  institution  where  children  are 
kept  in  absolutely  separate  wards  from  open  cases 
of  tuberculosis.  Most  cases  of  tuberculosis  in 
childhood  are  not  in  themselves  contagious,  but 
in  the  few  instances  where  this  does  occur,  these 
patients  should  be  separated  from  active  “closed” 
cases. 

Cases  classified  as  suspected  usually  need  fur- 
ther observation.  There  should  be  available  some 
bed  space  where  an  intensive  work-up  of  these 
cases  can  be  completed,  and  where  they  can  be 
observed  for  a period  of  study.  The  teaching 
wards  of  Lane  Hospital,  which  is  the  teaching 
hospital  for  the  University  Medical  School,  served 
such  a purpose  for  our  clinic.  Other  places  avail- 
able for  suspected  cases  are  the  tuberculosis  pre- 
ventoria  for  children,  several  of  which  are  in  the 
vicinity.  Cases  classified  as  suspected  should,  of 
course,  be  placed  in  one  of  the  other  two  groups 
as  soon  as  possible. 

Many  cases  classified  as  latent  may  be  dis- 
missed to  return  in  several  months  for  further 
observation.  Others  need  treatment  for  some 
other  ailment,  and  attention  called  to  the  correc- 
tion of  certain  defects.  Some  of  these  patients 
are  suitable  candidates  for  convalescent  homes,  or 
for  a stay  in  the  country  under  the  stimulating 
benefits  of  fresh  air,  sunshine,  and  proper  food. 

From  the  700  cases  of  tuberculous  infection 
obtained  from  a testing  of  over  2500  children, 
the  following  diagnoses  were  made : 


Tuberculosis,  lymph  nodes,  active 15 

Tuberculosis,  lymph  nodes,  healed 5 

Tuberculosis,  bones  and  joints,  active 23 

Tuberculous  pleuritis,  with  effusion 13 

Tuberculosis,  hilar,  suspected ..173 

Tuberculosis,  hilar,  active 65 

Tuberculosis,  latent  396 

Tuberculosis,  pulmonary,  adult  type,  suspected 12 

Tuberculosis,  pulmonary,  adult  type,  active 21 

Tuberculosis,  pulmonary,  adult  type,  latent 6 

Tuberculosis,  miliary,  active 4 

Tuberculosis,  miliary,  healed 2 

Tuberculosis,  meninges,  active 6 

Tuberculosis,  kidneys,  active 3 

Tuberculosis,  skin,  active 2 

Tuberculosis,  choroid,  active.. 2 

Tuberculosis,  active,  of  epididymis,  peritoneum,  and 
larynx,  each 1 


We  feel  that,  except  for  the  careful  study  that 
this  special  clinic  afforded,  many  of  the  cases 
would  have  been  misdiagnosed,  or  undiagnosed. 
The  status  of  the  children  diagnosed  as  latent 
tuberculosis,  or  the  so-called  “pretuberculous”  chil- 
dren, is  especially  important  to  determine.  This  is 
the  potentially  diseased  group  among  which  the 
satisfying  but  rather  undramatic  practice  of  pre- 
ventive medicine  can  be  instituted.  From  the 
standpoint  of  the  diagnosis  of  cases  alone,  the 
clinic  has  amply  justified  its  existence,  and  the 
money  expended  in  it.  Besides  this  it  has  afforded 
an  excellent  opportunity  for  a study  of  the  inci- 
dence of  tuberculous  infection  among  children  in 
the  vicinity,  of  tuberculous  disease  among  those 
infected,  and  the  experiment  has  accumulated  a 
wealth  of  material  for  further  clinical  study.  The 
association  of  this  clinic  with  the  children’s  clinic 


February,  1930 


ANESTHESIA  FOR  CHILDREN — MARTIN 


95 


of  the  Stanford  Medical  School  has  been  of  great 
value  in  the  teaching  of  tuberculosis  in  childhood, 
and  has  helped  many  future  practitioners  of  medi- 
cine to  realize  the  importance  of  such  an  ever 
present  medical  problem. 

Stanford  Medical  School. 


ANESTHESIA  FOR  CHILDREN* 

WITH  REFERENCE  TO  ORTHOPEDIC  SURGERY 

By  James  Raymond  Martin,  M.  D. 

Los  Angeles 

TN  the  administration  of  anesthetics  to  children 

needing  orthopedic  surgery,  we  are  confronted 
with  two  problems.  First  and  most  important, 
the  carrying  of  the  patient  through  the  operation 
with  the  minimum  amount  of  shock  and  undesir- 
able postoperative  effect.  Second,  making  the  an- 
esthetic as  pleasant  as  possible  for  the  patient. 
Many  of  these  children  need  several  operations 
before  the  desired  results  are  obtained,  and  a dis- 
agreeable anesthetic  experience  at  the  first  opera- 
tion may  upset  the  whole  plan  of  the  surgeon. 

CASE  RECORDS  HERE  REVIEWED 

It  is  with  these  two  problems  in  mind  that  this 
resume  has  been  prepared.  It  is  based  on  the  past 
four  years’  anesthetic  records  of  the  Los  Angeles 
Orthopedic  Hospital.  These  records  cover  a total 
of  1807  general  anesthetics,  including  both  major 
and  minor  operations,  with  tonsillectomy  ex- 
cluded. There  have  been  no  deaths.  In  one  case 
a possible  pneumonia  followed  an  ether  anesthetic 
in  a little  Mexican  child.  This  patient  was  consid- 
ered a poor  risk  and  was  complicated  by  a post- 
operative staphylococcus  wound  infection.  Most 
of  the  anesthetics  have  been  given  by  one  person 
and  all  by  skilled  anesthetists.  Only  a portion  of 
the  1807  anesthetics  records  have  been  selected 
for  this  survey.  The  records  for  1928  were 
chosen  because  a more  accurate  record  system  has 
been  in  use  in  the  past  two  years.  Before  dis- 
cussing these  records  several  points  are  worthy  of 
mention  in  regard  to  preparation  and  technique. 
See  Tables  No.  1 and  2. 

PROCEDURES  USED 

These  surgical  patients  have  a two-day  prepa- 
ration during  which  time  the  usual  examinations 
and  surgical  preparations  are  made.  This  is  a 
period  when  the  patient  should  be  put  at  ease,  so 
that  the  stage  of  excitement  on  entering  the  oper- 
ating room  is  almost  nil. 

It  is  our  rule  not  to  hold  or  tie  the  patient  on 
the  table  when  the  anesthetic  starts.  An  attend- 
ant standing  by  is  able  to  guide  the  hands  away 
from  the  mask.  Using  nitrous  oxid  or  ethylene 
induction  there  is  seldom  any  resistance,  especi- 
ally when  the  eyes  are  allowed  to  remain  uncov- 
ered. Patients  are  anesthetized  on  their  backs 
regardless  of  the  location  of  the  operation.  When 
it  is  necessary  to  turn  a patient  flat  on  the  ab- 
domen, a small  sand  bag  placed  under  the  left 

* Read  before  the  Anesthesiology  Section  of  the  Cali- 
fornia Medical  Association  at  the  Fifty-Eighth  Annual 
Session,  Coronado,  May  6-9,  1929. 


shoulder  and  another  under  the  left  hip  will  lift 
the  body  enough  to  make  breathing  much  easier. 
In  this  way  respiratory  muscles  are  relieved  from 
lifting  the  body  at  each  respiration,  preventing  re- 
spiratory fatigue.  The  diaphragm  is  not  crowded 
up  by  the  abdominal  contents,  giving  more  free- 
dom for  the  heart  action.  This  position  does  not 
interfere  with  spinal  fusion  or  other  back  opera- 
tions, and  seems  to  be  a great  aid  in  the  preven- 
tion of  both  cardiac  and  respiratory  fatigue. 

Most  orthopedic  operations  are  not  emergency 
surgery.  Therefore  the  operative  work  is  done  at 
a time  when  the  patient  is  in  the  best  physical 
condition.  Oftentimes  it  is  necessary  to  have  the 
patients  under  medical  care  several  weeks  before 
they  are  considered  safe  risks.  This  care  no  doubt 
is  a big  factor  in  the  ultimate  results.  Acute 
osteomyelitis,  accident  cases  and  spastic  paralysis 
make  up  the  larger  part  of  the  poor  risks.  By 
studying  the  accompanying  chart,  we  find  that, 
out  of  a total  of  486  cases,  some  were  considered 
A risks,  some  were  B risks,  some  were  C risks, 
and  some  D risks.  The  spastic  paralysis  cases 
are  usually  considered  B risks  because  of  the  in- 
stability of  the  autonomic  nervous  system. 

The  condition  of  the  patient  at  the  close  of  the 
operation  was  found  to  correspond  very  closely 
to  the  condition  when  the  anesthetic  began.  The 
figures  show  a good  general  condition  for  88  per 
cent,  a fair  condition  for  12  per  cent,  and  a poor 
condition  for  .01  per  cent.  The  degree  of  shock 
or  circulatory  depression  at  the  close  of  the  opera- 
tion corresponds  very  closely  to  the  type  of  surgi- 
cal risk  to  be  operated.  We  find : first  degree, 
or  no  shock,  87  per  cent ; second  degree  shock, 
12  per  cent;  third  degree  shock,  .01  per  cent. 

The  length  of  time  and  severity  of  the  opera- 
tion, the  loss  of  blood,  and  the  fear  on  the  part 
of  the  child  are  all  important  factors  which  must 
be  considered  as  producing  shock.  In  the  series 
here  reported  165  operations  were  less  than  thirty 
minutes  in  length,  with  very  little  hemorrhage. 
However,  this  group  included  a number  of  hip 
reductions  in  infants  which  produced  a noticeable 
degree  of  shock.  There  were  307  operations, 
ranging  in  time  from  thirty  minutes  to  over  two 
hours  in  length,  including  such  operations  as  open 
hip  reductions,  ramisectomy  and  spinal  fusions, 
procedures  which  produce  a great  deal  of  shock 
and  considerable  loss  of  blood. 

Secondary  or  follow-up  operations  at  too  short 
intervals  for  recuperation  also  tend  to  produce 
shock  and  leave  the  patient  in  poor  condition. 
The  anesthetic  in  these  patients  seems  to  come 
secondary  to  the  surgery  in  the  postoperative 
effect. 

FIGURES  FOR  DIFFERENT  ANESTHETICS 

Ethylene  was  adopted  as  a routine  anesthetic 
in  this  hospital  early  in  1927  and  has  since  been 
used  for  all  general  work  unless  contraindicated. 

In  this  resume  ethylene  was  given  in  76  per 
cent  of  all  the  anesthetics.  The  full  number 
include  twelve  instances  when  nitrous  oxid  was 
substituted  while  the  motor  saw  was  being  used  ; 
one  hundred  and  ten  cases  in  which  a small 


94 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


Table  1.- — Showing  Total  Number  of  Patients  and  Classification 


Ethylene 

Ethylene 
and  Ether 

Ether 

Nitrous  Oxid  and 
Nitrous  Oxid 
and  Ether 

Total 

Cases 

251 

110 

60 

65 

486 

Risks 

A 209 

B 37 

C 5 

A 89 
B 13 
C 6 
D 2 

A 50 

B 10 

A 65 

A 413 

B 60 

C 11 

D 2 

Shock 

1 218 

2 33 

1 85 

2 20 

3 3 

1 54 

2 5 

3 1 

1 63 

2 2 

1 420 

2 60 

3 4 

Postoperative 

condition 

G 209 

F 20 

P 2 

G 99 

F 6 

P 5 

G 38 

F 22 

G 64 

F 1 

G 430 

F 49 

P 7 

Nausea 

No  209 

Moderate  42 

No  78 

Moderate  32 

No  40 

Moderate  19 

Severe  1 

No  61 

Moderate  4 

No  386 
Moderate  97 
Severe  1 

Less  than  thirty 
minutes 

85  85 

17 

23 

40 

165 

More  than  thirty 
minutes 

152 

93 

37 

25 

307 

Urine 

Negative  232 

Acetone  5 

Albumin  2 

Negative  76 

Acetone  31 

Albumen  and 
casts  3 

Negative  49 

Acetone  11 

Negative  54 

Acetone  6 

Negative  411 

Acetone  53 

Albumin  2 

Albumin  and 
casts  3 

amount  of  ether  was  used  to  get  complete  relaxa- 
tion in  the  absence  of  a preoperative  narcotic. 
The  addition  of  ether  in  most  cases  was  for  only 
a very  small  part  of  the  anesthesia. 

In  this  group  appear  most  of  the  serious  opera- 
tions and  also  the  largest  percentage  of  the  poor 
risks.  Twenty-eight  per  cent  of  the  children  in 
this  series  were  under  eight  years  of  age.  Their 
records  correspond  very  closely  with  72  per  cent 
that  were  over  eight  years  of  age.  The  number 
of  male  and  female  patients  was  about  evenly 
divided  and  showed  no  noticeable  differences  in 
anesthetic  reaction. 

In  this  group  receiving  ethylene  and  including 
those  that  received  a small  amount  of  ether  in 


addition,  we  find  the  percentage  of  good  condition 
higher  at  the  close  of  the  anesthetic  than  the  per 
cent  of  good  risks  before  operation  in  spite  of 
the  fact  that  the  anesthetics  were  longer  and  the 
operations  more  severe. 

A little  larger  per  cent  showed  signs  of  shock, 
or  circulatory  depression,  before  they  left  the 
table,  but  this  quickly  passed  off  when  they  were 
returned  to  bed.  The  estimation  of  shock  was  by 
pulse  only,  the  blood  pressure  not  being  taken. 
A large  percentage  of  the  ethylene  patients  vom- 
ited when  the  mask  was  removed,  but  this  com- 
plication is  not  noted  in  the  records.  Only  the 
nausea  and  vomiting  after  the  patient  was  re- 
turned to  bed  was  recorded.  In  a very  small  per 


Table  2. — Showing  Totals  of  Table  1,  Transposed  into  Percentages 


Ethylene 

Ethylene 
and  Ether 

Ether 

Nitrous  Oxid  and 
Nitrous  Oxid 
and  Ether 

Total 

Cases 

251 

110 

60 

65 

486 

Risks 

A .83 

B .15 

C .02 

A .81 

B .12 

C .05 

D .008 

A .83 

B .17 

A 1.00 

A .85 

B .123 

C .023 

D .004 

Shock 

1 .87 

2 .13 

1 .77 

1 .18 

3 .27 

1 .90 

2 ,0S 

3 .017 

1 .97 

2 .0. 

1 .86 

2 .12 

3 .008 

t .004 

Postoperative 

condition 

G .91 

F .08 

P .008 

G .90 

F .05 

P .05 

G .63 

F .37 

G .98 

F .02 

G .885 

F .101 

P .01 

Nausea 

No  .83 

Moderate  .17 

No  .11 

Moderate  .29 

No  .66 

Moderate  .37 

Severe  .02 

No  .94 

Moderate  .06 

No  .80 

Moderate  .20 

Severe  .002 

Less  than  thirty 
minutes 

.39 

.15 

.38 

.62 

.34 

Over  thirty 
minutes 

.61 

.85 

.62 

.38 

.63 

t .03 

Urine 

Negative  .92 

Acetone  .02 

Albumin  .007 

Negative  .69 

Acetone  .28 

Albumin  and 

Casts  .03 

Negative  .82 

Acetone  .18 

Negative  .83 

Acetone  .09 

Negative  .S5 

Acetone  .11 

Albumin  .004 

Albumin  and 
cast  .006 

t .04 

t Cases  not  recorded. 


February,  1930 


CARCINOMA — SOI  LAND  AND  COSTOLOW 


95 


cent  was  this  continued  longer  than  two  hours. 
There  was  a larger  number  in  this  group  showing 
acetone  the  first  twenty-four  hours.  This  seems 
to  be  confined  largely  to  the  long  operations  and 
the  poor  risks. 

Preoperative  narcotic  was  used  in  25  per  cent 
of  the  cases  exclusive  of  children  under  eight 
years  of  age.  This  is  too  small  a number  to  draw 
any  definite  conclusions.  However,  in  those  cases 
in  which  it  was  used,  the  results  to  the  patient 
have  been  favorable  and,  from  the  anesthetist’s 
standpoint,  very  helpful. 

Morphin  and  atropin  have  been  used  mostly, 
but  recently  scopolamin  has  been  added  with  very 
gratifying  results.  It  appears  that,  with  more 
experience  in  its  use,  scopolamin  may  become  an 
adjunct  to  anesthesia  for  children. 

A few  times  a respiratory  paralysis  was  ob- 
served. The  breathing  can  be  readily  reestab- 
lished by  inflating  the  lungs  immediately  with 
oxygen  and  carbon  dioxid,  but  it  must  be  done 
before  the  pulse  begins  to  slow  and  become  weak. 

The  group  of  patients  who  receive  ether  alone 
has  become  steadily  smaller  each  month  until  now 
this  group  includes  only  14  per  cent  of  those  anes- 
thetized. Most  of  the  ether  anesthesias  were 
given  either  by  colleagues  who  feel  a little  timid 
about  handling  all  patients  under  nitrous  oxid  or 
ethylene,  or  because  the  surgeon  requested  its  use. 
Ether  was  also  used  with  infants.  It  has  been  the 
anesthetic  of  choice  for  the  infant  because  of  the 
broad  margin  of  safety. 

Recently  we  have  obtained  a .small  mask  that 
enables  the  administration  of  nitrous  oxid  and 
ethylene  to  very  small  children,  and  our  results 
correspond  with  those  of  the  older  children.  In 
this  group  all  ages  are  represented  and  the  aver- 
age risks  are  included.  Most  of  these  were  short, 
light  anesthetics.  The  percentage  of  postoperative 
depression  is  higher  than  for  other  anesthetics. 
The  amount  of  shock  is  less.  The  explanation  of 
this  may  be  the  fact  that  both  ether  and  nitrous 
oxid  are  circulatory  stimulants,  while  ethylene  is 
a slight  depressant.  The  result  of  stopping  the 
anesthetic  removes  this  stimulant  and  a depres- 
sion is  noted.  Acetone  was  present  in  18  per  cent 
of  the  cases  receiving  ether  alone. 

The  group  of  patients  to  whom  nitrous  oxid 
or  nitrous  oxid  and  ether  anesthesia  was  admin- 
istered was  considered  A risk.  Most  of  the  surgi- 
cal work  was  of  a minor  character,  such  as  closed 
reduction  of  fractures,  manipulation  of  club-feet 
or  congenital  dislocated  hips.  The  procedures 
used  were  such  that  very  little  shock  was  pro- 
duced, and  only  light  anesthesia  was  required. 

Because  of  the  danger  of  explosion  from  ethy- 
lene when  the  x-ray  or  fluoroscope  is  used, 
nitrous  oxid  has  been  the  anesthetic  of  choice  for 
this  type  of  work,  ether  being  added  for  a few 
minutes  to  get  relaxation  if  necessary.  This 
group  represents  a larger  proportion  of  minor 
work  and  should  not  be  contrasted  with  the  other 
groups  where  there  are  poorer  risks,  longer  and 
deeper  anesthesia,  and  more  severe  surgical  shock. 

Moderate  nausea  was  noted  in  only  four  of  the 
sixty  cases.  The  condition  of  the  patients  after 


return  to  bed  was  good  in  all  cases  except  one, 
which  was  considered  fair.  The  record  of  the 
postoperative  urine  findings  showed  83  per  cent 
clear,  and  17  per  cent  showed  acetone  the  first 
twenty-four  hours. 

SUMMARY 

It  is  fully  admitted  that  there  are  many  valu- 
able facts  concerning  the  anesthesia  for  children 
which  might  be  gleaned  from  further  study  of 
this  small  series  of  case  records.  These  records 
represent  the  total  series  of  1807  cases,  beginning 
with  a higher  percentage  of  ether  anesthetics, 
while  later  nitrous  oxid  was  in  the  lead.  The  past 
eighteen  months,  ethylene  has  been  used  almost 
as  routine  anesthetic. 

It  would  seem  that  each  anesthetic  agent  has 
its  merits  and  its  shortcomings.  In  this  type  of 
work  the  anesthetic  of  most  merit  and  best  suited 
for  the  individual  case  should  be  used.  The  physi- 
cal and  mental  condition  of  the  child  on  entering 
the  operating  room,  the  care  and  skill  of  adminis- 
tering the  anesthetic,  the  length  of  time  and  sever- 
ity of  operation,  are  all  important  points  to  be 
noted  just  as  in  adult  anesthesia.  In  conclusion, 
from  a study  of  this  series  it  would  seem  that 
the  proper  handling  of  the  patient,  both  before 
and  during  the  anesthetic,  is  as  important  as  the 
type  of  anesthetic  used. 

746  Francisco  Street. 


CARCINOMA  OF  THE  UTERUS — ITS 
TREATMENT  BY  RADIATION* * 

By  Albert  Soiland,  M.  D. 
and 

William  E.  Costolow,  M.  D. 

Los  Angeles 

Discussion  by  R.  R.  Newell,  M.  D.,  San  Francisco ; 
Lyell  Cary  Kinney,  M.D.,  San  Diego;  H.  J.  Ullmann, 
M.  D.,  Santa  Barbara. 

HP  HE  first  radium  treatment  for  carcinoma  of 
the  uterus  was  given  by  Abbe  in  New  York 
in  1905.  Following  this  the  technique  was  rapidly 
developed  in  this  country,  and  also  in  France, 
where  faith  in  radium  has  remained  constant  and 
where  it  has  largely  replaced  surgery.  Results 
became  better  as  the  radium  technique  in  car- 
cinoma of  the  cervix  improved,  until  at  present 
it  is  the  method  of  choice  in  practically  all 
medical  centers. 

CLASSIFICATION  ACCORDING  TO  EXTENT 

In  the  consideration  of  the  treatment  of  car- 
cinoma of  the  cervix,  it  is  important  to  group 
the  cases  according  to  the  extent  of  the  disease. 
The  following  grouping  advised  by  Schmitz  2 is 
the  one  generally  used  in  this  country : 

Group  1. — Comprises  the  cases  in  which  the 
cancer  is  clearly  localized  to  the  cervix. 

Group  2. — In  which  doubt  exists  as  to  local- 
ization. These  cases  usually  show  a doughy  or 

* From  the  Albert  Soiland  Clinic,  Los  Angeles. 

* Read  before  the  union  meeting  of  the  Surgical  sec- 
tions of  the  California  Medical  Association  at  the  fifty- 
eighth  annual  session,  Coronado,  May  6-9,  1929. 


96 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


edematous  consistency  of  the  paracervical  tissues. 
(Border-line  cases.) 

Group  3. — Cases  in  which  there  is  an  indura- 
tion of  the  contiguous  tissues  and  organs.  (In- 
operable group.) 

Group  4. — Contains  the  cases  in  which  there 
are  necrotic  craters,  frozen  pelvis,  advanced 
cachexia,  and  distant  metastasis. 

Early  cases  which  would  compare  with 
Group  1,  as  above,  are  rarely  seen,  and  probably 
do  not  amount  to  more  than  ten  per  cent  of  the 
cases  of  carcinoma  of  the  cervix  applying  for 
treatment  at  the  various  hospitals  and  clinics. 
Less  than  five  per  cent  of  550  cases  of  cervical 
carcinoma  treated  at  the  Soiland  Clinic  during 
the  past  six  years  would  fall  into  this  group. 
Most  of  the  very  early  cases  were  those  which 
were  accidentally  discovered. 

We  are  not  including  a statistical  review  of 
the  results  from  our  own  clinic  because  it  has 
been  impossible  for  us  to  obtain  a complete 
follow-up  system,  and  not  until  recently  have  we 
insisted  upon  biopsy  and  microscopical  examina- 
tion in  every  case.  Statistics  are  certainly  not  of 
much  value  if  it  is  impossible  to  trace  a con- 
siderable percentage  of  cases.  Our  clinic  records 
extend  back  to  the  first  days  of  the  use  of  radia- 
tion, and  the  number  of  five-year  symptom-free 
cases  which  we  have  been  able  to  trace  leads  us 
to  believe  that  our  statistics,  were  they  complete, 
would  compare  favorably  with  those  from  reliable 
sources  which  are  quoted  in  this  article. 

SURGICAL  STATISTICS 

The  surgical  results  in  carcinoma  of  the  cervix 
have  been  extremely  poor  even  from  the  most 
radical  operations.  Heyman  1 found,  in  collecting 
statistics  from  twenty  large  clinics  (5806  cases), 
that  the  absolute  five-year  cure  amounted  to  only 

19.1  per  cent.  These  results  are  from  clinics  of 
the  best  operators,  using  the  most  radical  forms 
of  operation. 

For  many  years  practically  everyone  has  been 
willing  to  allot  most  of  the  border-line  or  doubtful 
operable  cases,  and  all  of  the  advanced  cases,  to 
radiation  treatment  but,  until  recently,  some  have 
insisted  on  surgery  in  the  early  cases.  From 
twenty-four  different  clinics  Heyman 1 collected 
3659  cases  (early  and  border-line  corresponding 
to  Groups  1 and  2 as  outlined)  which  were 
treated  by  surgery  alone.  He  found  only  35.6 
per  cent  cures.  The  mortality  amounted  to 

17.2  per  cent. 

The  high  mortality  (8  to  20  per  cent — 
Polak4),  and  the  high  morbidity  detract  greatly 
from  surgical  results.  Wertheim  had  a mortality 
of  30  per  cent  in  the  first  100  cases  in  which  he 
carried  out  his  radical  operative  procedure.  This 
causes  one  to  wonder  what  mortality  and  morbid- 
ity the  average  surgeon  must  have  who  attempts 
this  radical  operation,  and  who  probably  does 
not  operate  on  100  cases  during  his  entire  career. 

The  difficulty  of  technique  and  the  high  mor- 
tality of  radical  operations,  as  the  Wertheim,  has 
caused  the  average  surgeon  often  to  do  only  the 


ordinary  panhysterectomy  or,  as  in  some  cases 
of  carcinoma  of  the  fundus  which  we  have  been 
called  on  later  to  treat,  only  a subtotal  hysterec- 
tomy was  performed.  Of  course,  the  above 
procedures  are  unjustifiable.  Certainly,  the  five- 
year  cures  would  undoubtedly  be  very  few  if 
statistical  results  were  available  in  these  cases. 

It  is  difficult  to  improve  surgical  technique 
much  further,  as  the  vital  organs  surrounding 
the  cervix  limit  the  extent  of  the  radical  pro- 
cedures. On  the  other  hand,  radiation  technique 
is  being  constantly  improved  and  the  percentage 
of  five-year  cures  is  increasing  from  year  to  year 
in  various  clinics. 

John  G.  Clark,  of  Philadelphia,  who  was  one 
of  the  pioneers  in  the  development  of  the  radical 
operation,  even  preceding  Wertheim,  was  one  of 
the  first  men  in  this  country  to  give  up  surgery 
in  carcinoma  of  the  cervix  in  favor  of  radium. 

RADIATION  IN  EARLY  STAGES 

Radiation  has  not  been  used  in  early  and 
border-line  cases  of  carcinoma  of  the  cervix  a 
sufficient  length  of  time  for  a very  large  series 
of  cases  to  be  collected.  Heyman  1 collected  960 
cases  from  twelve  different  clinics,  treated  exclu- 
sively by  radiation.  He  found  34.9  per  cent  five- 
year  cures,  with  a mortality  of  less  than  two  per 
cent.  In  the  statistics  collected  by  Heyman,  the 
operability  in  the  surgical  cases  was  43  per  cent 
as  compared  to  less  than  30  per  cent  in  the  radio- 
logical figures.  Even  though  the  surgical  and 
radiological  results  in  the  early  cases  appear 
similar,  the  advantage  of  radiation  treatment  is 
obvious  when  the  17  per  cent  mortality  of  the 
surgical  statistics  is  considered.  In  clinics  where 
a careful  follow-up  system  is  maintained,  per- 
centages of  five-year  radiation  cures  in  early  cases 
have  been  reported  which  are  much  better  than 
the  average  referred  to  in  Heyman’s  article,  the 
Radiumhemmet  in  Stockholm 1 reporting  44.4 
per  cent  and  Ward  5 at  the  Woman’s  Hospital 
Clinic,  New  York  (May,  1928)  reporting  53.1 
per  cent  five-year  cures.  These  facts  have  caused 
the  majority  of  the  important  gynecological 
clinics  in  this  country  and  abroad  to  use  radium 
and  roentgen  ray  exclusively  in  all  cases  of  car- 
cinoma of  the  cervix. 

As  for  the  use  of  the  cautery,  Greenough 3 
reports  from  the  material  collected  for  the 
American  College  of  Surgeons,  that  of  fifty-two 
cases  reported  where  the  cautery  alone  was  used, 
there  was  not  a single  five-year  cure. 

IMPORTANCE  OF  THE  CONSIDERATION  OF 
RADIOSENSITIVITY 

Increasing  attention  has  recently  been  given  to 
the  consideration  of  the  type  of  cell  in  the  partic- 
ular growth  and  to  the  question  of  radiosensi- 
tivity. For  many  years  it  has  been  noted  that 
cervical  carcinoma  has  varied  in  its  response  to 
radiation.  Where  the  conditions  clinically  appeared 
similar,  and  were  treated  by  the  same  technique, 


February,  1930 


CARCINOMA — SOILAND  AND  COSTOLOW 


97 


it  has  been  observed  that  the  response  in  one  case 
would  be  slow  and  uncertain,  while  in  other  cases 
the  disease  would  melt  away  rapidly  and  com- 
pletely. It  is  now  known  that  this  is  largely  due 
to  a difference  in  radiosensitivity  of  the  cells. 

CLASSIFICATION  ACCORDING  TO  CELL  TYPE 

The  method  of  grading  the  degree  of  malig- 
nancy used  at  the  Memorial  Hospital  in  New 
York,  and  worked  out  by  Doctors  Healy  7 and 
Cutler,  with  the  cooperation  of  Doctor  James 
Ewing,  is  probably  the  simplest  and  most  satisfac- 
tory for  practical  purposes.  The  cases  are  graded 
according  to  the  degree  of  anaplasia  present  in 
the  cells  and  the  relative  amount  of  stroma.  The 
greater  the  degree  of  anaplasia  the  more  malig- 
nant the  cell.  The  different  grades  are  described 
as  follows : 

Grade  1. — Adult  type.  Cells  adult  in  charac- 
ter, highly  differentiated,  with  a tendency  to 
hornification  and  pearl  formation. 

Grade  2. — Plexiform  type.  Only  partial  differ- 
entiation and  moderate  anaplasia.  Squamous 
characters  either  slight  or,  more  often,  absent. 
The  growth  may  be  atypical  but  lacks  diffuse 
infiltration ; there  is  a partial  loss  of  polarity. 
The  cells  are  large  and  frequently  show  a plexi- 
form arrangement. 

Grade  3. — Anaplastic  type.  Cells  small,  round 
or  spindle  shaped,  the  nucleus  markedly  hyper- 
chromatic  with  numerous,  atypical  mitosis.  The 
cells  show  absence  of  squamous  characters, 
atypical  qualities,  complete  loss  of  differentiation, 
and  diffuse  infiltrative  growth. 

Group  1 has  a low  degree  of  malignancy. 
Group  2 medium,  and  Group  3 a high  degree  of 
malignancy.  The  more  malignant  the  cells,  the 
more  radiosensitive  they  are ; hence  Group  3 is 
highly  radiosensitive.  Healy  found  that  96  to  98 
per  cent  of  their  cervical  cases  were  squamous 
epidermoid  carcinomata,  only  two  to  four  per 
cent  being  adenocarcinoma  arising  from  the  cells 
of  the  cervical  mucous  glands. 

It  is  not  always  possible  to  determine  the  degree 
of  malignancy  of  the  growth.  Ward  and  Farrar  8 
state  that  prediction  of  prognosis  from  the  type 
of  cell  present  has  not  been  satisfactory,  as  pieces 
of  tissue  taken  from  different  places  in  the  growth 
have  not  always  revealed  the  same  type  of  cancer 
cells.  Martzloff  9 found  that  in  carcinoma  of  the 
cervix  uteri  a study  of  the  biopsy  material  failed 
to  indicate  correctly  the  predominant  variety  of 
cancer  cells  in  the  parent  tumor  in  about  one- 
third  of  the  cases.  On  account  of  the  above 
findings,  it  is  seen  that  an  attempt  to  segregate 
the  Grade  1 or  less  radiosensitive  cases  by  biopsy, 
in  order  that  they  might  be  treated  by  surgery, 
would  not  be  very  practicable.  We  also  know,  as 
will  be  demonstrated  in  the  next  table,  that  a large 
percentage  of  the  Grade  1 cases  will  respond  to 
radiation  treatment. 

Healy,7  in  grouping  200  cases  according  to  the 
degree  of  anaplasia  and  radiosensitivity,  found 
the  following: 


Table  1. — Grouping  of  Tzvo  Hundred  Cases 


Cell  Type 

Number  of  Cases 

Per  Cent 

Adult 

I 

35 

17 

Plexiform 

II 

123 

62 

Anaplastic 

III 

42 

21 

It  is  seen  that  the  adult  type,  or  the  less  radio- 
sensitive type,  forms  the  smallest  group,  with 
more  than  80  per  cent  of  the  cases  appearing  in 
the  more  radiosensitive  group. 

The  effect  of  the  histologic  cell  structure  upon 
end  results  is  shown  by  tlealy  10  in  Table  No.  2 
of  cases  treated  at  the  New  York  Memorial 
Hospital : 


Table  2. — Cases  Treated  at  the  New  York 
Memorial  Hospital 


Cell 

Type 

Stage  of 
Disease 

Total  No. 
of  Cases 

No.  Well 

Per  Cent 
Cured 

5 Years 

Adult 

(Grade 

I) 

Early 

and 

border- 

line 

10 

5 

50 

Advanced 

25 

1 

4 

Plexi- 

form 

(Grade 

II) 

Early 

and 

border- 

line 

21 

9 

43 

Advanced 

102 

15 

14 

Ana- 

plastic 

(Grade 

III) 

Early 

and 

border- 

line 

9 

6 

66 

Advanced 

33 

14 

42 

In  Table  2 it  is  demonstrated,  the  greater  the 
degree  of  malignancy  the  more  favorable  the 
prognosis  from  radiation  treatment.  It  is  also 
seen  that  a large  percentage  of  cures  occurred  in 
the  Grade  1 cases,  which  are  considered  to  be  the 
least  radiosensitive. 

A comparison  has  been  made  of  the  surgical 
and  radiological  results  in  carcinoma  of  the 
cervix,  showing  that  as  the  malignancy  of  the  cell 
increases,  the  surgical  results  become  poorer  and 
the  radiological  results  better.  This  is  shown  in 
Table  3. 

Table  3. — Percentage  Incidence  of  Five-Year 
Cures  for  the  Different  Types  of  Epi- 
dermoid Carcinoma  of  the  Cervix 
(After  Healy)  (Early  Cases) 


Spinal 

Cell  Cancer 
(Grade  II 
of  Broders) 

Transitional 
Cell  Cancer 
(Grade  III 
of  Broders) 

Spindle 
Cell  Cancer 
(Grade  IV 
of  Broders) 

Johns  Hopkins 
Hospital 
(Martzloff) 
(Surgery) 

47% 

24% 

9y2% 

Mayo  Clinic 
(Broders) 
(Surgery) 

53% 

21% 

9%% 

Memorial 

Hospital 

(Radiation) 

50% 

43% 

42%  — 66% 
Adv.  Early 
cases  cases 

98 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII.  No.  2 


Table  3 thus  demonstrates  that,  in  the  cases 
of  low  degree  of  malignancy,  surgical  and  radio- 
logical results  are  similar,  while  in  the  highest 
degree  of  malignancy  surgery  is  almost  useless 
and  radiation  is  of  great  value. 

VIEWPOINTS  OF  SOME  SURGEONS 

Swanberg  6 cites  a few  quotations  from  prom- 
inent surgeons  and  gynecologists  which  express 
the  present-day  opinions  regarding  the  treatment 
of  carcinoma  of  the  cervix : 

Dr.  George  Gray  Ward,  Professor  of  Gyne- 
cology, Cornell  University. — “We  believe  that 
our  results  show  that  radium  is  preferable  in  all 
classes  of  cervical  carcinoma.” 

Dr.  William  J.  Mayo,  Mayo  Clinic. — “Cancer 
of  the  cervix  even  in  the  early  stages  is  certainly 
as  well  treated  by  radium  as  by  hysterectomy.” 

Dr.  William  P.  Healy,  Memorial  Hospital,  New 
York. — “Hysterectomy  is  no  longer  justifiable  as 
the  treatment  of  carcinoma  of  the  cervix,  based 
upon  five-year  results.” 

Dr.  Charles  C.  Norris,  Professor  of  Gynecol- 
ogy, University  of  Pennsylvania.— -“We  have  not 
submitted  a case  of  cervical  carcinoma  to  hys- 
terectomy for  five  years.” 

References  could  be  given  to  many  other  large 
clinics,  in  this  country  and  abroad,  where  radia- 
tion is  used  exclusively  in  all  cases  of  carcinoma 
of  the  cervix. 

TECHNIQUE  OF  RADIUM  TREATMENT 

In  order  to  secure  good  results  from  the  use 
of  radium  in  carcinoma  of  the  cervix,  a carefully 
planned  technique  should  be  followed.  At  the 
present  time  the  dangers  of  radium  are  few, 
except  in  the  hands  of  the  inexperienced,  where 
great  harm  may  result.  Cases  must  be  consid- 
ered and  treated  individually,  but  as  much  stand- 
ardization of  technique  as  possible  should  be  used. 
A specimen  should  be  removed  for  diagnosis  of 
the  cell  type  in  all  cases  of  cervical  carcinoma. 
This  should  be  followed  immediately  by  an  appli- 
cation of  radium.  The  habit  of  removing  a 
section  and  waiting  a week  or  ten  days  before 
instituting  treatment  is  pernicious.  At  the  present 
time  we  feel  that  a technique  similar  to  that 
advanced  by  Heyman,11  in  which  only  heavily 
filtered  radium  is  used,  gives  the  best  end  results. 

In  the  average  cervical  carcinoma  favorable  for 
treatment,  we  are  at  present  dividing  the  treat- 
ment into  two  applications,  with  three  weeks’  time 
intervening.  At  the  first  application  a total  of 

3500  milligram  eh  hours  are  given,  applying 

2100  milligram  eh  hours  against  the  cervix, 

filtered  by  two  millimeters  of  gold  and  one  milli- 
meter of  rubber,  and  1400  milligram  eh  hours 
intrauterine,  filtered  by  one  millimeter  of  gold 
and  one  millimeter  of  rubber.  Three  weeks  later, 
by  the  use  of  similar  filtration,  a total  of  3000 
milligram  eh  hours  are  given,  applying  1800 
milligram  eh  hours  against  the  cervix  and 
1200  milligram  eh  hours  intrauterine.  Three 

twenty-five  milligram  tubes  are  used  in  the  vaginal 


applicator,  and  two  twenty-five  milligram  tubes, 
placed  in  tandem,  are  used  in  the  uterine  appli- 
cator. These  tubes  are  all  covered  by  .5  milli- 
meter of  silver.  The  duration  of  the  first  applica- 
tion is  twenty-eight  hours  and  the  second  applica- 
tion twenty-four  hours,  the  radium  being  applied 
against  the  cervix  and  intrauterine  at  the  same 
time.  Following  this,  no  further  radium  should 
be  given  for  from  six  to  twelve  months. 

The  patient  is  observed  at  monthly  intervals, 
and  late  recurrences,  appearing  a year  or  so  after 
the  original  treatment,  are  often  treated  with 
small  doses  of  radium  applied  locally,  although 
g'reat  care  is  exercised.  Often  suspicious  thick- 
ened areas  remain  for  several  months  and  finally 
disappear.  These  areas  should  not  be  treated 
unless  they  are  definite  of  malignancy.  Experi- 
ence of  observation  is  a most  valuable  asset  at  this 
stage  of  the  treatment. 

VALUE  OF  ROENTGEN  RAY  TREATMENTS  IN 
CONJUNCTION  WITH  RADIUM 

Some  gynecologists  have  used  radium  alone  in 
the  treatment  of  cervical  carcinoma,  with  results 
which  are  good.  In  early  cases  radium  alone  may 
possibly  be  sufficient  but,  as  urged  by  Schmitz,12 
roentgen  ray  should  be  applied  to  produce  a 
homogeneous  radiation  throughout  the  pelvis,  in 
order  that  the  regional  lymph  nodes  may  receive 
sufficient  radiation.  Schmitz  13  found  in  his  series 
of  cases  that  there  was  a higher  percentage  of 
five-year  cures  in  the  group  which  received  high 
voltage  roentgen  ray  treatment  in  addition  to  the 
radium.  For  many  years  various  writers  have 
reported  complete  cures  in  cervical  cases  from  the 
use  of  roentgen  ray  therapy  alone.  Recent 
reports  by  Zweifel 14  and  H.  Holzveissig 15  con- 
firm this.  Knowing  the  definite  value  of  additional 
roentgen  ray  treatment,  we  believe  that  the  patient 
should  be  given  the  advantage  of  this  treatment 
following  the  radium  in  all  cases,  if  there  are  no 
definite  contraindications  such  as  severe  anemia 
or  a poor  general  condition.  We  usually  begin 
the  high  voltage  roentgen  ray  treatments  from 
ten  to  fourteen  days  after  the  last  radium  appli- 
cation, and  we  give  as  near  a complete  depth 
dosage  as  possible.  The  roentgen  ray  treatments 
may  be  given  before  the  radium  applications. 

CARCINOMA  OF  THE  FUNDUS  UTERI 

It  has  been  estimated  that  only  about  ten  per 
cent  of  uterine  cancers  originate  in  the  fundus. 
Carcinoma  of  the  fundus  usually  occurs  after  the 
menopause.  Peterson  states  that  73  per  cent  of 
his  cases  were  between  fifty-five  and  sixty-five 
years  of  age.  At  this  age,  patients  frequently 
show  signs  of  degenerative  changes  in  the  heart 
and  kidneys,  and  often  are  poor  operative  risks. 
Irregular  bleeding  after  the  menopause  is  indica- 
tive of  malignancy,  although  not  always.  Very 
often  the  bleeding  is  from  a benign  condition ; 
such  as  senile  endometritis,  senile  vaginitis,  hyper- 
tension, or  cervical  polyps.  Benthin  16  found,  in  a 
series  of  131  cases  of  bleeding  after  the  meno- 
pause, that  cancer  was  the  cause  in  only  fifty-six 
cases.  In  seventy-five  of  the  cases  there  was  no 


February,  1930 


CARCINOMA — SOI l, AND  AND  COSTOLOW 


99 


tumor  of  any  kind,  either  benign  or  malignant. 
Curettage  is  the  most  positive  diagnostic  method 
in  this  condition,  but  it  is  not  by  any  means 
infallible.  There  are  certain  dangers  to  curettage 
in  the  presence  of  carcinoma.  Victor-Pauchet 17 
has  pointed  out  that  the  removal  of  fragments  of 
tissue  from  the  body  of  the  uterus  may  produce 
perforations  which  heal  spontaneously,  but  which 
very  frequently  result  in  metastasis  of  the  cancer. 
Pelvic  peritonitis  from  the  stirring  up  of  an  asso- 
ciated pyometra,  as  well  as  transtubal  trans- 
plantations of  carcinoma  cells,  has  occurred. 
Certainly,  if  diagnostic  curettage  is  to  be  done,  it 
should  be  followed  the  same  day  by  the  applica- 
tion of  radium,  or  by  a total  hysterectomy. 

END-RESULTS  IN  SURGICAL  TREATMENT  AND 
RADIATION 

The  general  belief  is  often  expressed  that  the 
results  in  carcinoma  of  the  fundus  are  very  favor- 
able if  hysterectomy  is  done.  An  examination  of 
the  best  operative  statistics  shows  that  such  is  not 
the  case.  Smith  and  Grinnell 18  report  an  absolute 
curability  of  only  about  20  per  cent.  Clark  and 
Norris  19  found  that  only  34.8  per  cent  of  their 
cases  were  alive  at  the  end  of  three  years. 
Heyman  1 found  42.8  per  cent  absolute  five-year 
cures  in  318  cases  gathered  from  six  different 
foreign  surgical  clinics.  In  early  cases,  which 
were  clearly  operable,  he  found  58.8  per  cent 
cures  in  323  cases  from  eight  different  clinics.  In 
118  early,  operable  cases  treated  by  radiation 
alone  in  five  different  clinics,  he  found  47.5  per 
cent  five-year  cures. 

Heyman  1 has  compared  the  five-year  cures  in 
carcinoma  of  the  fundus  at  the  Radiumhemmet 
with  the  best  surgical  statistics  as  follows : 


Table  4. — Comparison  of  Surgical  and  Radium 

Cures 


Percentage  of 
Surgical  Cures 

Percentage  of 
Radium  Cures 

All  cases 

42.8% 

43.5% 

Early  or  operable 
cases 

58.8% 

60.0% 

All  inoperable  cases  of  carcinoma  of  the 
fundus,  and  cases  technically  difficult  of  opera- 
tion. should  certainly  be  irradiated.  It  seems 
possible  that  even  in  the  operable  cases  results 
may  be  obtained  by  radiation  which  would  equal 
the  present  surgical  results. 

In  the  treatment  of  carcinoma  of  the  fundus, 
we  use  combined  radium  and  roentgen  ray  treat- 
ment. A total  dosage  of  4000  to  5000  milligram 
el.  hours  of  radium,  filtered  by  one  milli- 
meter of  gold  and  one  millimeter  of  rubber,  is 
applied  intrauterine.  This  is  followed  by  deep 
roentgen  ray  therapy  in  about  two  weeks. 

CONCLUSIONS 

1.  Roentgen  ray  therapy  should  be  combined 
with  radium  in  all  cases  of  uterine  carcinoma 
unless  contraindicated  by  the  poor,  general  con- 
dition of  the  patient. 


2.  Advanced  cases  of  carcinoma  of  the  fundus 
uteri  should  be  treated  by  radiation  alone.  It 
seems  possible  that  results  may  be  obtained  by 
radiation  in  early  cases  of  carcinoma  of  the 
fundus  which  will  equal  the  present  surgical 
results. 

3.  Carcinoma  of  the  cervix  uteri  is  no  longer  a 
surgical  condition  and  should  be  treated  by 
radiation  alone. 

1407  South  Hope  Street. 

REFERENCES 

1.  Heyman:  Acta  Radiologica,  25,  xi,  1927. 

2.  Schmitz:  Journal  American  Med.  Ass’n.,  Jan- 
uary 10,  1925. 

3.  Greenough:  Surgery,  Gynecology  & Obstetrics, 
xxxix,  1924,  pp.  18-26. 

4.  Polak  and  Phelan:  Radium:  Third  Series  No.  2, 
October  1925. 

5.  Ward:  Bulletin  American  College  of  Surgeons, 
1929. 

6.  Swanberg:  Radiological  Review,  March  1929. 

7.  Healy:  American  Journal  of  Obstetrics  & Gyne- 
cology, October  1928. 

8.  Ward  and  Farrar:  Journal  of  American  Med. 
Ass’n.,  August  4,  1928. 

9.  Martzloff:  American  Journal  of  Obstetrics  & 
Gynecology,  October  1928. 

10.  Healy:  Symposium  at  Radiological  Society  of 
No.  America,  Chicago,  December  1928. 

11.  Heyman:  Journal  of  Obstetrics  & Gynecology 
of  British  Empire,  Vol.  31,  No.  1.  Spring,  1924. 

12.  Schmitz:  American  Journal  of  Obstetrics  & 
Gynecology,  May  1925. 

13.  Schmitz:  Personal  Communication. 

14.  Zweifel:  British  Journal  of  Radiology,  London, 
September  1927. 

15.  H.  Holzveissig:  Archiv  fur  Klinische  Cherur- 
gui,  Berlin,  December  23,  1928. 

16.  Benthin:  Abstract  Journal  American  Medical 
Ass’n.,  September  29,  1928. 

17.  Victor-Pauchet:  Bulletins  et  Mein  de  la  Soc.  des 
Chirurgieus  de  Paris,  20:709-764,  November  2,  1928. 

18.  Smith,  G.  V.,  and  Grinnell,  R.  S.:  American 
Journal  of  Obstetrics  & Gynecology,  June  1928. 

19.  Clark  and  Norris:  Radium  in  Gynecology  (Lip- 
pincott  & Co.,  1927). 

DISCUSSION 

R.  R.  Newell,  M.  D.  (Stanford  University  Hospi- 
tal, San  Francisco). — At  Stanford  we  have  used  a 
number  of  methods  against  cancer  of  the  cervix: 
Single  massive  radium  dosage  in  the  canal,  radium 
followed  by  radical  operation,  radium  together  with 
x-ray  deep  therapy,  x-ray  without  radium.  Our  results 
have  seemed  to  us  much  better  since,  under  the  influ- 
ence of  Heyman’s  work,  we  adopted  straight  radium 
treatment,  heavy  filtration,  broken  dosage. 

Technique  is  of  basic  importance.  Cross  fire  is  the 
underlying  principle.  Experience  in  placing  the 
radium  is  invaluable.  The  cases  must  be  individual- 
ized. Dosage  must  be  very  heavy,  yet  one  must 
avoid  producing  a fistula.  Our  vaginal  applicators  are 
two  centimeters  in  diameter  and  are  customarily 
packed  into  the  lateral  fornices.  Thus  fixed,  one 
centimeter  spacing  of  the  radium  away  from  vaginal 
mucosa  is  a safety  feature  of  great  importance.  But 
the  intrauterine  applicator  must  be  slim,  so  that 
cancer  be  not  disseminated  by  vigorous  dilatation. 

We  have  stopped  using  x-ray  to  supplement  the 
radium.  This  in  spite  of  the  fact  that  we  have  a very 
few  cures  from  x-ray  alone.  These  we  attribute  in 
each  instance  to  Extraordinary  susceptibility  of  the 
patient  to  x-ray,  amounting  to  idiosyncrasy.  In  most 
patients  it  is  only  by  huge  doses  of  radiation  that  a 
cure  will  be  accomplished.  Such  huge  doses  can  be 
done  with  radium  because  of  the  narrow  field  treated, 
but  x-ray  to  the  whole  true  pelvis  cannot  be  given  to 
a quarter  that  intensity  without  danger  of  roentgen 
ulcer  or  even  fatal  roentgen  sickness.  Safe  x-ray 


100 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


dosage  will  almost  always  help,  sometimes  definitely 
relieve,  but  when  we  are  aiming  at  possible  cure, 
then  it  is  radium  we  depend  on.  To  my  mind  the 
important  difference  between  radium  and  x-ray  is  not 
in  quality  but  in  distribution  of  energy. 

We  have  been  advising  surgical  treatment  in  all 
operable  cases  of  carcinoma  of  the  body  of  the  uterus. 
Soiland  and  Costolow  show  results  of  radium  treat- 
ment just  as  good  and  without  the  primary  mortality. 
We  are  quite  in  agreement  with  their  heavy  dosage. 
We  have  given  4000  mg.  hrs.  in  one  dose,  by  string- 
ing several  radium  tubes  the  whole  length  of  the 
uterine  and  cervical  canal. 

We  are  also  in  hearty  agreement  with  their  policy 
of  refusing  to  treat  again  for  a very  long  time.  One 
has  the  best  chance  to  cure  a patient  the  first  time  he 
treats  her  and  if  then  he  has  given  all  that  is  safe 
and  finds  later  that  this  did  not  in  fact  cure  her,  he 
should  have  the  courage  to  admit  defeat.  It  then 
becomes  important  not  to  do  anything  to  increase  her 
suffering — and  repeated  heavy  radium  doses  are  likely 
to  cause  much  and  persistent  pain. 

The  statistical  studies  according  to  stage  of  disease 
and  cell  type  constitute  an  important  advance  in  our 
knowledge  of  carcinoma  of  the  cervix.  They  have 
confirmed  us,  too,  in  our  intention  to  treat  all  cases 
by  radium,  whatever  the  stage  or  type. 

* 

Lyell  Cary  Kinney,  Mu  D.  (510  Medico-Dental 
Building,  San  Diego). — The  results  presented  in  this 
paper  further  define  the  value  of  radium.  It  is  only 
in  carcinoma  limited  to  the  wall  of  the  uterus  that 
surgery  claims  results  equal  to  those  of  radiation,  but 
even  in  cases  thus  limited  the  surgical  indication  is 
restricted.  Where  there  is  advanced  cell  differentia- 
tion of  Broders’  classification  1 and  2,  surgical  cures 
approximate  those  of  radium.  In  the  more  numerous 
Class  3,  radium  has  twice  as  many  cures  as  surgery 
and  in  the  extremely  malignant  Class  4 radium  is 
five  to  seven  times  more  effective.  Another  determin- 
ing factor  in  the  choice  of  radium  is  Martzloff’s 
experience,  discovering  carcinoma  in  the  adnexae  in 
30  per  cent  of  those  cases  that  were  clinically  free 
from  induration.  These  cases  are  inoperable,  although 
clinically  limited  in  extent.  From  these  observations, 
the  percentage  of  cases  is  extremely  small  where  sur- 
gery may  be  chosen  instead  of  radium. 

Emphasis  should  be  laid  on  the  fact  that  operability 
must  be  determined  at  the  first  decision.  An  inoper- 
able case  does  not  become  operable  following  the  use 
of  radium  no  matter  how  complete  the  apparent 
result.  It  is  the  extension  into  the  broad  ligaments 
and  adnexae  that  contraindicates  surgery  at  any  time, 
and  the  fact  of  healing  of  the  cervix  does  not  dimin- 
ish the  danger  of  cutting  into  and  liberating  encapsu- 
lated and  viable  cells  in  subsequent  operation.  It  is 
good  judgment  to  use  preoperative  radium  in  clearly 
defined  operable  cases,  but  radium  does  not  render 
a case  operable. 

The  value  of  x-ray  in  conjunction  with  radium  is 
still  under  discussion.  The  clinics  presenting  the  best 
results  are  nearly  equally  divided,  although  their  sta- 
tistics are  very  similar.  Ward  and  Farrar  and  Heyman 
do  not  use  x-ray,  while  Bowing,  Healy  and  Schmitz 
depend  upon  additional  deep  therapy.  Measurements 
at  the  Memorial  Flospital  show  that  lethal  doses  of 
radiation  do  not  reach  the  pelvis  wall  from  radium 
applied  in  the  uterus  and  fornices.  The  supplementary 
x-ray  is  logical.  Our  custom  is  to  follow  radium  with 
deep  therapy  wherever  there  is  definite  broad  ligament 
involvement. 

We  have  made  it  a rule  to  follow  our  carcinoma 
cases  very  closely  for  a long  time.  Small  local  recur- 
rences can  be  nipped  with  an  implanted  needle  or  small 
doses  of  radium  in  contact  and  extensive  recurrence 
often  prevented.  Ward  and  Farrar  attribute  much  of 
their  extraordinary  success  to  this  procedure.  When 
a recurrence  is  once  established  it  is  not  only  futile, 
but  disastrous  to  repeat  the  original  massive  radiation. 

Doctors  Soiland  and  Costolow  describe  a technique 
that  well  represents  the  foremost  thought  of  the  day. 


Their  contention  that  radiation  is  the  treatment  of 
choice  in  all  types  of  carcinoma  of  the  cervix  is  logical 
and  is  forcefully  presented. 

* 

H.  J.  Ullmann,  M.  D.  (Cottage  Hospital,  Santa 
Barbara). — I was  very  much  interested  in  Doctors 
Soiland  and  Costolow’s  paper,  especially  from  the. 
standpoint  of  technique,  as  we  have  been  using  the 
Radiumhemmet  method  for  several  years,  but  not 
long  enough  to  make  a statistical  report.  There  is  no 
question,  however,  but  that  our  immediate  effects  are 
a great  improvement  over  the  older  methods.  With 
one  or  two  exceptions  we  have  been  using  the  three 
application  method  rather  than  the  two.  A total  dose 
of  three  treatments  is  2520  milligram  hours  in  the 
uterine  canal,  and  4680  milligram  hours  in  the  vagina. 
The  first  two  treatments  are  given  a week  apart  and 
the  third  treatment  three  weeks  from  the  second. 
There  is  always  a marked  regression  of  the  visible 
carcinoma  seen  at  the  last  treatment.  The  intra- 
uterine applicator  has  a filter  of  0.5  millimeter  of  silver 
plus  brass  one  millimeter  plus  aluminum  one  milli- 
meter, and  contains  thirty-five  milligrams  radium  ele- 
ment. The  vaginal  applicator  is  a flat  box  covered 
with  dental  compound  and  designed  so  that  it  may 
be  placed  against  the  cervix.  This  point  has  the  least 
thickness  of  the  dental  compound,  and,  therefore,  the 
distance  from  tissue  is  also  the  least.  The  filtration 
here  consists  of  0.5  millimeter  of  silver  plus  lead  two 
millimeters  plus  dental  compound  one  to  two  milli- 
meters, on  the  face,  and  a varying  thickness  on  the 
sides,  depending  upon  local  conditions.  This  box  is 
a centimeter  square  and  contains  sixty-five  milli- 
grams of  radium  element  evenly  distributed.  No  x-ray 
is  used.  In  the  event  of  recurrence  in  the  parametrium 
or  extensive  pelvic  infiltrations  a totally  different 
technique  is  used.  This  consists  of  broken  doses  of 
roentgen  ray  externally  and  radium  internally,  with 
the  use  of  small  doses  of  our  lead  compound  intra- 
venously to  increase  the  sensitivity  of  the  tumor  to 
radiation.  So  far,  this  method  has  given  splendid 
palliative  results.  I am  glad  that  Doctor  Soiland  and 
Doctor  Costolow  placed  emphasis  on  the  present 
trend  of  therapy  for  carcinoma  of  the  cervix,  i.  e.,  that 
radiation  in  place  of  operation  is  the  method  of  choice 
for  this  condition  in  nearly  all  of  the  cancer  centers 
of  the  world. 

* 

Doctor  Costolow  (Closing). — We  wish  to  thank  the 
discussers  of  our  paper,  and  note  their  general  agree- 
ment. 

We  rely  chiefly  upon  the  heavy  doses  of  radium  in 
the  treatment  of  carcinoma  of  the  cervix,  but  have 
observed  some  cases  in  which  additional  x-ray  was 
undoubtedly  of  much  value  in  bringing  about  a five- 
year  arrest.  No  bad  effects  have  been  noticed  from 
the  added  x-ray  therapy  because  we  give  it  some  time 
after,  when  the  reaction  from  the  radium  is  decreas- 
ing, and  in  this  manner  obtain  the  saturation  effect  of 
the  radiation.  It  is  difficult  at  present  to  determine 
the  exact  amount  of  added  benefit  of  the  additional 
x-ray  but.  even  though  it  be  small,  the  patient  deserves 
all  available  aid  in  this  serious  condition. 

Probably  there  is  not  a single  medical  condition  in 
which  there  is  more  general  agreement  regarding  the 
proper  method  of  treatment  than  in  carcinoma  of  the 
cervix.  In  practically  all  large  hospitals  and  clinics 
throughout  the  world  radiation  has  been  rapidly 
accepted  as  the  best  method  of  treatment  of  all  cases. 
Only  a few  European  clinics,  where  a very  few  men 
have  developed  a highly  skillful  surgical  technique, 
are  still  operating  upon  the  early  cases,  and  these  men 
usually  giving  postoperative  radiation  treatment. 
When  we  see  our  own  American  surgeons  in  large 
clinics,  as  the  Mayo  Clinic,  who  have  thoroughly  tried 
radical  operation  and  cautery,  give  up  these  operative 
measures  and  treat  all  their  cases  of  carcinoma  of  the 
cervix  by  radiation,  it  certainly  seems  that  the 
progress  for  the  future  in  this  disease  must  depend 
upon  the  further  development  of  radiological  instead 
of  surgical  technique. 


February,  1930 


TENDOVAGINITIS — WATKINS  AND  PITKIN 


101 


STENOSING  TENDOVAGINITIS  OF 
DE  QUERVAIN* 


REPORT  OF  CASE 


By  James  T.  Watkins,  M.  D. 

AND 

Horace  C.  Pitkin,  M.  D. 
San  Francisco 


A CCORDING  to  Schneider,1  whose  recent  arti- 
cle  is  the  first  to  describe  this  condition  in  the 
American  literature,  De  Quervain’s  disease  is  not 
so  uncommon,  as  is  its  diagnosis.  Nevertheless 
the  diagnosis  offers  no  difficulties.  Briefly  sum- 
marized, the  main  features  of  the  disease  are  as 
given  below. 

° HISTORICAL 


The  disease  was  first  described  by  De  Quer- 
vain,2  of  Basle,  Switzerland,  in  1895,  who  re- 
ported five  cases. 

Alfonse  Eschle  3 collected  one  hundred  and  ten 
cases  from  the  literature  in  1924,  adding  nineteen 
cases  of  his  own.  Schneider  1 also  added  fifteen 
cases. 

SYMPTOMS 

Age:  Any.  Sex:  Males,  121/,  percent.  Females, 
87 Yi  per  cent.  Occupation:  Approximately  60 
per  cent  maids  and  housewives.  Onset:  Usually 
gradual,  occasionally  traumatic.  Pain:  Localized 
in  region  of  radial  styloid  (occasionally  neuralgic 
in  hand  and  forearm ; aggravated  by  motions  of 
wrist,  but  chiefly  by  abduction  and  extension  of 
thumb).  Swelling  and  tenderness:  Localized  to 
region  of  radial  styloid.  Local  heat  and  redness: 
Never  present.  Crepitation:  Was  complained  of 
in  our  case,  though  it  could  not  be  palpated  by 
us.  Schneider  says,  “never  any  crepitation.” 
Disability:  Often  complete  of  affected  wrist. 


SIGNS 

Swelling  and  Tenderness. — Localized  at  point 
where  the  tendons  of  the  abductor  longus  pollicis 
and  the  extensor  brevis  pollicis  curve  around  the 
distal  end  of  the  radius. 

Limitation  of  motion  of  wrist  and  thumb  in 
varying  degrees. 

Roentgenological  Findings.  — Calcification  of 
the  periosteum  where  affected  tendons  pass  over 
the  radial  styloid. 

PATHOLOGY 

Etiology  is  unknown.  Possibly  repeated  trauma 
of  monotonous  occupations  may  predispose. 

Noninflammatory  proliferation  of  connective 
tissue  in  middle  layers  of  tendon  sheaths  at  this 
point.  Dorsal  carpal  ligament  and  periosteum  may 
also  be  thickened.  Lumen  of  tendon  sheaths  strik- 
ingly narrowed.  treatment 


Immobilization  of  thumb  by  plaster  of  Paris 
cast  of  thumb  and  wrist.  If  not  well  in  six  to 
eight  weeks : 

Operation. — Simple  longitudinal  incision,  with- 
out suture,  of  affected  portion  of  sheaths,  followed 
by  early  active  motion.  The  various  forms  of 
physiotherapy  are  valueless  except  following 
operation.  prognosis 

Without  operation,  70  per  cent  of  the  cases  can 
be  cured. 


* Read  before  the  Section  on  Industrial  Surgery  of  the 
San  Francisco  County  Medical  Society. 


With  operation,  99  per  cent  of  the  cases  can  be 
cured. 

Full  return  of  function  after  operation,  two 
to  three  weeks;  (industrial  cases,  four  to  six 
weeks). 

COMMENT 

In  the  following  report  the  most  interesting 
features  to  us  are : 

1.  The  general  surgeon  who  first  handled  the 
case  missed  the  diagnosis,  though  he  treated  the 
patient  for  over  one  month. 

2.  So  did  the  surgeon’s  roentgenologist. 

3.  So  did  both  the  authors. 

4.  So  did  their  roentgenologist  on  two  exami- 
nations. 

5.  The  pathology  found  at  operation  was  ap- 
preciated, and  although  not  recognized  as  De 
Quervain’s,  appropriate  treatment  resulted  in 
cure ; rather  to  our  surprise. 

6.  Diagnosis  was  made  by  survey  of  the  litera- 
ture only  after  patient’s  final  discharge. 

Therefore  we  feel  that  a clinical  entity  so  easy 
of  diagnosis,  so  disabling,  and  yet  so  amenable  to 
treatment  deserves  more  widespread  recognition 
than  apparently  obtains  at  present  in  this  country. 

REPORT  OF  CASE 

William  M.,  October  4,  1928. 

Chief  Complaint. — Pain  on  motion,  and  stiffness  in 
left  wrist. 

Present  Illness. — August  29,  1928,  crate  weighing  two 
hundred  pounds  fell  on  left  wrist.  Continued  work- 
ing, but  swelling  appeared  over  lateral  surface  lower 
extremity  left  radius,  and  wrist  became  painful.  So 
August  31,  stopped  working  and  went  to  Dr.  R.,  who 
took  x-rays,  said  “no  bones  broken”  and  put  band- 
age on  wrist.  Patient  bathed  wrist  in  hot  water  at 
home.  Did  not  work.  September  20,  Dr.  R.  splinted 
left  wrist  with  anterior  yucca  board  and  ordered  bak- 
ing, massage,  active  and  passive  motion.  This  treat- 
ment continued  every  day  to  present. 

Present  Status. — Swelling  still  present;  has  never  been 
discolored;  is  gradually  decreasing  in  size,  though  very 
slowly. 

Pain  located  at  swelling,  occurs  only  on  active  or 
passive  motion;  none  at  night. 

Patient  occasionally  feels  crepitus  at  the  site  of  the 
swelling  when  thumb  is  moved. 

Physical  Examination. — Inspection:  Localized  swell- 
ing size  of  half-dollar  lateral  aspect  lower  extremity 
of  left  radius.  No  redness  nor  ecchymosis. 

Palpation:  Swelling  is  firm,  attached  to  bone,  has 
smooth  sides,  is  only  moderately  tender,  does  not  pit 
on  pressure.  No  local  heat.  No  tenderness  elsewhere. 

Manipulation:  Extremes  of  any  motion  of  wrist, 
particularly  palmar  flexion  and  radial  flexion,  cause 
slight  pain  at  site  of  swelling;  no  crepitus  felt.  Com- 
pression of  radius  and  ulna  at  mid-forearm  causes  no 
motion  or  pain  at  wrist. 

Active  motion:  Pronation,  supination,  flexion  of 
fingers,  extension  of  fingers,  normal;  palmar  flexion 
wrist,  45/60;  dorsi-flexion  wrist,  40/50;  radial  flexion 
wrist,  17/37;  ulnar  flexion  wrist,  25/27;  thumb  to 
tips  of  fifth  finger,  normal;  thumb  to  base  of  fifth 
finger,  lacks  one-half  inch. 

Comment. — Localized  swelling,  moderately  painful, 
immediately  following  direct  trauma  done  five  weeks 
ago.  Never  discolored,  therefore  periosteum  unbroken. 
Now  shows  a tumefaction  attached  to  bone,  firm, 
only  moderately  tender,  without  signs  of  inflamma- 
tion or  dislocation.  Moderate  limitation  of  motion, 
chiefly  in  those  motions  where  the  acting  tendons  pass 
over  the  swelling. 

Impression. — Subperiosteal,  ossifying  hematoma. 

X-ray  Report. — October  5,  1928.  “Roentgen  exami- 
nation of  the  left  wrist  showed  well-marked  irregu- 


102 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


larity  of  lower  end  of  radius.  Apparently  old  healed 
fracture  of  lower  end  of  ulna.” 

Progress  Note  on  October  15. — After  ten  days  of  in- 
tensive physical  therapy,  the  patient  volunteers  that 
he  has  seen  some  improvement,  but  at  so  slow  a rate 
that  it  would  be  months  before  he  would  be  cured. 
He  is  of  the  opinion  that  the  mass  beneath  the  abduc- 
tors of  his  thumb  will  have  to  be  removed  before  he 
can  get  relief.  We  would  suspect  a tenosynovitis  if 
the  pain  were  not  so  localized.  Operation  advised. 

Operation,  October  17,  192S. — 1.  Three  and  one-half 
inch  longitudinal  incision  in  anatomical  snuff  box  of 
left  hand. 

The  annular  ligament  was  found  to  be  several  times 
thicker  than  normal,  and  on  its  central  part  presented 
a number  of  plates  of  what  appeared  to  be  cartilage. 
The  sheaths  of  the  tendons  were  split  on  the  postero- 
external aspect  where  pain  had  been  complained  of 
when  the  hand  was  palmar  flexed.  This  appeared  to 
release  them  from  tension. 

2.  A prominent  piece  of  bone  one  centimeter  by  two 
centimeters  was  chiseled  from  the  lower  end  of  radius 
opposite  the  site  of  protested  pain. 

3.  The  wound  was  closed  with  light  catgut  and  over 
it  dermal.  Plaster  of  Paris  was  not  applied,  nor  was 
any  immobilizing  splint. 

Progress  Note  on  November  20,  1928. — This  lad  has 
done  a good  deal  better  than  I had  any  reason  to 
expect  he  would.  The  pain  is  all  gone  from  his  wrist; 
the  motion  has  increased  until  it  is  almost  normal; 
there  is  an  area  of  numbness  between  the  base  of 
thumb  and  of  first  finger,  apparently  due  to  traction 
on  the  radial  nerve  at  operation,  and  the  swelling  in 
the  wrist  has  markedly  diminished. 

These  results  have  come  rather  lately  and  I shall 
continue  physiotherapy  until  the  first  of  the  month, 
at  which  time  I hope  to  discharge  him  cured  without 
disability  excepting  possibly  for  this  little  numbness 
at  the  base  of  the  thumb. 

November  27,  1928. — Patient  discharged  today  hav- 
ing normal  thumb  and  wrist  motions  in  both  hands. 

909  Hyde  Street. 

REFERENCES 

1.  Schneider:  Surg.  Gyn.  Obst.,  xlvi,  846-850,  June 
1928. 

2.  De  Quervain:  Ueber  eine  Form  von  chronischer 
Tendovaginitis,  Cor.-Bl.  f.  schweiz.  Aerzte,  1895,  xiii, 
389. 

3.  Eschle:  Tendovaginitis  Ueber  Styloid  Proc., 

Schweiz.  Med.  Wochenschr.,  vol.  liv,  1006-1010,  Octo- 
ber 30,  1924.  

H EMOCH  ROM  ATOSI S* 


REPORT  OF  CASE 

By  Milo  K.  Tedstrom,  M.  D. 
A naheim 


HEMOCHROMATOSIS,  variously  known  as 
bronze  diabetes,  pigmentary  cirrhosis,  and 
generalized  hemochromatosis,  is  a chronic  disease 
characterized  by : 

1.  A peculiar  discoloration  of  the  skin  due  to 
iron-containing  pigment,  especially  hemosiderin  in 
the  skin  and  various  viscera. 

2.  Cirrhosis,  especially  of  the  liver  and  pan- 
creas. 


3.  Slightly  enlarged  spleen. 

4.  In  many  cases  a hyperglycemia,  with  or 
without  glycosuria.  The  disease  usually  termi- 
nates fatally,  in  the  end  stages  being  accompanied 
by  cachexia,  anemia,  acidosis,  and  possibly  dia- 
betic coma. 


EARLY  STUDIES 


Troisier 1 in  1871  first  described  the  disease, 
but  it  was  not  until  1889  that  Von  Reckling- 
hausen 2 showed  that  the  pigmentary  changes 


* From  the  Department  of  Internal  Medicine,  Johnston- 
Wickett  Clinic,  Anaheim. 


were  due  to  the  hemosiderin  in  the  skin,  and 
named  this  symptom  complex  “hemochromatosis.” 
About  one  hundred  cases,  all  adults,  have  been 
reported  in  the  literature,  only  four  or  five  of 
which  were  females.  The  majority  of  the  cases 
were  diagnosed  postmortem. 

The  etiology  of  hemochromatosis  is  uncertain, 
but  there  are  many  theories.  Many  of  the  cases 
have  a history  of  chronic  alcoholism,  but  it  is  diffi- 
cult to  see  how  this  could  be  a factor  when  we 
see  many  cases  of  alcoholic  cirrhosis  without  the 
pigmentary  changes.  Mallory  3 has  recently  pub- 
lished considerable  experimental  and  some  clinical 
evidence  to  support  chronic  copper  poisoning  as 
the  causative  factor.  He  had  several  patients  who 
gave  a history  of  long-standing  copper  exposure. 
However,  with  the  increased  copper  distillation 
of  alcoholic  beverages  it  seems  that  hemochroma- 
tosis should  be  very  common  now  if  copper  were 
a factor.  Mills  is  quoted  by  Coustam  4 as  report- 
ing that  Koreans  use  brass  vessels  for  cooking 
purposes,  and  there  are  few  pigmentary  disturb- 
ances among  these  people. 

Hall  and  Butt 5 repeated  Mallory’s  experiments 
and  confirmed  his  findings.  They  believe  that  “a 
direct  relation  exists  between  the  amount  of  cir- 
rhosis of  the  liver  and  the  quantity  of  pigment 
deposited.”  Flinn  and  von  Glahn  6 repeated  Mal- 
lory’s experiments  on  rabbits,  guinea-pigs,  and 
rats  and  concluded  that  neither  copper  nor  its 
compounds  cause  cirrhosis  of,  nor  deposition  of 
pigment  in,  the  liver.  They  were  able  to  produce 
pigment  depositions  in  the  liver  of  rabbits  by 
feeding  them  an  exclusive  carrot  diet. 

ORIGIN  OF  THE  PIGMENT 

There  are  numerous  theories  as  to  the  origin 
of  the  pigment.  Some  of  them  are : that  some 
unknown  agent  acts  on  the  blood  causing  the  ery- 
throcytes to  give  up  their  iron ; that  the  autolytic 
function  of  the  liver  cells  or  spleen  is  impaired ; 
that  there  is  a decreased  iron  output  by  the  kid- 
neys and  intestines ; and  that  there  is  a primary 
cirrhosis  of  the  liver  with  secondary  pancreatic 
changes  and  skin  pigmentation.  Recent  animal 
experiments  by  Rous 7 tend  to  show  that  the 
cirrhosis  is  the  primary  lesion.  His  experiments 
also  tend  to  show  that  “while  the  increased  de- 
struction of  red  blood  cells  cannot  be  the  primary 
cause  of  hemochromatosis,  yet  these  elements  are 
certainly  the  source  of  the  hemosiderin.”  Many 
authorities  consider  that  the  pigmentation  is  pri- 
mary, and  leads  to  cirrhosis  of  the  liver  and  pan- 
creas. The  case  reported  seems  to  have  had  a 
primary  skin  pigmentation  change  followed  by 
cirrhosis  of  the  liver  and  spleen.  As  the  iron  de- 
posits are  increased  in  the  cells  normally  metabo- 
lizing iron,  it  would  seem  that  the  initial  lesion 
is  a failure  of  organs  which  normally  take  care 
of  the  products  of  blood  destruction  to  do  so. 
Sprunt 8 and  others  have  advanced  this  theory. 
Gaskell  and  others  9 have  found  an  increase  in 
iron  content  of  blood  with  defective  iron  elimi- 
nation. symptoms 

The  onset  of  the  disease  is  usually  gradual. 
Quite  frequently  the  patient  presents  himself  with 
the  typical  symptoms  of  diabetes,  that  is  polyuria, 
polydipsia,  and  polyphagia.  Others  have  not  re- 


February,  1930 


1 1 EMOCH  ROM  ATOSIS — TEDSTROM 


103 


covered  their  health  following  an  acute  infection. 
It  seems  strange  that  so  many  of  the  patients 
have  not  noticed  the  discoloration  of  the  skin  until 
their  attention  is  called  to  it  by  their  physician. 
The  usual  symptoms  complained  of  are : general 
malaise,  weakness,  loss  of  weight,  and  some  epi- 
gastric discomfort,  especially  nausea  and  vomit- 
ing, constipation,  loss  of  appetite,  and  occasional 
swelling  of  the  abdomen.  Examination  usually 
reveals  a malnourished  individual  with  dry  skin. 
The  discoloration  is  variously  described  as  grayish 
brown,  gray  black,  blue  black,  dirty  gray,  or 
brownish  gray,  and  affects  the  greater  part  of 
the  body,  being  less  marked  around  the  axillae, 
areolae,  and  genitals.  The  liver  is  smoothly  en- 
larged ; ascites  is  present ; and  the  spleen  is  usu- 
ally palpable.  Occasionally  purpuric  spots  or  pete- 
chiae  are  seen.  Slight  jaundice  has  been  noted. 
The  laboratory  tests  usually  reveal  glycosuria, 
hyperglycemia,  some  albumin  and  a few  casts, 
and  normal  erythrocytes  and  leukocytes  with 
normal  differential.  The  urobilin  is  not  increased 
in  the  blood  and  there  is  no  bile  in  the  urine. 

DIAGNOSIS 

The  condition  must  be  differentiated  from 
Addison’s  disease,  which  it  suggests  due  to  the 
pigmentation  of  the  skin.  The  absence  of  pig- 
mentation in  the  mucous  membrane  of  the  mouth, 
normal  or  elevated  blood  pressure,  and  enlarged 
liver,  all  serve  to  differentiate  the  case  from  Addi- 
son’s disease. 

Argyria  occasionally  may  be  confounded  with 
it,  but  the  history  and  hepatic  cirrhosis  will  rule 
it  out.  The  finding  of  hemosiderin  in  a section 
of  skin  removed  by  biopsy,  and  in  the  urinary 
sediment,  is  diagnostic  of  hemochromatosis.  The 
pathologic  examination  reveals  cirrhosis  of  the 
liver,  pancreas  and  lymph  nodes,  with  much  iron- 
containing  pigment.  This  pigment  is  also  ob- 
served in  the  kidneys,  adrenals,  and  entire  gastro- 
intestinal tract.  The  spleen  is  large,  hard,  and 
dark  in  color.  The  skin,  of  course,  has  iron  pig- 
ment present,  chiefly  around  the  sweat  glands. 

The  results  of  treatment  are  very  unsatisfac- 
tory. The  patient  should  have  general  measures 
to  improve  his  health  and  prevent  secondary  in- 
fections. Diabetes,  if  present,  should  be  treated. 
However,  Coustam  4 has  reported  a case  with  dia- 
betes and  acidosis  that  was  refractory  to  insulin. 

REPORT  OF  CASE 

29229,  forty-six  years  of  age,  male,  entered  the 
hospital  on  December  23,  1928.  His  chief  complaint 
was  swelling  of  the  abdomen.  For  the  past  year  he 
had  noted  gradual  loss  of  weight  and  strength,  and 
had  had  some  nausea  at  intervals.  About  October  23, 
1928,  he  had  had  general  aching,  malaise,  and  fever, 
which  he  thought  was  “flu.”  He  recovered  after  one 
week.  While  lifting  acetylene  tanks  on  November  20, 
1928,  he  suddenly  had  severe  mid-epigastric  pain, 
which  cleared  up  after  a short  while.  Since  that  time 
he  had  had  intermittent  dull  pain  in  the  epigastrium, 
especially  during  the  past  two  weeks.  Two  weeks 
before  he  entered  the  hospital  he  noted  enlargement 
of  his  abdomen.  This  enlargement  had  progressively 
increased.  At  the  time  of  his  entrance  he  was  having 
dull  epigastric  pain  (chiefly  on  the  right),  orthopnea, 
dyspnea,  tachycardia,  and  considerable  enlargement 
of  the  abdomen.  On  being  questioned,  the  patient 
said  he  had  noted  discoloration  of  the  skin  for  the 
past  year;  his  family  physician  had  noted  it  for  three 
years. 


Past  History. — Scarlet  fever  at  six  years  of  age. 
Gonorrhea  at  eighteen  years  of  age.  The  patient 
denied  lues.  He  had  been  a chronic  alcoholic  for  the 
greater  part  of  his  life.  He  had  worked  around  brass 
for  the  past  fifteen  or  twenty  years. 

Family  History. — Essentially  negative. 

Physical  Examination.  — The  patient  was  greatly 
emaciated,  very  orthopneic,  and  dyspneic.  There  were 
blackish  brown  discolored  areas  of  skin  with  normal 
areas  in  their  midst.  These  were  chiefly  over  the 
chest,  axillae,  back,  inguinal  regions,  inner  sides  and 
front  of  thighs,  and  buttocks.  The  facial  appearance 
was  somewhat  mask-like,  without  expression.  The 
blood  pressure  was:  systolic,  130;  diastolic,  90.  Ex- 
amination of  the  heart  was  negative.  Examination 
of  the  lungs  revealed  a few  crepitations  at  the  bases 
posteriorly.  The  abdomen  was  enormously  distended, 
with  prominent  superficial  veins..  There  was  shifting 
dullness  in  both  flanks,  and  a fluid  wave  on  both  sides. 
After  paracentesis  the  liver  edge  was  felt  three  finger- 
breadths  below  the  costal  margin,  firm  and  smooth. 
The  spleen  tip  was  also  palpable. 

Laboratory  Reports.- — Urine:  Trace  of  albumin;  occa- 
sional hyaline  casts;  sugar,  urobilin,  and  indican  were 
negative;  urine  sediment  showed  hemosiderin. 

Blood:  Hemoglobin,  48  per  cent  (Newcomer);  red 
blood  cells,  2,480,000;  white  blood  cells,  6000.  Differ- 
ential: Polymorphonuclear  leukocytes,  82  per  cent; 
lymphocytes,  18  per  cent.  Nonprotein  nitrogen,  17.5 
milligrams.  Blood  sugar,  109  milligrams.  Blood  Was- 
sermann:  negative.  Sugar  tolerance:  normal  curve. 

Gastric  analysis:  Free  HC1,  24°;  total  acid,  58°. 

Ascitic  fluid:  Albumin,  four  plus;  specific  gravity, 
1.010;  microscopic,  negative. 

Fragility  test:  Hemolysis  begins  at  .40  per  cent  and 
is  complete  at  .30  per  cent. 

Van  den  Bergh  reaction  was  direct.  Serum  bili- 
rubin was  estimated  as  2.3  milligrams  for  each  100 
cubic  centimeters. 

Section  of  skin  removed  by  biopsy  showed  hemo- 
siderin in  great  quantities,  especially  around  the  sweat 
glands. 

Section  of  liver  removed  at  time  of  omentopexy 
showed  considerable  destruction  of  liver  cells  with 
replacement  by  scar  tissue.  Abundant  iron-containing 
pigment  was  also  present. 

COMMENT 

This  patient  had  considerable  ascites  which  was 
only  slightly  benefited  by  the  administration  of 
ammonium  chlorid  and  novasurol.  An  omen- 
topexy was  decided  upon  and  was  done  under  local 
anesthesia  on  January  22,  1929  by  Dr.  Herbert 
A.  Johnston.  Since  that  time  the  patient  has  had 
only  one  tapping  (in  five  months),  whereas  pre- 
viously he  had  required  almost  daily  paracentesis. 
The  spleen  is  no  longer  palpable,  and  the  liver  is 
smaller  although  still  palpable.  There  is  no  evi- 
dence of  ascites  at  present.  The  patient  has  re- 
gained his  strength  and  has  returned  to  his  work. 
The  relief  of  his  ascites  has  apparently  made  him 
as  well,  physically,  as  before  the  onset  of  the  dis- 
ease. He  has  not  yet  developed  hyperglycemia 
or  glycosuria.  Although  his  pigmentation  is  un- 
changed, we  feel  that  omentopexy  has  been  of 
decided  benefit  to  this  patient.  Since  writing  the 
above  the  patient  has  been  seen,  and  his  abnormal 
pigmentation  is  much  less,  and  the  liver  is  smaller. 

SUMMARY 

A case  of  hemochromatosis,  proved  by  the  find- 
ings of  hemosiderin  in  the  skin,  in  the  urine  sedi- 
ment, and  in  the  liver  section  removed  at  time  of 
operation,  is  presented. 

This  patient  has  a history  of  both  chronic  alco- 
holism and  possible  chronic  brass  poisoning,  both 


104- 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


of  which  are  theoretical  causes  of  hemochroma- 
tosis. 

Omentopexy  was  done  on  this  patient  with 
remarkable  improvement  in  his  condition,  so 
much  so  that  he  was  able  to  return  to  his  work. 
The  literature  does  not  reveal  any  previous  case 
of  hemochromatosis  having  an  omentopexy  for 
relief  of  the  ascites. 

The  history  suggests  very  definitely  that  the 
pigmentary  change  was  the  primary  lesion,  being 
followed  by  cirrhosis  of  the  liver  and  ascites. 

117  N.  Claudine. 

REFERENCES 

1.  Russel,  E. : M.  J.  Australia,  1:251,  March  1925. 

2.  Von  Recklinghausen : Tagebld.,  d.  62.  Versammel. 
d.  naturf.  u.  Aertzte,  p.  324,  1889. 

3.  Mallory,  F.  B.,  Parker,  Frederick,  Jr.,  and  Nye, 
Robert  N.:'j-  M.  Res.,  42:461,  1921. 

4.  Coustam:  Proceedings  of  the  Staff  Meetings  of 
Mayo  Clinic,  3:225,  August  1928. 

5.  Hall,  E.  M.,  and  Butt,  E.  M.:  Arch.  Path.,  6:1, 
1928. 

6.  Flinn  and  von  Glahn:  J.  Exper.  Med.  49:5, 
January  1929. 

7.  Rous,  Peyton,  and  Oliver:  J.  Exper.  Med.,  28:645, 
1918;  ibid.  28:629,  1918. 

8.  Sprunt:  Hemochromatosis,  Nelson  Loose-Leaf 
Living  Med.,  3:207.  Arch.  Int.  Med.,  8:75,  July  1911. 

9.  Gaskell,  Wallis,  Sladen,  Vaile,  and  Garrod:  Quart. 
J.  Med.,  7:129,  1914. 


FOREIGN  BODIES  IN  THE  URETER* * 

REPORT  OF  CASES 

By  William  E.  Stevens,  M.  D. 

San  Francisco 


Discussion  by  Charles  P.  Mathe,  M.D.,  San  Francisco ; 
IV.  JV . Cross,  M.D.,  Oakland;  Robert  V.  Day,  M.D.,  Los 
Angeles. 


"FOREIGN  bodies  which  have  been  introduced 
from  outside  the  body  are  rarely  found  in  the 
ureter.  No  mention  of  this  condition  is  made 
in  the  majority  of  the  recent  books  on  urology. 
Hugh  Cabot 1 cites  but  one  case,  that  of  a male 
patient  who  was  seen  some  years  ago  by  the  late 
A.  T.  Cabot.  A long  straw  had  entered  the  right 
ureter,  having  been  inserted,  doubtlessly,  into  the 
urethra.  The  lower  third  of  the  straw  projected 
into  the  bladder  and  was  removed  with  a lithotrite. 


CASES  REPORTED  IN  LITERATURE 

In  the  majority  of  the  very  few  cases  reported 
in  the  literature  the  foreign  bodies  consisted  of 
a fragment  of  catheter  which  had  broken  off 
in  the  ureter.  Young 2 states  that  this  type  of 
accident  is  extremely  rare  and  that  if  a catheter 
does  break  in  the  ureter  it  will  probably  be  ex- 
pelled. The  only  instance  of  a foreign  body  in 
the  ureter  mentioned  by  him  is  the  case  reported 
by  Cabot. 

Augustus  Riley  3 recently  reported  a case  in 
which  one  inch  of  a spiral  filiform  tipped  catheter 
which  had  been  used  to  get  by  a stricture  in  the 
lower  third  of  the  right  ureter  doubled  on  itself 
and  was  broken  off.  It  was  eight  weeks  before 
Riley  was  able  to  remove  the  fragment  and  it 
was  then  found  to  be  encrusted  with  a soft  stone 


* From  Stanford  University  Medical  School. 

* Read  before  the  Urology  Section,  California  Medical 
Association,  at  the  Fifty-eighth  Annual  Session,  May  6-9, 
1929. 


three-quarters  of  an  inch  long  and  one-quarter  of 
an  inch  in  diameter. 

Strominger  and  Blum  4 report  the  very  interest- 
ing case  of  a man  thirty-seven  years  of  age  who 
complained  of  frequent  urination,  pain  at  the 
beginning  of  urination  and  cloudy  urine.  The 
bladder  capacity  was  reduced  to  120  cc.  Tem- 
porary improvement  followed  instillations  of 
protargol  solution  and  treatment  at  mineral 
springs  but  finally  fever  appeared,  the  vesical 
symptoms  increased  in  severity  and  the  patient 
complained  of  severe  pain  in  the  right  kidney 
region.  Examination  revealed  a stricture  in  the 
bulbous  portion  of  the  urethra,  marked  inflam- 
matory lesions  of  the  bladder  and  an  impassable 
obstruction  in  the  right  ureter  ten  cm.  from  the 
uretero-vesical  orifice.  The  bladder  contained  a 
calculus  the  size  of  a nut.  The  patient  was  not 
seen  again  for  three  months.  The  bladder  symp- 
toms were  then  still  more  pronounced.  Because 
of  the  marked  reduction  in  bladder  capacity  and 
the  fact  that  the  urethra  could  not  be  dilated  it 
was  decided  to  perform  an  open  operation.  In 
addition  to  the  vesical  calculus  seven  cm.  of  a 
ureteral  catheter  were  found  projecting  from  the 
right  ureter.  That  portion  of  the  fragment  of 
catheter  remaining  in  the  ureter  measured  twelve 
cm.  in  length.  At  the  ureteral  orifice  the  catheter 
was  surrounded  by  a small  calculus.  This  frag- 
ment of  catheter  had  been  in  the  ureter  for  over 
one  and  one-half  years.  It  was  permeable  and 
there  was  no  dilatation  of  the  kidney  pelvis. 

These  same  authors  state  that  they  know  of 
one  case  in  which  a fragment  of  catheter  fifteen 
cm.  long  was  lost  in  the  ureter  during  catheter- 
ization. It  was  removed  four  days  later  through 
an  iliac  incision. 

Schlagintweit 5 reported  a case  of  foreign  body 
which  he  believes  had  remained  in  the  left  ureter 
for  from  ten  to  fifteen  years.  The  patient  had 
suffered  from  pain  in  the  left  reno-ureteral  region 
for  many  years.  Examination  revealed  pyone- 
phrosis of  the  left  kidney.  Radiography  showed 
a calculus  in  the  lower  third  of  the  ureter  from 
which  a thin  hook-shaped  formation  projected 
like  the  stem  of  a pear.  After  removal  of  the 
pyonephrotic  kidney  the  ureter  was  incised  and 
the  calculus  together  with  a hook-shaped  piece 
of  wire  was  extracted.  No  periurethritis  or  scar 
tissue  were  found  at  the  site  of  the  foreign  body 
and  stone  but  the  ureter  was  hypertrophic  and 
dilated.  The  author  was  unable  to  explain  how 
the  wire,  bent  at  a right  angle  at  its  lower  end, 
could  have  entered  the  ureter. 

Galland  6 reported  the  remarkable  case  of  a man 
forty-two  years  of  age  who  inserted  the  horn 
stem,  eight  cm.  long  and  eleven  mm.  in  circum- 
ference, of  a tobacco  pipe  into  his  urethra.  After 
passing  into  the  bladder  it  had  probably  been 
forced  by  contraction  of  this  organ  into  the  right 
ureter  for  a distance  of  two  cm.  Its  extremity 
perforated  the  wall  of  the  ureter  and  the  patient 
died  fourteen  days  later. 

Galland  also  mentions  a case  recorded  by  Bayle 
in  1686  in  which  a pin  was  found  imbedded  in  the 
wall  of  the  ureter.  It  was  impossible  to  determine 


February,  1930 


FOREIGN  BODIES  IN  URETER — STEVENS 


105 


whether  the  pin  had  entered  the  ureter  from  the 
bowel  or  through  the  bladder. 

In  a case  recorded  by  Peirce  a spiral  shell  was 
found  in  the  ureter. 

Cases  of  foreign  bodies  ascending  the  entire 
length  of  the  urinary  tract  from  the  external 
urethral  meatus  to  the  pelvis  of  the  kidney  are 
rare.  In  this  connection,  one  recently  reported 
by  T.  P.  Waring,7  is  of  interest.  A blade  of  grass 
passed  from  the  urethra  of  a man  thirty-eight 
years  of  age  into  the  bladder  and  thence  through 
the  ureter  to  the  pelvis  of  the  kidney.  Waring 
believes  that  strong  antiperistaltic  ureteral  waves 
forced  the  grass  upward  to  the  renal  pelvis. 
I believe  that  regurgitation  should  also  be  con- 
sidered as  a factor  in  this  case.  Alexander  H. 
Peacock s calls  attention  to  the  fact  that  Lewis 
and  Goldschmidt  produced  reverse  peristalsis  by 
filling  and  stimulating  the  bladder.  This  was 
accompanied  by  reflux  of  fluid  from  the  bladder 
to  the  kidney.  Foreign  bodies  which  enter  the 
ureter  directly  from  outside  the  body  usually 
travel  downward  toward  the  bladder. 

REPORT  OF  CASES 

Case  1. — A married  woman  forty  years  of  age  com- 
plained of  pain  in  the  right  upper  abdominal  quadrant 
radiating  to  the  back.  This  had  begun  three  months 
before  coming  under  observation  but  had  increased 
in  severity  during  the  past  two  days.  She  also  suf- 
fered occasionally  from  nausea  and  vomiting  after 
meals;  loss  of  weight.  The  right  ovary  and  appen- 
dix had  been  removed  ten  years  previously.  Palpa- 
tion revealed  a slightly  enlarged  right  kidney  which 
descended  into  the  right  lower  quadrant  on  deep 
inspiration.  The  characteristic  pain  was  reproduced 
by  pressure  on  this  organ.  A catheterized  specimen 
of  bladder  urine  contained  an  occasional  group  of  pus 
cells  but  was  culturally  negative.  The  kidney  func- 
tion was  normal.  A number  six  ureteral  catheter  en- 
countered some  resistance  about  six  cm.  from  the 
uretero-vesical  orifice.  Partial  relief  from  pain  fol- 
lowed the  first  catheterization.  Pyelography  revealed 
moderate  dilatation  of  the  renal  pelvis. 

Diagnosis. — Stricture  of  the  right  ureter  and  hy- 
dronephrosis. Marked  relief  followed  a few  dilatations 
with  bulbed  catheters.  Following  one  of  the  dilata- 
tions about  three  cm.  of  the  catheter,  including  a 
number  fourteen  bulb,  broke  off  in  the  ureter.  A 
number  of  attempts  to  extract  this  fragment  were 
unsuccessful  but  following  pyelography  six  weeks 
later  it  was  passed  by  the  patient.  The  catheter  was 
permeable  and  pyelograms  now  showed  but  slight 
dilatation  of  the  kidney  pelvis.  Notwithstanding  the 
presence  of  the  broken  catheter  in  the  ureter  for  sev- 
eral weeks  the  pain  had  been  absent  for  over  two 
months. 

■f  i i 

Case  2. — A man  fifty-six  years  of  age  complained 
of  pain  in  the  right  lumbar  region  and  frequent  urina- 
tion. A catheterized  specimen  of  bladder  urine  con- 
tained about  twelve  pus  and  blood  cells  to  the  high 
power  field.  Radiographs  with  opaque  catheters  in 
the  ureters  revealed  a calculus  in  the  right  ureter  at 
the  pelvic  brim.  Calibration  of  the  ureters  showed 
a stricture  just  below  the  stone.  The  ureter  was 
noticeably  dilated  above  this  point,  although  the  pelvis 
of  the  kidney  was  of  normal  size  and  contour.  After 
several  dilatations  of  the  ureter,  followed  by  the 
injection  of  olive  oil,  the  calculus  escaped  into  the 
bladder  and  was  passed  with  the  urine.  A Walther 
flexible  metallic  bougie  was  then  inserted  for  the  pur- 
pose of  further  dilating  the  stricture.  Unfortunately 
the  filiform  became  detached  and  remained  in  the 
ureter.  Numerous  attempts  to  remove  the  filiform  by 
means  of  various  recognized  procedures  were  unsuc- 


cessful and  incision  of  the  ureter  following  extra- 
peritoneal  exposure  finally  became  necessary. 

COMMENT 

This  second  case  demonstrates  the  danger 
attending  the  use  of  the  above  type  of  dilators. 
1 now  use  Blasucci  or  Garceau  catheters  and  con- 
sider the  former  superior  to  bulbed  catheters  and 
bougies  or  any  other  type  of  instrument  for 
ureteral  dilatation. 

SYMPTOMS  AND  TREATMENT 

The  symptoms  of  other  foreign  bodies  in  the 
ureter  are  similar  to  those  produced  by  calculi. 
The  treatment  is  likewise  the  same  in  the  great 
majority  of  cases.  Conservative  treatment  by 
cystoscopic  methods  is  first  indicated  but  severe 
pain,  complete  obstruction  of  the  ureter,  infec- 
tion, or  progressive  dilatation  of  the  kidney  pel- 
vis demands  early  operative  procedures. 

SUMMARY 

Foreign  bodies  with  the  exception  of  stones 
are  rarely  found  in  the  ureter.  They  may  enter 
the  ureter  directly  from  outside  the  body  or  from 
the  kidney,  intestines,  or  bladder.  The  latter  route 
is  far  more  common.  Contraction  of  the  bladder 
or  regurgitation  may  force  or  carry  a foreign 
body  from  the  bladder  into  the  ureter.  It  may 
then  travel  upward  as  high  as  the  pelvis  of  the 
kidney  as  a result  of  ureteral  antiperistalsis  and 
regurgitation. 

Catheters,  bougies  and  other  instruments 
should  be  carefully  examined  for  imperfections 
before  they  are  inserted  into  the  ureter. 

One  should  hesitate  before  employing  ureteral 
instruments  with  detachable  parts  and  the  great- 
est care  should  be  exercised  in  their  manipulation. 

Flood  Building. 

REFERENCES 

1.  Cabot,  Hugh:  Modern  Urology,  volume  2,  p.  196. 

2.  Young,  Hugh  H.:  Practice  of  Urology,  volume 
2,  p.  170. 

3.  Riley,  Augustus:  Read  before  the  New  England 
Branch  of  the  American  Urological  Association, 
April  3,  1928. 

4.  Strominger,  L.,  and  Blum,  J.:  Fragment  de  Sonde 
Ureterale  Perdu  dans  L’Uretere  et  Enleve  par  La 
Taille  Hypogastrique.  J.  D’Urol.  Med.  et  Chir.,  Par. 
31:  347-349,  (April)  1926. 

5.  Schlagintweit,  F. : Operation  wegen  Frandkorper 
enbekannter  im  Harnleiter.  Beitr.  z.  klin.  Chir., 
Tubing.,  122:333-334,  1921. 

6.  Galland,  Charles  Paul:  Foreign  Bodies  in  the 
Ureter,  Paris  Thesis,  1885. 

7.  Waring,  T.  P.:  Journal  of  the  American  Medical 
Association,  Jan.  26,  1929,  p.  341. 

8.  Peacock,  Alexander  H.:  A Clinic  Study  of 
Ureters,  Journal  of  the  American  Medical  Associa- 
tion, November  3,  1923,  volume  81,  pp.  1512-1516. 

DISCUSSION 

Charles  P.  Mathe,  M.  D.  (760  Market  Street,  San 
Francisco). — Doctor  Stevens  has  called  our  attention 
to  the  danger  of  breaking  and  leaving  pieces  of  a 
catheter  in  the  ureter  in  making  routine  treatments  of 
pathological  conditions  of  the  kidney  and  ureter. 
I feel  that  the  accident  of  breaking  a catheter  in  the 
ureter  can  be  avoided  by  employing  new  catheters 
with  no  defects.  One  must  not  forget  that  the  ureteral 
catheter  is  constructed  of  gum  and  silk.  When  the 
catheter  becomes  old,  slight  forcing  will  cause  the 
gum  to  crack  thereby  allowing  solutions  to  come  in 
contact  with  and  to  disintegrate  the  silk  threads. 
Such  a catheter  will  break  readily,  particularly  if  it  is 


106 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


caught  in  a tight  ureter  or  if  it  forms  a loop  within 
an  enlarged  ureter.  A great  number  of  these  accidents 
can  be  avoided  if  catheters  will  be  discarded  when 
they  are  defective  or  have  disintegrated  with  age. 

■» 

W.  W.  Cross,  M.  D.  (1624  Franklin  Street,  Oak- 
land).— Ureteral  catheters,  when  passed,  may  turn 
back  when  the  pelvis  is  reached  and  the  point  go  down 
the  ureter.  In  this  manner  a loop  is  made  and  upon 
withdrawing  the  catheter  it  will  come  down  doubled 
upon  itself.  If  the  catheter  is  not  strong  it  may 
break.  In  dilating  ureteral  strictures  Doctor  Hunner 
used  beeswax  and  oil.  The  oil  is  not  required  and 
may  destroy  some  of  the  adhering  quality  of  the  wax, 
so  that  it  may  come  away  and  be  left  in  the  ureter. 
The  wax  should  be  melted  in  a wax  spoon  and  flowed 
on  the  catheters  and  cooled  in  the  air.  Moisture  on 
the  catheter  may  prevent  proper  adhesion,  so  that  the 
catheter  must  in  every  instance  be  dry. 

I have  observed  foreign  bodies  in  the  bladder  on 
several  occasions  but  never  had  the  experience  to  see 
them  go  up  the  ureter.  Recently  a Chinaman  came 
to  the  clinic  at  the  prison  with  chewing  gum  in  the 
bladder. 

* 

Robert  V.  Day,  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles). — Doctor  Stevens  is  to  be  congratulated 
on  his  report  of  these  cases.  Searching  the  literature 
takes  an  immense  deal  of  work.  Most  of  us 
I think  have  seen  few,  if  any,  foreign  bodies  except 
stone  in  the  ureter.  One  should  always  discard  an  im- 
perfect ureteral  catheter — especially  one  which  bends 
at  the  eye  when  the  point  is  being  introduced  into 
the  ureter.  I agree  also  that  the  Blasucci  is  the  ideal 
instrument  for  dilating  the  ureter. 


THE  LURE  OF  MEDICAL  HISTORY 


A NOTE  ON  THE  MEDICAL  BOOKS  OF 
FAMOUS  PRINTERS* 

PART  II 

By  Ciiauncey  D.  Leake,  Ph.  D. 

San  Francisco 

THE  MOST  BEAUTIFUL  BOOK 

/CONNOISSEURS  have  frequently  discussed 
the  most  beautiful  book  ever  printed  without 
considering  the  merits  of  Vesalius’  masterpiece, 
the  Fabrica  de  corporis  humani  libri  septem,  pub- 
lished by  Operinus  from  Basle  in  1543,  and  re- 
published by  him  in  still  more  beautiful  format 
in  1555.  Perhaps  because  it  is  supposed  to  be  a 
purely  technical  medical  book  it  is  not  to  be  con- 
sidered beautiful.  But  it  is,  in  fact,  a landmark 
in  fine  printing  as  well  as  in  science.  As  it  was 
the  first  modern  medical  book,  the  foundation, 
indeed,  of  modern  medicine,  so  it  established  new 
criteria  of  excellence  in  the  superb  typography 
and  in  the  judicious  composition  of  its  pages.  The 
initial  letters  are  a delight ; the  illustrations  are 
the  superlative  woodcuts  of  the  drawings  made 
by  Titian’s  pupil,  Jan  Van  Calcar,  and  the  illus- 
trations and  type  are  so  arranged  on  the  wide- 

* This  preliminary  study  was  inspired  by  the  notable 
collection  of  medical  classics  exhibited  by  Dr.  LeRoy 
Crummer  at  the  University  of  California  Medical  School 
in  February,  1929.  Helpful  stimulus  has  also  been  received 
from  conversations  with  Dr.  Sanford  Larkey.  It  is  hoped 
that  their  influence  may  maintain  a lively  interest  in  some 
of  the  more  artistic  aspects  of  medical  publication  among 
California  physicians.  Part  I was  printed  in  the  January 
issue. 


margined  folio  pages  as  to  give  the  most  pleasing 
sense  of  balance  and  proportion. 

Andreas  Vesalius  (1514-1564),  the  swash- 
buckling young  Belgian,  wrote  this  book  when 
he  was  only  twenty-seven  or  twenty-eight  years 
old,  although  he  had  already  been  professor  of 
anatomy  and  surgery  at  Padua  for  two  years.  It 
was  here  that  he  reintroduced  actual  dissection 
in  anatomy,  and  so  brilliant  were  his  lectures  that 
students  from  all  over  flocked  to  his  squalid  little 
amphitheater.  The  title  page  of  his  Fabrica  shows 
him  lecturing  in  a splendid  big  hall,  but  this  was 
pure  propaganda,  as  he  was  trying  to  show  by 
such  a title  page  that  he  really  deserved  a digni- 
fied lecture  hall.  As  frequently  happens  in  such 
university  efforts,  he  didn’t  get  it,  and  soon  after 
deserted  his  work  to  become  court  physician  to 
Charles  V and  Philip  II  of  Spain. 

Fortunately,  in  deciding  to  publish  a real  ana- 
tomical text  glorifying  the  human  body  as  not 
even  Flo  Ziegfeld  has  done,  Vesalius  selected 
a real  artist  to  make  his  plates  and  one  of  the 
best  printers  in  Europe  to  publish  the  book.  Both 
men  were  his  friends  and  apparently  put  their 
best  into  the  effort.  The  result  is,  without  ques- 
tion, the  finest  medical  book  ever  published  and 
certainly  one  of  the  most  beautiful  books  of  all 
time. 

OTHER  FAMOUS  SWISS  PRINTERS 

In  Basle  also  were  many  other  great  printers 
who  tempered  the  practical  aspects  of  their  Ger- 
man training  with  the  more  delicate  and  graceful 
artistry  of  the  Italian  and  French  masters.  Of 
these,  Froben,  with  his  staff  and  serpents,  issued 
many  medical  items  of  importance.  His  great  six- 
volume  Opera  Omnia  of  Galen,  with  the  annota- 
tions of  Vesalius  connected  with  some  of  the 
chapters,  was  published  in  1542.  But  his  splen- 
did Greek  text  folio  of  Plippocrates,  with  the 
authoritative  readings  of  Cornarius,  and  the  su- 
perb typography,  was  his  real  triumph  in  medical 
literature.  It  was  printed  in  1538,  and  long  re- 
mained standard. 

Froben  derived  his  skill  from  the  worthy 
Cratander,  his  immediate  predecessor,  who  also 
issued  several  of  the  better  known  works  of 
Galen,  among  them  being  the  De  usu  partium, 
the  standard  physiological  treatise  of  the  time, 
in  1533. 

SOME  GREAT  GERMAN  PRINTERS 

During  the  fifteenth  and  sixteenth  centuries, 
German  printing  was  among  the  best  and  most 
interesting  in  Europe.  It  was  especially  influential 
in  introducing  books  in  the  people’s  tongue.  This 
resulted  in  widespread  use  and  study  of  the  books, 
so  that  most  of  them  have  truly  been  worn  out 
of  existence.  These  early  German  books,  printed 
in  the  vernacular,  are  among  the  rarest  of  all 
books,  and  are  eagerly  sought  by  collectors. 

Some  of  the  early  ones  of  this  sort  were 
“herbals” — that  is,  illustrated  botanical  books, 
most  of  them  showing  plants  of  medicinal  use. 
The  pictures  were  often  very  beautiful,  and  fre- 
quently quite  accurate.  Many  of  them  had  been 


February,  1930 


FAMOUS  MEDICAL  PRINTERS — LEAKE 


107 


taken  from  early  manuscripts,  however,  and  were 
slavish  imitations  of  imaginary  plants,  and  of  little 
value.  With  the  printing  of  Latin  translations  of 
Dioscorides,  however,  better  care  was  taken  to 
see  that  the  illustrations  conformed  to  the  high 
value  of  the  text. 

One  of  the  best  early  editions  of  Dioscorides’ 
Dc  medicinali  materia  libri  sex,  is  the  1543  folio 
published  by  Egenolff  of  Frankfurt.  This  was 
the  translation  of  Ruellius,  and  contained  Walther 
Ryff’s  notes.  Since  the  cuts  used  were  copied 
from  Fuchs’  Historia  stirpium,  and  since  Ryff 
made  some  rather  slighting  remarks  about  Fuchs, 
this  book  initiated  one  of  the  first  famous  book 
controversies,  involving  plagiarism,  the  rights  to 
illustrations,  and  the  like.  Egenolff  also  published 
in  1545,  in  folio,  Walter  Ryff’s  intriguing  Frauen 
Rosengarten,  with  the  amazing  woodcuts.  This 
was  the  first  obstetrical  text,  and  was  issued  for 
popular  use,  as  indicated  by  the  use  of  the  ver- 
nacular. Another  excellent  medical  text  from 
Egenolff’s  press  was  the  octavo  Klein  Wundartz- 
nei  of  the  French  surgeon  Lanfranchi,  issued  in 
1569. 

Another  great  Frankfurt  printer  was  S.  Fey- 
erabend,  who  published  several  of  the  startling 
tracts  of  Paracelsus  in  German,  such  as  his  Wund- 
artsnei,  with  the  fine  woodcuts  of  J.  Amman, 
in  1565.  Feyerabend  also  employed  Amman  to 
illustrate  another  important  obstetrical  work,  the 
Hebammen  Buck  of  J.  Rueff,  which  appeared  in 
quarto  in  1580,  and  later  for  professional  use  in 
Latin  as  De  conceptu  et  generatione  homini  in 
1587.  This  work  has  many  remarkable  illustra- 
tions of  obstetrical  practice. 

With  the  advent  of  the  terrible  Thirty  Years 
War,  all  intellectual  activity  in  Germany  ceased, 
and  fine  printing  has  only  developed  again  in  that 
country  within  the  last  century. 

THE  GIUNTA  PRESS 

During  the  sixteenth  and  early  part  of  the 
seventeenth  centuries,  several  printers,  notably 
Christian  Wechel  and  the  Giuntas,  seemed  almost 
to  specialize  in  medical  books.  The  Giunta  Press 
flourished  for  a time  in  Florence,  and  then  was 
transferred  to  Venice.  It  has  sponsored  more  of 
the  great  classics  of  antiquity  in  medicine  than 
almost  any  other  press. 

Specially  renowned  are  its  nine  great  folio  edi- 
tions of  Galen’s  Opera,  extending  for  more  than 
a century.  This  series  used  the  best  translations 
of  the  different  books,  and  the  number  of  times 
it  was  reprinted  is  proof  of  its  success.  The 
typography  is  in  the  finest  Italian  tradition,  with 
finely  proportioned  composition,  so  that  the  wide- 
margined  folio  pages  are  a delight  to  examine. 
The  title  page  has  become  quite  famous  because 
of  the  historiated  woodcut  border  showing  imagi- 
nary scenes  in  the  life  of  Galen.  The  peculiar 
costumes  worn  by  the  physicians  in  the  pictures 
and  the  quaint  attitudes  assumed  by  them  are 
very  charming.  In  the  bottom  scene  Galen  is 
demonstrating  the  function  of  the  recurrent 
laryngeal  nerve  on  a pig,  and  in  another  scene 


^fNDRE^fE  HES^fLIUS 


Fig.  7. — Woodcut  portrait  of  Vesalius  by  Calcar,  in  the  1543 
edition  of  the  Fabrica,  one  of  the  finest  books  of  all  time. 


is  bewildering  his  chief  professional  rival  in  con- 
sultation. 

Another  fine  production  of  the  Giunta  press  is 
the  folio  Avicenna,  Liber  canonis  medicinae,  pub- 
lished in  1527,  which  contains  all  the  huge  com- 
pilations of  the  ancient  medical  writers  made  by 
the  great  Arab.  A very  fine  quarto  from  the 
Giunta  press  is  the  Opera  Omnia  of  H.  Fracas- 
toro  of  Verona,  issued  in  1555.  This  contains 
the  celebrated  poem  describing  the  symptoms  and 
treatment  of,  and  giving  the  name  to,  syphilis. 
It  also  contains  the  interesting  notions  of  the 
author  on  contagion,  of  which  the  Singers  have 
written  so  charmingly  in  the  first  issue  of  The 
Annals  of  Medical  History. 

CELEBRATED  DUTCH  PRINTERS 

Taking  as  a device  a hand  from  the  sky  hold- 
ing a pair  of  dividers,  Christopher  Plantin  of 
Antwerp  upheld  in  Holland  during  the  sixteenth 
century  the  high  standard  of  printing  established 
in  Italy  and  France.  He  issued  many  finely 
illustrated  botanical  works,  and  a few  books  of 
medical  interest.  Among  them  were  J.  Grevin’s 
Dc  venenis  libri  duo,  a beautiful  quarto  of  1571, 
and  the  Dc  natura  hominis  of  Nemesius  Episcopus 
in  1565.  This  latter  little  octavo  is  supposed  to 
contain  a passage  describing  the  circulation  of 
the  blood. 

The  most  famous  Dutch  printers  belonged  to 
the  Elzevir  clan.  This  prolific  house  made  Leyden 
one  of  the  book  centers  of  the  world,  even  rival- 
ing the  great  annual  Frankfurt  book  market,  to 
which  before  the  Thirty  Years’  War  all  pub- 
lishers sent  their  wares.  Many  collectors  make 


108 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


Elzevirs  their  special  hobby,  and  the  finely  bound 
little  volumes  are  always  found  carefully  pre- 
served. The  device  of  the  Elzevirs  was  a man 
standing  under  a tree  with  the  motto,  “Non  solus.” 

Among  the  many  great  medical  classics  pub- 
lished by  the  Elzevirs,  the  most  interesting  is 
William  Harvey’s  Exercitationes  de  generations 
animalium,  published  in  1651  in  12mo,  and  in  a 
rare  variant  carrying  a reduced  engraved  title 
page  of  the  first  O.  Pulleyn  London  imprint  of 
the  same  year.  This  great  book  was  secured  by 
George  Ent,  Harvey’s  friend,  for  publication,  and 
it  yet  remains  to  be  adequately  studied  and  appre- 
ciated. It  is  the  best  commentary  there  is  on 
Aristotelian  ideas  on  embryology.  Harvey’s  own 
contribution  was  brought  to  a standstill,  as  in  the 
case  of  his  demonstration  of  the  circulation  of 
the  blood,  only  because  of  inadequate  technical 
help  in  the  form  of  a microscope. 

Another  fine  Elzevir  is  J.  B.  Van  Helmont’s 
Ortus  medicinae,  published  in  quarto  in  1652. 
This  contains  much  of  the  great  mystic’s  specula- 
tion on  the  function  of  fermentation,  and  his 
stimulating  theories  on  gases.  The  Elzevirs  also 
issued  a very  fine  little  Celsus  in  16mo  in  1657. 
The  first  popular  physiological  treatise,  which 
successfully  introduced  Harvey’s  ideas  to  the 
public,  and  which  began  experimentation  in  nerve- 
muscle  physiology,  was  Rene  Descartes’  Tractatus 
de  homine  et  de  formations  foetus.  This  was  pub- 
lished by  the  Elzevirs  in  a handsomely  illustrated 
quarto  in  1677. 

Perhaps  the  best  known  medical  painting  is  the 
Rembrandt  showing  Dr.  N.  Tulp  demonstrating 
the  muscles  of  the  arm  of  a cadaver  to  some 
of  his  ruff-collared  Burgemeister  friends.  The 
Elzevirs  published  his  Observationes  medicae, 
with  fine  copperplate  engravings  in  1672,  in  octavo. 

With  the  introduction  of  copperplates,  the  old 
charm  of  the  woodcut  disappeared  from  printed 
books,  and  the  elegant  typography  of  the  seven- 
teenth century  was  developed  with  special  refer- 
ence to  its  harmony  with  the  coppers.  Some  of 
the  finest  books  of  all  time  were  printed  by  the 
Dutch  printers  for  the  anatomical  atlases  of 
Albinus  and  his  contemporaries.  These  books, 
mostly  by  Verbeek,  and  with  the  coppers  by 
VandeWar,  are  still  worth  most  careful  study  by 
those  wishing  to  know  anatomy  as  it  may  best  be 
pictured. 

EARLY  ENGLISH  PRESSES 

The  publications  of  the  early  English  presses 
were  mostly  in  the  vernacular,  and  were  so  used 
as  to  have  practically  disappeared.  The  first  Eng- 
lish printed  medical  book  was  A Passing  Gode 
Lityll  Poke  Necessarye  and  Behovefull  Agenst 
the  Pestilence  issued  in  1485,  it  is  said  by  William 
Caxton,  but  according  to  Garrison,  by  William 
de  Machlinia.  Caxton  published  The  Governayle 
of  Helthe  in  1491.  Wynkyn  de  Worde  published 
the  first  medical  picture  in  England.  This  was 
a dissection  scene  from  Bartholomaeus  Anglicus’ 
Encyclopedia  issued  in  1495.  In  1510  Wynkyn 
de  Worde  printed  The  Judycyal  of  Urins. 
The  first  English  anatomical  text  was  Thomas 


On  bllfrtlctCKti  fojqhcfienSiifdlktt  fcnb  ct< 

4,  mu 


•«* 

PH'S'  vmt>  Wartong  ir<tKrr./>ngfir«wi.  »n6  am*tm 
tnenlufepnfcvonnfccn.  VUvc  Giro  Mg  grbra 


Fig.  8. — Title  page  of  Walter  Ryff’s  Frauen  Rosengarten,  pub- 
lished by  Christian  Egenolff  in  Frankfurt,  in  1545. 


Vicary’s  The  Englishman  s Treasure,  London, 
1548.  These  books  were  not  well  printed,  but 
because  of  their  rarity  are  extremely  valuable. 

One  of  the  great  early  London  printers  was 
Thomas  Berthelet,  whose  bindings  in  black  calf 
are  most  precious.  In  1541  he  issued  in  quarto 
Sir  Thomas  Elyot’s  The  Cast  el  of  Hclth,  a book 
which  had  a deserved  popularity.  Written  by  an 
interested  layman,  it  was  bitterly  resented  by  the 
profession,  but  undoubtedly  had  much  influence 
in  improving  the  sanitary  conditions  and  dietary 
habits  of  the  masses. 

One  of  the  interesting  English  printed  books 
of  the  early  seventeenth  century  is  The  Workes 
of  that  Famous  Chirurgion  Ambrose  Parey.  This 
is  a folio  issued  in  1634,  and,  it  is  said,  by  the 
printers  of  the  first  folio  Shakespeare,  Thomas 
Cotes  and  R.  Young  of  London.  It  is  also  said 
that  the  first  folio  Shakespeare,  published  in  1623, 
carried  a notice  of  the  forthcoming  appearance 
of  this  English  translation  of  the  works  of  Pare. 
Pare’s  first  publications  were  little  octavos  issued 
in  French  for  the  guidance  of  the  struggling  lay- 
surgeons  of  the  time.  So  useful  and  handy  were 
these  little  volumes  that  they  have  practically  been 
worn  out  of  existence.  The  English  of  this  1634 
edition  is  in  the  virile  Tudor  style,  and  it  is  stimu- 
lating and  entertaining  reading  although  not  well 
printed.  Pare’s  Little  Journeys  is  a classic  in 
narrative. 

THE  REVIVAL  OF  INTEREST  IN  GOOD  PRINTING 

During  the  latter  part  of  the  seventeenth  cen- 
tury and  the  early  part  of  the  eighteenth,  interest 
in  good  printing  waned.  The  times  were  too 


February,  1930 


FAMOUS  MEDICAL  PRINTERS — LEAKE 


109 


turbulent,  perhaps,  for  good  work  to  be  done  in 
this  rather  artistic  and  intellectual  field.  There 
were  many  printers,  of  course,  but  none  of  them 
were  outstanding,  and  very  few  of  their  works 
have  any  artistic  value.  William  Caslon,  an  Eng- 
lish type  founder,  stabilized  the  many  different 
forms  of  Roman  type,  and  evolved  what  has  since 
become  known  as  Caslon  Old  Style  type,  the 
standard  type  for  publications  of  today.  It  is  a 
plain,  sturdy,  type  font,  and  very  flexible  in 
regard  to  the  ease  with  which  different  letters 
may  be  combined  and  yet  maintain  good  propor- 
tions. This  is  one  of  the  most  difficult  aspects  of 
typography  and  composition.  Individually  each 
letter  may  be  perfectly  proportioned  in  the  style 
in  which  it  is  made,  and  yet  when  placed  next  to 
other  letters  the  effect  is  not  very  artistic.  Caslon 
worked  out  a rather  simple  set  of  type  fonts  which 
quite  satisfactorily  meet  most  demands  of  good 
modern  printing. 

A revival  of  interest  in  good  artistic  printing 
began  about  the  same  time  in  England  and  in 
Italy.  In  England  the  famous  press  of  John 
Baskerville  at  Birmingham  began  to  apply  Cas- 
lon’s  work,  and  to  use  artistic  discrimination  in 
the  setup  of  pages  in  order  to  secure  a harmoni- 
ous and  pleasing  ensemble.  The  only  medical 
work  issued  by  this  press  was  William  Hunter’s 
royal  folio,  Anatomia  uteri  kumani  gravidi  tabulis 
Must  rata,  published  in  1774.  The  magnificent 
thirty-four  plates  accompanying  the  text  have 
never  been  surpassed  for  accuracy  and  beauty  of 
delineation. 

In  Italy,  Giambattista  Bodoni  established  at 
Parma  his  famous  press,  which  began  to  experi- 
ment with  entirely  new  decorative  types  having 
no  traditional  background.  These  developed  grad- 


Fig.  9. — Title  page  of  one  of  the  many  famous  medical  books 
published  by  the  renowned  Elzevirs  of  Holland.  Nicolaus  Tulp  was 
the  subject  of  Rembrandt’s  well-known  “Anatomy.” 


ually  into  the  fluted  and  blocked  letters  used  now 
for  display  purposes.  When  artistically  composed 
on  fine  grade  paper,  with  proper  borders,  they 
form  a most  charming  effect. 

The  best  medical  work  from  this  modern  press 
is  Zaccarelli’s  Italian  translation  with  Latin  text 
of  Fracastoro’s  poem  on  syphilis.  This  was  pub- 
lished in  folio  in  1829,  and  has  been  hailed  as  one 
of  the  best  productions  of  the  Bodoni  press. 

Another  very  influential  modern  press  was  that 
of  the  “English  Aldus,”  William  Pickering  of 
London.  Two  of  his  medical  productions  are 
famous.  In  1833  he  issued  Sir  Charles  Bell’s 
The  Hand,  one  of  the  most  beautifully  printed 
and  illustrated  monographs  which  has  ever  been 
published.  Some  time  later  Pickering  brought  out 
one  of  the  most  lovely  little  editions  of  the  Religio 
Medici  of  Sir  Thomas  Browne — Osier’s  favorite 
book. 

THE  PRESENT  OUTLOOK 

There  is  now  a great  deal  of  attention  paid 
to  the  physical  characters  of  the  printed  book. 
Modern  printers  and  publishers  are  trying  hard 
to  see  that  the  best  and  most  artistic  efforts  are 
put  into  their  publications.  This  is  reflected  in 
medical  books. 

In  the  United  States  there  have  been  many 
interesting  printing  efforts.  Benjamin  Franklin’s 
are  celebrated.  He  issued  one  or  two  little  medi- 
cal items,  a famous  one  being  Cadwallader’s  Essay 
on  the  West  India  Dry  Gripes.  During  the  long 
sterile  period  of  the  eighteenth  century,  no  dis- 
tinctive printing  work  was  done  in  this  country. 
Since  William  Morris’  Kelmscott  press,  however, 
and  the  amazing  simplicity  of  Cobden-Sanderson 
and  the  Doves  press  in  England,  there  has  devel- 
oped a fine  appreciation  in  America  for  good 
printing.  One  of  the  great  typographers  of  the 
world  has  done  his  best  work  here,  and  Bruce 
Rogers’  name  in  connection  with  a book  is  assur- 
ance that  typographically  it  will  be  as  nearly  per- 
fect as  possible.  Paul  Hoeber  of  New  York,  who 
devotes  himself  exclusively  to  medical  publishing 
of  the  finer  sort,  has  employed  T.  W.  Goudy  to 
design  the  type  for  his  Annals  of  Medical  His- 
tory, the  finest  printed  of  all  medical  periodicals, 
and  for  many  of  his  better  books. 

A deliberate  effort  to  print  worthwhile  medical 
books  in  pleasing  and  attractive  style  has  been  in- 
augurated by  Charles  C.  Thomas  of  Springfield, 
Illinois.  Inasmuch  as  Mr.  Thomas  is  also  trying 
to  publish  his  books  at  as  reasonable  a price  as 
possible,  his  effort  deserves  more  than  passing 
support.  Many  of  the  great  university  presses 
have  published  medical  books  with  due  regard  for 
the  canons  of  good  taste  which  they  have  estab- 
lished. The  current  German  medical  publishers 
are  doing  superb  work,  but  they  are  making  it 
difficult  for  the  average  individual  to  secure  their 
publications  because  of  the  exorbitant  prices  they 
are  demanding. 

In  connection  with  the  tercentenary  of  William 
Harvey’s  demonstration  of  the  circulation  of  the 
blood  in  1928,  the  Nonesuch  Press  issued  a re- 
print of  the  first  English  translation  (1653)  of 
the  De  Motu  Cordis.  This  was  edited  by  Geoffrey 


110 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


Keynes  and  published  in  a handsome  binding  with 
a special  Dutch  typography.  As  far  as  I know, 
this  has  been  the  only  medical  publication  of  any 
of  the  modern  private  presses.  Some  of  the  most 
famous  private  presses  in  the  world  are  in  San 
Francisco,  but  none  of  them  seem  to  have  issued 
a book  of  medical  interest.  The  Stanford  Uni- 
versity press  has  just  issued,  in  beautiful  format, 
Doctor  Casey  Wood’s  translation,  with  annota- 
tions and  reproductions,  of  the  De  Oculis  of 
Benevenutus  Grassus  of  Jerusalem.  This  early 
ophthalmological  treatise  was  first  published  in 
1478  at  Ferrara  and,  while  very  significant,  is 
extremely  rare.  Here  is  a splendid  beginning 
for  the  elegant  printing  of  medical  books  on  the 
Pacific  Coast. 

Interest  in  the  format  of  a book  is  one  of  the 
pleasant  little  bypaths  of  bookish  lore.  Behind 
every  book  there  is  a story — a story  of  the  author, 
of  the  printer,  and  of  the  period,  and  often  these 
little  stories  are  more  entertaining  and  significant 
than  the  book  itself.  At  any  rate,  it  is  worth  while 
to  pay  some  attention  to  the  artistic  qualities  of 
books. 

University  of  California  Medical  School. 

Note:  Pictures  of  the  title  pages  of  many  of  the  books  mentioned 
above  may  be  seen  in  Sir  William  Osier’s  Evolution  of  Modern 
Medicine,  New  Haven,  1920.  In  the  huge  catalogue  of  his  library, 
compiled  by  W.  W.  Francis,  Archibald  Malloch,  and  L.  L.  Mackall 
( Bibliotheca  Osleriana) , one  may  find  interesting  notes  on  many  of 
the  significant  finely  printed  medical  books.  One  may  also  turn  to 
the  many  beautiful  catalogues  issued  by  Maggs  Bros,  of  London, 
R.  Lier  of  Florence,  and  Hertzberger  of  Amsterdam,  for  items 
about  the  medical  books  of  the  famous  presses  of  the  world. 


CLINICAL  NOTES  AND  CASE 
REPORTS 


TOXIC  AMBLYOPIA 

REPORT  OF  CASES 
By  Earle  L.  Creveling,  M.  D. 

Reno,  Nevada 

AMBLYOPIA  is  derived  from  two  Greek 
-‘■“-words : “ambys,”  meaning  blunt ; “opsis,” 
meaning  sight.  Toxic  amblyopia  is  a condition 
that  is  becoming  more  common  on  account  of  the 
excessive  use  of  tobacco  during  youth  and  by 
women,  and  also  because  of  the  use  of  methyl 
alcohol,  or  of  a poor  grade  of  ethyl  alcohol  or 
redistilled  denatured  alcohol.  These  latter  are 
perhaps  less  harmful  than  cigars,  strong  pipe 
tobacco  or  snuff.  The  excessive  smoking  of 
cigarettes  probably  saturates  the  system  with 
harmful  poisons  of  tobacco.  The  use  of  poison- 
ous alcohol  is  far  greater  than  is  generally  real- 
ized, as  is  attested  by  gastric,  hepatic,  nephritic, 
and  ocular  lesions  due  to  its  ingestion. 

Of  the  substances  enumerated,  tobacco  is  the 
one  most  often  responsible  for  amblyopia.  As  the 
users  of  tobacco  are  also  frequently  consumers 
of  alcohol,  it  is  difficult  to  separate  the  etiologic 
influence  of  these  two  drugs.  Hence  the  name 
intoxication  or  toxic  amblyopia  is  used  to  describe 
a central  amblyopia. 

This  condition  is  almost  always  bilateral,  al- 
though there  are  a few  doubtful  cases  on  record 
of  it  being  unilateral.  The  characteristic  of  the 


scotomata  of  toxic  amblyopia  is  a centrocecal  im- 
perfection with  drooping  margins,  pericentral  in 
location,  and  containing  one  or  two  spots  of 
greater  vividness.  The  imperfection  for  the  color 
red  is  far  more  than  that  for  white.  These  find- 
ings differentiate  it  from  the  other  toxic  scoto- 
mata in  the  central  area  of  the  field. 

The  pathologic  lesion,  according  to  Uhthoff,  is 
an  interstitial  inflammation  of  the  papillomacular 
fibers  of  the  optic  nerve.  These  fibers,  traced  by 
means  of  their  degeneration,  consist  of  a bundle 
shaped  like  a triangle,  with  their  base  in  the  lower 
and  outer  part  of  the  nerve,  and  their  apex  at 
the  central  vessels.  Gradually  the  bundle  passes 
to  the  center  of  the  nerve,  which  it  reaches  in  the 
optic  canal,  and  finally  it  can  be  followed  into  the 
chiasm  and  tracts.  Nuel  and  others  believe  that 
the  so-called  central  toxic  scotoma  is  not  caused 
primarily  by  neuritis  of  the  macular  bundle,  but 
signifies  a disease  of  the  macula  lutea,  causing 
degeneration  of  its  cells ; and  that  the  optic  nerve 
changes  are  secondary  to  destruction  of  the  nerve 
cells  in  the  macula.  Birch-Hirschfeld  believes 
that  there  is  a primary  involvement  of  the  nerv- 
ous elements  of  the  nerve  and  retina,  with  an 
accompanying  proliferation  of  the  glia  and  in- 
crease in  the  connective  tissue.  The  course  is  a 
chance  one,  but  the  prognosis  of  the  tobacco  and 
alcoholic  types  is  good,  provided  treatment  is 
started  before  the  disease  is  too  far  advanced. 

Treatment.- — Total  abstinence  from  the  use  of 
alcohol  and  tobacco.  Later,  strychnin,  pushed  to 
its  physiological  limit.  For  absorption  of  inflam- 
matory products,  potassium  iodid,  free  sweating, 
purgation,  and  the  drinking  of  copious  quantities 
of  water  are  indicated. 

REPORT  OF  CASES 

Case  1. — Alcoholic  amblyopia  in  a young  man  nine- 
teen years  of  age.  On  Christmas  eve  of  last  year  he 
went  to  a party  where  some  form  of  an  alcoholic 
beverage  was  served;  he  had  several  drinks,  and  two 
days  later  noticed  that  the  vision  in  his  right  eye 
was  less  acute  than  in  the  left,  but  he  made  no  men- 
tion of  the  fact  until  his  family  physician  was  treat- 
ing him  for  grippe  two  weeks  later,  when  the  doctor 
questioned  him  about  his  eyes  as  the  pupils  were 
unusually  dilated. 

When  first  seen  by  me,  about  five  weeks  after  he 
had  taken  the  alcohol,  both  pupils  were  widely  dilated. 
They  reacted  to  light  and  not  to  accommodation. 
The  cornea,  lens  and  refractive  media  of  both  eyes 
were  apparently  normal.  The  ophthalmoscopic  ex- 
amination of  the  right  eye  showed  a distinct  pallor  of 
the  temporal  segment  of  the  nerve  head  with  a blur- 
ring of  the  edges  of  the  disk.  The  nasal  side  of  the 
disk  was  hyperemic.  There  was  no  retinal  hemor- 
rhage. The  perimetric  examination  revealed  a cen- 
tral scotoma,  which  was  oval  in  shape,  and  included 
the  blind  spot  or  optic  papilla  and  the  fixation  point. 
On  this  area  there  was  an  absolute  loss  of  color 
vision  for  green,  red,  and  blue.  Form  perception  was 
also  lost.  His  vision  was  reduced  to  8/200. 

The  left  eye  was  less  extensively  involved;  pupil 
was  widely  dilated;  it  reacted  to  light,  but  not  to- 
accommodation.  The  ophthalmoscopic  examination 
gave  less  pronounced  findings.  The  perimetric  exami- 
nation showed  a scotoma,  with  the  loss  of  color  vision 
to  green.  Vision  O.  S.,  20/200. 

Six  months  after  the  onset  of  the  disease  the  exami- 
nation of  the  right  eye  showed  a chalky  white  color 
on  the  temporal  segment  of  the  optic  nerve  head,  an 
indication  of  optic  atrophy.  Vision  was  nil.  In  the 


February,  1930 


CASE  REPORTS 


ill 


left  eye  the  disease  had  been  arrested  and  the  optic 
nerve  head  showed  less  involvemnt.  Vision  O.  S., 
20/70. 

■r  i i 

Case  2. — Nicotin  poisoning  in  a man,  age  twenty- 
three.  Shoemaker  by  trade.  Negative  family  history. 
Denies  ever  drinking  spirituous  beverages,  but  he 
used  tobacco  to  excess.  He  stated  that  he  smoked 
between  forty  and  fifty  cigarettes  a day;  chewed 
tobacco  at  the  same  time;  and  all  he  took  for  his 
usual  breakfast  was  a quart  of  strong  black  coffee. 
His  chief  complaint  was  dimness  of  vision.  Stated 
that  everything  looked  as  though  it  were  misty.  He 
wanted  glasses  to  overcome  this  discomfort  so  he 
could  see  to  work  and  read.  He  also  stated  that  his 
vision  was  better  at  night,  and  that  was  when  he  did 
most  of  his  work.  Vision  O.  D.,  20/70;  O.  S.,  20/100. 
Pupils  reacted  to  light  and  accommodation.  The  eyes 
were  otherwise  normal  except  for  a pallor  of  the  optic 
nerve  head  on  the  temporal  side.  This  pallor  was 
horizontal  and  oval  in  form  and  extended  from  the 
macula  lutea  to  the  blind  spot. 

He  discontinued  the  use  of  tobacco  and  coffee. 
With  the  use  of  sodium  phosphate,  strychnin,  and 
sweating,  his  condition  improved,  and  on  examination 
eight  weeks  later  his  vision  was:  O.  D.,  20/30;  O.  S., 
20/40.  The  pallor  of  the  disks  had  entirely  dis- 
appeared and  the  patient  was  in  a cheerful  mood. 

COMMENT 

Any  patient,  regardless  of  age,  who  complains 
of  dimness  of  vision  should  receive  an  immediate 
and  careful  examination  to  determine  its  cause 
and  should  be  treated  accordingly.  Especially  is 
this  necessary  for  patients  whose  vocation  de- 
mands that  they  he  able  to  differentiate  between 
green  and  red.  Any  patient  with  bilateral  dimin- 
ished visual  acuity,  for  which  no  other  causes  are 
evident,  should  make  one  suspicious  of  some  form 
of  toxic  amblyopia.  Treatment  should  be  started 
early  and  continued  over  a long  period  of  time. 

17  North  Virginia  Street. 


RUPTURE  OF  UTERUS* 


REPORT  OF  CASES 

By  W.  J.  Blevins,  M.  D. 
tVoodtand 


"OUPTURE  of  the  uterus  is  a potential  com- 
plication  of  every  pregnancy.  Its  occurrence 
should  always  be  anticipated,  for,  after  the  acci- 
dent, only  prompt  action  can  save  the  life  of 
mother  and  child. 


Available  statistics  indicate  that  rupture  of  the 
uterus  occurs  about  once  in  three  thousand  preg- 
nancies. Since  in  the  hands  of  the  general  practi- 
tioner, the  true  condition  is  often  not  recognized, 
it  is  our  opinion  that  the  accident  occurs  much 
more  frequently.  In  fact  our  series  shows  five 
■cases  of  rupture  in  3061  pregnancies. 

Rupture  of  the  uterus  may  occur  from  direct 
violence  as,  for  example,  during  a forceps  de- 
livery, or  it  may  occur  spontaneously.  In  the 
latter  instance  the  remote  cause  usually  will  be 
found  in  some  condition  or  procedure  which  has 
left  a deficiency  of  the  uterine  wall.  Such  a 
weakened  area  may  result  from  fibroids,  from  a 
previous  cesarean  operation,  or  from  a cicatrized 


* From  the  Department  of  Obstetrics,  Woodland  Clinic, 
Woodland. 


area  resultant  on  the  manual  removal  of  an  ad- 
herent placenta.  Overstimulation  of  uterine  con- 
tracture is  a further  cause  of  spontaneous  rupture 
and  the  unwise  use  of  pituitrin  undoubtedly  has 
been  responsible  for  many  such  accidents. 

That  the  incidence  of  uterine  rupture  is  cer- 
tainly less  than  in  the  past  is  easily  understood 
when  we  consider  the  vast  improvement  in  the 
technique  of  directing  labor  cases.  Cesarean 
operations  are  more  skillfully  done ; fibroids  are 
not  permitted  to  go  unattended ; forceps  are  used 
more  intelligently;  pituitrin  is  being  respected  as 
much  for  its  powers  for  evil  as  for  the  safe  as- 
sistance that  it  may  occasionally  render.  More- 
over women  are  becoming  educated  to  the  wisdom 
of  hospitalization  at  the  time  of  accouchement, 
the  result  being  that  postpartum  conditions  do  not 
invite  disaster  in  future  pregnancies  as  was  for- 
merly the  case. 

KINDS  OF  RUPTURE  DURING  DELIVERY 

Ruptures  at  the  time  of  delivery  are  divided 
by  DeLee  into  two  classes : spontaneous  and 
traumatic.  He  classifies  spontaneous  ruptures  as 
those  which  occur  as  the  result  of  the  natural 
forces  of  labor  as  when  there  is  disproportion 
between  the  child  and  the  pelvis,  when  the  pelvis 
is  abnormal,  when  tumors  interfere  with  delivery, 
or  when  either  the  uterine  or  abdominal  wall  is 
weak. 

Traumatic  ruptures  are  those  which  result  from 
violence,  or  from  unskilled  and  faulty  interfer- 
ence with  delivery.  This  accident  may  result  from 
the  unwise  use  of  ergot  or  pituitrin;  from  im- 
proper application  of  forceps ; from  an  attempt  at 
version  before  the  cervix  is  completely  dilated ; 
or  by  reason  of  unduly  prolonged  labor  after  dila- 
tation is  complete.  In  the  latter  instance  the 
anterior  portion  of  the  cervix  may  be  caught 
between  the  head  and  the  pubic  bone,  or  the  pos- 
terior portion  may  be  caught  between  the  head 
and  the  sacral  prominence,  causing  necrosis,  re- 
sulting in  the  rupture  of  the  injured  portion  dur- 
ing delivery. 

If  the  attending  physician  has  in  mind  the 
danger  of  rupture,  he  will  be  on  the  alert  for  it. 
The  symptoms  of  impending  spontaneous  rupture 
in  cases  of  long  delayed  labor  may  be  recognized 
by  a contraction  ring  appearing  high  above  the 
pubes,  frequently  as  high  as  the  umbilicus,  the 
lower  uterine  segment  gradually  thinning  out  so 
that  the  fetal  parts  may  be  easily  felt  through  the 
abdominal  wall.  There  is  increasing  tenderness  in 
the  pelvis,  especially  with  each  contraction,  and 
it  is  impossible  at  times  to  make  a satisfactory 
examination  without  an  anesthetic.  However,  the 
tissues  may  fail  gradually  and  rupture  may  occur 
without  premonitory  signs. 

Following  rupture  there  is  usually  a cessation 
of  pain,  the  patient  probably  saying  that  some- 
thing “broke”  and  gave  relief.  Contractions  cease 
in  a few  minutes.  The  child,  if  it  escapes,  or 
partly  escapes  into  the  abdomen,  soon  dies.  It 
may  be  felt  plainly  against  the  abdominal  wall. 
Soon  symptoms  of  shock  (thready,  rapid  pulse. 


112 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


pallid  skin,  and  weakness)  appear.  There  may  be 
no  vaginal  bleeding,  in  fact  there  is  likely  to  be 
none  unless  the  cervix  is  torn. 

With  traumatic  rupture,  the  picture  is  different. 
If  it  is  caused  by  manual  dilatation  with  the  use 
of  forceps,  or  by  version,  no  untoward  symptoms 
may  appear  until  delivery  is  completed.  Severe 
hemorrhage  may  then  be  the  first  evidence  of 
trouble,  followed  by  shock.  If  caused  by  the  use 
of  pituitrin  any  part  of  the  uterus  may  rupture 
and,  if  the  tear  is  in  the  body  of  the  uterus,  the 
symptoms  will  be  the  same  as  those  following 
spontaneous  rupture. 

Pituitrin  is  a dangerous  drug  if  used  without 
a careful  study  of  the  patient.  Contraindications 
to  its  use  are  deformity,  disproportion  between 
the  child  and  pelvis,  a history  of  an  adherent  pla- 
centa removed  with  difficulty,  or  a uterus  weak- 
ened by  many  previous  labors. 

A version  should  never  be  attempted  until  dila- 
tation is  complete ; the  same  rule  applies  to  the 
application  of  forceps.  Where  there  has  been  a 
cesarean  operation  in  the  past  for  other  reasons 
than  a deformed  pelvis  or  other  structural  ab- 
normality, a trial  labor  may  be  given,  watching 
carefully  for  delay  in  dilatation  or  faulty  position 
of  the  child.  (This  should  be  done  by  means 
of  rectal  examination.  With  the  first  sign  of 
delayed  labor,  a cesarean  section  should  be  con- 
sidered. 

If  this  accident  occurs  in  practice  out  of  a 
hospital,  treatment  depends  entirely  upon  the 
facilities  at  hand.  There  is  always  great  danger 
to  both  mother  and  child.  The  vagina  should  be 
packed  as  rapidly  and  as  carefully  as  possible  and 
the  patient  taken  to  a hospital  at  once.  We  think 
it  is  not  best  to  insert  the  packing  tightly  into  the 
uterus  for  the  reason  that  the  wound  may  be  kept 
open,  with  increased  bleeding,  as  the  uterus  con- 
tracts over  the  packing. 

After  the  patient  has  been  placed  in  the  hospi- 
tal, or  if  the  accident  occurs  there,  treatment 
depends  on  the  site  of  the  rupture.  If  the  lacera- 
tion is  above  the  vagina,  an  abdominal  operation 
should  be  done  at  once.  A hysterectomy  is  usually 
best.  If  the  wound  is  in  the  body  of  the  uterus 
it  is  generally  safe  to  leave  the  cervix,  but  if  the 
tear  extends  into  the  cervix  a complete  removal 
of  the  organ  should  be  done.  If  only  the  cervix 
is  lacerated  and  the  injured  tissue  can  be  reached 
from  the  vagina,  the  cervix  may  be  repaired  at 
once,  and  bleeding  will  stop  as  soon  as  the  uterus 
is  contracted. 

If  the  vaginal  portion  of  the  uterus  is  necrosed 
from  pressure  in  delayed  labor,  the  injured  tissue 
may  be  severed  and  sutures  sufficient  to  control 
the  hemorrhage  may  be  put  in.  If  much  blood 
has  been  lost,  the  patient  should  have  a trans- 
fusion before,  during,  or  after  any  of  these 
procedures. 

REPORT  OF  CASES 

We  are  reporting  five  cases  showing  a different 
injury  in  each,  with  treatment  and  results: 

Case  1. — Mrs.  M.  H.,  age  thirty-two,  first  seen 
July  20,  1924,  12  noon.  Two  previous  pregnancies: 
First  child  stillborn  by  reason  of  malposition.  Second 


child  delivered  by  cesarean  section  on  account  of 
shoulder  presentation.  Present  pregnancy  of  about 
eight  months  duration.  During  the  night  experienced 
severe  pain  followed  by  symptoms  of  shock.  She  was 
brought  to  the  hospital  at  once. 

Examination  showed  no  fetal  movement  nor  fetal 
heart  sounds:  fetal  parts  not  outlined.  No  uterine 
contractions.  Urinalysis  showed  albumin,  but  no 
casts.  The  blood  count  showed  secondary  anemia 
(hemoglobin  48  per  cent),  low  white  count,  and  rela- 
tively high  neutrophil  count.  Temperature  normal. 

Operation  at  2 p m.:  Midline  incision.  The  fundus 
of  the  uterus  was  found  adherent  to  the  abdominal 
wall  about  the  umbilicus.  The  uterus  was  edematous; 
there  was  a large  hematoma  in  the  muscular  wall. 
The  uterus  was  ruptured  posteriorly  at  the  level  of 
the  internal  os,  and  was  filled  by  old  blood-clots.  The 
fetus  was  dead.  A subtotal  hysterectomy  was  done. 

The  reaction  from  operation  was  very  unsatisfac- 
tory for  the  first  twelve  hours.  Following  that  period 
of  time,  progress  was  good  except  for  some  pleurisy. 
The  patient  was  dismissed  on  August  18,  1924,  in 
entirely  satisfactory  condition. 

/ / i 

Case  2. — Mrs.  F.  S.,  age  twenty-four,  first  seen 
May  20,  1925,  9:30  a.  m.  Two  previous  pregnancies: 
First  (six  years  before  entry)  in  labor  several  days 
and  finally  had  cesarean  section;  dead  fetus.  Second 
pregnancy:  normal  delivery,  somewhat  prolonged. 
Present  pregnancy  apparently  normal. 

At  3 a.  m.  on  the  day  of  entry,  patient  arose  to  void 
and  was  seized  with  violent  pain  in  the  abdomen. 
She  was  seen  by  a physician  at  5:30  a.  m.  in  extreme 
pain  and  shock;  pulse,  120;  temperature  not  taken. 
She  arrived  at  the  hospital  at  9:30  a.  m.  Examination 
showed  no  signs  of  labor;  the  fetal  parts  were  felt 
plainly  through  the  abdominal  wall.  There  were  no 
fetal  heart  tones.  There  was  considerable  abdominal 
tenderness  and  marked  hemorrhage.  The  urinalysis 
was  essentially  negative.  The  blood  count  showed 
marked  secondary  anemia  (hemoglobin,  32  per  cent) 
and  a high  white  and  neutrophil  count. 

Operation  at  11  a.  m.  A dead  fetus,  the  placenta 
and  many  large  old  blood-clots  were  found  in  the 
abdominal  cavity.  The  uterus  was  ruptured  along  the 
scar  of  the  former  cesarean  section.  Hysterectomy 
was  done  and  a transfusion  of  blood  given. 

The  immediate  postoperative  reaction  was  good,  but 
on  the  sixth  postoperative  day  her  temperature  was 
103,  and  she  had  a severe  chill.  A blood  culture 
showed  B.  coll,  for  which  mercurochrome  was  given 
intravenously.  The  patient  was  fever  free  on  the 
seventeenth  postoperative  day,  with  normal  progress 
thereafter.  She  was  dismissed  on  June  11,  1925,  in 
good  condition. 

ill 

Case  3. — Mrs.  M.  D.,  age  thirty-eight,  first  seen 
December  25,  1927,  7 a.  m.  Catamenia  entirely  nega- 
tive. Eleven  previous  pregnancies,  all  normal  with 
normal  deliveries.  This  pregnancy,  at  term,  normal, 
except  that  fetus  seemed  to  be  more  in  midline  and 
high  in  the  abdomen.  Labor,  began  six  hours  before 
entry  into  the  hospital.  After  labor  had  continued 
for  four  or  five  hours  with  little  progress,  a hypo- 
dermic (presumably  pituitrin)  was  given  to  increase 
the  pains,  which  became  severe  and  rapid,  but  ceased 
suddenly.  A large  lump  was  noted  in  the  right  side 
of  the  abdomen.  The  physician  in  charge  then  ad- 
vised hospitalization. 

Examination  showed  the  abdomen  to  be  very  large 
and  the  abdominal  muscles  very  tense.  No  fetal  heart 
sounds  could  be  heard.  Urinalysis  showed  some  albu- 
min and  some  red  blood  cells.  The  blood  count 
showed  a high  white  and  neutrophil  count. 

Operation  was  done  at  8:30  a.  m.  on  the  day  of 
entry.  Much  free  fluid  was  found  in  the  abdomen.  A 
dead  fetus  and  the  placenta  were  found  in  the  ab- 
dominal cavity.  The  uterus  was  split  from  the  middle 


February,  1930 


CASE  REPORTS 


113 


portion  out  through  the  broad  ligament  to  the  lat- 
eral abdominal  wall.  A total  hysterectomy,  bilateral 
oophorectomy  and  salpingectomy  were  done,  and  a 
transfusion  of  500  cubic  centimeters  of  blood  given. 

The  postoperative  reaction  and  progress  were  very 
satisfactory  and  the  patient  was  discharged  January 
12,  1928. 

i i i 

Case  4. — Mrs.  F.  N.,  age  thirty-two,  entered  the 
hospital  June  28,  1929.  Catamenia  normal.  Two  pre- 
vious pregnancies,  the  first  normal;  the  second  was 
terminated  by  abortion  at  two  months.  This  preg- 
nancy was  normal  until  May  25,  when  considerable 
“water”  passed.  On  June  8 there  was  a large  gush 
of  “water,”  but  no  pains.  The  position  of  the  fetus 
was  normal  at  that  time. 

Labor  began  on  the  afternoon  of  June  27,  1928,  at 
6:30  p.  m.,  with  hard  pains  every  three  minutes.  On 
th'e  following  morning  the  pains  came  on  at  one  to 
two-minute  intervals,  but  were  not  sustained.  At 
3 a.  m.  the  patient  was  given  one-half  cubic  centimeter 
of  pituitrin  by  hypodermic,  but  there  was  no  progress. 
At  4 a.  m.  a forceps  delivery  was  attempted.  It  was 
unsuccessful  and  the  patient  was  sent  to  the  hospital 
by  ambulance. 

A Dutryden’s  band  was  discovered  as  well  as  the 
fact  that  the  child’s  head  was  very  large.  Version  was 
attempted,  but  was  unsuccessful.  The  uterus  ruptured 
and  cesarean  section  was  decided  upon. 

Operation  at  8 a.  m.:  Extraperitoneal  approach. 
A dead  fetus  was  obtained,  the  head  very  large 
(hydrocephalus).  The  usual  closure  of  the  uterus  was 
made  and  the  cervical  tears  repaired. 

The  postoperative  reaction  was  good.  There  was 
some  thrombophlebitis  of  the  left  leg  and  infection  of 
the  wound,  both  of  which  improved  rapidly.  The 
patient  was  dismissed  on  July  19,  1928,  in  good  con- 
dition. She  made  an  excellent  recovery. 

/ Y 1 

Case  5. — Mrs.  E.  S.,  age  thirty-eight,  para  10,  en- 
tered the  hospital  on  June  9,  1929.  Nine  previous 
pregnancies  with  natural  births.  First  labor  normal 
in  time  and  natural  birth.  There  were  bilateral  lacera- 
tions of  the  uterus  during  the  second  labor  and  the 
patient  had  a rather  severe  hemorrhage.  All  the  other 
labors  were  easy.  In  all  but  the  first,  the  patient  was 
usually  in  labor  two  or  three  hours  with  contractions, 
but  no  pain  nor  expulsive  force  until  dilatation  was 
completed.  There  wTas  usually  a rapid  labor  after 
expulsive  contractions  started. 

In  this  confinement  the  patient  was  admitted  to  the 
hospital  at  9 a.  m.,  after  having  driven  a heavy  car 
forty  miles  after  labor  began.  She  continued  to  have 
regular  contractions,  but  no  pain  for  three  hours. 
The  cervix  was  completely  effaced,  but  head  had  not 
engaged. 

One-half  cubic  centimeter  of  pituitrin  was  given  to 
start  expulsive  pains,  without  effect.  Forty-five  min- 
utes later  a second  one-half  cubic  centimeter  of  pitui- 
trin was  administered.  Within  ten  minutes  expulsive 
pains  began  and  a living  child  was  born  in  a few 
minutes,  four  hours  after  entry.  The  old  laceration 
of  the  left  was  reopened,  extending  into  the  body  of 
the  uterus. 

As  soon  as  the  child  was  expelled  the  patient  began 
to  bleed  freely  and  was  soon  in  a condition  of  shock. 
The  cervix  was  immediately  grasped  with  the  hand 
in  the  vagina,  and  pressure  was  applied  over  the 
fundus.  Gas  was  administered  and  the  rupture  re- 
paired through  vagina  with  chromic  catgut.  The 
uterus  was  packed  lightly  and  the  old  laceration  on 
the  right  was  brought  together  over  the  packing. 
Four  grains  of  caffein  sodium  benzoate  were  given. 
A transfusion  of  500  cubic  centimeters  of  blood  was 
given  as  soon  as  possible.  The  patient  rallied  immedi- 
ately and  the  packing  was  removed  after  twenty-four 


hours.  At  no  time  had  the  patient  an  elevation  of 
temperature. 

Seventeen  days  after  delivery  she  had  a sudden 
severe  hemorrhage.  After  the  usual  procedures  this 
improved  and  the  following  day  a transfusion  of  500 
cubic  centimeters  of  citrated  blood  was  given.  Two 
days  later  the  packing  was  removed  from  the  vagina. 
This  was  done  under  anesthesia  as  there  was  a possi- 
bility of  a sudden,  alarming  hemorrhage  that  might 
require  surgical  procedure.  As  she  continued  very 
anemic  another  transfusion  was  given  on  July  13, 
following  which  her  condition  continued  to  be  very 
good.  However,  on  July  22  there  was  a severe  hemor- 
rhage with  loss  of  a great  amount  of  blood  causing 
the  collapse  of  the  patient.  Transfusion  was  immedi- 
ately resorted  to,  and  the  next  day  a complete  abdomi- 
nal hysterectomy  and  salpingectomy  were  done.  It 
was  found  that  the  laceration  had  extended  far  into 
the  left  broad  ligament  with  an  area  of  considerable 
infection.  This  was  carefully  sterilized  with  iodin  and 
sutured  carefully.  Considerable  difficulty  was  encoun- 
tered at  this  point  from  hemorrhage. 

The  pathologist’s  report  read:  “Uterus,  150  grams. 
Retained  seminecrotic  placental  tissue.  Marked  chronic 
cervicitis  with  erosion.” 

Her  subsequent  progress  was  very  satisfactory, 
showing  gradual  but  very  sure  improvement,  and  she 
was  dismissed  from  the  hospital  August  24,  1929,  in 
good  condition. 

Although  this  patient  had  had  previous  rapid  labors, 
the  contractions  had  not  reopened  the  old  lacerations. 
This  accident  was  probably  the  result  of  the  use  of 
pituitrin  which  started  contractions  of  the  entire 
uterus,  causing  expulsion  before  the  head  had  time 
to  mold. 

SUMMARY 

Case  1 : Spontaneous,  but  not  in  line  of  scar 
made  by  previous  cesarean  section.  This  rupture 
was  in  the  posterior  surface  of  a uterus  weakened 
by  previous  malpositions. 

Case  2 : Spontaneous.  In  the  line  of  the  scar 
of  a previous  cesarean  section. 

Case  3:  Traumatic.  Caused  by  the  weakened 
walls  of  a uterus  that  had  been  stretched  to  its 
utmost  eleven  times  before,  with  the  sudden 
strong  contractions  excited  by  the  administration 
of  pituitrin. 

Case  4:  Traumatic.  Caused  by  the  use  of  pitui- 
trin, which  brought  on  sudden  violent  contrac- 
tions of  a uterus  that  had  borne  nine  previous 
pregnancies.  A head  not  properly  molded  was 
forced  too  rapidly  through  this  previously  weak- 
ened cervix. 

CONCLUSIONS 

All  patients  who  have  had  previous  cesarean 
operations  should  be  warned  of  the  danger  of 
rupture  of  the  uterus  in  subsequent  labors,  and 
if  given  a trial  labor  should  not  be  permitted  to 
have  severe  contractions  during  the  early  stage. 

Version  or  the  use  of  forceps  should  never  be 
attempted  until  the  cervix  is  completely  dilated  and 
the  patient  is  entirely  relaxed  with  an  anesthetic. 

Pituitrin  is  a dangerous  drug  when  used  to 
hasten  labor,  no  matter  what  the  indications  for 
its  use  may  be.  If  administered,  it  should  be  given 
in  very  small  doses  (one  to  three  minims)  at 
proper  intervals  to  sustain  contractions.  Some 
consider  intranasal  application  to  be  the  safest 
method. 

Woodland  Clinic. 


114 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


PHENOBARBITAL — RASH  AND  OTHER 
TOXIC  EFFECTS 

REPORT  OF  CASES 

By  Suren  H.  Babington,  M.  D. 

Berkeley 

ipHENOBARBITAL  (luminal)  is  a valuable 
sedative  and  hypnotic.  It  has  come  to  be  a 
widely  used  medicine.  The  average  daily  dose 
runs  between  one-half  to  one  and  one-half  grains. 
In  state  hospitals  for  the  insane,  one  occasion- 
ally sees  it  being  administered  in  doses  as  large 
as  ten  grains  daily  to  patients  suffering  from  epi- 
lepsy. Apparently  epileptic  patients  have  a higher 
resistance,  or  they  gradually  develop  a certain 
degree  of  tolerance  to  the  drug,  so  that  large 
doses  can  be  given  them  without  ill  effects. 

Ill  Effects. — Sometimes  even  small  doses  of 
phenobarbital  produce  some  ill  effects  that  are 
worthy  of  consideration.  Some  of  these  are: 
drowsiness,  headache,  nausea,  and  a rash  resem- 
bling that  of  measles  or  scarlet  fever.  In  some 
cases  even  fever  has  been  reported.  Nevertheless, 
all  of  these  symptoms  usually  clear  up  upon  dis- 
continuance of  the  use  of  the  drug,  and  without 
injury  to  the  patient. 

Rash. — Jackson 1 reported  six  cases  of  skin 
eruption  out  of  fivo  hundred  patients  who  took 
luminal. 

Later,  Bollinger 2 reported  two  cases  out  of 
two  hundred  patients. 

Still  later,  Menninger 3 reported  three  cases  out 
of  four  hundred  patients.  In  going  over  the  liter- 
ature, he  found  that,  since  the  introduction  of 
the  drug  in  1912,  there  were  only  forty-one  case 
reports,  including  his  own  three,  mentioning  skin 
eruption  resulting  from  the  use  of  phenobarbital. 
The  frequency  of  the  rash  lies  between  one  and 
three  per  cent  of  all  cases  reported  upon. 

In  my  series  of  approximately  one  hundred 
and  fifty  patients  who  have  received  luminal  in 
the  hospital  and  in  private  practice,  three  de- 
veloped skin  rash  with  other  symptoms,  thus  rais- 
ing the  number  above  reported  to  forty-four. 

The  fourth  case,  which  is  reported  below,  is 
given  because  of  the  smallness  of  the  dose  ad- 
ministered, in  order  to  avoid  ill  effects  of  any 
kind. 

REPORT  OF  CASES 

Case  1. — A man,  fifty-two  years  old,  received  sodium 
luminal,  grain  one-fourth  b.  i.  d.,  for  two  days  for 
restlessness.  On  the  second  day  he  began  complain- 
ing of  generalized  itching.  At  the  end  of  the  day  he 
showed  a macular  eruption  all  over  the  body.  The 
drug  was  discontinued.  After  three  days  the  medicine 
was  given  again  for  two  days.  The  itching  and 
macular  rash  reappeared.  Upon  discontinuance  of  the 
drug,  all  was  well.  Several  days  later  the  skin  began 
shedding  like  a very  fine  dandruff.  Some  physicians 
may  contend  that  the  rash  is  due  to  failure  to  use  an 
alkali  with  the  luminal.  However,  in  this  case  the 
patient  received  sodium  luminal,  which  is  an  alkaline 
preparation. 

y y i 

Case  2. — A woman,  age  twenty-four,  was  given 
luminal,  grain  one-fourth  b.  i.  d.,  for  nervousness.  On 
the  fifth  day  she  called  up  complaining  of  frontal 
headache,  “a  kind  of  headache  she  never  had  before 
in  her  life.”  It  felt  “hard  and  heavy  in  the  head.” 


The  drug  was  discontinued:  the  headache  stopped. 
However,  a week  later  she  developed  a measles-like 
rash  over  the  neck,  gradually  extending  to  the  trunk; 
none  on  the  extremities  or  face.  The  rash  persisted 
for  several  days  with  considerable  itching,  which  had 
to  be  controlled  by  internal  and  external  medication. 
A month  later,  luminal  was  administered  again  on 
the  assumption  that  perhaps  the  symptoms  had  been 
due  to  something  else.  After  three  days  all  of  the 
above  symptoms  returned.  The  rash  and  itching  then 
persisted  for  nearly  a month.  The  patient  was  not 
given  any  more  luminal,  and  she  has  as  yet  never  had 
a recurrence  of  the  above  described  headache  nor  of 
the  rash  since  that  time.  I did  not  like  to  make  the 
experiment  with  her  for  the  third  time. 

y i i 

Case  3. — A woman,  sixty-one  years  old,  was  given 
luminal,  grain  one-fourth  b.  i.  d.,  for  insomnia  and 
nervousness.  On  the  second  day  she  developed  a 
scarlet-fever-like  rash  all  over  the  body  (including  the 
extremities  and  face,  unlike  Case  2),  accompanied  by 
a marked  itching  which  required  medication  for  relief. 
The  luminal  was  discontinued  for  three  days  and  the 
itching  and  rash  disappeared,  except  in  the  inter- 
digital spaces  on  the  hands,  where  there  was  some 
swelling  and  redness  present,  due,  apparently,  to 
scratching  and  rubbing.  Three  days  later  the  luminal 
was  resumed.  In  a day,  rash  and  pruritus  returned 
and  were  as  severe  as  before.  Upon  discontinuance 
of  the  luminal,  the  rash  disappeared  and  the  itching 
ceased. 

y i r 

Case  4. — A woman,  age  sixty-five,  weight  one  hun- 
dred and  fifty  pounds,  after  taking  one-fourth  grain 
of  luminal  b.  i.  d.  for  two  days  for  insomnia,  com- 
plained that  she  “could  not  raise  her  arms,”  and  she 
felt  “very  light  in  the  feet.”  She  could  not  keep  her 
eyes  open.  She  had  no  skin  eruption  or  reaction.  The 
dosage  was  cut  down  to  one-eighth  grain  by  breaking 
into  two  pieces  the  smallest  tablet  manufactured 
(which  is  one-fourth  grain).  The  by-effects  dis- 
appeared, and  this  small  dose  produced  the  desired 
results. 

COMMENT 

Many  theories  have  been  advanced  to  explain 
the  cause  of  the  rash,  such  as  idiosyncrasy, 
poisoning,  and  calcium  deficiency.  Some  contend 
that  the  rash  is  due  to  failure  to  use  some  alkali 
with  luminal.  However,  our  first  case  received 
sodium  luminal,  which  is  an  alkaline  preparation. 

2301  Ward  Street. 

REFERENCES 

1.  Jackson,  A.  S.:  Toxic  Reaction  from  Phenobarbi- 
tal (Luminal),  J.  A.  M.  A.,  88,  642,  February  26,  1927. 

2.  Bollinger,  H.  J.:  Toxic  Reaction  from  Pheno- 
barbital (Luminal),  California  and  West.  Med.,  26, 
659,  May  1927. 

3.  Menninger,  W.  C. : Skin  Eruptions  with  Pheno- 
barbital (Luminal),  J.  A.  M.  A.,  91,  14,  July  7,  1928. 


Prevention  of  the  Introduction  of  Diseases  From 
Abroad. — A report  which  shows  the  activities  of  the 
United  States  Public  Health  Service  in  preventing 
the  introduction  of  diseases  from  abroad  was  recently 
forwarded  to  Congress  by  Surgeon-General  H.  S. 
Cumming.  This  report  indicates  that  no  instance  of 
the  importation  of  any  quarantinable  disease  occurred 
during  the  past  fiscal  year.  No  cases  of  plague, 
cholera,  yellow  fever,  or  typhus  fever  arrived  at  quar- 
antine stations  in  the  United  States.  There  were, 
however,  ten  instances  during  the  year  of  bubonic 
plague  occurring  on  vessels  arriving  at  ports  in  for- 
eign countries.  The  preventive  measures  applied  by 
officers  of  the  Public  Health  Service  at  foreign  ports 
of  departure  are  reflected  in  the  small  number  of 
quarantinable  diseases  on  vessels  arriving  at  ports 
of  the  United  States. — United  States  Health  Service, 
December  24,  1929. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 


THE  LUMP  IN  THE  BREAST 

Alson  Kilgore,  San  Francisco. — In  our 
courts  the  accused  is  innocent  until  proved  guilty, 
but  in  the  breast  a lump  is  cancer  until  proved 
benign.  The  surgeon  who  advises  watchful  wait- 
ing in  the  presence  of  a single  definite  breast 
lump  in  a woman  over  twenty-five  will  find  too 
often  that  he  has  been  watching  an  early  cancer 
become  incurable.  Even,-  such  lump  should  be 
explored.  In  the  examination  of  a breast  (with- 
out skin  retraction  or  other  classical  signs  of 
cancer)  decision  should  be  limited  to  the  ques- 
tion of  whether  an  actual  lump  is  present  or 
whether  the  mass  felt  by  the  patient  is  only  a 
“lumpy”  area  of  breast  tissue — a decision  that,  in 
itself,  often  requires  no  mean  skill  and  experi- 
ence. And  the  surgeon  should  never  lose  sight 
of  the  fact  that  extended  or  vigorous  examina- 
tion may  cause  rapid  metastasis  of  an  early  cancer. 
One  or  two  gentle  touches  must  furnish  all  the 
information  needed.  Leaving  a breast  sore  from 
clinical  examination  is  absolutely  inexcusable. 

It  is  today  settled  and  no  longer  debatable  that 
exploration  of  a breast  lump  is  justifiable,  but  it- 
is  equally  undebatable  that  if  cancer  is  found,  the 
complete  operation  must  be  done  at  the  same  time. 
Frozen  section  diagnosis  should  always  be  avail- 
able. Occasionally  only  a microscopic  section  will 
settle  the  diagnosis.  But  the  average  hurried 
frozen  section  is  less  trustworthy  than  paraffin  or 
celloidin  sections,  and  the  competent  surgeon  will 
depend  upon  a reasonably  clear  gross  diagnosis 
rather  than  on  frozen  section  if  the  two  disagree. 
The  really  competent  breast  surgeon  must  be  at 
least  a good  amateur  pathologist.  It  is  not  too 
much  to  ask  that  he  be  confident  of  his  recogni- 
tion of  certain  typical  pictures — of  normal  breast 
tissue,  of  cancer,  of  the  encapsulated  lump,  of 
the  simple  and  the  papillomatous  cyst,  and  of  the 
nonencapsulated  cystadenoma. 

But  our  responsibility  is  not  ended  when  we 
have  learned  to  deal  properly  with  breast  lumps. 
We  cannot  treat  early  cancers  unless  our  patients 
bring  them  early.  It  has  been  proved  possible  to 
educate  communities  about  breast  lumps.  There 
is  still  room  for  improvement  in  popular  knowl- 
edge in  California.  Physicians  must  educate  their 
patients  to  bring  breast  lumps  for  examination 
the  moment  of  discovery.  As  a matter  of  fact, 
we  can  well  go  farther  than  that.  Over  90  per 
cent  of  breast  cancers  are  discovered  acciden- 
tally— unintentional  contact  of  the  hand  on  the 
breast  in  bathing  or  dressing.  The  accidentally 
discovered  lump  has  often  been  present  and  dis- 
coverable for  months  before  it  is  found.  Lumps 
should  be  sought  for  by  every  woman  routinely, 
not  discovered  accidentally.  If  we  teach  our  pa- 
tients to  keep  track  of  themselves  as  a matter  of 


habit,  passing  a soaped  hand  flat  over  the  breasts 
at  frequent  intervals,  we  will  see  many  more 
curable  cancers.  And  the  sensible  woman,  taught 
that  a lump  is  the  one  important  danger  sign,  will 
not  develop  a morbid  phobia  so  long  as  she  con- 
tinues to  find  her  breasts  free  of  lumps. 

* * * 

Edwin  I.  Bartlett,  San  Francisco. — The 
old  adage,  “When  in  doubt  do  a complete  breast 
operation,”  still  holds  today.  At  one  time  it  meant 
the  removal  of  a lot  of  innocent  breasts  because 
we  depended  entirely  upon  the  clinical  diagnosis. 
Today  there  need  never  be  any  doubt  and,  there- 
fore, no  innocent  breasts  need  be  sacrificed.  This 
comes  about  through  the  perfection  of  the  ex- 
ploratory operation  and  the  diagnosis  at  the  oper- 
ating table  by  the  gross  appearance  of  the  tumor 
or  by  the  frozen  section.  All  cases  can  be  posi- 
tively diagnosed  and  properly  treated  while  the 
patient  is  still  under  the  primary  anesthetic. 

The  old  saying,  “Amputation  of  the  breast  is 
not  enough  for  cancer,  and  too  much  for  any- 
thing else.”  still  holds  today.  Simple  amputation 
is  seldom  indicated,  therefore  a woman  may  have 
practically  a guaranty  that  she  will  not  lose  her 
breast  unless  cancer  is  found.  She  can  be  further 
assured  that  the  gland  will  be  restored  completely 
or  nearly  to  its  normal  shape,  that  the  function 
will  not  be  seriously  interfered  with,  that  she 
need  have  no  fears  regarding  serious  discomfort 
or  distress  with  lactation,  and  that  the  skin  over 
the  breast  will  show  only  a fine  white  line.  To 
accomplish  all  this  the  surgeon  makes  an  incision 
radiating  from  the  nipple,  he  dissects  the  tumor 
very  carefully  away  from  the  surface  of  the  gland 
or  simply  strips  the  lining  of  a cyst.  If  it  becomes 
necessary  to  remove  a portion  of  a gland,  he  takes 
a wedge-shaped  piece  with  the  base  of  the  wedge 
at  the  periphery  of  the  breast,  and  the  blade  of 
the  wedge  toward  the  nipple.  Fie  closes  the  de- 
fect by  accurately  approximating  the  posterior  cut 
edges  of  the  gland.  He  thus  avoids  lactation 
trouble  by  leaving  behind  no  secreting  breast 
tissue  which  does  not  have  free  drainage  to  the 
nipple,  and  he  leaves  no  furrows  or  depressions 
in  the  surface  of  the  breast  gland. 

* * * 

M.  T.  Burrows,  Pasadena. — While  most  can- 
cers of  the  breast  make  themselves  known  by  the 
development  of  a lump,  there  are  a few  which 
fail  to  give  this  signal.  The  cancers  which  are 
most  frequently  missed  are  those  arising  from 
the  ducts  deep  in  the  breast  and  the  more  diffuse 
cancers  which  have  an  acute  onset.  The  first  of 
the  latter  types  are  easily  diagnosed  by  the  ap- 
pearance of  an  eczematous  rash  about  the  nipple. 
A suddenly  developing  acutely  swollen,  red  and 
tense  breast,  especially  coming  on  without  warn- 

115 


116 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


ing,  should  be  considered  cancerous  until  proved 
otherwise. 

While  the  easiest  method  of  treatment  of  any 
breast  tumor  is  exploration  and  removal  it  must 
be  remembered  that  the  removal  of  the  breast  of 
a young  woman,  or  even  cutting  into  it,  means 
either  robbing  this  woman  of  one  of  the  charms 
of  her  womanhood  or  doing  injury  to  the  ducts 
which  will  be  a constant  source  of  trouble  to  her 
throughout  her  sexual  life. 

Where  it  is  possible  to  make  a definite  diag- 
nosis of  cancer  the  breast  must  be  removed. 
Whether  one  should  advise  the  immediate  re- 
moval of  every  tumor  of  the  breast  is  a question 
to  be  solved.  While  a few  breast  cancers 
make  themselves  known  by  the  appearance  of 
a rash  about  the  nipple,  most  cancers  of  the 
breast  begin  in  a mastitis  of  shorter  or  longer 
duration  or  other  tumors.  Since  our  recent  work 
on  the  relation  of  cancer  to  vitamin  deficiency,  we 
have  assumed  quite  a different  attitude  toward 
many  of  these  precancerous  lesions.  The  breast 
of  one  woman  with  an  eczematous  rash  just 
appearing  about  the  nipple  healed  completely  with 
the  removal  of  several  abscessed  teeth  and  the  use 
of  a healthful  diet.  Cancers  were  found  at  opera- 
tion deep  in  the  breast  of  two  other  patients.  In 
one  the  eczema  had  existed  for  six  months ; in 
the  other,  two  years. 

One  sees  a tumor  often  in  the  breasts  of 
young  and  middle-aged  women  who  may  or 
may  not  have  borne  children.  Many  of  these 
cases  have  been  associated  with  a cervicitis, 
abscessed  teeth,  and  secondary  anemias.  The 
breasts  of  these  patients  which  showed  no  defi- 
nite signs  of  malignancy  have  not  been  touched. 
The  associated  lesions,  on  the  other  hand,  have 
been  treated  at  once.  The  abscessed  teeth  have 
been  removed,  cervicitis  treated,  and  an  attempt 
has  been  made  to  clear  the  anemia.  It  is  surpris- 
ing how  many  breast  lesions  have  disappeared 
under  this  treatment.  Our  method  is  to  institute 
the  treatment  of  these  associated  lesions  at  once. 
If  the  breast  lesion  does  not  recede  or  disappear 
within  two  to  four  weeks,  operation  is  then  ad- 
vised. Of  the  twenty-one  cases  of  this  type  seen 
during  the  last  one  and  a half  years,  seven  have 
been  operated  upon  and  six  found  malignant. 

Besides  these  types  of  lesion  one  sees  tumors 
in  the  breasts  of  many  of  the  thyroid  cases  and 
other  cases  where  there  has  been  a disturbance 
in  the  sex  organs.  What  is  to  be  done  with  many 
of  these  cases  is  a question  yet  to  be  solved. 
While  a few  of  these  patients  have  come  to  the 
office  with  infections  in  the  breast,  a heightened 
leukocyte  count  and  a low  afternoon  fever,  others 
have  shown  no  such  symptoms.  The  former  group 
have  been  operated ; the  latter  have  been  placed 
on  the  waiting  list  and  their  general  health  im- 
proved as  much  as  possible,  especially  if  they  are 
young  girls  the  removal  of  whose  breast  would 
be  a distinct  handicap  to  their  future  happiness. 

Most  of  the  other  benign  tumors  of  the  breast 
have  been  removed  because  of  disfigurement  or 
lack  of  positive  means  of  diagnosis. 

Many  authors  advise  the  removal  of  all  lumps 
from  the  breast.  Many  such  lumps  appear  in 


young  girls  before  marriage.  Many  of  these  are 
connective  tissue  overgrowths,  the  immediate  re- 
moval of  which  is  uncalled  for  because  most  of 
them  respond  readily  to  the  treating  of  focal  in- 
fections, good  food,  marriage  and  children.  While 
it  is  true  they  may  reappear,  as  old  mastitis  of 
nursing  may  reappear  in  later  years,  it  is  probably 
better  to  wait  and  treat  them  at  this  later  period. 

Cancer  is  not  a local  disease.  Our  recent 
studies  have  indicated  that  it  depends  not  only 
upon  a certain  type  of  local  degeneration,  but  also 
upon  a drop  in  the  general  nutrition  or  health  of 
the  patient.  When  we  have  appreciated  this  fact 
and  have  looked  upon  our  cancer  patients  as 
patients  whose  general  health  must  be  restored 
first,  then  many  more  cures  will  be  the  result. 
Cancer  is  not  a disease  to  be  treated  by  any  one 
particular  method.  There  is  no  such  method. 
Each  cancer  must  be  removed  completely  or  other- 
wise destroyed  by  the  simplest  method  available. 
Each  case  is  a problem  by  itself.  It  is  a disease 
which  must  be  treated  by  men  skilled  both  in 
pathology  and  general  clinical  methods.  Cancer 
deals  with  the  most  fundamental  problems  of  life. 
It  is  an  overgrowth  of  cells.  It  is  not  a true  dis- 
ease. It  is  a reaction  which  may  take  place  in  any 
area  suffering  degeneration  when  there  is  a drop 
in  the  general  nutrition  of  the  organism.  Its  treat- 
ment demands  not  only  its  removal,  but  the  restora- 
tion of  the  patient  to  his  former  state  of  health. 

Treatment  of  Diabetic  Coma. — At  the  Peter  Bent 
Brigham  Hospital,  nurses  and  house  officers  have  re- 
ceived the  following  instructions  for  the  management 
of  diabetic  coma: 

1.  As  soon  as  the  patient  arrives  place  him  in  a 
warm  bed. 

2.  Give  an  enema  and  obtain  a blood  and  urine 
sample. 

3.  Give  1000  c.c.  of  saline  subpectorally  at  once. 

4.  Give  25  units  of  insulin  at  once. 

5.  Give  insulin  about  every  two  hours  thereafter 
until  the  urine  becomes  sugar-free,  judging  the  dose 
by  the  amount  of  sugar  present  in  catheter  urine 
specimens.  When  the  urine  becomes  sugar-free  con- 
tinue to  examine  it  at  %-hour  intervals  using  enough 
insulin  to  prevent  the  return  of  glycosuria  and  acidosis. 

6.  Let  the  patient  have  about  4000  c.c.  of  fluid 
each  24  hours  during  the  first  few  days  in  the  form 
of  subpectoral  injections,  rectal  taps  or  fluids  by 
mouth.  The  rectal  tap  should  consist  of  5 per  cent 
glucose  in  saline  or  tap  water.  Do  not  use  sodium 
bicarbonate. 

7.  As  soon  as  the  patient  becomes  cooperative, 
let  him  have  small  amounts  of  warm  fluids  to  drink, 
and,  by  way  of  food,  as  much  orange  juice,  ginger 
ale,  or  oatmeal  gruel  as  he  likes. 

8.  As  soon  as  the  patient’s  condition  warrants  it, 
allow  him  to  eat  a low  calorie  “soft”  diet  including 
milk,  cream,  butter,  crackers,  eggs,  and  cereals. 

9.  Comatose  patients  whose  acidosis  does  not  im- 
prove, as  measured  by  the  plasma  bicarbonate,  within 
eight  hours  after  insulin  is  first  given,  should  receive 
25  gm.  of  sodium  bicarbonate  by  mouth,  rectum  or 
vein  during  the  course  of  a few  hours.  This  dose 
should  be  repeated  in  twelve  hours  if  acidosis  persists. 

10.  Diabetic  patients  admitted  to  the  medical  wards 
with  any  complication  of  a possible  surgical  nature 
(carbuncle,  gangrene,  lymphangitis)  should  be  seen 
by  the  Surgical  Resident  at  once.  A diabetic  patient 
can  be  prepared  for  operation  in  a few  hours  by 
the  proper  use  of  insulin. 

11.  Hypoglycemic  reactions  are  to  be  treated  with 
the  oral  or  rectal  administration  of  10-20  gm.  of 
sugar.  Intravenous  injections  of  sugar  are  rarely 
needed. — Journal  of  the  Medical  Society  of  New  Jersey. 


February,  1930 


EDITORIALS 


117 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Official  Organ  of  the  California,  Utah  and  <7^rvada  t Medical  c Associations 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 


Telephone  ‘Douglas  0062 


Editors 

Associate  Editor  for  Nevada  . 
Associate  Editor  for  Utah 


j GEORGE  H.  KRESS 
* ) EMMA  W.  POPE 
. HORACE  J.  BROWN 
. . . . J.  U.  GIESY 


Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 

single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  Address. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned. 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects..  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 

Contributions — Exclusive  Publication. — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


EDITORIALS 


DOES  LOS  ANGELES  COUNTY  HOSPITAL 
EXTENSION  INTO  PRIVATE  HOSPI- 
TALS CONSTITUTE  A MENACE 
TO  MEDICAL  PRACTICE? 

Los  Angeles  County  Hospital  Overcrowded: 
Ten  Million  Dollar  Building  Being  Erected. — 
The  Los  Angeles  County  General  Hospital  is 
going  through  the  strain  of  somewhat  severe 
overcrowding.  For  a number  of  years  the  annual 
reports  have  stressed  its  need  for  more  beds. 
In  response  to  the  agitation  for  facilities  adequate 
to  care  for  the  indigent  sick  and  injured  of  Los 
Angeles  County  who  seek  admission  to  its 
wards,  a new  hospital  unit  is  being  erected. 
This  new  unit  for  injuries  and  for  acute  diseases 
will  cost  some  $10,000,000!  Perhaps  $12,000,000 
will  be  nearer  the  total  cost  of  this  new  unit. 
Part  of  this  immense  sum  of  money  has  come  out 
of  an  initial  $5,000,000  bond  issue.  The  remain- 
der is  being  taken  from  the  annual  tax  levy  funds 
of  the  county,  because  the  taxpayers  have 
acquired  a partial  prejudice  toward  bond  issues, 
and  general  taxation  brings  in  the  money  with 
less  general  strain  on  the  body  politic.  This  new 
unit  probably  will  not  be  ready  for  occupancy  for 
another  year  or  so. 

The  new  structure  is  a massive  building  that 
is  unique  in  many  ways  and  quite  different  from 


any  hospital  which  has  up  to  this  time  been  con- 
structed, anywhere  in  the  entire  world.  Califor- 
nia and  Western  Medicine  in  proper  time  will 
present  to  its  readers  a description  of  this  new 
building,  with  comments  on  its  arrangements 
and  facilities,  and  on  its  relationships  to  the  com- 
munity and  to  the  medical  profession. 

* * * 

Why  These  Criticisms  by  the  Council  of  the 
California  Medical  Association  Are  Made.- — At 
this  time,  comment  will  be  made  on  the  announce- 
ments which  recently  have  been  put  forth  by  the 
hospital  authorities,  or  means  to  meet  its  present 
overcrowded  condition.  Criticism  is  not  here 
expressed  on  the  effort  of  the  hospital  authorities 
in  striving  to  provide  care  for  the  indigent  sick 
and.  injured,  since  that  is  their  obligation  as 
officials ; but  rather  because  provision  has  not  been 
made  before  now  to  meet  this  need  which  for  a 
long  time  has  been  so  evident,  through  the  erec- 
tion, say  of  a battery  of  simple  one-story,  easily 
constructed,  practically  fireproof  temporary  struc- 
tures, by  means  of  which  at  very  moderate 
expense  the  rich  county  of  Los  Angeles  could 
easily  have  provided  one  to  two  hundred  addi- 
tional beds. 

Such  temporary  structures  could  have  been 
built  either  on  the  present  hospital  site  acreage  or 
at  the  county  farm.  If  at  the  latter  place,  then 
the  beds  of  these  emergency  structures  could  have 
been  filled  by  some  of  the  less  ill  or  chronic 
inmates  of  the  county  hospital,  and  placed  under 
the  care  of  salaried  residents  and  of  interns  at 
the  infirmary  division  of  the  county  farm.  Such 
buildings  later  on  could  have  been  utilized  for 
other  purposes. 

The  opinions  here  expressed,  probably  would 
not  have  been  made  were  it  not  for  the  fact  that 
the  plan  which  has  been  devised  to  meet  the  Los 
Angeles  County  Hospital’s  needs,  presumably  by 
its  medical  director,  are  of  such  nature  as  to  be 
a possible  menace  to  the  future  welfare  of  the 
medical  profession  and  the  standards  to  which  it 
is  committed.  Since  the  California  Medical  As- 
sociation is  much  interested  in  the  maintenance 
of  such  standards,  it  cannot  be  expected  to  stand 
by  without  pointing  out  what  seem  to  be  serious 
mistakes  in  procedure. 

* * * 

The  Plan  as  Outlined  in  Bulletin  of  January  11, 
1930. — In  the  opinion  of  the  members  of  the 
Council  of  the  California  Medical  Association, 
this  new  Los  Angeles  County  Hospital  plan,  even 
though  intended  only  as  an  emergency  measure, 
is  fraught  with  danger  to  the  maintenance  of  the 
best  standards  in  public  health  and  in  organized 
medicine,  and  since  it  could  have  been  avoided,  to 
that  extent  at  least,  would  seem  to  have  been 
unnecessary. 

The  procedure  to  be  followed  in  this  innova- 
tion is  outlined  in  Los  Angeles  County  Hospital 
Bulletin  No.  1072  of  date  of  January  11,  1930. 
This  bulletin  is  addressed  “To  Cooperating  Pri- 


118 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


vate  Hospitals  in  Los  Angeles  County  Accepting 
County  Hospital  Patients  and  also  to  their  Med- 
ical Staffs”  and  contains  some  twelve  items  of 
information  and  instructions,  covering  three 
pages.  Among  other  things,  it  is  stated  therein 
that  the  Los  Angeles  County  Hospital  itself 
charges  inpatients,  who  are  not  indigent,  that  is, 
who  are  not  in  the  pauper  classification  of  the 
California  Code,  the  sum  of  $3.50  per  day,  and 
that  the  outpatients,  namely,  the  ambulatory  or 
dispensary  patients,  are  charged  50  cents  per 
patient  visit. 

* * * 

An  Example  of  Hypersensitivity. — Item  11  of 
the  bulletin  restates  these  charges,  and  at  the  same 
time  practically  informs  members  of  private  hos- 
pital staffs  who  may  be  called  upon  to  care  for 
such  county  hospital  patients,  to  exercise  caution 
and  not  to  mention  the  words  “indigent,”  “county 
charge,”  or  “pauper.”  Perhaps  it  will  be  just  as 
well  to  quote  this  item  exactly  as  it  reads : 

“11.  While,  as  stated  in  the  attached  mimeographed 
report,  all  county  hospital  patients  are  classed  as  indi- 
gents,  even  though  a few  of  them  pay  the  county  as 
much  as  $3.50  per  day  for  in-patient  care  and  fifty 
cents  per  out-patient  visit,  the  greatest  care  is  taken 
that  no  hospital  employee  or  attache  ever  refers  to 
them  and  in  their  presence  using  such  words  as  “indi- 
gent,” “pauper,”1  “county  charge,”  etc.,  as  many  times 
our  patients  are  extremely  sensitive  on  this  point.” 

The  above  delicacy  of  feeling  for  these  indigent 
patients  is  of  interest  when  one  remembers  that 
the  Los  Angeles  General  Hospital,  which  accord- 
ing to  state  law  can  only  care  for  indigent 
patients,  has  a varying  capacity  of  1564  to  1659 
beds,  and  that  some  29,410  inpatients  were 
admitted  thereto  in  the  fiscal  year  ending  June  30, 
1929;  that  some  223,475  outpatient  or  dispensary 
visits  were  recorded  for  the  same  time  period ; 
that  the  professional  services  rendered  by  some 
150  to  200  members  of  the  Los  Angeles  County 
Medical  Association,  when  estimated  on  the 
extremely  nominal  basis  of  $1  per  hour  for 
time  spent  in  the  institution  (little  more  than  a 
day  laborer’s  wage),  and  of  $10  for  the  major 
operations  performed  by  these  physicians  and 
surgeons,  approximates  the  huge  sum  of  some- 
thing like  $500,000  yearly,  which  these  physicians 
and  surgeons  gratuitously  give  to  these  patients 
and  the  county  with  little  or  no  recognition  from 
the  general  public  of  Los  Angeles  for  this  super- 
latively generous  donation  on  the  part  of  the 
medical  profession ; that  in  addition  to  the  above, 
the  private  hospitals  and  the  staffs  of  such  institu- 
tions are  now  called  upon  to  make  further  and 
additional  donations  to  the  county ; and  last  but 
not  least,  that  while  the  members  of  the  medical 
profession  are  expected  to  do  their  stupendous 
v/ork  in  this  and  similar  institutions,  almost 
unhonored  and  unsung,  they  at  the  same  time 
must  not  divulge  to  the  indigent  or  pauper 
patients  that  they  as  physicians  and  surgeons  are 
donating  their  services  to  these  county  charges, 
and  above  all  else  not  make  mention  of  the  words 


“indigent,”  “pauper”  or  “county  charge”  in  the 
hearing  of  such  patients. 

The  writer  has  been  on  the  staff  of  this  institu- 
tion and  a member  of  its  executive  medical  board 
for  almost  twenty-five  consecutive  years.  In  all 
that  time  he  can  remember  no  single  time  when 
complaint  was  made  of  attending  staff  members 
speaking  of  patients  in  their  presence,  as  paupers 
or  indigents.  It  would  seem  logical  to  assume 
that  a group  of  physicians  and  surgeons  who  are 
willing  to  donate  the  great  amount  of  profes- 
sional services  already  indicated,  would  also 
observe  the  proprieties,  and  be  sensitive  to  the 
unfortunate  condition  of  the  indigent  patients, 
and  not  attempt,  through  unnecessary  or  cold 
remarks  to  humiliate  such  county  charges.  And 
as  a matter  of  fact  they  have  not  done  so  in  the 
past  nor  are  such  physicians  and  surgeons  apt 
to  do  so  in  the  present  or  future. 

It  certainly  seems  that  this  cold-blooded  accept- 
ance by  a rich  county  and  people,  of  massive  and 
generous  professional  service  of  the  character 
just  mentioned,  when  coupled  with  what  might 
be  called  this  official  supersensitivity  on  behalf 
of  these  indigent  fellow  citizens,  is  just  a wee  bit 
incongruous. 

And  especially  so,  since  the  last  annual  report 
of  the  institution  itself  states,  “what  constitutes 
a pauper  or  poor  indigent  person  entitled  to 
county  aid.”  The  same  annual  reports,  however, 
have  not  been  brought  out  in  printed  form  nor 
are  the  vast  monetary  equivalents  of  the  services 
rendered  by  the  members  of  the  attending  staff 
of  the  institution,  indicated  therein  in  forms  of 
nominal  or  real  monetary  values.  Some  day  phy- 
sicians and  surgeons  will  rebel  against  such 
callous  treatment  and  nonappreciation  of  gratui- 
tous professional  services,  and  insist  that  their 
donations  be  listed  in  dollar  and  cents  evalua- 
tions, as  are  those  of  lay  citizens. 

It  is  of  interest  to  note,  also,  that  when  the 
county  of  Los  Angeles  sues  relatives  of  persons 
who  have  been  inpatients,  in  order  to  collect  the 
$3.50  per  day  which  it  charges  and  attempts  to 
collect  when  possible  from  any  whom  it  believes 
are  not  indigent,  that  it  does  so  on  the  legal 
ground  that  such  inpatients  were  not  entitled  to 
free  care,  because  of  evidence  that  such  patients 
were  in  fact,  not  “paupers.”  In  other  words,  the 
county  and  hospital  can  cold-bloodedly  use  the 
words  “indigent,  county  charges  and  paupers” 
to  serve  its  material  interests,  but  the  doctors 
giving  the  gratuitous  service  to  the  rich  county 
and  to  the  indigent  sick  and  injured  are  cautioned 
that  they  must  not  do  so,  even  though  there  is 
no  record  of  their  having  done  so  during  many 
years  of  service. 

* * * 

Industrial  Accident  Fee  Table  Is  Dragged  In 
to  Hold  Down  Possible,  “If  Any,”  Fees. — In  a 
pink  sheet  enclosure  to  Bulletin  1072,  to  which  is 
also  attached  a blue  “Fee  Schedule — Approved 
by  the  Industrial  Accident  Commission,”  and  a 


February,  1930 


EDITORIALS 


119 


copy  of  the  Los  Angeles  County  Hospital  "Report 
for  the  Fiscal  Year  Ending  June  30,  1929,"  it  is 
stated  that  for  the  care  of  county  hospital  indi- 
gent patients  in  private  hospitals,  it  is 

“understood  that  the  (private)  hospital  charges  for 
such  patients  will  not  exceed  $4.50  per  day  for  general 
ward  care  and  nursing  service  and  that  if  payment 
of  physicians’  services  becomes  necessary  that  their 
charges  will  be  at  rates  similar  to  those  established 
by  the  fee  schedule  for  physicians  and  surgeons  car- 
ing for  patients  under  the  Workmen’s  Compensation 
Insurance  and  Safety  Act  approved  by  the  Industrial 
Accident  Commission.  (Form  No.  97.)’’ 

2.  “Please  submit  to  me  on  the  1st,  10th  and  20th 
of  each  month,  duplicate  bills  for  the  hospital  care 
of,  and  also  duplicate  bills,  if  any,  for  all  physicians’ 
services  to  this  patient;  each  such  bill  to  include  the 
dates  and  amounts  of  all  former  unpaid  bills  and  to 
state  briefly  but  accurately  the  present  diagnosis  of 
the  patient  at  the  time  the  bill  is  rendered  and  also 
the  probable  length  of  time  the  patient  will  need  to 
remain  in  the  hospital  thereafter.” 

* * * 

Alloivance  for  Private  Hospitals  Below  County 
Hospital  Per  Capita  Cost! — One  other  quotation, 
and  this,  from  the  annual  report : 

“During  the  present  year  its  per  capita  cost  per  day 
for  in-patients  was  $5,272  and  per  out-patient  visit, 
$1,235.” 

In  other  words,  the  rich  county  of  Los  Angeles, 
with  no  overhead  charges  such  as  taxes,  and  with 
gratuitous  services  from  about  two  hundred  phy- 
sicians and  surgeons  who  at  the  ridiculously  low 
estimate  previously  mentioned,  give  services  of  a 
monetary  value  of  $500,000  yearly,  finds  its  own 
per  capita  cost  per  day  for  a bed  or  inpatient  to  be 
five  dollars  and  twenty-seven  cents  ($5.27),  but 
asks  private  hospitals  to  accept  such  patients  at 
four  dollars  and  a half  ($4.50)  per  day  and 
seemingly  sees  no  inconsistency  in  such  action. 
At  the  same  time,  it  instructs  members  of  the 
attending  staffs  of  private  hospitals  : one,  to  make 
out  their  bills  for  services,  in  case  such  staff 
members  do  not  wish  also  to  donate  their  services 
(the  language  used  almost  implying  that  they 
should  so  donate),  according  to  the  fee  schedule 
listed  in  the  industrial  accident  fee  table, — a fee 
table  which  the  California  Medical  Association, 
at  the  time  of  its  adoption,  never  intended  should 
be  applied  to  other  than  industrial  accident  cases ; 
and  two,  not  to  mention  the  dreadful  words 
“indigent”  or  “county  charge”  in  the  presence  of 
such  county  hospital  patients. 

* * * 

California  Medical  Association  Council  Urges 
Consideration  of  This  Problem. — The  Council  of 
the  California  Medical  Association  at  its  reg- 
ular meeting  on  January  18  reviewed  the  peculiar 
situation  which  has  arisen  in  the  Los  Angeles 
County  Hospital  and  of  which  some  of  the  issues 
are  as  above  outlined.  The  Council  believes 

that  the  facts  and  principles  herein  mentioned 
are  worthy  of  careful  thought  by  members  of 
the  California  Medical  Association,  and  has 

instructed  that  the  foregoing  presentation  be 

printed  in  the  official  journal  of  the  Association. 
Should  occasion  warrant,  the  Council  later  may 
make  further  comments  relative  to  these  matters. 


DIFFICULTIES  MET  WITH  IN  TRYING  TO 
EDUCATE  CITIZENS  CONCERNING 
QUACKERY 

Editor  American  Medical  Association  Journal 
Visits  California. — Dr.  Morris  Fishbein,  editor 
of  the  Journal  of  the  American  Medical  Associa- 
tion, recently  visited  California,  making  a goodly 
number  of  addresses  before  different  medical, 
social  service  and  civic  organizations.  His  recep- 
tion in  Southern  California  was  not  without 
reverberations,  and  to  members  of  the  medical 
profession  should  be  of  some  interest  as  showing 
certain  thought  trends  in  modern  day  newspapers 
and  among  some  lay  citizens. 

One  of  the  Los  Angeles  newspapers,  the 
Times,  on  one  day  gave  a two-column  interview 
in  which  were  presented  some  of  Doctor  Fishbein’s 
viewpoints  on  public  health  and  medical  matters, 
and  on  some  phenomena  which  can  be  observed 
in  certain  cultist  healing  art  groups.  Subsequently 
it  printed  other  articles  which  will  be  referred 
to  in  these  comments. 

* * * 

No  Official  Spokesman  in  Medicine. — Doctor 
Fishbein  in  all  his  lectures  and  interviews  was 
speaking  for  himself,  and  not  for  the  American 
Medical  Association  or  for  the  California  Medi- 
cal Association.  Dr.  Fishbein  was  careful  tO' 
bring  out  this  point,  because  it  is  well  known 
that  our  county,  state  and  national  medical  asso- 
ciations do  not  provide  in  their  organizations 
for  official  mouthpieces  or  publication  commit- 
tees. 

Or  to  put  it  otherwise,  every  physician  who' 
practices  non-sectarian  medicine  has  not  only  the 
right  to  give  expression  to  his  own  individual 
viewpoints  concerning  disease — as  he  interprets 
disease  through  scientific  facts  well  established — - 
but  has  also  equal  right  to  express  his  personal 
opinions  on  matters  of  medical  organization,, 
procedure  and  policy.  It  is  true  that  men  often 
speak  presumably  with  some  authority  and  with 
a great  deal  of  support  from  the  profession,  but 
that  is  not  because  of  the  speakers  themselves 
or  of  any  official  positions  which  they  hold,  but 
rather  because  of  the  soundness  of  the  facts  and 
doctrines  which  they  expound.  In  such  sense, 
perhaps,  the  viewpoints  of  Dr.  Fishbein  may 
carry  more  than  ordinary  weight. 

* * * 

Doctor  Fishbein’s  Pasadena  Experience. — 
Subsequent  to  several  Los  Angeles  addresses, 
Doctor  Fishbein  went  to  Pasadena,  where  he 
delivered  a talk  on  “Healing  Fads  and  Quackery” 
as  one  of  the  speakers  in  a regular  lecture  course 
at  the  Pasadena  Community  Play  House.  At 
this  lecture  Doctor  Fishbein  must  have  thought 
he  was  on  a strenuous  political  campaign,  because 
his  audience  contained  a goodly  number  of 
individuals  who  took  considerable  pleasure  in 
heckling  him.  So  much  was  this  the  case  that 
Doctor  Fishbein  felt  called  upon  to  tell  his  audi- 
ence that  he  was  there  to  discuss  his  subject  from 
the  standpoint  of  his  own  knowledge  of  the  sub- 


120 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


ject  and  of  his  own  conclusions,  and  that  he 
intended  to  do  so;  and  further,  that  if  his  view- 
points were  obnoxious  to  any  of  his  hearers,  such 
persons  were  invited  to  leave  the  hall.  In  other 
words,  if  his  hearers  desired  to  hear  his  opinions 
they  were  welcome  to  stay  and  then  form  their 
own  conclusions  thereon.  Otherwise  their  room 
was  preferable  to  their  presence. 

* * * 

A Newspaper  Editorial  on  “Medical  Intoler- 
ance.”— What  was  presumably  a follow-up  of  this 
Pasadena  lecture  is  to  be  found  in  an  editorial 
captioned  “Medical  Intolerance,’’  which  appeared 
a couple  of  days  later  in  the  Los  Angeles  Times. 
The  style  marks  of  the  said  editorial  would 
tempt  one  to  be  almost  suspicious  that  it  had 
been  kindly  placed  in  the  hands  of  the  editor  of 
that  newspaper  by  one  or  more  sympathizers  with 
the  Pasadena  hecklers. 

As  might  be  expected  from  its  caption,  there 
was  a general  effort  in  this  particular  editorial 
to  piay  up  broad-mindedness  and  similar  virtues, 
going  on  from  that  to  emphasize  that  the  editor 
of  the  Journal  of  the  American  Medical  Asso- 
ciation should  be  above  “bigotry,  narrow-minded- 
ness and  bygone  prejudice.”  The  editorial  even 
went  so  far  as  to  state  that  it  was. 

“to  be  regretted  that  Dr.  Morris  Fishbein,  editor  of 
the  Journal  of  the  American  Medical  Association  should 
attempt  to  hog-tie  the  medical  profession  in  the 
straitjacket  of  intolerant  conformity  to  dogmatic  theo- 
ries from  which  the  helpers  and  healers  of  humanity 
at  large  have  of  late  been  so  successful  in  freeing 
themselves.” 

The  editorial  called  upon  the  American  Medi- 
cal Association  to  “clear  itself  of  the  charges  of 
arrogant  intolerance,”  and  stated  further,  that 
“his  slur  on  Los  Angeles  as  a paradise  for  medi- 
cal quacks  is  a boomerang  that  hits  hardest  the 
very  profession  Doctor  Fishbein  has  elected  him- 
self to  defend.”  There  was  also  a very  gentle 
but  nevertheless  pronounced  defense  of  the 
“simple  form  of  healing  through  faith,  employed 
by  Christ  himself.” 

A particularly  naive  paragraph  in  the  editorial 
in  which  the  writer  or  writers  showed  a pathetic 
lack  of  knowledge  of  the  educational  and  pro- 
fessional training  requirements  which  should  be 
demanded  of  every  practitioner  of  the  healing 
art,  no  matter  of  what  supposed  school,  is  to  be 
found  in  the  following: 

“If  there  are  fifty  cults  in  this  community  formed 
to  fight  disease,  outside  the  orthodox  medical  pale, 
as  Doctor  Fishbein  alleges,  it  is  but  another  sign  of 
the  immensity  of  this  field  of  research  and  how  much 
territory  remains  to  be  covered.  Should  some  ex- 
plorer discover  that  many  ailments,  now  allocated  to 
the  pharmacopeia  and  the  operating  table,  could  be 
as  effectively  cured  by  attention  to  diet  and  hygiene, 
he  would  decidedly  deserve  well  of  his  fellow  beings. 
Medical  diagnosis,  under  the  canons  of  the  regular 
school,  is  not  such  an  exact  science  as  to  call  for 
sneering  reference  to  the  substitution  of  the  violet 
rays  of  the  sun  for  the  old-time  allopathic  drug- 
doping in  the  treatment  of  tuberculosis.”1 


A later  inconsistency  is  presented  in  the  last 
sentence  of  the  editorial.  It  is  well  known  that 
without  the  publicity  which  through  the  news- 
papers is  given  to  cultist  and  faddist  medicine 
and  to  quackery,  that  these  excrescences  on  heal- 
ing art  practice  would  die  a natural  death  through 
inanition — or  to  use  the  late  Mr.  Barnum’s  ver- 
nacular, through  “lack  of  suckers.”  The  advertis- 
ing managers  of  newspapers  are  usually  well 
aware  of  this  important  fact  and  govern  them- 
selves accordingly. 

Therefore  it  is  interesting  to  note  that  the  last 
sentence  of  the  Times  editor  emphasized  his 
belief  that  the  good  opinion  which  lay  citizens 
supposedly  have  of  cultist  groups,  should  be  an 
adequate  and  complete  defense  for  the  existence 
of  such  cults  ! The  editorial  closes  as  follows  : 

“No  one  denies  that  there  are  many  charlatans  and 
quacks  in  Los  Angeles,  as  in  every  other  large  city, 
who  exploit  the  sufferings  and  sickness  of  humanity 
for  their  own  personal  profit.  It  is  the  duty  of  every 
good  citizen  to  expose  such  practices  when  they  come 
under  his  notice.  In  doing  so  Doctor  Fishbein  would 
have  been  properly  within  his  province.  But  this  is 
an  entirely  different  proceeding  from  virulently  at- 
tacking organizations  and  systems  recognized  as  bene- 
ficial and  by  large  numbers  of  our  best  credited  and 
most  influential  people.” 

Because  the  line  of  thought  expressed  by  the 
Times  editor  reveals  the  peculiar  psychologic 
approach  which  a considerable  number  of  the 
laity  hold  on  matters  having  to  do  with  the  public 
health  and  the  healing  art,  it  seems  worth  the 
while  to  call  attention  to  this  particular  and  recent 
California  happening. 

* * * 

Viezvpoint  of  Another  Lay  Editor- — Chester 
Rowell  of  California. — Fortunately,  all  editors  do 
not  hold  such  views,  as  witness  the  very  sane  and 
excellent  discussion  of  this  same  Times  editorial 
on  “Medical  Intolerance,”  as  printed  in  the  San 
Francisco  Chronicle,  and  which  came  into  our 
hands  after  the  above  paragraphs  were  written. 
In  order  that  the  readers  of  California  and 
Western  Medicine  may  have  the  opportunity  of 
reading  an  able  defense  by  a Californian  who 
is  a layman,  the  “Chester  Rowell’s  Comment” 
which  appeared  in  the  Chronicle  will  be  found  in 
this  issue,  in  the  “As  Others  See  Us”  column  of 
the  Miscellany  Department.  Our  readers  are 
advised  to  read  it.  Also  the  illuminating  article 
in  the  Miscellany  Department,  which  appears 
under  the  title  “Descartes  Was  Right.”  and  which 
is  from  the  pen  of  Dr.  Harry  M.  Hall,  secretary- 
editor  of  the  West  Virginia  Medical  Association. 

Among  the  special  articles  of  the  current  issue 
of  this  journal  is  also  printed  an  article  by  Dr. 
A.  B.  Cooke  of  Los  Angeles  on  the  “Cost  of 
Medical  Care  and  Hospitalization.”  Bearing  on 
the  same  general  subject,  is  a letter  from  Dr. 
J.  M.  Neil  of  Oakland,  which  will  be  found  in 
the  Correspondence  column  in  the  Miscellany 
department  of  this  issue.  These  articles  are  all 
worthy  of  perusal  and  thought. 


February,  1930 


EDITORIALS 


121 


THE  “COST  OF  MEDICAL  CARE”— AS 
DISCUSSED  IN  SOME  RECENT 
LAY  JOURNALS 

The  Unfortunate  Slogan,  “The  Cost  of  Medi- 
cal Care,”  and  Its  New  Adjective  Prefix,  “High,” 
Whether  or  not  the  publicity  which  in  consider- 
able part  has  been  brought  into  existence  by  the 
establishment  of  the  national  Committee  on  the 
Cost  of  Medical  Care — a publicity  of  which, 
during  the  last  year  it  might  be  said,  that  it  had 
almost  transformed  itself  into  a type  of  propa- 
ganda— as  yet  has  reached  its  peak,  is  at  this 
time  somewhat  difficult  to  say.  From  recent  lay 
press  contributions,  it  would  seem  that  it  had 
not,  for  all  signs  indicate  that  a vast  deal  of 
printed  material  will  come  off  the  press  in  the 
form  of  books,  and  as  articles  in  periodicals  and 
newspapers,  before  the  medical  profession  hears 
the  last  of  this  most  unfortunate  slogan— “The 
Cost  of  Medical  Care” — a slogan  which  in  pop- 
ular usage,  through  the  addition  of  an  adjective, 
now  is  more  often  referred  to  as  “The  High  Cost 
of  Medical  Care.” 

Medical  men  and  women  who  hold  to  a con- 
trary viewpoint  on  these  matters  are  referred 
to  recent  issues  of  magazines  such  as  the  Survey- 
Graphic,  Collier's,  the  Literary  Digest,  and  others, 
in  which  have  appeared  a large  number  of  articles 
dealing  with  the  subject,  “The  Cost  of  Medical 
Care” ; a subject  which  is  really  of  great  im- 
portance to  both  the  medical  profession  and  the 
laity,  because  of  recent  changes  in  modes  and 
standards  of  American  living,  and  which  it  may 
be  taken  for  granted,  will  not  down  without 
serious  attempts  at  its  solution. 

* * * 

A Symposium  on  the  “Cost  of  Health,”  in  the 
Survey-Graphic. — The  Survey-Graphic  of  Janu- 
ary 1930,  Vol.  16,  No.  4,  is  practically  a special 
edition  on  this  subject.  The  editor  of  that  maga- 
zine, however,  kindly  changed  the  caption  of  his 
symposium  from  “The  Cost  of  Medical  Care” 
to  that  of  “The  Cost  of  Health,”  although  a 
cover  subhead  in  red  was  entitled  “Adequate 
Medical  Care  for  Every  Man.”  The  captions 
almost  tell  the  story.  This  January  number  of  the 
Survey-Graphic  contains  some  sixteen  articles  on 
different  phases  of  the  supposedly  same  subject — 
“The  Cost  of  Health,”  and  make  interesting 
reading. 

* * * 

Three  Californians  Honored  as  Contributors 
to  This  Symposium. — From  the  standpoint  of 
local  pride  California  should  feel  flattered,  because 
with  forty-eight  states  in  the  Union  and  only 
sixteen  contributors  to  this  national  magazine, 
three  members  of  the  California  Medical  Asso- 
ciation were  enlisted  to  write  articles.  Whom  to 
thank  for  this  special  selectivity  is  still  a mystery. 
Nor  in  one  sense  is  that  knowledge  necessary, 
inasmuch  as  each  of  the  three  Californians  gave 
an  excellent  exposition  of  his  particular  topic. 

First,  Dr.  Lovell  Langstroth  of  San  Fran- 
cisco presented  an  article  entitled  “Patients  Cry 


for  It,”  in  which  topics  such  as  food,  exercise, 
sunshine  and  other  health  factors  were  com- 
mented upon,  in  their  relation  to  the  cost  of 
medical  care.  Second,  Dr.  Philip  King  Brown  of 
San  Francisco  discussed  “Industry’s  Answer” 
and  showed  “How  a Railroad  Safeguards  Its 
Employees  in  Health  and  Sickness,”  as  based  on 
experiences  of  the  medical  department  of  the 
Southern  Pacific  Railroad.  Third,  Ray  Lyman 
Wilbur  took  up  “The  Task  of  the  Committee  on 
the  Cost  of  Medical  Care,”  of  which  committee 
he  is  chairman,  and  the  investigations  and  pre- 
liminary reports  of  which  committee  have  seem- 
ingly excited  the  curiosity  and  interest  of  more 
lay  than  medical  publications. 

* * * 

Some  Viewpoints  of  Dr.  Ray  Lyman  Wilbur. — 
Our  esteemed  colleague,  Doctor  Wilbur,  Presi- 
dent of  Stanford  University,  on  leave,  and  also 
Secretary  of  the  Interior  of  the  United  States, 
in  his  article  makes  a number  of  statements  which 
should  lead  many  members  of  the  medical  profes- 
sion, especially  those  who  would  scoff  at  all  this, 
to  please — “Stop,  Look,  and  Listen.” 

For  instance,  Doctor  Wilbur  puts  himself  on 
record  as  follows : 

“Yet  the  members  of  the  medical  profession  are 
tradition-ridden  and  uneconomic  in  their  thinking. 
They  have  grown  up  under  the  historical  system  of 
the  charitable  care  of  the  indigent  sick.”  . . . “With 
the  rapid  changes  going  on  in  every  phase  of  Ameri- 
can life,  the  medical  profession  is  constantly  con- 
fronted with  the  fact  that  it  is  losing  step,  working 
at  a disadvantage,  and  that  unless  order  comes  out 
of  the  present  chaos  in  some  way  or  in  another,  ab- 
normal solutions  may  be  developed  in  some  of  the 
forty-eight  states  which  will  be  of  great  detriment  to 
the  interests  of  both  patients  and  doctors.” 

It  is  not  possible  to  go  into  detail  concerning 
the  sixteen  articles,  other  than  to  state  that  they 
present  in  somewhat  compact  form  a mass  of 
expression  in  current  thought  on  these  important 
topics,  in  which  every  practicing  physician  and 
surgeon  might  well  be  so  interested  that  he  would 
wish  to  obtain  a copy  for  his  own  perusal.* 

* * * 

Mr.  Julius  Roscnwald  of  Sears,  Roebuck  Helps 
Spread  the  News. — By  an  interesting  coincidence, 
while  the  thoughts  here  presented  were  being 
transcribed  by  the  writer,  and  after  he  had  him- 
self purchased  extra  copies  to  send  to  his  fellow 
councilors  of  the  California  Medical  Association, 
there  came  to  him  a letter  from  one  of  the  rep- 
resentatives of  the  Survey-Graphic,  which  itself 
is  most  illuminating,  as  showing  how  so  prominent 
an  individual  as  Mr.  Julius  Rosenwald,  head  of 
the  Sears-Roebuck  Company,  looks  upon  this 
January  issue  of  the  Survey-Graphic . 

Mr.  Julius  Rosenwald  of  Chicago,  founder  of 
the  Rosenwald  Foundation,  has  been  very  much 

*For  the  convenience  of  readers,  who  cannot  obtain  a 
copy  of  this  issue  through  their  local  news  dealer,  it  may 
be  stated  that  the  address  of  the  “Survey-Graphic"  is 
112  East  Nineteenth  Street,  New  York.  Single  copies, 
thirty  cents. 


122 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


interested  in  a number  of  these  matters,  and 
certain  of  his  viewpoints  on  some  of  the  functions 
of  the  medical  profession  might  be  stated  to  be 
almost  as  radical  as  those  held  by  Mr.  Henry 
Ford,  of  which  comment  was  made  in  this  column 
in  the  July  1929  issue  of  this  journal,  page  59. 
Mr.  Rosenwald  evidently  looked  upon  the  recent 
January  issue  of  the  Survey-Graphic  as  an  im- 
portant contribution,  for  in  the  letter  which  came 
to  the  writer,  it  was  stated : 

“Through  the  generosity  of  Mr.  Julius  Rosenwald 
the  current  issue  of  Survey-Graphic  is  being  sent  to 
you  and  to  a number  of  persons  who,  we  believe,  are 
interested  in  the  cost  of  medical  care.  This  subject  is 
important  to  those  millions  of  people  who  receive 
medical  service,  and  to  the  hundreds  of  thousands 
who  are  professionally  engaged  in  rendering  it.” 

“In  this  number  we  have  tried  to  assemble  the 
viewpoints  of  both  consumers  and  producers;  the  man 
or  woman  of  moderate  means,  the  physician,  the  hos- 
pital manager,  the  nurse,  the  public  health  adminis- 
trator and  social  worker.  We  have  not  attempted  to 
present  solutions,  but  facts,  impressions,  and  ideas, 
which  may  stimulate  thought  and  constructive  dis- 
cussion. 

“Later  issues  will  continue  to  develop  this  and  re- 
lated themes.”  . . . 

♦ * * * 

The  Lesson  in  All  This. — A lesson  can  well  be 
taken  to  heart  by  members  of  the  medical  pro- 
fession who  look  askance  at  a discussion  of 
these  medico-  economic  and  sociologic  problems — 
from  the  fact  that  Mr.  Rosenwald,  a layman,  saw 
fit  to  purchase  a large  number  of  this  particular 
issue  of  the  Survey-Graphic,  and  to  distribute 
the  same  to  members  of  the  medical  profession 
and  to  the  laity.  If  his  action  means  anything,  it 
would  indicate  that  these  subjects  are  being 
seriously  considered  by  large  groups  of  influential 
and  wealthy  laymen.  In  our  country,  where 
“money  talks,”  and  where  successful  men  in  busi- 
ness so  often  feel  themselves  competent  to  sit 
in  decisive  judgment  on  most  matters  in  which 
they  are  interested,  that  means  that  certain  of 
such  lay  fellow  citizens  in  the  not  remote  future, 
are  more  than  apt  to  outline  in  considerable  de- 
tail and  finality  just  how  they  think  the  so-called 
great  white  collar  brigade  of  fellow  citizens 
should  be  medically  cared  for.  And  in  such 
analyses,  unless  humans  of  today  are  different 
than  in  the  past — -which  they  are  not — the  medi- 
cal profession  may  find  to  its  sorrow,  that  through 
its  own  lack  of  active  interest  (as  our  prominent 
California  colleague  of  the  United  States  Depart- 
ment of  the  Interior,  Doctor  Wilbur,  has  well 
said),  the  end  results  “will  be  of  great  detriment 
to  the  interests  of  both  patients  and  doctors.” 

Wherefore,  it  seemingly  behooves  all  medical 
men  and  women,  who  would  safeguard  the  inter- 
ests of  medical  science  and  practice,  in  order  that 
in  the  future  the  profession  may  measure  up  to 
its  greatest  possibilities,  and  in  order  that  suc- 
ceeding generations  of  physicians  may  be  sur- 
rounded by  conditions  favorable  to  the  develop- 
ment of  the  highest  type  of  medical  science  and 
practice,  that  these  important  medical  and  eco- 
nomic problems  be  thoroughly  studied.  In  this 


matter-of-fact  age,  escape  from  unpleasant  situa- 
tions does  not  come  through  application  of  the 
ostrich  strategy  of  burying  the  head  in  sand,  but 
through  accurate  and  scientific  investigations  and 
search  for  fundamental  facts,  the  possession  of 
which  would  make  possible  logical  plans  for 
future  lines  of  action. 

There  is  no  reason  for  fear,  but  on  the  other 
hand,  there  are  a large  number  of  reasons  why 
members  of  the  medical  profession  should  have 
as  much  accurate  information  on  these  matters 
as  do  laymen.  With  such  information  and  facts, 
combined  with  clear  thinking,  and  with  that  spirit 
of  loyalty  to  the  medical  profession  which  has 
always  been  so  characteristic  of  its  disciples,  the 
solution  of  most  of  these  problems  should  be 
possible.  Let  us  see  to  it  that  the  solutions  shall 
come  in  good  part  from  within,  and  not  entirely 
from  without. 


A Question  of  Ethics. — One  of  the  especially  in- 
teresting features  of  this  number  will  be  found  in  the 
letter  of  the  Committee  on  Ethics  and  Discipline  of 
the  Massachusetts  Medical  Society  respecting  the  as- 
sociation of  a physician  with  an  organization  very 
much  like  the  Life  Extension  Institute. 

The  committee  makes  clear  the  fact  that  the  com- 
pany advertises  for  business  and  quotes  the  statement 
of  the  physician  in  charge  with  respect  to  his  inter- 
pretation of  his  functions. 

The  business  of  the  company  apparently  is  to  ex- 
amine persons  and,  based  on  this  examination,  give 
such  advice  as  may  be  indicated  for  the  guidance  of 
the  patient  in  dealing  with  abnormalities  detected  or 
methods  of  living  which  are  not  conducive  to  health. 

The  assumption  of  the  medical  director  that  this 
examination  and  advice  do  not  constitute  the  practice 
of  medicine  is,  we  believe,  at  variance  with  the  broad 
conception  of  the  functions  of  the  doctor.  The  idea 
that  the  practice  of  medicine  is  restricted  to  the  treat- 
ment of  a demonstrable  disease  is  narrow  and  even 
absurd  because  it  is  generally  believed  that  preventive 
medicine  has  accomplished  even  more  for  humanity 
than  the  wonderful  resources  of  therapeutics,  and  the 
examination  of  patients  for  the  purpose  of  correcting 
defects  present  or  impending  must  be  construed  as 
practicing  medicine  because  only  educated  physicians 
are  equipped  to  do  this  work. 

The  question  of  whether  the  law  relating  to  the 
practice  of  medicine  controls  this  type  of  work  may 
wait  for  solution  by  the  courts,  but  the  ethics  of  ad- 
vertising is  of  major  importance  and  should  engage 
the  thoughtful  consideration  of  those  in  positions  to 
influence  the  behavior  of  the  fellows  of  the  society. 
Intelligent  laymen  are  watching  the  habits  of  doctors 
with  interest  and  many  in  the  profession  are  looking 
for  clearer  definitions  of  what  is  permissible  in  reports 
of  interviews  or  published  statements  in  the  lay  press 
or  the  use  of  one’s  name  in  connection  with  business 
organizations.  The  attitude  of  the  committee  seems 
to  furnish  quite  definite  conclusions  in  this  particular 
instance.  If  still  broader  conclusions  and  definitions 
are  forthcoming  they  will  be  welcomed  by  those  who 
wish  to  adopt  approved  customs.  Until  some  definite 
standards  relating  to  publicity  by  physicians  are  out- 
lined confusion  will  exist  in  the  minds  of  some  well- 
intentioned  persons. 

The  committee  has  clearly  defined  opinions  which 
are  in  accord  with  the  best  thought  in  the  profession 
and  has  full  power  to  deal  with  the  situation.  The 
suggestion  that  the  members  of  the  society  give  care- 
ful consideration  to  the  whole  problem  will  stimulate 
discussion  and  tend  to  crystallize  opinion.  We  sin- 
cerely hope  that  the  request  of  the  committee  will 
bring  about  the  object  desired. — Editorial,  Neva  Eng- 
land Journal  of  Medicine. 


MEDICINE  TODAY 

Current  comment  on  medical  progress,  discussion  of  selected  topics  from  recent  books  or  periodic  literature,  by 
contributing  members.  Every  member  of  the  California  Medical  Association  is  invited  to  submit  discussion 
suitable  for  publication  in  this  department.  No  discussion  should  be  over  five  hundred  words  in  length. 

Pediatrics 

Parenteral  Infections  and  Infantile  Diarrhea. 

The  relationship  between  parenteral  infec- 
tions and  infantile  diarrhea  has  been  emphasized 
so  frequently  within  the  last  few  years  that  there 
exists  a somewhat  distorted  view  of  its  impor- 
tance. As  a result  of  unusual  publicity,  the  belief 
that  diarrhea  and  middle-ear  infections  are  closely 
related  has  become  firmly  established.  However, 
there  have  always  been  a number  of  pediatricians 
who  are  skeptical  of  the  importance  of  this  rela- 
tionship and  who  are  fearful  lest  innumerable 
unnecessary  mastoid  operations  become  a routine 
therapeutic  procedure. 

The  presence  of  pus  in  the  middle  ear  of  chil- 
dren who  have  died  of  diarrhea  is  by  no  means 
a recent  discovery,  and  there  seems  no  need  to 
manufacture  a syndrome  and  rename  it  after  a 
man  who  has  simply  popularized  a previously 
known  fact.  Marriott,  himself,  states  that  the 
presence  of  pus  in  the  mastoid  antrum  in  these 
cases  was  first  noted  by  du  Verney  in  1584.  As 
this  is  often  the  only  abnormal  change  found  at 
autopsy,  the  pathologists  are  wont  to  place  the 
blame  for  the  entire  illness  on  this  finding.  This 
view  was  strongly  opposed  by  Czerny,  the  cele- 
brated German  pediatrician,  and  in  an  address 
delivered  at  Strassburg  nearly  twenty  years  ago 
he  stated  his  views  as  follows : “This  unsatisfac- 
tory state  of  our  knowledge  has  led  to  the  laying 
of  altogether  too  much  importance  on  the  second- 
ary infections  of  atrophic  children.  This  is  es- 
pecially true  of  otitis  media.  As  a matter  of  fact, 
pus  is  often  found  in  the  middle  ear  of  children 
who  have  died  in  a condition  of  atrophy.  A 
natural  result  of  this  finding  was  the  belief  that 
bacterial  products  of  a poisonous  kind  could  be 
absorbed  from  the  purulent  areas  produced  by 
these  bacteria,  and  that  in  consequence  the  atro- 
phy is  nothing  more  than  the  result  of  a septic 
intoxication.  The  question  was  never  asked  of  the 
clinician  whether  the  otitis  media  first  appeared 
when  the  child  was  already  atrophic,  or  whether 
it  ushered  in  the  entire  process.  The  finding  of 
a purulent  otitis  media  was  regarded  as  sufficient 
ground  for  teaching  physicians  that  atrophy  is  the 
result  of  otitis  media. 

“One  thing  at  least  can  be  said  for  pathologists  : 
they  were  at  all  times  of  one  mind.  They  were 
at  first  all  fully  convinced  that  there  was  an  in- 
testinal atrophy  and  they  were  later  convinced 
that  otitis  media  played  a most  alarming  part  in 
the  high  infant  mortality.  This  unanimity  of 
opinion  was  not  to  be  found  among  the  clinicians 
at  any  time. 


“Atrophy  is  not  a disease  per  se,  but  a disturb- 
ance in  growth  and  in  general  nutrition,  which 
is  the  result  of  nutritional  disturbances,  or  of  in- 
fectious processes,  or  of  both.  The  clinical  pic- 
ture may  be  the  same  in  all  these  instances,  but 
a differentiation  based  on  etiology  is  of  great 
importance  to  us  on  account  of  prophylaxis  and 
therapy.  If  the  disease  is  a nutritional  disturb- 
ance, splendid  results  can  be  obtained  by  dietetic 
management.  If,  however,  an  infection  which  we 
cannot  therapeutically  influence  is  the  exciting 
factor,  we  are  often  placed  in  a position  where 
we  can  neither  check  nor  cure  the  atrophy.” 

A recent  discussion  of  this  question  by  Dr. 
Oscar  Schloss  indicates  again  the  lack  of  proof 
that  otitis  media  is  a causative  factor  in  the  pro- 
duction of  severe  diarrhea.  At  a meeting  at  the 
New  York  Academy  he  mentioned  some  of  the 
outstanding  objections:  “There  is  much  evidence 
against  Doctor  Marriott’s  views.  Diarrhea  is  not 
a common  symptom  of  clinical  mastoiditis.  Otitis 
media,  which  is  always  accompanied  by  pus  in 
the  mastoid  antrum,  is  an  extremely  common  dis- 
ease and  is  rarely  accompanied  by  severe  diar- 
rhea. The  mastoid  antrum  and  middle  ear  of 
infants  are  exceedingly  small  and  a toxin  must 
be  extremely  powerful  and  absorption  very  active 
to  cause  the  severe  symptoms  of  intestinal  in- 
toxication.” 

Still  more  interesting  is  the  statement  that  “of 
fifty-one  postmortem  examinations  in  cases  of 
diarrhea  and  dehydration  for  the  past  four  years 
at  the  New  York  Nursery  and  Child’s  Hospital, 
pus  was  found  in  the  middle  ear  and  mastoid 
antrum  in  thirty-nine  cases.  In  no  case  was  a true 
mastoiditis  with  involvement  of  the  bone  present.” 

From  the  foregoing  it  is  at  once  evident  that 
the  question  is  by  no  means  settled,  and  a final 
judgment,  at  least  temporarily,  must  be  deferred. 
The  situation  is  summed  up  by  Doctor  Schloss, 
who  says:  “Despite  all  theoretical  objections,  it 
would  seem  that  the  proof  of  Doctor  Marriott’s 
view  must  rest  on  a therapeutic  test.  If  he  can 
show  that  by  early  operation  on  the  mastoid  an- 
trum the  mortality  from  diarrhea  is  substantially 
less  than  by  other  methods,  it  will  go  a long  way 
toward  proving  his  view.” 

Finally,  one  more  point  deserves  attention.  The 
operation,  as  performed  at  the  St.  Louis  Clinic, 
is  extremely  simple,  and  carried  out  so  rapidly, 
that  it  does  little,  if  any,  harm  to  the  patient’s 
general  condition.  Under  local  anesthesia  a small 
button  of  bone  is  removed  over  the  antrum  and 
a drain  inserted.  No  curettage  is  done,  but  a 
probe  is  usually  inserted  through  the  aditus  to 


123 


124 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


render  it  patent.  Some  of  the  bad  results  seen  in 
many  of  the  other  clinics  may  be  attributed  to 
operators  who  attempt  to  do  the  standard  type 
of  mastoidectomy  in  these  critically  ill  patients. 

Phillip  E.  Rothman,  Los  Angeles. 


Diphtheria 

Synthetic  Diphtheria  Antitoxin. — Under  the 
stimulus  of  the  newer  concepts  of  immun- 
ology1 several  recent  attempts  have  been  made 
to  prepare  artificial  specific  antitoxins.  A very 
suggestive  result  has  recently  been  reported  by 
Sdrawosmisslow  and  Kostromin  of  the  Bacterio- 
logical Institute,  Perm,  Russia.2  These  workers 
incubated  diphtheria  toxin  with  a large  excess  of 
trypsin,  and  obtained  a nontoxic  toxin  “trypsi- 
nate”  which,  in  their  hands,  was  apparently 
identical  with  true  diphtheria  antitoxin. 

Although  Kimmelstiel  of  the  Hygienic  Insti- 
tute, Breslau,  Germany  3 has  recently  questioned 
this  conclusion,  offering  an  alternate  explanation 
of  their  observed  antitoxic  effects,  she  does  not 
question  their  claim  that  their  “trypsinate  has 
distinct  antitoxic  properties. 

W.  H.  Manwaring,  Stanford  University. 

REFERENCES 

1.  The  Newer  Knowledge  of  Bacteriology  and  Im- 
munology, University  of  Chicago  Press,  Chap.  81, 
p.  1078. 

2.  Ztschr.  f.  Immunitatsforch  u.  exper.  Therap., 
Vol.  liv,  p.  1,  1927-28. 

3.  Ibid.,  Vol.  lxii,  p.  245,  1929. 


Medicine 

PART  II* 

The  Present  Status  of  Liver  Function  Tests. 

It  is  a very  different  story  with  the  excretion 
tests  of  liver  function.  Here  we  have  at  our 
command  at  least  three  reasonably  simple  tests 
of  which  we  can  expect  definite  information  in 
regard  to  suspected  liver  injury  in  individual 
cases.  In  the  first  place,  there  is  the  quantitative 
estimation  of  serum  bilirubin  by  means  of  Bern- 
heim’s  icterus  index,1  or  the  more  complicated 
quantitative  van  den  Bergh.  Then  we  have  the 
quantitative  urine  urobilogen  test,  the  simplest  of 
the  three,  if  the  Wallace-Diamond  technique  be 
used.2  Finally,  one  can  use  one  of  the  dye  excre- 
tion tests  of  which  the  Rose-Bengal 3 test  is  pref- 
erable to  others.  Below  is  given  a brief  discussion 
on  what  tests  to  select  and  what  to  expect  of  them 
in  the  more  common  liver  conditions. 

1.  In  catarrhal  jaundice  the  icterus  index  and 
the  dye  excretion  tests  are  practically  parallel  in 
their  reports  on  the  degree  of  liver  injury  and 
the  same  is  true  of  the  urine  urobilinogen  except 
that  at  the  height  of  the  disease  there  is  almost 

* Part  I appeared  in  the  January  issue  of  California  and 
Western  Medicine. 


no  urobilogen  found  probably  due  to  almost  com- 
plete obstruction  of  the  bile  passages.  Since 
these  liver  function  tests  have  taught  us  that  in 
catarrhal  jaundice  the  amount  of  liver  damage 
is  parallel  to  the  depth  of  jaundice,  there  is  for 
all  practical  purposes  no  necessity  of  doing  them 
in  ordinary  cases  of  this  disease. 

2.  In  obstructive  jaundice  of  any  type  the 
depth  of  color  is  a satisfactory  measure  of  the 
amount  of  liver  damage  just  as  in  catarrhal  jaun- 
dice. In  addition,  here  it  is  often  valuable  to 
know,  from  the  standpoint  of  diagnosis  and  prog- 
nosis, the  exact  degree  of  jaundice  and  especially 
its  trend  to  increase  or  decrease.  In  this  respect 
the  icterus  index  is  much  more  accurate  than  the 
eye.  In  complete  biliary  obstruction  urobilogen 
disappears  from  the  urine  altogether. 

3.  In  arsenical  jaundice  all  three  tests  are  posi- 
tive and  about  equally  reliable.  No  arsenicals 
should  be  given  till  the  return  of  function  to 
normal,  as  shown  by  one  or  more  of  these  tests. 

4.  Carcinoma  of  the  liver  and  bile  ducts  with 
obstruction  belongs  in  the  class  of  obstructive 
jaundice.  In  carcinoma  of  the  liver  without  ob- 
struction, dye  excretion  seems  to  be  impaired  most 
often  (in  about  70  per  cent  of  cases  in  one 
series),  an  increased  icterus  index  is  a close 
second  (in  about  60  per  cent)  and  increase  in 
urobilogen  comes  third  with  positive  results  in 
only  40  per  cent  of  cases.  The  explanation  for 
such  poor  results  is  that  carcinoma  involves  ’the 
liver  only  in  spots,  leaving  much  healthy  liver 
tisssue  for  compensation  of  function.  From  this 
it  can  be  said  that  in  suspected  cases  of  carci- 
noma of  the  liver  only  positive  results  are  of 
value. 

5.  Cirrhosis  of  the  liver,  whether  of  the  portal 
or  biliary  type,  always  shows  a reduction  of  dye 
excretion,  the  extent  of  which  is  a reliable  guide 
to  the  degree  of  liver  damage.  This  fact  is  of 
special  importance  since  the  icterus  index  only 
shows  the  presence  or  absence  of  latent  jaundice 
in  portal  cirrhosis  and  the  degree  of  jaundice  in 
biliary  cirrhosis,  while  the  increase  in  urobilogen 
is  by  no  means  a constant  factor  in  cirrhosis  as 
well  as  in  other  chronic  liver  conditions.  The  dye 
test  is  of  special  value  in  differential  diagnosis 
of  portal  cirrhosis  in  the  presence  of  ascites  be- 
cause dye  excretion  is  normal  in  cardiac  failure, 
tuberculous  peritonitis,  and  carcinomatosis  of  the 
peritoneum.  On  the  other  hand,  urobilogen  is 
often  increased  in  chronic  passive  congestion  of 
the  viscera. 

6.  In  severe  infections  of  the  liver  both  the  dye 
retention  and  increase  in  urine  urobilogen  are 
marked  and  express  the  degree  of  liver  involve- 
ment, while  the  increase  in  the  icterus  index  may 
be  slight. 

7.  Finally,  in  diseases  of  the  hematopoietic 
system  like  hemolytic  jaundice,  pernicious  anemia, 
polycythemia,  leukemia,  and  Gaucher’s  disease, 
dye  elimination  is  normal.  In  Banti’s  disease  dye 
retention  indicates  the  presence  of  cirrhosis  of 
the  liver.  The  icterus  index  in  these  conditions 
serves  merely  as  an  index  of  hemolysis  and  urine 


February,  1930 


MEDICINE  TODAY 


125 


urobilogen  is  usually  increased  in  cases  of  exces- 
sive blood  destruction. 

Before  closing  I would  like  to  say  that  I do 
not  share  the  opinion  often  expressed  that  liver 
function  tests  compare  unfavorably  with  kidney 
function  tests.  If  we  take  as  an  example  the  dye 
excretion  tests,  the  two  most  frequent  criticisms 
are : First,  that  it  does  not  express  the  impair- 
ment of  all  functions  of  the  liver,  and,  second, 
that  when  the  test  is  positive  there  are  already 
other  signs  of  liver  disease  present.  But  precisely 
the  same  is  true  of  the  phthalein  test  for  kidney 
function:  While  the  retention  of  the  dye  roughly 
corresponds  to  that  of  nitrogenous  products  in 
the  blood,  it  gives  us  no  idea  in  regard  to  water 
or  salt  retention.  Also  one  usually  does  not  do  the 
phthalein  test  unless  there  are  some  clinical  indi- 
cations of  kidney  damage  and,  I might  say,  unless 
another  excretion  test  of  the  kidney,  namely,  a 
urine  analysis,  has  shown  some  abnormalities. 

The  conclusion  from  this  review  of  liver  func- 
tion tests  is  that,  by  judicious  selection  of  one  or 
more  from  the  three  discussed  excretion  tests,  it 
is  possible  in  most  cases  to  confirm  a suspicion 
of  liver  damage  when  it  is  present  and  to  gain 
some  conception  of  its  extent. 

T.  L.  Altjiausen,  San  Francisco. 

REFERENCES 

1.  Bernheim,  A.  R. : The  Icterus  Index,  J.  A.  M.  A., 
82:291,  January  26,  1924. 

2.  Wallace,  J.  B.,  and  Diamond,  J.  S.:  The  Signifi- 
cance of  Urobilogen  in  the  Urine  as  a Test  for  Liver 
Function,  Arch.  Int.  Med.,  35:698,  June  1925. 

3.  Epstein,  N.  N.,  Delprat,  J.  D.,  and  Kerr,  W.  J.: 
The  Rose-Bengal  Test  for  Liver  Function,  J.  A.  M.  A., 
88:1619,  May  21,  1927. 


Allergy 

Acute  Articular  Rheumatism  an  Allergic 
Manifestation. — Swift  has  recently  sug- 
gested that  acute  articular  rheumatism  is  a mani- 
festation of  allergy.  It  has  long  been  known  that 
there  is  a relationship  between  tonsillitis  and  the 
joint  infection.  With  the  allergic  conception  this 
seems  satisfactorily  explained. 

When  the  primary  infection  is  in  the  tonsils, 
the  streptococci  and  the  protein  derived  from 
them  gain  access  to  the  blood  stream ; and,  in  the 
same  manner  as  in  tuberculosis,  the  body  cells 
are  rendered  sensitive  to  streptococci  and  their 
products. 

There  are  certain  tissues  which  streptococci  are 
prone  to  infect,  among  which  are  the  heart  valves 
and  joint  structures.  These  localizations  are  prob- 
ably selective,  the  same  as  the  tonsils  are  the 
location  of  choice  in  the  primary  streptococcus 
infection  and  in  diphtheria;  and  Peyer’s  patches 
in  typhoid  fever. 

Streptococci  may  escape  from  the  tonsillar 
infection  and  circulate  in  the  blood  in  small 
quantities,  the  same  as  tubercle  bacilli,  without 
producing  illness.  But  let  them  become  implanted 
in  a joint  or  in  the  heart  valves  and  an  immediate 
reaction  occurs,  differing  according  to  the  nature 


of  the  tissues  in  the  two  situations.  In  both  in- 
stances the  cells  have  been  sensitized  by  the  circu- 
lating streptococcus  protein.  In  the  former  the 
allergic  reaction  shows  as  a predominantly  exu- 
dative process  which  later  may  become  pre- 
dominantly proliferative  or  may  disappear  by 
absorption  of  the  exudate.  Large  quantities  of 
serum  may  be  poured  out  in  the  joint  just  as 
large  effusions  occur  in  the  pleura  when  it  is  the 
seat  of  an  allergic  reaction  in  tuberculosis.  In 
the  heart  valve,  on  the  other  hand,  the  tissues  are 
dense  and  the  reaction,  while  inflammatory,  shows 
a preponderance  of  proliferation  and  a minimum 
of  exudation.  The  after  course  of  the  infection 
will  depend  on  its  severity  and  upon  whether 
or  not  the  allergic  reaction  is  kept  up  for  a period 
of  time  by  further  quantities  of  streptococci  and 
streptococcal  products  gaining  access  to  the  blood 
stream  and  coming  in  contact  with  the  joint  or 
valvular  tissues.  Where  the  tonsils  are  furnish- 
ing the  source  of  repeated  reinoculations,  immedi- 
ate tonsillectomy  should  relieve  the  exacerbations, 
unless  further  reinoculation  is  caused  by  the 
trauma  of  the  operation.  Owing  to  the  fact  that 
there  is  great  danger  of  reinoculations  following 
tonsillectomy  during  acute  inflammation,  it  is  a 
very  questionable  procedure,  however,  and  should 
be  done  only  after  most  careful  consideration.  If 
no  new  exacerbations  are  taking  place,  the  re- 
moval of  the  tonsils  can  await  recovery  of  the 
joint. 

F.  M.  Pottenger,  Monrovia. 


Medical  History  Course  at  University  of  California 
School  of  Medicine. — The  University  of  California 
Medical  School  will  inaugurate  a new  course  in  the 
field  of  medical  history  and  bibliography  with  the 
opening  of  instruction  for  the  spring  semester  on 
Tuesday,  January  14,  according  to  an  announcement 
just  made  by  Dr.  Langley  Porter,  dean  of  the  school. 

In  order  to  provide  instruction  in  these  subjects 
two  appointments  to  the  faculty  have  been  made. 
Dr.  LeRoy  Crummer  of  Omaha,  Nebraska,  has  ac- 
cepted appointment  as  clinical  professor  of  medical 
history  and  bibliography,  beginning  this  month,  and 
Dr.  Sanford  Larkey  has  been  appointed  assistant  pro- 
fessor of  medical  history  and  bibliography,  effective 
July  1,  1930. 

Doctor  Crummer  visited  California  in  January,. 
1929,  to  give  a series  of  lectures  on  old  medical  books 
and  medical  history.  To  illustrate  his  lectures  he 
brought  with  him  part  of  his  own  collection  of  rare 
books  which  is  one  of  the  best  in  the  country.  The 
portion  that  he  brought  with  him  was  valued  at 
$96,000. — University  of  California  Clip  Sheet. 


The  Surgeon’s  Hands 
His  face,  I know  not  whether  it  be  fair 
Or  lined  and  grayed  to  mark  the  slipping  years, 

His  eyes,  I do  not  glimpse  the  pity  there. 

Or  try  to  probe  their  depths  for  hopes  or  fears. 

Only  upon  his  wondrous  hands  I gaze. 

And  search  my  memory  through  so  fittingly 
To  voice  their  loveliness,  in  still  amaze 
I bow  before  their  quiet  dignity. 

They  make  the  crooked  straight  and  heal  old  sores,. 
The  blind  to  see,  the  war-torn  clean  and  whole. 
Throughout  the  suffering  world  they  touch  the  doors 
That  open  wide  to  life,  the  bitter  bowl 
Of  pain  they  sweeten  till  the  weary  rest, 

As  though  the  hands  of  Christ  had  served  and  blest.”' 

■t — Ida  Norton  Munsen. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION* 


MORTON  R.  GIBBONS - President 

LTELL  C.  KINNEY President-Elect 

EMMA  W.  POPE Secretary 


OFFICIAL  NOTICES 

Next  Council  Meeting. — A special  meeting  of  the 
Council  of  the  California  Medical  Association  has 
been  called  for  Saturday,  March  1,  at  10  a.  m.,  at  the 
home  of  Doctor  Kress,  Uplifters  Club,  Santa  Monica. 


Optional  Medical  Defense. — “I  think  my  member- 
ship lapsed  this  year.  Will  you  see  if  I am  entitled 
to  assistance?”  is  a telephone  message  that  comes  to 
your  state  office  more  than  once.  Recently,  the  call 
was  from  a member  who  had  carried  insurance  con- 
tinuously from  1924  to  1929.  His  suit  was  for  $100,000, 
the  usual  modest  sum  demanded  by  the  present  dis- 
gruntled patient.  Protection  for  1930  has  since  been 
secured,  and  probably  will  hereafter  be  carried  so 
long  as  optional  defense  is  available. 

Ten  dollars  may  loom  large  when  no  suit  is  threat- 
ening, but  it  shrivels  to  a paltry  sum  in  the  face  of 
definite  court  action. 

Members  who,  when  suit  threatens,  will  want  the 
counsel  of  the  Association’s  legal  advisers  can  secure 
it  through  Optional  Medical  Defense  service  at  the 
nominal  figure  of  $10  a year.  Favorable  decision  now 
may  save  years  of  regret.  Cards  of  application  and 
more  detailed  information  will  be  sent  on  request. 
Address  2004,  Four  Fifty  Sutter  Street,  San  Francisco. 


Hotel  Rates  for  Annual  Session. — Members  who 
plan  to  attend  the  annual  session  at  Hotel  Del  Monte, 
April  28  to  May  1,  inclusive,  will  be  interested  in  the 
following  information. 

Every  member  should  make  his  reservation  early, 
and  insist  on  confirmation  of  same. 

Hotel  Del  Monte 
American  Plan 

Single  room  without  bath  (one  person),  $8. 

Double  room  without  bath  (two  persons),  $7.50 
each. 

Single  room  with  bath  (one  person),  $10. 

Double  room  with  bath  (two  persons),  $9  each. 

Two  single  rooms,  bath  between  (two  persons), 
$9.50  each. 

Two  double  rooms,  bath  between  (four  persons), 
$8.50  each. 

If  all  available  space  is  utilized,  six  hundred  mem- 
bers can  be  accommodated.  It  is  hoped  that  members 
will  bear  in  mind  the  necessity  for  utilizing  double 
rooms  as  much  as  possible. 

* * * 

San  Carlos  Hotel,  Monterey 
European  Plan 

Single  room,  shower  bath,  $2.50  and  $3. 

Double  room,  shower  bath,  $4.50. 

Double  room,  tub  bath,  $5. 

Twin-bedded  room,  tub  bath,  $6  to  $7. 

Extra  cot  in  room,  $1.50  each. 

* For  a complete  list  of  general  officers,  of  standing 
committees,  of  section  officers,  and  of  executive  officers 
of  the  component  county  societies,  see  index  reference  on 
the  front  cover,  under  Miscellany. 


Pebble  Beach  Lodge 
European  Plan 

Single  room  with  bath,  $7  to  $12. 

Double  room  with  bath,  $8  to  $14. 

* * * 

Kimball  and  Monterey,  Monterey 
European  Plan 

Rooms  range  from  $1.50  to  $4.50. 

* * * 

Luncheon  and  Dinner  Rates  at  Del  Monte 

For  members  stopping  in  other  hotels  during  the 
convention,  Hotel  Del  Monte  has  made  a special  price 
for  luncheon  of  $1.50  and  for  dinner,  $2.  Ticket  may 
be  purchased  at  the  cashier’s  window,  or  at  the  en- 
trance to  the  dining  room,  before  each  meal. 


COMPONENT  COUNTY  SOCIETIES 

ALAMEDA  COUNTY 

The  regular  meeting  of  the  Alameda  County  Medi- 
cal Association  was  held  in  the  auditorium  of  the 
Board  of  Education’s  new  administration  building  at 
8:15  p.  m.  Doctor  Meads  was  in  the  chair.  The  eve- 
ning was  devoted  to  a clinic  by  Dr.  L.  F.  Barker, 
professor  emeritus  of  medicine  of  Johns  Hopkins 
University. 

Doctor  Barker  discussed  four  cases,  the  first  a case 
of  polyposis  of  the  colon  in  which  the  x-ray  pictures 
were  diagnostic  of  the  condition  and  in  which  x-ray 
therapy  brought  about  almost  complete  cure.  Doctor 
Barker  pointed  out  the  fact  that  the  x-ray  is  abso- 
lutely diagnostic  in  this  condition  and  the  further  fact 
that  there  is  a definite  relation  between  polyposis  of 
the  large  bowel  and  carcinoma  of  the  rectum,  so  much 
so  that  the  doctor  prophesied  rectal  cancer  as  an  ulti- 
mate lesion  in  this  patient.  The  use  of  x-ray  therapy 
is  interesting  in  view  of  the  fact  that  this  is  one  of 
the  first  cases  of  the  kind  successfully  treated  by  this 
agent. 

The  second  case  was  a man  who  had  been  operated 
on  five  months  ago  for  a large  toxic  goiter,  with 
marked  temporary  postoperative  improvement  for  a 
few  months  and  later  a recurrence  of  all  symptoms. 
Doctor  Barker  demonstrated  all  of  the  characteristic 
eye  signs  of  this  condition,  and  in  the  discussion  of 
the  treatment  suggested  the  possibility  that  an  en- 
larged thymus  was  playing  an  important  part  in  the 
condition  and  advised  x-ray  and  sedative  treatment 
such  as  luminal  together  with  small  doses  of  iodin, 
with  the  mental  reservation  that  surgery  might  later 
be  necessary. 

The  third  case  demonstrated  was  a man  of  forty- 
one  years  who  had  a typical  history  of  ulcer  of  many 
years  standing  with  many  signs  which  at  the  present 
time  suggest  the  possibilities  of  malignancy. 

The  fourth  case  demonstrated  presented  central 
nervous  manifestations  with  many  symptoms  of  hys- 
teria but  with  a definite  increase  in  the  spinal  fluid 
globulin,  a slight  leukocytosis,  and  a temperature  of 
102.  Doctor  Barker  suggested  the  possibilities  of  a 
central  nervous  infection,  particularly  of  an  encephali- 
tic type,  and  predicted  the  development  within  six 
months  of  a Parkinsonian  syndrome. 

Following  the  clinic,  Dr.  Clarence  W.  Page  read 
an  “In  Memoriam”  to  Frank  W.  Simpson,  and  the 
meeting  adjourned  out  of  respect  to  the  memories  of 
Doctors  Frank  W.  Simpson  and  Ilo  R.  Aiken,  both 
of  whom  had  been  called  by  death  within  the  month. 

Gertrude  Moore,  Secretary. 


126 


February,  1930 


STATE  MEDICAL  ASSOCIATIONS 


127 


CONTRA  COSTA  COUNTY 

The  Contra  Costa  County  Medical  Society  met  at 
Memorial  Hall,  Crockett,  on  January  14,  Doctor 
Bumgarner  presiding.  Dr.  John  Scudder  of  Oakland 
read  a very  interesting  paper  on  the  “Errors  in  Diag- 
nosis of  Appendicitis.”  The  doctor  gave  a very  com- 
plete review  of  the  literature  on  the  subject  and  dis- 
cussed the  differential  diagnosis  of  appendicitis  in 
detail.  Operative  failures  from  chronic  appendicitis 
were  attributed  to  improper  diagnoses.  The  relapsing 
form  of  chronic  appendicitis  is  the  most  successful, 
from  an  operative  standpoint.  Much  hearty  discussion 
of  Doctor  Scudder’s  paper  was  participated  in  by 
members. 

At  the  request  of  the  Contra  Costa  Public  Health 
Association  a resolution  was  unanimously  passed 
favoring  the  investigation  by  the  County  Board  of 
Supervisors  of  the  advisability  of  hospitalizing  tuber- 
culous cases  from  this  county  in  Sunshine  Camp 
instead  of  Weimar  Sanitarium,  and  assuring  them  of 
the  cooperation  of  the  society  in  this  health  problem. 
Dr.  I.  O.  Church,  county  health  physician,  reported 
on  the  work  being  done  by  the  Contra  Costa  Public 
Health  Association.  Dr.  J.  M.  McCullough  was  ap- 
pointed delegate  to  the  next  executive  board  meeting 
of  the  Association  to  be  held  February  2 at  Sunshine 
Camp. 

Important  business  matters,  such  as  fee  schedule 
and  membership  dues,  were  also  discussed,  but  no 
action  was  taken. 

While  the  society  was  having  its  scientific  meeting 
the  physicians’  wives  met  at  the  home  of  Mrs.  J.  M. 
McCullough  for  the  purpose  of  forming  a woman’s 
auxiliary  to  the  medical  society.  Formation  of  this 
auxiliary  was  voted,  with  officers  as  follows:  Presi- 
dent, Mrs.  J.  M.  McCullough  of  Crockett;  first  vice- 
president,  Mrs.  L.  H.  Fraser  of  Richmond;  second 
vice-president,  Mrs.  H.  D.  Neufeld  of  Bay  Point; 
secretary,  Mrs.  S.  N.  Weil  of  Rodeo. 

After  the  business  meeting  a delightful  supper  was 
served  to  members  of  the  society  and  auxiliary  and 
guests  at  the  Crockett  Memorial  Hall.  Dr.  and  Mrs. 
McCullough  were  the  hosts. 

A symposium  on  respiratory  diseases  by  members 
of  the  society  was  annorjnced  as  the  program  of  the 
next  meeting. 

L.  H.  Fraser,  Secretary. 

* 

FRESNO  COUNTY 

The  regular  monthly  meeting  of  the  Fresno  County 
Medical  Society  was  held  Tuesday,  January  7,  at 
8 p.  m.  at  the  Hotel  Fresno.  Forty  members  were 
present. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

It  was  moved  by  Doctor  Tupper,  seconded  by 
Doctor  Vanderburgh,  that  Dr.  K.  D.  Luechauer’s 
application  for  membership  in  the  society  be  accepted. 

The  president  appointed  the  following  committees 
for  the  year: 

Board  of  Censors — Harry  J.  Craycroft  (chairman), 
B.  B.  Lamkin,  D.  I.  Aller. 

Ethics  Committee — John  D.  Morgan  (chairman), 
E.  R.  Scarboro,  Neil  Dau. 

Library  Committee  — H.  O.  Collins  (chairman), 
G.  A.  Hare,  Guy  Manson. 

Program  Committee — C.  M.  Vanderburgh  (chair- 
man), Kenneth  J.  Stamford,  L.  R.  Willson. 

Welfare  Committee — A.  B.  Cowan  (chairman), 
J.  R.  Walker,  C.  P.  Kjaerbye. 

Publicity  Committee — C.  O.  Mitchell,  E.  L.  Ben- 
nett, A.  E.  Anderson. 

Dr.  W.  F.  Wiese  was  appointed  to  audit  the  so- 
ciety’s books  for  the  year  1929. 

Dr.  Julian  M.  Wolfsohn,  psychiatrist  of  Stanford 
University,  gave  a talk  on  “Symptomatic  and  Idio- 
pathic Epilepsies,”  which  was  very  much  enjoyed. 
The  symptomatic  epilepsies  he  divides  into  those  due 
to  brain  tumor;  traumatic  epilepsy;  syphilis;  toxic 
epileptiform  convulsions,  which  are  commonly  due  to 
alcohol;  those  associated  with  arteriosclerosis  and 


cardiovascular  diseases;  those  associated  with  acute 
infections,  especially  scarlet  fever;  and  the  convul- 
sions of  infancy  and  childhood.  These  form  the  con- 
necting link  with  the  next  class,  namely,  idiopathic 
epilepsy. 

Doctor  Wolfsohn  discussed  in  detail  the  different 
forms  in  which  the  seizure  appears  and  reviewed  the 
various  methods  of  treatment.  In  treatment,  Doctor 
Wolfsohn  adheres  to  sodium  bromid,  fifteen  to  twenty 
grains  three  times  a day,  and  in  cases  of  petit  mal 
he  gives,  in  addition,  three  to  four  minims  of  tincture 
of  belladonna  three  times  a day.  The  first  dose  of 
sodium  bromid  is  taken  in  the  morning  before  getting 
up.  When  the  attacks  are  not  controlled  by  this 
method,  three-quarters  of  a grain  of  luminal  are  given 
at  bedtime. 

Meeting  adjourned. 

J.  M.  Frawley,  Secretary. 

NAPA  COUNTY 

The  regular  meeting  of  the  Napa  County  Medical 
Society  was  held  Wednesday,  January  8,  at  the  new 
Victory  Hospital.  The  members  of  the  medical  so- 
ciety were  guests  of  the  hospital  board  of  directors, 
who  provided  a delicious  dinner  preceding  the  busi- 
ness meeting.  The  new  Victory  Hospital  is  a modern, 
fireproof  structure  of  thirty-three  beds,  and  fills  a 
much  needed  want  in  the  community. 

Dr.  George  Dawson,  president,  opened  the  business 
meeting.  The  minutes  of  the  previous  meeting  were 
read  and  approved.  Dr.  Orville  Rockwell  of  the  St. 
Helena  Sanitarium  and  Dr.  C.  E.  Sisson  of  the  Napa 
State  Hospital  were  admitted  to  membership  by  trans- 
fer from  the  San  Francisco  County  Medical  Society 
and  the  Mendocino  County  Medical  Society. 

The  speaker  of  the  evening.  Dr.  Edmund  Butler,, 
chief  of  the  San  Francisco  Emergency  Hospitals, 
gave  a valuable  talk  on  “The  Equipment  of  the  Emer- 
gency Room  in  a Hospital”  (illustrated  with  lantern 
slides),  and  discussed  some  of  the  problems  to  be  met. 
He  also  exhibited  and  discussed  a motion-picture  reel 
of  some  European  clinics  which  he  recently  visited. 
This  was  followed  by  an  informal  discussion  of  his 
subject.  There  were  twenty-two  physicians  present, 
including  the  speaker,  Dr.  Bull,  of  the  Shriners’  Hos- 
pital for  Crippled  Children,  San  Francisco;  Dr.  James 
Eaves  of  Oakland  and  Dr.  Michelson  of  Lane  Hos- 
pital, San  Francisco. 

Members  present  were:  George  Wood,  D.  H.  Mur- 
ray, C.  E.  Nelson,  Robert  Northrup,  H.  V.  Baker, 
A.  K.  McGrath,  W.  L.  Blodgett,  George  I.  Dawson, 
C.  A.  Johnson,  Robert  Crees,  L.  Welti,  C.  H.  Bulson, 
H.  R.  Coleman,  E.  F.  Donnelley,  I.  E.  Charlesworth, 
C.  A.  Gregory.  Visitors:  C.  E.  Sisson,  A.  E.  Chappel. 

The  president,  Dr.  George  Dawson,  was  given 
authority  to  appoint  a committee  to  confer  with  the 
state  society  relative  to  a conference  with  the  legal 
profession  concerning  malpractice  suits. 

Meeting  adjourned. 

C.  A.  Johnson,  Secretary. 

ORANGE  COUNTY 

The  forty-second  annual  banquet  of  the  Orange 
County  Medical  Association  was  held  January  7 at  the 
Santa  Ana  Country  Club,  Santa  Ana.  Approximately 
one  hundred  members  and  their  wives  were  present. 
A delightful  menu  and  program,  with  Dr.  Merrill  W. 
Hollingsworth  as  toastmaster,  helped  to  make  this 
evening  a pleasant  and  successful  social  event  of  the 
year. 

A most  interesting  talk  was  given  by  Dr.  F.  Harold 
Gobar  of  Fullerton,  retiring  president,  on  “Medical 
Libraries.”  Our  own  medical  library  is  now  well 
started  and  all  members  of  the  society  have  the  privi- 


128 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


lege  of  using  it.  Other  delightful  talks  were  given  by 
Mrs.  F.  E.  Coulter  and  Judge  Frank  C.  Drumm. 

Mrs.  F.  E.  Coulter  is  president  of  the  Woman’s 
Auxiliary  of  the  society,  just  recently  organized. 
Judge  Frank  C.  Drumm  gave  the  principal  address  of 
the  evening  on  “Medical  Ambitions.”  Several  musical 
numbers  were  interspersed  between  these  talks. 

At  the  end  of  the  meeting  the  following  members 
of  the  society  were  introduced  as  officers  for  the 
year  1930:  H.  Miller  Robertson,  president;  Emerald 
J.  Steen,  vice-president;  Harry  G.  Huffman,  secre- 
tary treasurer;  Charles  D.  Ball,  librarian.  Councilors: 
Jay  L.  Beebe,  Dexter  R.  Ball,  George  M.  Tralle. 
Delegate,  Dexter  R.  Ball;  alternate,  George  M.  Tralle. 
Delegate,  Harry  E.  Zaiser;  alternate,  William  S. 
Wallace. 

Harry  G.  Huffman,  Secretary. 

* 

SAN  BERNARDINO  COUNTY 

The  meeting  of  the  San  Bernardino  County  Medical 
Society  was  called  to  order  by  the  president  at  8 p.  m. 
January  7. 

Minutes  of  the  previous  meeting  were  read  and 
approved. 

The  following  men  were  accepted  to  membership 
by  unanimous  vote:  Dr.  C.  W.  Moots,  Dr.  S.  A. 
Crooks,  and  Dr.  F.  H.  Garrett. 

The  program  of  the  evening  was  then  given. 

A motion  picture  on  “Infection  of  the  Hand”  by 
Doctor  Kanavel  was  presented  through  the  courtesy 
of  the  College  of  Medical  Evangelists  at  Loma  Linda 
by  Dr.  G.  M.  Taylor  of  Los  Angeles. 

A paper  on  “Fractures  and  Dislocations  of  the 
Hand  Excluding  the  Radius  and  Ulna”  by  Dr.  Philip 
Stephens  of  Los  Angeles  followed. 

The  discussion  of  these  papers  was  conducted 
jointly,  and  opened  for  the  first  paper  by  Dr.  Philip 
Savage  of  San  Bernardino  and  for  the  second  paper 
by  Dr.  K.  L.  Dole  of  Redlands. 

Members  who  had  interesting  or  unusual  cases  of 
infection  or  injuries  of  the  hand,  past  and  present, 
were  invited  to  present  these  cases  as  part  of  the 
discussion. 

Supper  was  served  at  10:30  o’clock. 

Doctor  Savage  was  called  away  and  Doctor  Hilliard 
opened  the  discussion  in  his  absence. 

There  were  about  forty  in  attendance. 

E.  J.  Eytinge,  Secretary. 

* 

SAN  JOAQUIN  COUNTY 

The  stated  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  Thursday  evening  at  8:30 
o’clock,  January  2,  in  the  Medico-Dental  Club,  242 
North  Sutter  Street,  Stockton. 

The  meeting  was  called  to  order  by  Dr.  C.  V. 
Thompson,  president,  who  immediately  turned  the 
chair  over  to  Dr.  Harry  E.  Kaplan,  the  newly  elected 
president.  The  minutes  of  the  previous  meeting  were 
read  by  Dr.  Fred  J.  Conzelmann,  secretary,  and  ap- 
proved. After  appropriate  remarks,  Doctor  Conzel- 
mann, who  has  most  efficiently  served  as  secretary- 
treasurer  for  four  years,  called  to  the  chair  the  new 
secretary-treasurer,  Dr.  C.  A.  Broaddus. 

The  scientific  program  was  opened  by  Dr.  Emmet 
Rixford  of  San  Francisco  with  a report  on  cocci- 
dioidal granuloma  illustrated  by  slides,  showing  the 
gross  and  microscopic  pictures  of  the  lesions. 

The  principal  paper  of  the  evening  was  presented 
by  Doctor  Rixford  on  the  subject  of  “Postoperative 
Treatment  in  Abdominal  Surgical  Cases.” 


The  doctor  evidently  disapproves  the  use  of  much 
treatment  and  therapeutic  frills.  He  quoted  from 
his  former  teacher,  Dr.  Clinton  Cushing,  who  often 
admonished  his  students  with  the  phrase,  “Don’t 
fuss!”  He  further  quoted  the  great  French  surgeon, 
Ambroise  Pare,  who  said,  “I  dressed  his  wound,  but 
God  healed  it.” 

“A  patient  who  is  sanely  prepared  for  operation  by 
rest,  mild  catharsis,  and  simple  cleansing  of  the  site 
of  incision  stands  the  best  chance  for  rapid  recovery. 
The  proper  maintenance  of  body  warmth  in  the  pa- 
tient during  operation  without  excessive  heat  and 
humidity  in  operating  room  is  highly  essential. 

“To  avoid  shock  and  postoperative  adhesions  it  is 
essential  to  handle  the  intestines  as  little  as  possible 
and  to  keep  them  within  the  abdomen. 

“After  operation  keep  the  patient  quiet,  without 
visitors,  and  use  narcotics.  Allow  time  for  peristalsis 
to  start  before  giving  food,  but  try  to  anticipate  the 
appearance  of  acetone,  which  demands  the  resumption 
of  feeding.  Vomiting  is  to  be  controlled  by  emptying 
the  stomach  by  lavage,  being  sure  there  is  no  in- 
testinal obstruction,  which  is  always  to  be  suspected. 

“The  most  suitable  remedy  in  shock  is  transfusion 
from  a proper  donor.  Caffein  in  two  to  three  grains 
every  two  or  three  hours  is  very  valuable.  Tyramin, 
one-third  grain  hypodermically,  is  valuable  for  quick 
action;  digitalis  derivatives  for  sustained  action. 

“Normal  urination  does  not  occur  ordinarily  for 
twelve  to  twenty-four  hours  and  stimulative  aids 
should  be  patiently  tried  before  resorting  to  the  use 
of  a catheter.  Even  catharsis  is  to  be  used  with  care, 
and  only  after  resort  to  milder  methods  has  failed. 
The  use  of  pituitrin  to  stimulate  peristalsis  is  regarded 
with  disfavor. 

“Postoperative  pain  is  best  controlled  by  morphia. 
Many  patients  sleep  comfortably  the  first  night  if  they 
receive  an  enema  of  opium  and  chloral.  For  gas  pains 
the  best  treatment  is  with  hot  moist  compresses. 
Peritonitis  is  controlled  by  the  time-honored  opium 
treatment.  Hypodermic  injection  of  serums,  prepared 
from  intestinal  bacteria,  is  of  great  value,  but  best  of 
all  is  the  use  of  a proper  bacteriophage. 

“Prophylaxis  is  the  proper  procedure  in  venous 
thrombosis  by  omitting  the  use  of  catgut  sutures  for 
wound  closure  and  maintaining  blood  pressure  by 
proper  methods.” 

Doctor  Conzelmann,  the  retiring  secretary,  spoke 
next  on  the  “Ethics  of  Psychiatry,”  the  study  of  the 
structure  of  the  mental  life  and  of  its  functional  dis- 
orders. Ethics,  on  the  other  hand,  deals  with  the 
standards  of  right  and  wrong.  It  deals  with  what 
ought  to  be,  rather  than  what  actually  is.  Psychiatry, 
by  virtue  of  its  intimate  survey  of  the  mental  life  and 
of  the  personality,  is  particularly  concerned  with  the 
remaking  of  human  nature  and  of  the  world  on  which 
we  live.  The  descriptive  data  which  mental  science 
offers  is  of  great  importance  to  the  student  of  ethics 
and  equally  the  consideration  of  ethical  values  is  of 
great  importance  to  the  creed  of  the  psychiatrist. 
Psychiatry  presents  us  with  distinctive  mental  types; 
it  is  a study  of  individual  differences,  individual  capaci- 
ties. Its  practical  purpose  is  to  remove  obstructions, 
conflicts  and  repression,  to  obtain  adequate  adjust- 
ment. 

The  discussion  of  papers  was  led  by  Dr.  J.  D. 
Dameron  and  Dr.  Linwood  Dozier. 

At  the  roll  call  the  following  members  were  present: 
Drs.  E.  A.  Arthur,  Barnes,  Blackmun,  Blinn,  Broad- 
dus, Buchanan,  Conzelmann,  Dameron,  Doughty, 
Dozier,  English,  Foard,  Frost,  Goodman,  Hansan, 
Hull,  Kaplan,  Krout,  McCoskey,  McGurk,  McNeil, 
Marnell,  O’Donnell,  Owens,  Petersen,  Pinney,  B.  J. 
Powell,  D.  R.  Powell,  Priestly,  Sanderson,  Sheldon, 
M.  H.  Smyth,  C.  V.  Thompson,  Van  Meter.  Visitors 


February,  1930 


STATE  MEDICAL  ASSOCIATIONS 


129 


present  were:  Mrs.  Rixford  and  Drs.  Sutton,  Vander- 
leek,  Kilgore,  and  Weiss. 

There  being  no  further  business  the  meeting  was 
adjourned  at  11:15  o’clock  and  refreshments  were 
served.  C.  A.  Broaddus,  Secretary. 

•» 

SAN  MATEO  COUNTY— SANTA  CLARA  COUNTY 

The  December  meeting  of  the  San  Mateo  Medical 
Society  was  held  in  conjunction  with  the  Santa  Clara 
Medical  Society  at  the  Oak  Tree  Inn,  San  Mateo, 
December  18.  Following  dinner  the  meeting  was 
turned  over  to  the  president  of  the  Santa  Clara 
Society,  who  introduced  the  speakers  of  the  evening, 
members  of  the  Santa  Clara  Society. 

Dr.  Charles  A.  Fernish  gave  a paper  on  “Injection 
Method  of  Treating  Varicose  Veins.”  Dr.  L.  M.  Rose 
presented  a paper  on  “Pathology  of  the  Heart,”'  ac- 
companied by  records  of  cardiac  rhythms.  Dr.  J.  H. 
Shephard  treated  the  subject  of  “Pathology  of  the 
Esophagus,”  very  comprehensively.  The  discussions 
were  instructive,  and  were  enjoyed  by  the  members  of 
both  societies. 

The  joint  meeting  was  attended  by  a good  repre- 
sentation from  each  society,  about  forty-five  being 
present. 

Erma  B.  Macomber,  Secretary. 

* 

STANISLAUS  COUNTY 

The  Stanislaus  County  Medical  Society  held  its 
regular  meeting  on  January  10.  The  meeting  was 
called  to  order  by  President  Hiatt.  Members  present 
were:  Doctors  Collins,  Cooper,  Finney,  Morris,  Mc- 
Kibbon,  Bemis,  Mottram,  Yocum,  Morgan,  Maxwell, 
Fields,  Downing,  Gould,  Hartman,  DeLappe,  Robert- 
son, Hiatt,  Pearson,  McPheeters,  and  Ransom. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

A letter  from  the  County  Nurses’  Association  ask- 
ing the  Medical  Association  if  they  desired  the  nurses 
to  start  a physicians  and  surgeons’  exchange,  was 
read.  The  letter  was  tabled  for  further  information. 

The  secretary  made  a report  of  a meeting  held  the 
previous  week  of  representative  Modesto  business  men 
when  the  advisability  of  building  a new  hospital  in 
Modesto  was  discussed.  President  Hiatt  appointed  a 
committee  of  six  doctors  to  meet  with  this  commit- 
tee: Doctors  DeLappe  (chairman),  Gould,  Maxwell, 
Morgan,  Falk,  and  Collins. 

The  new  county  charter  was  discussed  by  various 
members  and  it  was  the  consensus  of  opinion  that 
the  members  should  vote  against  it. 

Dr.  Sterling  Bunnell  of  San  Francisco  gave  a very 
interesting  talk  on  the  subject  “Nerve  Surgery.” 

Meeting  adjourned. 

Donald  L.  Robertson,  Secretary. 

VENTURA  COUNTY 

The  January  meeting  of  the  Ventura  County  Medi- 
cal Society  was  held  on  January  14  at  the  Clinic  build- 
ing of  the  Ventura  County  Hospital  at  8 p.  m.  The 
meeting  was  called  to  order  by  Vice-president  W.  S. 
Clark. 

Those  present  were:  Doctors  Armitstead,  Bardill, 
Bianchi,  W.  S.  Clark,  D.  G.  Clark,  Coffey,  Felber- 
baum,  Jones,  Schultz,  Smolt,  and  Welsh.  Doctors 
Henry  J.  Ullmann  and  Richard  Evans  of  Santa  Bar- 
bara were  present  as  guests. 

Doctor  Ullmann,  president-elect  of  the  American 
Radium  Society,  gave  an  extremely  interesting  lecture 
illustrated  by  lantern  slides.  His  subject  was  the 
treatment  of  malignant  disease  by  the  use  of  radium, 
x-ray,  and  chemotherapy.  The  lecture  dealt  chiefly 


with  skin  cancer,  though  a portion  of  it  was  devoted 
to  cancer  of  the  cervix. 

Due  to  lack  of  time,  no  business  meeting  was  held 
after  the  lecture  and  the  meeting  was  adjourned. 

Charles  A.  Smolt,  Secretary. 


CHANGES  IN  MEMBERSHIP 
New  Members 

Alameda  County — Clarence  S.  Gardner  and  Harold 
Philip  Maloney. 

Kern  County — Seymour  Strongin  and  Mark  A.  Wil- 
liamson. 

Placer  County — Arthur  William  McArthur  and  Ralph 
B.  Miller. 

Santa  Clara  County — Harry  Beal  Torrey  and  Frank 
I.  Putnam.  Transferred  Members 

Christopher  Leggo,  from  San  Francisco  to  Solano 
County. 

Eugene  C.  Grau,  from  Humboldt  to  Alameda 
Count>'-  Deaths* 

Browning,  Frederick  William.  Died  at  San  Fran- 
cisco, December  30,  1929,  age  64  years.  Graduate  of 
the  Royal  College  of  Physicians  and  Surgeons,  Edin- 
burgh, Scotland,  1888.  Licensed  in  California,  1894. 
Doctor  Browning  was  a member  of  the  Alameda 
County  Medical  Association,  the  California  Medical 
Association,  and  a Fellow  of  the  American  Medical 
Association. 

Draper,  Alfred  Lawrence.  Died  at  San  Francisco, 
January  3,  1930,  age  55  years.  Graduate  of  Cooper 
Medical  College,  San  Francisco,  1900.  Licensed  in 
California,  1901.  Doctor  Draper  was  a member  of  the 
San  Francisco  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

Jacobs,  Edward  H.  Died  at  Los  Angeles,  Decem- 
ber 21,  1929,  age  51  years.  Graduate  of  Rush  Medical 
College,  Chicago,  1903.  Licensed  in  California,  1911. 
Doctor  Jacobs  was  a member  of  the  Los  Angeles 
County  Medical  Association,  the  California  Medical 
Association,  and  the  American  Medical  Association. 

McKinnon,  Wilfred  Charles.  Died  at  San  Fran- 
cisco. December  20,  1929,  age  30  years.  Graduate  of 
the  University  and  Bellevue  Hospital  Medical  Col- 
leges, New  York,  1925.  Licensed  in  California,  1928. 
Doctor  McKinnon  was  a member  of  the  San  Fran- 
cisco County  Medical  Society,  the  California  Medical 
Association,  and  the  American  Medical  Association. 

Munroe,  Harrington  Bennett.  Died  at  Los  Angeles, 
December  17,  1929,  age  52  years.  Graduate  of  McGill 
University  Faculty  of  Medicine,  Montreal,  Quebec, 
1903.  Licensed  in  California,  1917.  Doctor  Munroe 
was  a member  of  the  Los  Angeles  County  Medical 
Association,  the  California  Medical  Association,  and 
a Fellow  of  the  American  Medical  Association. 

Shiels,  John  Wilson.  Died  at  San  Francisco,  De- 
cember 30,  1929.  Graduate  of  Royal  College  of  Phy- 
sicians and  Surgeons,  Edinburgh,  Scotland,  1895. 
Licensed  in  California,  1898.  Doctor  Shiels  was  a 
member  of  the  San  Francisco  County  Medical  Society, 
the  California  Medical  Association,  and  a Fellow  of 
the  American  Medical  Association. 

Sweeney,  George  J.  Died  at  San  Francisco,  De- 
cember 27,  1929.  Graduate  of  University  of  California 
Medical  School,  San  Francisco,  1900.  Licensed  in 
California,  1900.  Doctor  Sweeney  was  a member  of 
the  San  Francisco  County  Medical  Society,  the  Cali- 
fornia Medical  Association,  and  the  American  Medical 
Association. 

Tate,  C.  Francis  S.  Died  at  Los  Angeles,  Decem- 
ber 16,  1929,  age  56  years.  Graduate  of  University 
of  Southern  California  School  of  Medicine,  Los  An- 

* Erratum. — Correction  is  hereby  made  of  the  notice  of 
death  of  Joseph  Alexander  Parker,  M.  D.,  of  Los  Angeles, 
which  appeared  in  the  November  issue,  page  367.  The 
notice  should  have  read,  ‘‘Dr.  J.  A.  Parker  of  San  Fran- 
cisco.” 


130 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


geles,  1895.  Licensed  in  California,  1895.  Doctor  Tate 
was  a member  of  the  Los  Angeles  County  Medical 
Association,  the  California  Medical  Association,  and 
the  American  Medical  Association. 

Thompson,  Roy  Oliver.  Died  at  Calexico,  Decem- 
ber 22,  1929,  age  43  years.  Graduate  of  University 
of  Southern  California  School  of  Medicine,  Los  An- 
geles, 1914.  Licensed  in  California,  1914.  Doctor 
Thompson  was  a member  of  the  Imperial  County 
Medical  Society,  the  California  Medical  Association, 
and  a Fellow  of  the  American  Medical  Association. 


OBITUARIES 
John  Wilson  Shiels 

On  December  30,  1929,  John  Wilson  Shiels  passed 
away  at  the  Franklin  Hospital  following  a laparotomy 
designed  to  relieve,  if  possible,  a digestive  disturb- 
ance that  had  interfered  seriously  with  his  comfort 
and  well-being  for  some  time. 

Born  in  San  Francisco,  he  graduated  from  the 
School  of  Medicine  of  the  Royal  Colleges  at  Edin- 
burgh in  1895.  At  this  time  he  also  become  a licen- 
tiate of  the  Royal  College  of  Physicians,  Edinburgh, 
of  the  Royal  College  of  Surgeons,  Edinburgh,  and 
of  the  Royal  Faculty  of  Physicians  and  Surgeons  of 
Glasgow. 

During  his  period  of  study  in  Edinburgh  he  found 
time  to  become  a noted  swimmer  and  amateur  middle- 
weight boxer  and  to  play  football  for  his  college. 
Above  all,  he  was  outstanding  in  his  activities  in  the 
drama.  He  was  a leading  light  in  the  Edinburgh 
Dramatic  Society  and  served  as  its  president  for 
several  years. 

He  returned  to  San  Francisco  and  was  licensed  to 
practice  medicine  in  California  in  1898  and  began  to 
build  that  reputation  for  skill,  clinical  judgment  and 
broad  human  kindliness  which  endeared  him  to  his 
patients  and  to  the  profession. 

He  joined  the  medical  faculty  of  the  University  of 
California  in  1906  and  at  the  time  of  his  death  was 
a clinical  professor  of  medicine  in  the  medical  school. 
He  was  instrumental  in  organizing  the  San  Francisco 
Polyclinic  and  was  one  of  its  mainstays  for  many  of 
its  best  years. 

He  was  always  proud  of  his  association  with  the 
Medical  Corps  of  the  United  States  Army.  He  re- 
ceived his  commission  among  the  first  when  the 
Medical  Reserve  Corps  was  formed  in  1907,  and  this 
commission,  signed  by  Theodore  Roosevelt,  was 
always  cherished  by  him.  On  the  entry  of  the  United 
States  into  the  war  in  1917  he  was  immediately  com- 
missioned Captain,  National  Army,  and  shortly  re- 
ceived his  majority.  He  was  on  duty  as  chief  of  the 
medical  service  at  Letterman  General  Hospital,  which 
hospital  he  actually  commanded  for  a short  period. 
He  gained  golden  opinions  from  every  one  and  when 
the  Reserve  Corps  was  reorganized  after  the  war 
he  was  commissioned  Lieutenant-Colonel  and  five 
years  ago  received  his  commission  as  Colonel. 

For  the  past  eight  years  he  was  active  as  chief 
of  the  Department  of  Internal  Medicine  of  the  Frank- 
lin Hospital,  and  his  ability,  personality,  energy  and 
brilliant  attainments  helped  largely  to  place  the 
Franklin  Hospital  among  the  best  hospitals  of  San 
Francisco. 

His  histrionic  ability  and  his  love  for  play  writing 
gave  him  ample  opportunity  for  literary  and  artistic 
expression.  In  1908-09  he  was  president  of  the 
Bohemian  Club  and  in  1914  he  wrote  the  Grove  play, 
“Nec  Natoma.”  On  many  occasions  he  took  leading 
parts  in  the  plays  presented  by  the  Bohemian  Club. 

The  qualities  of  mind  and  soul  which  made  “Jack” 
Shiels  beloved  by  his  patients,  associates  and  club 


fellows,  gave  him  the  personality  and  powers  of  a 
great  teacher  and  physician.  He  was  truly  both  of 
these,  a master  of  medical  lore  and  a lover  of  his 
fellow  man — understanding,  kindly,  self-sacrificing, 
with  a heart  that  yielded  most  to  those  whose  need 
was  greatest. 

Medicine  in  California  has  lost  one  whom  it  can  ill 
afford  to  lose — a great  teacher,  a great  practitioner, 
a physician  whom  his  colleagues  and  patients  loved 
and  of  whom  they  were  proud. 

* * * 

AN  APPRECIATION  OF  A GENIUS  BY  ONE  WHO 
KNEW  HIM 

Life  holds  many  beautiful  things,  but  little  that  is 
more  beautiful  than  the  associations  that  are  possible 
when  one  has  the  privilege  of  working  with  brilliant 
minds. 

It  is  probably  the  most  selfish  form  of  pleasure,  for 
one  receives  so  much  and  can  give  so  little  in  return. 
It  was  my  opportunity  to  have  had  such  a privilege 
in  my  association  with  the  late  John  Wilson  Shiels. 
Man,  scholar,  friend,  athlete,  artist,  actor  and,  last 
but  by  no  means  least,  physician  extraordinary. 

Arthur  Collis  Gibson,  M.  D. 

* * * 

George  J.  Sweeney 

By  the  death  of  Dr.  George  J.  Sweeney  in  San 
Francisco  on  December  27,  1929,  the  medical  pro- 
fession has  lost  one  of  its  valued  members. 

Dr.  Sweeney  was  born  in  Petaluma,  California,  in 
1870;  received  his  medical  degree  from  the  University 
of  California  in  1900.  He  was  a member  of  the 
California  Medical  Association  and  the  San  Francisco 
County  Medical  Society.  For  twelve  years  he  served 
with  distinction  as  medical  director  of  the  French 
Hospital.  For  the  past  number  of  years,  and  until 
the  time  of  his  death,  he  devoted  himself  to  general 
practice. 

Dr.  Sweeney  was  typical  of  the  best  in  the  practice 
of  medicine.  His  life  was  characterized  by  devotion 
of  all  his  powers  and  skill  to  the  alleviation  of  the 
suffering,  rendering  medical  aid  to  the  poor,  and  to 
public  welfare.  His  kindness  and  sympathy  to  those 
in  need  of  his  services  and  assistance  gained  for  him 
an  affection  on  their  part  and  the  part  of  his  friends 
that  will  linger  in  their  memories  forever. 

* * * 

Wilfred  C.  McKinnon 

Dr.  McKinnon  was  one  of  the  younger  members 
of  the  medical  fraternity  in  San  Francisco,  being 
twenty-nine  years  old  at  the  time  of  his  death,  Christ- 
mas Day  would  have  been  his  thirtieth  birthday. 

He  took  his  pre-medical  work  at  the  University 
of  California  and  received  his  M.  D.  from  New  York 
University  and  Bellevue  Hospital  Medical  College. 
Following  his  graduation  from  medical  college  he 
served  two  years  in  Newark  City  Hospital,  Newark, 
New  Jersey,  during  the  concluding  six  months  of 
which  he  was  house  surgeon.  Following  his  intern- 
ship he  spent  some  time  abroad  before  locating  in 
San  Francisco.  He  had  been  practicing  in  this  city 
a little  over  a year. 

He  was  an  able  young  physician,  with  a rapidly 
growing  practice  and  a very  promising  future.  In 
addition  to  competency  in  his  profession  he  had  a 
kind,  sympathetic,  and  charming  personality  and  had 
a host  of  friends  in  this  city  and  elsewhere  in  North- 
ern California. 

He  was  born  in  Areata,  California,  being  the  son 
of  Dr.  and  Mrs.  George  W.  McKinnon  of  that  city, 
who  survive  him.  Dr.  George  W.  McKinnon  is  a 
well-known  Humboldt  County  physician.  Besides 


February,  1930 


STATE  MEDICAL  ASSOCIATIONS 


131 


his  parents  he  is  survived  by  a brother,  Harold  R. 
McKinnon,  a San  Francisco  attorney.  He  resided 
with  his  brother  at  the  University  Club,  San  Fran- 
cisco. 

He  was  a member  of  Nu  Sigma  Nu. 


THE  WOMAN’S  AUXILIARY  OF  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION  * 

MRS.  H.  S.  ROGERS President 

Sunny  Slope  Road,  Petaluma 

MRS.  W.  H.  GEISTWEIT First  Vice-President 

S10  Medico-Dental  Building,  San  Diego 
MRS.  JOHN  HUNT  SHEPHARD.  ..Second  Vice-President 
145  South  Twelfth  Street,  San  Jose 

MRS.  R.  A.  CUSHMAN Secretary-Treasurer 

632  North  Broadway,  Santa  Ana 


It  was  recommended  by  the  committee  that  the 
secretary-treasurer  be  elected  in  open  meeting. 

Nominations  were  called  for  the  office  of  secretary- 
treasurer,  and  Mrs.  Dexter  R.  Ball  was  nominated 
and  elected  unanimously. 

Mrs.  Cushman  then  asked  Mrs.  F.  E.  Coulter  to 
take  the  chair.  Mrs.  Coulter  gave  a short  speech  of 
acceptance  and  told  the  purpose  of  the  auxiliary  and 
the  general  need  for  friendship  and  social  contacts 
among  the  doctors  and  their  families. 

Motion  was  then  made  to  adjourn  until  February  4, 
1930,  that  the  auxiliary  might  meet  on  the  date  of 
the  regular  meeting  of  the  Orange  County  Society. 
Mrs.  Grace  M.  Zaiser  gave  a series  of  readings,  which 
were  delightful,  in  the  joint  meeting. 

Edna  M.  Ball,  Secretary. 


OFFICERS  OF  COUNTY  AUXILIARIES 
Contra  Costa  County 

President,  Mrs.  J.  M.  McCullough,  Crockett. 

First  vice-president,  Mrs.  L.  H.  Fraser,  Richmond. 
Second  vice-president,  Mrs.  H.  D.  Nuefeld,  Bav 
Point. 

Secretary-treasurer,  Mrs.  S.  N.  Weil,  Rodeo. 


Los  Angeles  County 

President,  Mrs.  James  F.  Percy,  Los  Angeles. 
First  vice-president,  Mrs.  P.  S.  Doane,  Pasadena. 
Second  vice-president,  Mrs.  B.  von  Wedelstaedt, 
Long  Beach. 

Secretary-Treasurer,  Mrs.  Martin  G.  Carter,  Los 
Angeles. 

Kern  County 


President,  Mrs.  F.  A.  Hamlin,  Bakersfield. 

First  vice-president,  Mrs.  F.  J.  Gundry,  Bakers- 
field. 

Second  vice-president,  Mrs.  A.  R.  Moodie,  Taft. 
Secretary-treasurer,  Mrs.  C.  S.  Compton,  ’ Bakers- 
field. 


Orange  County 


President,  Mrs.  F.  E.  Coulter,  Santa  Ana. 

First  vice-president,  Mrs.  H.  A.  Johnston,  Anaheim. 
Second  vice-president,  Mrs.  D.  C.  Cowles,  Fullerton. 
Secretary-treasurer,  Mrs.  Dexter  R.  Ball,  Santa 
Ana. 


San  Bernardino  County 


President,  Mrs.  F.  E.  Clough,  San  Bernardino. 
First  vice-president,  Mrs.  Walter  Pritchard,  Colton. 
Second  vice-president,  Mrs.  A.  L.  Weber,  Upland. 
Secretary-treasurer,  Mrs.  C.  L.  Curtiss,  Redlands. 


ORANGE  COUNTY 

The  second  meeting  of  the  Woman’s  Auxiliary  of 
the  Orange  C-ounty  Medical  Society  was  held  on 
Tuesday  evening,  December  3,  1929,' at  the  Orange 
County  Hospital.  The  meeting  was  called  to  order 
by  Mrs.  Clara  Cushman,  temporary  chairman.  The 
minutes  of  the  previous  meeting  were  read  and 
accepted. 

Mrs.  Cushman  read  a letter  from  Mrs.  Henry  S. 
Rogers,  president  of  the  Woman’s  Auxiliary  of  the 
California  Medical  Association  in  which  she  asked 
Doctor  Gobar  to  appoint  a committee  on  organization 
to  form  a woman’s  auxilary  in  Orange  County. 

Mrs.  Hollingsworth,  chairman  of  the  nominating 
committee,  recommended  the  following  names  for 
office:  Mrs.  F.  E.  Coulter  for  president;  Mrs.  H.  A. 
Johnston  for  first  vice-president;  and  Mrs.  D.  C. 
Cowles  for  second  vice-president. 


As  county  auxiliaries  to  the  Woman's  Auxiliary  of  the 
California  Medical  Association  are  formed,  the  names  of 
officers  should  be  forwarded  to  the  state  secretary-treas- 
urer,  Mrs.  R.  A.  Cushman,  632  North  Broadway,  Santa 
Ana,  and  to  the  California  Medical  Association  office 
Room  2004,  450  Sutter  Street,  San  Francisco.  Brief  re- 
ports of  county  auxiliary  meeting's  will  be  welcomed  for 
publication  in  this  column. 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY,  701  Medical  Arts  Building, 

Salt  Lake  City Associate  Editor  for  LTah 


UTAH  NEWS 

Recent  meetings  of  the  Academy  of  Medicine,  held 
Thursday  evenings  on  the  tenth  floor  of  the  Deseret 
Bank  building,  have  been  taken  up  by  the  following 
programs : 

December  19 — Coronary  Occlusion — Clinical  and 
Autopsy.  Dr.  E.  Viko.  Abdominal  Pain  in  Children, 
Doctor  Cheney. 

January  2 — Complications  of  Peptic  Ulcers,  Doctor 
Hatch.  Pregnancy  Complicated  by  Bicornute  Uterus — 
Report  of  Case,  Doctor  Giesy.  Gastroptosis  with 
Spastic  Colitis,  Doctor  Skofield. 

January  9 — Headache,  Doctor  Gordon.  Care  of  the 
Lactating  Breast,  Doctor  Wherritt.  Adenitis,  Doctor 
Sugden. 

* * * 

The  Holy  Cross  Hospital  Clinical  Association  meet- 
ing for  December  was  held  in  the  lecture  room  of 
the  hospital  on  the  evening  of  December  16. 

A short  program  consisting  of  a symposium  and 
case  reports  on  “Double  Uteri’’  was  given  by  Doctors 
T.  W.  Stevenson  and  J.  U.  Giesy.  Doctor  Stevenson’s 
case  was  surgical,  the  condition  being  discovered  at 
operation.  Doctor  Giesy’s  case  was  one  complicated 
by  pregnancy,  with  a dead  fetus  and  death  of  the 
mother  from  shock  after  the  extraction  of  the  child. 

Following  the  scientific  program  the  report  of  the 
treasurer  was  read  and  adopted,  and  officers  were 
elected  for  the  ensuing  year.  Election  resulted  in 
the  choice  of  Doctor  Ossman  for  president  and  Dr. 
Fuller  Bailey  for  secretary-treasurer. 

Meeting  adjourned. 


Steamship  Firms  Cooperating  with  University  of 
California  Tropic  Work. — As  a means  of  aiding  the 
University  of  California  in  diagnosis,  treatment  and 
study  of  tropical  diseases  which  transoceanic  com- 
merce brings  to  America,  ten  Pacific  Coast  steamship 
owners  have  subscribed  to  a Ship  Owners’  Fund  of 
$13,750  which  will  be  turned  over  to  the  University’s 
Institute  of  Tropical  Medicine  at  the  rate  of  $2750  a 
year  for  the  next  five  years. 

An  attempt  is  now  being  made  to  establish  related 
tropical  centers  in  Manila,  Shanghai,  Honolulu,  and 
Guatemala  City.  Donations  have  also  been  made  by 
other  Californians  as  follows:  George  Brommel,  $100 
for  wall  charts  and  lantern  slides;  Dr.  R.  K.  Smith, 
$103.45  for  malaria  moving-picture  film;  Hugo  Menke, 
$65  for  hookworm  moving  picture  film,  and  John 
Cahill,  $50  for  general  expense.- — University  of  Cali- 
fornia Clip  Sheet. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  department  are 
grouped:  News;  Medical  Economics;  Correspondence;  Department  of  Public  Health;  California  Board  of  Medical 
Examiners;  and  Twenty-Five  Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 


NEWS 


Popular  Medical  Lectures. — The  Stanford  Univer- 
sity Medical  School  announces  the  forty-eighth  course 
of  popular  medical  lectures  to  be  given  at  Lane  Hall, 
north  side  of  Sacramento  Street,  near  Webster,  on 
alternate  Friday  evenings  at  8 o’clock  sharp.  All 
interested  are  cordially  invited  to  attend. 

January  10 — Diabetes,  the  Cause  and  Cure,  Dr. 
Horace  Gray. 

January  24 — Some  Sanitary  Sins  of  the  Orient,  Dr. 
Alfred  C.  Reed. 

February  7 — Dental  Caries  as  Viewed  by  the  Bac- 
teriologist, Dr.  T.  D.  Beckwith. 

February  21 — What  Medicine  has  to  Offer  the  Ner- 
vous Patient,  Dr.  Henry  G.  Mehrtens. 

March  7 — Lessons  from  the  Biography  of  Genius, 
Dr.  Lewis  M.  Terman. 

March  21 — Poisonous  Animals,  Dr.  Karl  F.  Meyer. 


A meeting  of  the  San  Francisco  Pathological  Society 

was  held  January  6 at  8 p.  m.  at  the  Southern  Pacific 
Hospital.  Ten-minute  talks  were  on  the  following 
subjects : 

Preliminary  Report  of  Experiments  with  Cortical 
Suprarenal  Extracts  on  Malignant  Tumors,  W.  B. 
Coffey  and  J.  B.  Humber. 

Stenosis  of  Esophagus  (Probably  Congenital)  with 
Carcinoma  Arising  in  the  Dilated  Esophagus,  H. 
Brunn. 

Multiple  Myeloma,  W.  T.  Cummings. 

Two  Spinal  Cord  Tumors,  E.  B.  Towne. 
Adenocarcinoma  Arising  from  Acini  of  Breast, 
A.  R.  Kilgore. 

Ruptured  Dissecting  Aortic  Aneurysm,  A.  A. 
Berger. 

Bone  Cyst,  J.  R.  Rinehart. 

Presentation  of  Specimens,  D.  S.  Pulford. 
Presentation  of  Specimens,  Fred  Proescher. 


The  University  of  Southern  California  announces 
the  following  appointments  in  the  School  of  Medi- 
cine: Dr.  LeRoy  Crummer,  professor  of  the  history 
of  medicine;  and  Doctor  Verne  R.  Mason,  clinical 
professor  of  medicine. 

LeRoy  Crummer,  B.  S.,  M.  D.,  Lift.  D.,  professor 
of  the  history  of  medicine.  B.  S.,  University  of  Michi- 
gan, 1893;  M.  D.,  Northwestern  University  Medical 
School,  1896;  Litt.  D.,  University  of  Michigan,  1929. 
Postgraduate  student  at  Vienna,  Zurich,  and  London. 
Professor  of  medicine,  College  of  Medicine  and  Grad- 
uate School,  University  of  Nebraska,  1919-25;  emeri- 
tus professor  of  medicine,  1925. 

Verne  R.  Mason,  B.  S.,  M.  D.,  clinical  professor  of 
medicine.  B.  S.,  University  of  California,  1911;  M.  D., 
Johns  Hopkins  Medical  School,  1915.  Intern,  assist- 
ant resident  physician,  resident  physician,  Johns  Hop- 
kins Hospital,  1915-21;  assistant  in  medicine,  associate 
in  medicine,  Johns  Hopkins  Medical  School,  1919-21. 


The  Pacific  Coast  Surgical  Association  held  their 
annual  meeting  at  Del  Monte  on  February  7 and  8. 
Clinics  were  held  in  San  Francisco  two  days  previ- 
ously. The  officers  of  the  association  are:  Wallace  I. 
Terry,  M.  D.,  San  Francisco,  president;  and  Edgar  L. 
Gilcreest,  M.  D.,  San  Francisco  secretary. 


Meeting  of  San  Diego  Academy  of  Medicine. — -Dr. 
Allen  Kanavel  of  Chicago  will  give  a course  of  lec- 


tures on  February  17,  18,  and  19  before  the  San  Diego 
Academy  of  Medicine  on  “Infections  of  the  Hand”; 
“Injuries  of  the  Hand”;  and  “Diagnosis  of  Acute 
Surgical  Lesions  of  the  Abdomen.” 


Governor  Young  Appoints  Members  of  the  Cali- 
fornia Board  of  Medical  Examiners. — The  following 

press  dispatch  shows  the  changes  made  by  Governor 
Young  in  the  membership  of  the  California  Board  of 
Medical  Examiners. 

Sacramento,  Jan.  10  (By  United  Press). — Governor 
Young  today  announced  appointment  of  the  follow- 
ing members  to  the  State  Board  of  Medical  Exam- 
iners. They  are: 

Doctors  Harry  V.  Brown,  Glendale,  who  succeeds 
H.  M.  Robertson  of  Santa  Ana,  H.  A.  L.  Ryfkogel, 
succeeding  A.  W.  Morton,  both  of  San  Francisco,  and 
George  L.  Dock,  Pasadena,  who  succeeds  Wilburn 
Smith  of  Los  Angeles. 

Those  reappointed  were:  Doctors  Percy  T.  Phillips, 
Santa  Cruz,  president;  Charles  B.  Pinkham,  San 
Francisco,  secretary  and  executive  officer;  W.  R. 
Molony,  Los  Angeles;  and  J.  L.  Maupin,  Fresno. 


Greatest  American  Achievement  in  Science. — Search 
has  been  started  for  a miracle  worker  in  science — for 
an  American  citizen  whose  study  or  experiment  bears 
the  promise  of  achievement  of  the  greatest  value  to 
the  world. 

To  the  man  or  woman  whose  accomplishment  in 
the  twelve  months  prior  to  June  30,  1930,  meets  this 
test,  it  is  announced,  Popular  Science  Monthly  will 
award  a prize  of  $10,000,  accompanied  by  a gold 
medal.  A similar  award,  the  largest  in  America  for 
scientific  accomplishment,  will  be  made  annually 
thereafter. 

The  award  will  be  bestowed  under  the  auspices  of 
the  Popular  Science  Institute,  a research  organiza- 
tion maintained  by  the  magazine,  of  which  Prof. 
Collins  P.  Bliss,  associate  dean,  New  York  Univer- 
sity, is  director.  The  institute  has  enlisted  the  ser- 
vices of  twenty-four  leaders  in  American  science  to 
serve  as  a Committee  of  Award,  whose  task  it  will  be 
to  select  the  prize-winning  effort. 

The  prize  will  be  conferred  for  the  first  time  in 
September  1930,  and  the  initial  period  of  scientific 
accomplishment  to  be  considered  by  the  Committee 
of  Award  will  be  the  twelve  months  ending  June  30, 
1930.  All  scientific  workers,  professional  and  amateur, 
academic  and  commercial,  are  eligible. 

The  distinguished  men  comprising  the  Committee 
of  Award  are  Dr.  Charles  G.  Abbot,  secretary,  Smith- 
sonian Institution;  Prof.  Collins  P.  Bliss,  director, 
Popular  Science  Institute;  Dr.  Samuel  A.  Brown, 
dean,  New  York  University  and  Bellevue  Hospital 
Medical  College;  Dr.  George  K.  Burgess,  director, 
United  States  Bureau  of  Standards;  Dr.  William  W. 
Campbell,  president,  University  of  California;  Dr. 
Harvey  N.  Davis,  president,  Stevens  Institute  of 
Technology;  Dr.  Arthur  L.  Day,  director,  Geophy- 
sical Laboratory,  Carnegie  Institution;  Dr.  E.  E.  Free, 
consulting  engineer;  Travis  Hoke,  editor,  Popular 
Science  Monthly,  Dr.  Frank  B.  Jewett,  vice-president, 
American  Telephone  and  Telegraph  Company;  Dr. 
Vernon  Kellogg,  permanent  secretary,  National  Re- 
search Council;  Charles  F.  Kettering,  president,  Gen- 
eral Motors  Research  Corporation;  Dr.  Arthur  D. 
Little,  president,  Arthur  D.  Little,  Inc.;  Dr.  John  C. 
Merriam,  president,  Carnegie  Institution;  Dr.  Robert 
A.  Millikan,  chairman,  executive  council,  California 
Institute  of  Technology;  Dr.  Henry  Fairfield  Osborn, 


132 


February,  1930 


MISCELLANY 


133 


president,  American  Museum  of  Natural  History; 
Dr.  Elmer  A.  Sperry,  chairman,  board  of  directors, 
Sperry  Gyroscope  Company;  Dr.  Samuel  W.  Stratton, 
president,  Massachusetts  Institute  of  Technology;  Dr. 
Elihu  Thomson,  director,  Thomson  Laboratory  of 
the  General  Electric  Company,  Lynn  Massachusetts; 
Dr.  Edward  R.  Weidlein,  director,  Mollon  Institute 
of  Industrial  Research;  Henry  Herman  Westing- 
house,  chairman  board  of  directors,  Westinghouse 
Airbrake  Company;  Dr.  Albert  E.  White,  director, 
Department  of  Engineering  Research,  University  of 
Michigan;  Dr.  Willis  R.  Whitney,  director  of  re- 
search, General  Electric  Company,  Schenectady,  New 
York;  and  Orville  Wright,  co-inventor  of  the  airplane. 


Iodin  Research  Program. — Since  January  1,  1928, 
Mellon  Institute  of  Industrial  Research,  Pittsburgh, 
Pennsylvania,  has  had  in  operation  a Multiple  Indus- 
trial Fellowship  founded  for  the  purpose  of  investigat- 
ing the  properties  and  uses  of  iodin.  This  fellowship, 
which  is  sustained  by  the  Iodin  Educational  Bureau, 
64  Water  Street,  New  York,  N.  Y.,  is  headed  by 
Dr.  George  M.  Karns,  formerly  a member  of  the 
chemical  faculty  of  the  University  of  Illinois.  All  re- 
sults of  the  fellowship  studies  will  be  published. 

Recently,  through  an  additional  appropriation  from 
the  Fellowship  donor,  Mellon  Institute,  acting  for 
the  Iodin  Fellowship,  has  made  arrangements  for  the 
study  of  certain  iodin  problems  in  other  institutions 
that  have  special  facilities  for  such  types  of  work. 
On  October  7,  1929,  a scholarship  was  founded  at  the 
Philadelphia  College  of  Pharmacy  and  Science  by  a 
research  grant  from  the  institute.  This  scholarship— 
which,  for  the  college  year  1929-30,  will  be  held  by 
Mr.  L.  F.  Tice — will  have  for  its  aim  a broad  investi- 
gation of  vehicles  and  solvents  for  iodin,  especially 
for  external  use  in  medicine.  A large  number  of  new 
organic  chemicals  will  be  studied  as  solvents  with  the 
object  of  evolving,  if  possible,  a more  satisfactory 
preparation  than  the  alcoholic  tincture  now  in  use. 
The  research,  for  which  a definite  program  has  been 
laid  down,  will  be  supervised  by  Prof.  Charles  H. 
LaWall  with  the  advisory  collaboration  of  other 
faculty  members  of  the  Philadelphia  College  of  Phar- 
macy and  Science  and  with  the  direct  cooperation  of 
Doctor  Karns.  The  investigational  findings  of  the 
scholarship  will  be  reported  in  the  literature. 

Another  phase  of  the  research  program  includes  a 
grant  made  on  September  26,  1929,  to  the  Pennsyl- 
vania State  College  for  a comprehensive  investiga- 
tion—under  the  direction  of  Prof.  E.  B.  Forbes  of  the 
Institute  of  Animal  Nutrition — of  the  nutritional  place 
and  value  of  iodin  in  the  feeding  of  live  stock.  De- 
spite the  large  amount  of  work  which  has  been  done 
on  the  role  of  iodin  in  metabolism,  especially  with 
reference  to  the  thyroid,  very  little  is  known  regard- 
ing the  specific  dietetic  aspects  of  this  element,  par- 
ticularly in  the  lower  animals.  Doctor  Karns  and  his 
coworkers  on  the  Iodin  Fellowship  of  Mellon  Insti- 
tute are  cooperating  closely  with  Doctor  Forbes  and 
his  staff,  mainly  by  preparing  standardized  feeds.  The 
findings  of  this  research  also  will  be  made  available 
to  the  public, ; in  accordance  with  the  Iodin  Educa- 
tional Bureau  s policy  of  disseminating  to  everyone 
interested  the  results  of  all  investigations  made  under 
its  aegis. 

Mellon  Institute  is  giving  consideration  to  the 
founding  of  a research  scholarship  in  a medical  school 
for  the  purpose  of  aiding  in  the  solution  of  incom- 
pletely answered  questions  respecting  the  utility  of 
iodin  in  internal . medicine.  A number  of  pharma- 
cologists are  aiding  the  institute  in  determining  a 
program  for  such  pharmacodynamic  inquiry. 


University  of  Southern  California  Appointment. — 

The  University  of  Southern  California  announces  the 
following  appointment  in  the  School  of  Medicine- 
Robert  W.  Lamson,  B.  S.,  A.  M„  Ph.  D.,  M.  D.,  as- 
sociate professor  of  bacteriology  and  immunology. 
Doctor  Lamson  has  been  in  charge  of  the  allergy 
clinic,  Los  Angeles  County  General  Hospital,  Unit 
No.  1,  since  1928. 


MEDICAL  ECONOMICS 


Hospital  Costs.— The  following  article  is  taken  from 
the  San  Francisco  Examiner  of  January  20,  1930: 

“The  ‘other  side’  of  the  hospital  expense  question 
was  stressed  yesterday  by  Dr.  Howard  H.  Johnson, 
medical  superintendent  of  St.  Luke’s  Hospital,  who 
takes  issue  with  a statement  of  Dr.  Will  Mayo  that 
patients  in  general  are  paying  too  much.  Doctor 
Mayo’s  charge,  presented  before  the  meeting  of  the 
American  College  of  Surgeons,  stimulated  nation- 
wide comment. 

“Declaring  the  average  bill  per  patient  in  the  typi- 
cal general  hospital  is  reasonable,  Doctor  Johnson 
points  to  a study  of  one  hundred  bills  in  one  hundred 
such  institutions  appearing  in  the  current  issue  of  the 
Modern  Hospital.  The  average  bill,  he  emphasizes,  is 
shown  to  be  ‘less  than  what  the  average  patient  of 
moderate  means  spends  for  many  of  the  luxuries  that 
are  so  common  today,  yet  no  criticism  is  raised  as  to 
their  cost.’ 

“ ‘In  the  one  hundred  hospitals  studied,’  Doctor 
Johnson  quotes,  ‘the  average  bill  for  the  first  ten 
thousand  full-pay  patients  during  the  present  fiscal 
year  was  $71.99,  the  average  duration  of  stay  per 
patient  in  fifty-two  of  these  hospitals  was  11.04  days, 
the  average  bed  capacity  of  the  hospitals  186, , and 
their  total  bed  capacity  18,586.’ 

“Hospitals  in  thirty-three  states  are  embraced  in 
the  surgery,  including  four  in  California.  Room, 
board  and  treatment  (hospital  care)  are  responsible 
for  the  largest  share  of  the  bill,  roughly  70  per  cent. 
Use  of  the  operating  room  or  delivery  room  is  the 
next  important  item,  being  from  5 to  10  per  cent  of 
the  total. 

“That  hospital  privacy  is  costly  is  one  of  the  con- 
clusions drawn  from  the  study.  ‘It  is  perhaps  true 
that  if  general  hospitals  were  not  expected  to  provide 
comfortable  and  well  furnished  private  rooms  it 
would  be  possible  for  them  to  operate  at  a lower 
current  cost  and  consequently  reduce  their  charges. 
But  comfort  and  privacy  in  the  hospital  are  popular 
demands.’  Patients  throughout  are  getting  value  re- 
ceived, in  the  unanimous  opinion  of  the  institutions 
contributing  to  the  survey.” 


The  Physician’s  Income  Tax. — In  the  January  issue 
of  California  and  Western  Medicine,  page  67,  was 
printed  an  article  under  this  caption.  Attention  is  now 
called  to  an  article  in  the  Journal  of  the  American 
Medical  Association  of  date  of  January  11,  1930,  page 
128,  in  which  is  given  the  information  as  printed  in  the 
January  issue  of  California  and  Western  Medicine, 
plus  new  rulings  which  have  come  into  play  since 
1929.  The  article  referred  to  in  the  January  11,  1930 
Journal  A.  M.  A.  should  be  a very  handy  reference 
for  physicians,  whether  they  make  out  their  own 
reports  or  have  an  auditor  or  accountant  do  so. 


An  Example  Which  Explains  Much  Concerning 
“The  Cost  of  Medical  Care.” — The  following  item 
was  taken  from  the  Los  Angeles  Evening  Express  of 
January  21,  1930.  It  is  a reading  notice,  to  which 
space  was  probably  given  as  a return  courtesy  for 
an  advertisement  sent  in  by  the  particular  radio  firm. 
From  the  “Two  Autos  for  Every  Family”  advertis- 
ing slogan,  we  now  shall  possibly  witness  “A  Radio 
Extension  in  Every  Room”  slogan  repeatedly  played 
up  in  the  newspapers. 

Little  wonder,  when  illness  comes,  that  thousands 
of  lay  citizens  lack  the  financial  means  to  pay  for  the 
services  rendered  by  hospitals  and  doctors! 

The  item  referred  to  above,  reads  as  follows: 

RADIO  IN  EVERY  ROOM  PREDICTED 

“In  1910  the  person  who  owned  one  automobile 
marked  himself  from  the  crowd  as  being  a man  of 
prosperity.  Today  there  are  more  than  twenty-two 
million  passenger  cars  in  this  country  and  many  fami- 
lies have  two  or  sometimes  three  cars. 

“In  spite  of  the  youth  of  the  radio  industry,  a simi- 
lar situation  is  slowly  but  surely  coming  about. 


134 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


“It  will  probably  be  quite  a number  of  years  before 
every  room  in  a house  will  be  equipped  with  radio, 
but  many  homes  have  two  receivers.  Others,  while 
they  do  not  have  more  than  one  receiver,  do  have 
one  or  more  extra  loudspeakers  connected  with  their 
set. 

“The  Company  has  made  provision  for  these 

extra  loudspeakers  not  only  in  connection  with  its 
table  model  receivers,  but  even  in  conjunction  with 
its  console  models  employing  built-in  reproducers. 
This  unusual  provision  has  opened  a field  of  wider 
usefulness  for  the  radio  receiver.  One  can  now  get 
radio  reception  any  place  in  the  house  desired,  and 
does  not  need  to  be  confined  to  the  immediate  vicinity 
of  the  set.” 


Letter  in  Correspondence  Column. — Dr.  J.  M.  Neil 
of  Oakland  has  sent  a letter  to  the  Council,  which  is 
printed  in  the  Correspondence  column  of  this  issue. 
Doctor  Neil’s  discussion  of  some  economic  problems 
should  be  of  interest  to  members  of  the  California 
Medical  Association. 


CORRESPONDENCE  * 


Subject  of  Following  Letter:  Economic  Interests 
. of  the  Medical  Profession 

Oakland,  California, 
December  16,  1929. 

The  Editors, 

California  and  Western  Medicine: 

It  is  gratifying  to  see  that  the  California  Medical 
Association  is  coming  to  a discussion  of  the  economic 
problems  of  its  members.  For  too  many  years  we 
have  made  this  vital  phase  of  medical  life  taboo. 
Undoubtedly  the  bulk  of  the  profession  much  prefers 
to  look  only  at  the  humanitarian  side  of  practice,  but 
unfortunately,  or  fortunately,  very  few  are  financially 
able  to  be  philanthropists.  It  is  common  sense  then 
that  we  should  have  a commercial  as  well  as  a scien- 
tific organization,  and  this  is  a far  cry  from  com- 
mercialization of  medicine. 

We  are  all  cognizant  of  the  dissatisfaction  that 
exists  among  the  laity  with  present-day  medical  costs, 
at  the  same  time  we  know  that  a large  part  of  this 
unrest  results  from  faulty  education.  For  the  past 
few  years  numerous  articles  have  appeared  in  lay 
magazines  and  newspapers  setting  forth  the  excessive 
costs  of  medical  care.  Any  newspaper,  usually  with- 
out any  consideration  of  the  facts,  feels  free  to  tell 
its  readers  that  the  cost  is  excessive  and  that  good 
medicine  is  beyond  the  pocketbook  of  the  average 
wage-earner.  This  little  formula  has  been  so  well  sold 
to  the  public  that  most  any  patient  will  tell  you  that 
only  two  classes  of  society  obtain  first-class  medical 
care:  the  very  poor  and  the  very  rich.  We  who  con- 
stitute the  rank  and  file  of  the  profession  know  that 
this  criticism  is  unjust. 

The  same  newspaper  that  promulgates  these  dog- 
mas does  not  hesitate  for  one  moment  to  tell  that 
same  wage-earner  in  large  advertisements  and  accom- 
panying news  articles  that  radios  are  good  values 
from  $100  to  $500;  nor  does  it  hesitate  to  point  out 
that  the  set  of  last  year  is  obsolete  and  should  be 
traded  in  at  one-twentieth  of  its  previous  sale  price. 
How  many  physicians  have  ever  seen  any  effort  on 
the  part  of  our  sources  of  general  information  to  give 
the  public  any  idea  of  the  monetary  value  of  medical 
service;  almost  without  exception  such  articles  as 
appear  are  generalizations,  and  these  decry  the 
mounting  costs  of  present-day  medicine.  There  is  no 
fair  comparison,  say,  between  the  cost  of  an  up-to- 
date  radio  at  $300  and  a major  operation  that  saves 
a patient’s  life;  nor  is  any  effort  made  to  point  out 
the  economic  value  of  good  health.  One  of  the  short- 
comings of  medical  statistics  is  that  it  keeps  no  mor- 

*  California  and  Western  Medicine  in  printing-  letters  in 
the  Correspondence  column  does  so  without  committing 
the  California  Medical  Association  or  the  journal  to  any 
issues  that  are  discussed,  and  prints  such  communica- 
tions without  prejudice. 


bidity  tables.  Most  any  text  on  medicine  gives  in 
detail  the  mortality  rates  of  any  specific  disease,  but 
one  looks  in  vain  for  any  idea  of  the  percentage  of 
cripples  that  follow  in  its  wake.  It  is  easy  to  under- 
stand this  situation  because  the  physician’s  prime 
motive  is  to  preserve  life,  and  this  has  focused  our 
attention  on  death.  From  an  economic  standpoint, 
the  person  who  has  ceased  to  exist  is  no  longer  an 
economic  entity;  but  the  cripple  with  50  per  cent  effi- 
ciency is  a vital  factor  in  the  human  machine.  It  has 
been  our  shortcoming  in  the  past  that  we  have  failed 
to  stress  such  considerations.  We  have  not  made  the 
public  health-conscious,  and  in  failing  to  do  so  we 
are  faced  in  1930  with  a public  having  only  a mone- 
tary standard  of  values  and  no  corresponding  valua- 
tions for  medical  services. 

Nor  is  the  public  alone  in  this  matter  for,  because 
of  a scale  of  prices  graduated  to  the  patient’s  finan- 
cial ability,  each  patient  becomes  for  the  physician  an 
economic  as  well  as  a medical  problem.  But  where 
is  the  physician  to  turn  for  information  that  will  help 
him  determine  the  real  value  of  his  services  to  his 
patient.  How  is  he  to  know,  except  by  chance  con- 
versation with  other  physicians,  what  moral  support 
he  can  reasonably  expect  from  the  profession  as  a 
whole  of  any  fee  he  may  ask.  Truly  this  is  a peculiar 
state  of  affairs:  under  the  code  of  ethics  we.  are  ex- 
pected to  be  gentlemanly  rivals  of  our  brother  prac- 
titioners, we  are  asked  to  conduct  ourselves  that  we 
cast  no  reflection  on  the  previous  physician  the  pa- 
tient employed,  but  as  to  the  largest  factor  that  the 
American  public  uses  to  gauge  the  value  of  anything, 
the  factor  of  cost  in  dollars  and  cents,  our  present 
organization  leaves  us  in  a quandary.  The  impor- 
tance of  this  lack  of  coordination  in  medical  eco- 
nomics cannot  be  overestimated  in  the  production  of 
jealousy  within  the  ranks  of  the  profession;  nor  can 
the  importance  of  the  concomitant  failure  on  the  part 
of  the  profession  to  present  a solid  front  to  the  public 
at  large  be  overlooked  in  any  analysis  of  the  present 
urge  for  socialized  medicine.  Our  inability  to  definitely 
answer  for  the  individual  the  question  of  the  worth 
of  any  medical  service  immediately  puts  us  in  an 
arbitrary  position,  the  universal  psychological  re- 
sponse to  which  is  antagonism.  If  we  try  to  justify 
our  position  by  explaining  to  the  patient  that  such  is 
the  common  practice,  we  get  only  pity  for  ourselves 
and  a transference  of  the  antagonism  to  the  pro- 
fession as  a whole. 

The  present  industrial  accident  situation  is  also 
making  for  unrest  among  the  public.  The  fee  the 
physician  receives  for  this  class  of  work  is  rapidly 
becoming  a basis  for  comparison,  and  because  it  is 
a concrete  monetary  standard  (again  the  dollars  and 
cents!)  patients  in  private  practice  are  asking  and 
those  not  asking  are  wondering,  why  it  is  a doctor 
can  have  one  set  of  charges  for  individuals  and  an- 
other for  a corporation.  Initially  those  not  doing  this 
class  of  work  felt  they  could  ignore  the  situation,  but 
we  find  only  too  soon  that  we  cannot  ignore  any 
practice  that  puts  us  on  an  economically  competitive 
basis  with  other  licensed  men.  It  is  a factor  making 
for  centralized  control  of  medicine,  and  soon  we 
will  recognize  it  as  such.  The  answer  that  the  phy- 
sician is  at  liberty  to  show  that  his  services  are  worth 
more  than  the  scale,  anticipates  that  he  cannot  afford 
the  time  or  the  money  to  prove  his  point;  but  even 
if  he  did  it  would  not  remove  the  existing  psychology. 

Other  factors  are  rapidly  preparing  the  public  for 
lay  control  of  medicine.  Anyone  reading  the  adver- 
tisements of  the  large  insurance  companies;  anyone 
listening  to  the  arguments  of  the  insurance  agents  in 
behalf  of  health  insurance;  anyone  thinking  about  the 
possibilities  and  the  basic  psychology  of  the  periodic 
health  examinations  by  insurance  companies  cannot 
but  be  struck  with  the  underlying  program.  The 
public  is  gradually  being  taught  to  look  to  these  or- 
ganizations in  health  matters,  and  whether  or  no 
there  is  an  ultimate  intention  on  the  part  of  these 
agencies  to  take  over  the  control  of  medicine  is  beside 
the  point  that  public  support  is  being  weaned  away 
from  the  medical  profession.  In  theory  it  is  all  right 


February,  1930 


MISCELLANY 


135 


for  us  to  maintain  that  we  are  not  interested  in  mate- 
rial tilings;  but  as  a matter  of  self-preservation  we 
must  be  interested  in  power,  and  in  1929  power  is 
represented  by  wealth.  It  is  folly  for  us  to  even  at- 
tempt to  maintain  that  we  can  make  scientific  prog- 
ress; each  case  offers  its  own  peculiar  problem  and 
its  own  opportunity  for  generalization. 

In  the  December  issue  of  California  and  Western 
Medicine  is  an  article  on  the  achievements  of  the 
Rockefeller  Institute,  all  made  possible  only  because 
of  the  wealth  of  that  agency.  If  medicine  is  to  give 
to  coming  generations  all  that  it  is  possible  for  medi- 
cine to  give,  then  it  must  remain  in  the  hands  of  the 
medical  men,  and  not  become  the  tool  of  some  private 
group.  Medicine  stands  today  alone  as  the  one  re- 
maining vestige  of  a government  built  on  individual 
effort  and  ideals,  but  economic  coordination  is  vital 
if  we  are  to  maintain  control  of  our  heritage.  Each 
and  every  time  we  have  conceded  to  some  political 
group  functions  that  the  individual  at  one  time  carried 
out,  just  so  often  has  medicine  lost  and  the  politicians 
been  presented  with  another  source  of  patronage. 
Each  year  the  sphere  of  the  private  doctor  becomes 
smaller,  not  because  our  usefulness  for  scientific  ap- 
plication is  less,  for  we  have  more  to  offer  now  than 
ever  before,  but  because  our  economic  control  of  our 
charity  puts  the  private  doctor  in  the  untenable  posi- 
tion of  being  in  competition  with  charitable  institu- 
tions, with  an  ever  increasing  general  educational  pro- 
gram that  justifies  the  patient  in  seeking  free  medical 
care. 

This  is  not  a criticism  of  our  social  service  agen- 
cies, but  it  is  a realization  of  our  lack  of  appreciation 
of  the  public  psychology.  If  there  were  only  one 
method  of  entrance  of  patients  into  such  institutions, 
that  of  recommendation  of  the  patient’s  own  phy- 
sician, we  would  create  in  the  public  a moral  obliga- 
tion to  the  professions  and  not  a political  organization 
for  some  political  climber  who  is  willing  to  sell  not 
alone  his  integrity  but  our  charitable  impulse  to  fur- 
ther his  ambitions.  I am  sure  that  the  statement  may 
be  safely  made  that  the  man  practicing  under  the 
present  system  who  has  not  had  public  institutions 
take  away  patients  who  are  able  to  meet  their  obliga- 
tions were  they  willing  to  sacrifice  the  radio  or  some 
other  nonessential  is  the  exception;  and  the  man  who 
has  not  had  other  patients  much  better  fixed  finan- 
cially,. receive  care  because  of  political  pull  has  not 
been  in  practice  very  long. 

Socialized  medicine  may  come,  and  if  it  does  come 
it  will  be  because  we  have  refused  to  effect  an 
economic  organization.  If  it  comes  under  present 
existing  political  conditions  it  will  be  a failure,  as 
it  has  been  elsewhere,  because  no  socialized  system 
can  function  side  by  side  with  an  economic  system 
founded  on  the  predatory  instinct.  Medicine  faces  a 
crisis,,  but  in  that  crisis  is  opportunity,  opportunity  for 
socialization  of  medicine  within  itself,  opportunity 
for  service  not  alone  to  the  human,  but  opportunity 
for  service  to  the  body  politic.  Any  program  to  fore- 
stall political  control  of  medicine  must  be  grounded 
on  an  economic  basis,  must  put  back  into  the  hands 
of  the  men  most  vitally  interested  in  medicine  the 
control  of  medicine,  must  be  thoroughly  socialized 
within  itself,  with  safeguards  to  guarantee  pro- 
fessional and  economic  independence. 

Yours  truly, 

J.  M.  Neil,  M.  D. 


Subject  of  Following  Letter:  Federal  Laws  Regarding 
Pilot  Licenses  in  Aeronautics 

Department  of  Commerce 
Aeronautics  Branch 
Washington 

December  21,  1929. 

The  Editors, 

California  and  Western  Medicine: 

The  attached  resolutions  were  passed  by  the  Ameri- 
can Medical  Association  at  its  stated  assembly  held 
at  Portland,  Oregon,  in  July,  1929.  It  is  believed  that 
these  resolutions  are  of  sufficient  interest,  in  view  of 


the  rapidly  increasing  number  of  physicians  desig- 
nated as  medical  examiners,  to  warrant  publication  in 
your  journal. 

You  may  be  interested  to  know  that  all  applicants 
for  federal  pilot  licenses,  either  for  flying  or  for  train- 
ing as  pilots,  must  pass  physical  examinations  before 
physicians  designated  by  the  Secretary  of  Commerce. 
They  must  likewise  be  reexamined  periodically. 
These  examinations  cover  a rather  detailed  exami- 
nation of  the  eyes,  a brief  examination  of  the  ears, 
nose  and  throat,  equilibrium,  a general  physical  ex- 
amination, and  a detailed  examination  of  the  nervous 
system.  There  are  now  about  seven  hundred  and  fifty 
medical  examiners  so  designated  throughout  the  coun- 
try. All  these  examinations  are  reviewed  in  Wash- 
ington, where  the  applicant  is  finally  certified  as 
qualified  or  disqualified  for  the  grade  for  which  he 
has  applied.  Very  truly  yours, 

L.  H.  Bauer,  M.  D. 

Medical  Director. 

* * * 

Whereas,  The  Aeronautics  Branch,  Department  of 
Commerce,  has  organized  a medical  service  for  the 
physical  examinations  of  civil  pilots  and  prospective 
pilots,  in  the  interests  of  safety;  and 

Whereas,  The  physical  standards  adopted  are  in 
keeping  with  those  adopted  universally,  and  have  re- 
duced aircraft  accidents  from  physical  causes  to  a 
minimum;  and 

Whereas,  The  department  has  required  these  ex- 
aminations to  be  made  only  by  designated  physicians 
in  the  interest  of  uniformity  and  control  and  in  ac- 
cordance with  the  custom  adopted  for  the  Army  and 
Navy  and  in  other  countries;  and 

Whereas,  The  selection  of  examining  physicians  by 
the  department  has  been  based  on  training  as  flight 
surgeons  or  its  equivalent,  or  on  group  examinations 
by  specialists,  a high  standard  of  examination  has 
resulted;  and 

Whereas,  The  department  requires  that  all  ex- 
aminers hold  the  degree  of  Doctor  of  Medicine,  be 
licensed  to  practice  medicine  under  the  laws  of  their 
respective  states,  'and  further  requires  that  the  ap- 
pointees be  recognized  as  ethical  practitioners  in  their 
respective  localities,  thereby  supporting  the  high 
standards  advocated  by  this  association,  be  it 

Resolved,  That  the  American  Medical  Association 
at  its  stated  assembly  in  1929  endorses  the  medical 
work  of  the  Department  of  Commerce,  its  methods 
of  physical  examination  and  its  method  of  selection 
of  medical  examiners,  and  urges  that  the  same  high 
standards  be  continued  and  offers  the  support  of  the 
American  Medical  Association  in  furthering  the  spe- 
cialty of  aviation  medicine;  and  be  it  further 

Resolved,  That  a copy  of  this  resolution  be  sent 
to  the  President  of  the  United  States,  the  Secretary 
of  Commerce,  and  the  secretary  of  each  state  medical 
society.  


DESCARTES  WAS  RIGHT* 


By  Harry  M.  Hall,  M.  D. 

Wheeling,  W.  Fa. 

If  ever  the  human  race  is  raised  to  its  highest  practi- 
cable level  intellectually , morally  and  physically,  the 
science  of  medicine  nvill  perform  that  service. — Rene 
Descartes. 

Rene  Descartes,  the  French  philosopher,  was  born 
in  1596  and  died  in  1650.  Copernicus,  Vesalius,  and 
Chamberlen,  the  discoverer  of  obstetrical  forceps, 
flourished  about  the  same  period.  The  great  names  of 
that  era  were  a brilliant  galaxy,  destined  for  deathless 
fame,  but  it  is  doubtful  if  Descartes  looked  out  on 
an  impressive  medical  profession.  It  is  quite  impossi- 

* This  is  a paper  which  was  read  at  the  annual  con- 
ference of  secretaries  and  editors  of  constituent  state 
medical  associations  held  at  Chicago,  November  15-16, 
1929,  and  printed  in  the  American  Medical  Association 
Bulletin. 


136 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


ble  to  get  at  the  animadversions  of  the  modern  medi- 
cal mind  without  awarding  a hasty  glance  at  the  past. 
Medicine  certainly  had  moments  in  its  other  days 
reeking  with  sordid  discouragement,  shocking  oppres- 
sion and  insistent  persecution.  But  like  the  Jewish 
race  and  its  Bible,  it  managed  in  some  way  or  other — 
milling,  struggling,  suffering,  triumphing,  bleeding, 
pleading  and  dying  often  in  martyrdom — to  continu- 
ously develop  the  foundation  on  which  it  rests  today. 
Its  practitioners  had  to  face  vulgar,  unspeakable 
quackery;  absurd  antics  of  sinister  nondescripts; 
death  for  asserting  the  truth;  crassness;  idolatry; 
charms;  amulets;  absurd  superstitions.  If  they  suc- 
ceeded, little  reward  followed;  if  they  failed,  torture 
and  death.  They  pursued  their  profession,  forced  to 
mingle  with  toothless  hags,  itinerant  barbers,  with- 
ered soothsayers  and  vehement  fakers.  Had  they  a 
passion  for  anatomy,  they  must  work  in  a cellar,  fear- 
ful of  detection.  Had  they  a love  for  the  truth  and 
were  men  of  distinction,  they  must  needs  face  their 
king — and  the  axe  and  the  block  was  the  reward  for 
defending  the  fact  that  the  heart  beat  and  the  blood 
circulated.  What  courageous  men  they  were!  What 
a fine  faith!  It  should  be  enough  to  make  us  ashamed 
of  our  timorous  actions,  our  wavering  ideals.  We 
look  back  casually  and  commiserate  with  them.  Ah, 
it  is  here  we  make  our  mistake.  Allow  for  relativity 
in  time  and  place,  natural  improvement  of  all  civiliza- 
tion, the  intervening  years,  discoveries,  inventions  and 
the  like,  and  it  is  rather  doubtful  that  we  have  any 
room  for  commiseration. 

To  take  the  fearful  healer  of  the  day  of  Descartes 
and  compare  him  with  the  opulent  doctor  of  today 
riding  in  his  automobile  to  a magnificent  hospital 
seems  not  only  rather  grotesque  but  absurd.  Meas- 
ured in  terms  of  comfort,  standardized  living  and  ease 
of  carrying  on  the  medical  artfulness,  it  may  be 
ridiculous.  Man  does  not  live  by  bread  alone  and,  as 
we  shall  see,  other  trials  no  less  disturbing  hover  over 
the  modern  doctor.  These  very  comforts  might  be 
said  to  be  the  potions  that  fill  the  physician  of  1930 
with  a sense  of  security  he  does  not  possess.  In  1650 
he  well  knew  the  trials  of  the  hour.  When  it  comes 
to  certain  problems  that  serve  to  perplex  the  medical 
practitioner  of  today,  concerning  his  status  among 
his  fellow  men,  making  of  him  either  an  individual 
or  a member  of  a herd;  endowing  him  with  a certain 
self-respect  or  else  assigning  him  as  a mere  cog  in 
a great  paternalism,  describing  him  as  a man  or  some- 
thing akin  to  an  industrial  parasite,  it  is  hard  to 
believe  that  we  are,  just  now,  allowing  for  natural 
progress,  any  better  off  than  we  were  then.  The  great 
determining  factor  then  was  to  keep  one’s  head  on 
one’s  shoulders.  Today  it  is  to  keep  one’s  individual- 
ity and  self-respect  together.  One  is  just  as  priceless 
as  the  other.  That  is  why  the  Boston  Tea  Party  was 
organized  and,  as  I take  it,  why  we  are  here  today 
discussing  this  subject  in  the  manner  we  are.  We  are 
not  here  for  idle  criticism  nor  for  captious  carping. 
We  are  here  to  face  the  facts. 

If  we  speak  the  truth  here,  censure  concomitantly 
will  follow,  but  it  will  be  as  nothing  compared  to  the 
realization  that  we  have  these  adversities  with  us  to 
write  about  at  all.  The  path  of  the  essayist  who 
would  attempt  to  find  the  real  causes  of  medical  un- 
rest is  not  an  easy  one.  Perhaps  he  may  be  accused 
of  bitterness;  perhaps  he  may  wound  his  friends;  per- 
haps he  may  seem  almost  to  bite  the  hand  that  has 
befriended  him.  That,  I think,  is  why  so  little  real 
progress  has  been  made.  Reluctance  and  distaste, 
some  fear  and  not  a little  terror  seize  a writer  as  he 
meets  in  the  beginning  so  much  that  is  forbidding. 
The  only  comfort  one  can  gather  is  to  include  him- 
self at  once  in  all  the  delinquencies  as  one  who  has 
been  laggard  with  the  rest. 

Every  editor  and  secretary  here  has  doubtless  ex- 
perienced these  sorrows  as  he  has  done  his  best  to 
herald  the  clouds  that  appear  to  him  as  darkening  the 
horizon  of  medicine.  He  has  recoiled  too  with  some 
distress  and  quite  a little  discouragement  as  he  has 
seen  the  continuous  and  deliberate  disregard  with 


which  it  was  all  met.  Let  him  recall  that  there  are 
people  filled  with  want  and  distress  who  spend  their 
last  dollar  at  the  movies  in  the  attempt  to  have  their 
minds  distracted  from  the  misery  at  hand.  They  all 
have  hopes  that  on  the  mo-row  a job  will  appear. 
Just  so  there  are  many  doctors  running  hither  and 
thither  up  and  down  the  country  attending  medical 
conventions,  where  they  listen  to  well-spun  theories 
as  to  how  the  gall  bladder  is  infected,  who  do  so  to 
escape  the  grave  economic  and  social  problems  which 
beset  their  professional  lives  at  home  and  which  have 
become  so  intolerable  that  they  must  seek  surcease 
elsewhere  in  the  vain  hope  they  will  hear  unexpectedly 
some  panacea  for  their  woes.  To  their  surprise  every 
subject  and  every  disease  is  touched  on  save  this  one, 
which  is  by  far  more  important  in  this  day  and  hour 
than  all  else.  To  most  of  us,  trained  in  scientific 
methods  as  we  are,  revivalistic  methods  are  abhor- 
rent. Yet  we  would  that  out  of  all  of  our  glossy  self- 
confidence  and  hardened  technical  perfection,  a figure 
with  the  great  voice  of  a Napoleon,  the  compassion 
of  a Lincoln,  and  the  gentle  persuasiveness  of  Jesus 
Christ  might  appear  to  lead  us  out  of  our  lethargy — 
our  supreme  illusion  that  “all  is  well.” 

THE  JAZZ  AGE 

What  is  the  cause,  if  any,  of  this  calloused  indiffer- 
ence on  the  part  of  so  many  medical  men?  Today 
throughout  the  country  there  is  a situation  which,  for 
want  of  a better  name,  I shall  call  a syndrome.  Some 
of  its  characteristics  are  a waning  faith  in  religion 
with  nothing  apparent  to  take  its  place;  synthetic 
friendliness  by  way  of  service  clubs;  cynical  disbelief 
in  ideals  as  a form  of  flabby  idolatry;  substitution  of 
planes  and  cylindroids  for  beauty;  a gradual  elimina- 
tion of  the  older  idea  of  the  American  home;  transla- 
tion of  the  former  conception  of  love  into  frank  terms 
of  animal  passion;  complete  breakdown  of  the  ancient 
beliefs  as  to  marriage  and  making  it  probationary  by 
way  of  the  divorce  court;  a denial  that  there  is  much 
in  human  relationship  that  is  permanent,  and  that 
therefore  personal  contact  is  more  or  less  a matter 
of  transient  importance;  living  from  day  to  day,  for- 
getting yesterday  and  thinking  not  at  all  of  tomorrow 
until  it  comes;  seizing  on  what  is  offered  with  little 
or  no  examination  of  the  probable  insidious  sources 
from  whence  it  comes.  Synchronized  sensation  is  re- 
garded as  more  important  than  a sense  of  respon- 
sibility. Finally,  this  is  a mechanized  age,  and  as 
machines  have  no  conscience  there  is  no  particular 
necessity  for  those  who  operate  them  to  have  any 
either.  All  this  is  assembled,  so  to  speak,  thrown 
together  and  referred  to  as  the  “Jazz  Age.”  Into  this 
scene  is  thrown  the  modern  doctor.  We  might  para- 
phrase here,  the  old  oft-quoted  lines  of  Pope. 

Jazz  is  a figure  of  so  repellant  a mien, 

As  oft  to  be  ignored;  needs  but  to  be  seen. 

But  seen  too  oft,  familiar  with  her  face, 

We  first  pity;  then  endure;  then  embrace. 

Nearly  every  tradition  of  the  physician  is  opposed 
to  the  syndrome  of  which  I have  spoken.  He  is  by 
nature  and  education  set  against  the  credo  of  the 
senses.  His  calling  directly  involves  ideals,  faith,  hope 
and  responsibility.  He  has  carried  on  a certain  belief 
of  Hippocrates,  who  antedated  Christ  and  whose  oath 
slipped  by  the  low  estate  of  doctors  in  the  days  of 
Descartes  and  has  come  down  more  or  less  tri- 
umphant until  yesterday  serving  physicians  as  their 
rules  of  ethical  conduct.  The  profession  of  medicine 
by  means  of  its  ethics,  imperfect  and  openly  violated 
as  they  are,  has  built  up  a science  and  art  as  orderly 
as  the  progressive  and  complete  one  of  nature  in 
causing  the  chromasomes  to  flower  into  a human 
being.  Suddenly,  the  syndrome  appears,  making  its 
impress  on  all  contemporary  life.  Old  rules  no  longer 
hold  in  many  things.  The  staid  medical  man  finds 
life  about  him  jumping  over  the  stroma  like  a lot 
of  cancerous  cells,  and  development  and  progress  a 
matter  of  carcinomatous  revelry.  The  portraits  of  a 
Rembrandt  are  replaced  by  silly  daubs  that  resembled 


February,  1930 


MISCELLANY 


137 


those  you  made  on  scratch  books  at  school.  Music 
of  the  immortals  is  transposed  into  nonsensical  theme 
songs  that  savor  of  idiocy. 

What  has  the  medical  man  to  do  with  a Jazz  Age? 
He  cannot  ignore  it  any  more  than  the  doctor  of  1650 
could  shut  the  door  in  the  face  of  a royal  order.  Some 
there  are  who  will  hide  in  the  cellar  or  die  before 
they  acknowledge  its  presence.  But  for  most  of  us, 
there  it  is.  To  many,  the  Jazz  Age  applies  to  a wild 
dancing,  singing,  night  club  existence.  The  syndrome 
I have  related  has  no  such  connection.  It  applies  to 
the  life  we  all  are  living.  So  the  syndrome  has  worked 
its  way  into  the  conduct  of  many  a medical  man,  to 
the  end  that  it  has  quite  upset  his  outlook. 

The  best  example  I can  give  is  that  of  the  brilliant 
and  well  educated  opportunist  who  has  multiplied 
many  times  in  our  midst  the  last  few  years.  A quick 
survey  of  him  is  as  follows.  He  says  he  must  take 
any  good  contract  if  offered,  regardless.  He  will  affili- 
ate with  the  schemes  of  a merchant  prince  if  it  gives 
him  a little  brief  authority  and,  if  necessary,  give  the 
kiss  of  Judas  to  his  profession.  Flippantly,  he  re- 
marks that  the  oath  of  Hippocrates  has  gone  the  way 
of  corsets  and  that  every  man  of  preferment  splits 
fees  as  a necessity  and  that  ethics,  the  golden  rule, 
and  the  idea  of  fair  play  are  like  Jupiter,  Venus, 
Tannhauser,  and  the  Valkyries — worn-out  myths;  that 
the  idea  of  a gentleman’s  agreement  is  like  hell- 
spoken  of  but  not  believed  in;  that  none  of  these  ever 
got  you  a seat  in  the  subway,  a following  of  politi- 
cians, a lucrative  position,  or  any  worthwhile  rewards. 
He  feels  the  officers  of  his  medical  societies  “play 
him  for  a sucker”  to  use  the  classic  words  of  Texas 
Guinan,  so  why  heed  them?  He  attends  a medical 
meeting  now  and  then  on  the  way  to  some  other 
engagement,  but  as  he  is  practicing  surgery  because 
internal  medicine  does  not  pay  well,  he  will  walk 
out  immediately  unless  a surgical  topic  is  being  dis- 
cussed. To  do  him  justice,  he  is  clever,  brilliant,  well 
educated,  and  dexterous,  and  he  carries  through  his 
operative  work  with  a certain  rather  elegant  poise, 
arrogant  assumption,  and  superb  finish.  His  cures  are 
not  spurious  and  are  exceptionally  definite.  From 
month,  to  month  and  by  way  of  carefully  planned 
advertising,  he  gains  a great  reputation  and  rides  the 
crest  of  the  wave.  He  becomes  an  A1  Jolson  in  sur- 
gery. Bye  and  bye  personality  is  substituted  for 
science  in  his  attitude  toward  his  patients.  He  comes 
to  believe  it  is  solely  on  his  own  merits  and  not  by 
way  of  any  medical  organization  that  he  has  reached 
where  he  is,  so  he  assumes  a tolerant  air  to  all  that 
pertains  to  medical  solidarity.  What  does  he  need 
with  anything  outside  of  himself?  He  takes  on  any 
contract,  gives  testimonials  for  any  product,  commits 
any  breach  of  etiquette,  ridicules  any  of  his  contempo- 
raries, and  in  a good-natured  way  says,  “Well,  what 
are  you  going  to  do  about  it?  My  clientele  won’t  let 
you  do  very  much.  He  has  become  the  superman. 
He  proudly  states  he  is  “hard-boiled”  to  all  that 
medical  ethics  business  and  has  come  to  where  he 
is,  despite  it,  because  he  gave  people  the  kind  of  medi- 
cal service  they  wanted.  I shall  not  go  into  how  this 
gentleman  has  paid  except  to  say  that  he  is  hard  and 
brittle. 

I fancy  you  all  recognize  this  type.  He  is  in  almost 
every  town  and  city.  You  must  always  acknowledge 
that  his  work  is  good  unless  he  becomes  too  intoxi- 
cated with  himself  and  becomes  careless.  Doubtless 
he  is  superb,  brilliant,  a credit  to  the  science  he  is 
following.  In  social  life,  he  is  known  as  a “corking 
good  fellow.”  All  he  lacks  is  the  spirit  that  Descartes 
indicated  would  make  us  the  saviors  of  humanity. 
And  just  because  he  lacks  it  and  it  is  so  all  impor- 
tant, I believe  this  type  of  man  is  directly  respon- 
sible for  a lot  that  besets  us.  I in  no  sense  begrudge 
him  his  success.  Such  a man  could  have  been  equally 
successful  by  living  according  to  rules  and  the  ethics 
of  his  profession.  It  is  the  bad  example  he  sets  to 
others  that  I object  to.  A colleague  battling  along, 
trying  to  observe  the  finer  graces,  and  keeping  his 


obligations  to  his  contemporaries,  faced  with  such 
illuminated  competition,  is  not  likely  to  adhere  to  the 
perhaps  slower  method.  He  debates  on  going  and 
doing  likewise,  and  he  usually  does.  So  the  idea  has 
spread  until  it  is  now  a well  recognized  and  prosper- 
ous schism.  Interns  in  the  hospitals  compare  the 
quick  results  obtained  by  the  visiting  men  who  affect 
such  views,  and  it  can  be  easily  seen  which  road  they 
ultimately  take.  So  I reiterate  that  this  ever  increas- 
ing type  of  man  is  the  instigator  of  a great  deal  of 
the  present  situation. 

THE  CROWD 

Years  ago,  Gustave  Le  Bon  wrote  a small  classic 
called  “The  Crowd,”  a study  of  the  popular  mind, 
in  which  he  held  that  a crowd  cannot  be  compared 
to  the  individuals  that  make  it  possible;  that  the 
mean  average  is  probably  of  little  value,  as  the  new 
character  of  a crowd  takes  on  new  features  and  the 
new  average  is  below  that  of  the  mean.  One  learns 
from  Le  Bon  that  a wide  chasm  may  separate  a great 
surgeon  from  an  orderly  and  yet,  as  to  character, 
the  more  lowly  one  may  be  the  better  of  the  two; 
that  men  seem  to  take  to  the  primitive  in  the  mass; 
and  that  crowds  may  be  composed  of  units  spread 
out  over  a wide  territory  held  together  by  a common 
emotion.  All  this  helps  in  trying  to  understand  medi- 
cal assemblages.  Doctors  in  their  home  environment 
may  be  individually  men  of  great  judgment  and  keen 
to  see  the  dangers  of  the  future.  When  brought  to- 
gether in  the  mass,  however,  they  seem  to  take  on 
rather  childlike  qualities  as  may  be  seen  by  their 
restlessness,  tendencies  to  run  in  and  out,  irritation 
over  some  mechanical  error,  and  above  all  their  op- 
position to  an  address  pointing  out  to  them  the  weak- 
nesses in  their  nonprofessional  outlook.  Under  the 
spell  of  a celebrated  speaker  or  a well  known  person- 
age, I can  think  of  no  audience  more  quickly  led  than 
that  of  a group  of  medical  men.  This  was  illustrated 
the  other  day  at  Detroit  when  the  powers  of  the  In- 
terstate Postgraduate  Assembly  conferred  on  Henry 
Ford  the  honorary  title  of  Doctor  before  an  audience 
of  nearly  five  thousand  physicians.  The  crowd  went 
wild  and  clanped  its  hands  and  shouted  in  childish 
enthusiasm.  Mr.  Ford  stood  smiling  amidst  a num- 
ber of  celebrated  medical  men  while  Doctor  Deaver, 
his  picturesque  personality  all  aglow,  delivered  the 
bestowal  address.  The  industrialist  said  not  a word, 
but  bowed  and  retired  from  the  scene,  as  a mighty 
roar  of  approval  followed.  This  idea  is  covered  in 
Gustave  Le  Bon’s  book.  Had  any  member,  promi- 
nent or  obscure,  of  that  august  gathering  arisen  and 
told  this  shouting  crowd  that  they  were  about  to 
award  a great  honor  to  one  who  had  lately  criti- 
cized their  whole  profession  rather  harshly  in  a series 
of  syndicated  articles,  written  on  decidedly  slender 
knowledge,  and  that  in  Detroit  he  had  built  a hospi- 
tal to  controvert  directly  the  medical  profession’s-idea 
of  how  a hospital  should  be  run  and  that  in  the  medi- 
cal fraternity  in  his  city  there  was  more  than  one 
doctor  who  felt  decidedly  hostile  to  his  attitude — that 
member  would  have  been  summarily  dealt  with. 

Mr.  Ford  is  a great  inventor  who  made  a good  car 
that  has  carried  many  a doctor  efficiently  to  his  desti- 
nation. I doubt  if  Mr.  Ford  ever  constructed  his 
car  as  a benevolent  gesture.  But  I should  like  to  ask 
if  Behring  would  not  have  been  a millionaire  if  he 
had  patented  diphtheria  serum?  Would  not  Roentgen 
have  been  more  of  a Croesus  than  Ford  if  he  had 
received  $20  on  all  x-ray  outfits  and  a royalty  on  the 
plates?  Where  would  the  man  be  who  invented  the 
vaginal  speculum  if  he  had  patented  it?  What  about 
Banting  and  a cent  on  every  unit  of  insulin?  Any 
one  of  these  men  could  be  where  Ford  is  if  he  had 
said  he  chose  to  run  that  way.  Always  we  overlook 
our  own  great  discoverers. 

It  may  be  that  we  are  rewarded  in  heaven  for  turn- 
ing the  right  cheek  when  the  left  has  been  slapped, 
but  to  me  the  performance  in  the  Ford  case  is  merely 
an  instance  of  playing  the  sycophant  and  has  no 
merit.  This  brings  me  up  to  why  we,  as  a profession. 


138 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


are  so  prone  to  do  this.  Let  us  once  more  go  back 
to  the  past.  I have  reminded  you  of  our  precarious 
situation  in  the  times  of  Descartes.  Hippocrates  and 
Galen  may  have  been  veritable  mountain  peaks  in 
history,  but  the  dark  succeeding  periods  saw  us  con- 
sorting with  barbers  on  about  an  equal  footing. 
Always,  however,  we  had  to  depend  on  royalty  or  the 
rich  and  powerful  for  any  advancement.  In  savage 
tribes,  even  the  medicine  man  has  to  seek  the  favor 
of  his  chief.  Always,  as  no  other  men  have  had  to  do, 
we  have  dealt  with  death.  Since  time  began  death 
is  by  far  the  greatest  tragedy,  and  always  the  fight- 
ing of  death  has  been  our  vocation.  The  demise  of 
a king  or  the  exodus  of  a rich  man  has  no  elements 
of  triviality  about  it  to  the  populace.  When  death 
occurs,  the  doctor's,  whether  deserving  of  it  or  not, 
has  been  the  only  tangible  head  on  which  blame  could 
be  lowered.  Oftentimes,  in  many  scenes  the  medical 
adviser  has  paid  with  his  life.  Doctors,  like  women, 
in  the  past  had  to  learn  to  be  subtle,  shrewd,  and  in 
the  end  something  of  the  sycophant  in  order  to  carry 
on.  We  have  never  really  gotten  over  it.  It  has  be- 
come a sort  of  hereditary  matter  which  we  feel,  as 
men  in  general  hate  the  reptiles,  because  their  ante- 
cedents, the  apes,  feared  the  serpents.  In  the  dim 
distant  past,  if  we  moved  too  rapidly,  some  ignorant 
yet  powerful  segment  of  the  population  saw  to  it  we 
were  halted  and  punished,  so  we  learned  to  respect 
and  fear  authority,  power  and  money.  It  is  true  the 
doctor  along  with  the  court  fool  rose  to  positions  of 
great  power.  But  then  the  day  came  when  the  doctor 
told  the  king  he  had  a four  plus  Wassermann  reaction 
in  terms  of  the  grand  mal.  The  jester  joked  about  it. 
The  next  day  saw  them  both  on  the  way  to  the 
guillotine. 

If  we  have  the  courage  to  brush  subterfuge  aside 
and  look  at  things  squarely  as  they  are,  we  will  see 
we  are  exactly  in  the  same  position  today,  allowing 
only  that  humanity  has  sickened  of  the  scaffold. 
There  are  two  ways  of  being  afraid  of  power  and 
authority.  The  old  way  was  fear  of  your  life.  The 
new  way  is  fear  for  your  position  and  self-respect 
and,  in  some  places,  your  livelihood.  None  of  us  can 
be  said  to  live  in  any  abject  terror  of  anything  per- 
haps, but  close  analysis  will  reveal  almost  all  medical 
men  exist  with  some  sword  of  Damocles  over  them. 
I believe  every  medical  man  should  acquire  all  of  this 
world’s  goods  he  can.  None  of  them  will  ever  acquire 
a vast  sum  at  his  profession  alone.  It  cannot  be  done. 
I could  scarcely  do  other  than  wish  to  every  other 
man  the  attainment  of  all  the  great  wealth  he  can 
honestly  assemble.  The  great  evil  is  that  when  some 
men  acquire  great  wealth  they  feel  it  incumbent  on 
them  to  try  to  direct  and  to  influence  great  forces 
and  organizations  which  essentially  lie  quite  outside 
and  beyond  their  knowledge,  and  certainly  outside 
any  such  offices  to  control.  Especially  is  this  per- 
nicious when  it  is  extended  into  some  technical  or 
scientific  realm  where  the  disturbing  factor  cannot 
possibly  have  the  necessary  intelligence  or  education 
to  comprehend  peculiar  and  highly  specialized  respon- 
sibilities which  have  been  slowly  acquired  through 
the  ages  and  at  the  high  cost  of  experience  and  study. 
To  do  so  strikes  me  as  utterly  indefensible,  wholly 
uncalled  for,  gratuitously  insulting  and  designed  ulti- 
mately to  interfere  with  the  orderly  and  natural  prog- 
ress of  the  given  scientific  activity  and  to  contribute 
greatly  to  a destruction  of  its  morale.  Men  are  either 
leaders  or  are  among  the  led.  There  are  not  many 
leaders.  The  medical  profession  especially  has  a pen- 
chant for  the  abject  worship  of  great  names  and 
leaders.  Now  wealth  and  power  have  developed  many 
master  minds,  and  in  industry  they  are  allowed  to 
become  well-nigh  invincible. 

INDUSTRY  AND  WEALTH  VS.  MEDICINE 

Life,  it  seems,  has  settled  down  into  a strenuous 
contest  between  large  groups,  pretentious  mergers, 
great  communities  and  power  in  the  mass.  Industry 
and  wealth  has  seen  fit  to  pit  its  master  minds  against 
those  of  medicine.  It  is  like  a duel  between  two  cour- 
ageous men  where  one  is  a skilled  swordsman  and  the 
other  has  nothing  save  his  valor.  In  many  instances 


medicine  has  come  out  with  nothing  left  but  its  life. 
So  we  mostly  stand  aside  when  a battle  is  imminent. 
The  country  doctor  feels  the  authority  of  the  small 
town  banker.  The  general  practitioner  in  the  city  is 
glad  to  join  the  Rotary  Club.  The  specialist  en- 
deavors to  placate  the  merchant  to  keep  him  from 
seeking  advice  in  the  metropolis.  Tim  great  surgeon 
who  should  have  no  peer,  boasts  his  trivial  confi- 
dences with  well  known  men  of  power.  The  head  of 
a great  group  or  clinic  makes  peasant-like  obeisance 
in  the  hope  of  getting  the  millionaire  to  make  an  en- 
dowment that  shall  see  his  plant  end  in  a big  foun- 
dation. The  instances  could  be  multiplied.  Medicine 
never  had  any  real  reason  to  bow  to  anybody.  It 
never  has,  scientifically  and  as  an  art.  We  have 
carried  the  complex,  hidden  mysteries  of  a forbidding, 
tragic  misdirection  of  evolution  (if  such  it  actually  is) 
to  as  great  a height  as  human  experience  could  war- 
rant. We  can  never  be  assailed  for  not  making  ten 
more  talents  out  of  the  ten  that  were  given  us.  Where 
we  erred,  from  the  beginning  on,  was  in  not  realiz- 
ing if  we  were  to  fulfill  our  destiny  that  there  is  more 
to  medicine  than  just  medicine.  To  have  come  to  our 
fullest  efficiency  we  should  have  conceived  that  there 
was  a side  to  us  that  was  in  no  sense  medical.  The 
steel  corporation  is  not  in  any  manner  devoted  en- 
tirely to  the  fabrication  of  steel.  Utilities  are  not  con- 
cerned wholly  with  the  making  of  light  and  power. 
Coal  companies  are  more  than  just  developers  of  coal. 
They  have  other  things  to  consider,  one  of  which  is 
medical  attention  to  their  employees.  Their  best 
minds  are  centered  on  organization,  expansion  and 
executive  work  for  their  enlargement  and  making 
them  more  or  less  impregnable — in  short,  monopolies. 

We  went  along  confining  ourselves  to  one  thing — 
curing  disease.  We  had  an  organization — -nay  many 
of  them — but  they  too  were  ordered  to  think  of  noth- 
ing outside  of  healing  disease  and  increasing  research. 
In  an  ideal  world  this  would  no  doubt  be  the  better 
way.  But  it  is  not  an  ideal  world  and  human  nature 
is  what  it  is.  Business  and  industry  suddenly  dis- 
covered it  needed  medicine.  Heretofore  it  had  paid 
little  attention  to  it,  regarding  it  as  a personal  mat- 
ter. They  saw  health  as  the  very  keystone  of  the 
arch  of  all  existence.  No  canal  could  be  built  where 
yellow  fever  raged,  no  steel  mill  was  efficient  when 
an  epidemic  kept  half  the  men  at  home.  Injured  men 
were  a big  liability.  People  could  not  buy  if  harassed 
by  illness.  A king  was  not  a king  with  a pleuritic 
effusion.  No  prospecting  expedition  could  go  forth 
without  a medical  adviser.  A captain  of  industry  was 
useless  if  agonized  with  a kidney  stone.  Great  wealth 
and  business  found  it  had  one  enemy  which  was  heed- 
less of  its  power.  They  could  not  control  it.  So  they 
set  about  to  control  the  agency  that  came  nearest  to 
controlling  disease — that  was  medicine.  They  had 
found  the  law  receptive  and  the  ministry  weak.  So 
industry  met  medicine  on  the  highway  of  humanity, 
and  the  outcome  does  not  need  recital.  Hospitals, 
medical  colleges,  research  laboratories  are  today  con- 
trolled not  by  medical  men,  but  by  trustees  and 
boards  of  wealthy  laymen.  By  way  of  contracts, 
supervision  is  had  over  the  manner  of  administration 
that  hundreds  of  doctors  perform.  I could  go  on  giv- 
ing many  more  instances,  but  the  time  at  my  disposal 
forbids.  The  present  gesture  is  that  men  of  vast 
wealth  shall  spend  their  declining  years  pointing  out 
to  us  our  delinquencies,  lecturing  us  on  our  frailties 
and  essaying  to  make  us  over  to  their  heart’s  desire. 

They  speak  to  us  of  philanthropy — we  that  can  be 
almost  said  to  have  invented  it.  They  prate  to  us  of 
social  uplift.  The  only  practical  uplift  today  is  by 
way  of  medicine.  Our  cooperation  alone  has  made  all 
social  work  possible.  So  far  other  uplift  work  has 
been  more  or  less  of  a failure.  No  scheme  to  reform 
criminals  is  effective,  for  crime  is  on  the  increase.  No 
missionary  work  in  foreign  countries  has  made  much 
progress  for  religion  except  in  the  places  where  hos- 
pitals have  been  included.  The  hospitals  alone  have 


February,  1930 


MISCELLANY 


139 


made  the  natives  better  off  and  have  been  successful. 
Half  the  prestige  our  country  bears  in  other  climes 
is  through  the  hospitals  we  have  bestowed  on  them. 

Henry  Ford  and  Julius  Rosenwald  and  many  others 
may  hold  us  up  to  scorn  because  commerce  and  inven- 
tion— not  highly  original  occupations — have  seemed 
to  pick  them  out  as  oracles.  Yet  both  would  resent 
being  told  by  prominent  medical  men  that  the  one 
had  made  several  bungling  engineering  feats  he  had 
to  do  over  and  once  on  the  witness  stand  had  to 
deny  knowledge  of  articles  that  practically  bore  his 
name,  whereas  the  other  has  economically  driven  un- 
told small  town  merchants  out  of  business  apparently 
without  any  thought  of  what  was  going  to  become  of 
them.  It  seems  to  me  that  some  large  institution 
should  be  provided  for  these  men  having  no  occupa- 
tion-— business  care  at  a lower  cost — giving  some  idea 
of  what  they  were  to  do  next  might  be  a fine  piece 
of  benevolence. 

'i  regret  to  take  up  so  much  time  with  this  sort  of 
observation,  but  it  seems  to  me  that  it  is  all  done 
for  a purpose — not  as  whimsical  criticism  or  as  mere 
talk,  but  as  something  in  the  nature  of  a threat.  For 
hospitals  and  institutions  are  built  which  are  placed 
in  competition  with  those  we  happen  to  frequent,  in 
order  to  bring  us  to  terms.  We  are  told  in  so  many 
words,  either  to  begin  to  think  in  their  terms  or  we 
will  be  forced  to  do  it.  That  we  have  lost  control  of 
the  agencies  through  which  we  accomplish  what  we 
do  is  largely  our  own  fault.  Had  we  stepped  in  and 
included  executive,  organizing,  economic  features  into 
our  calling  as  the  great  industries  have  appropriated 
medicine  into  theirs,  we  would  now  be  perhaps  the 
most  powerful  single  group  on  the  face  of  the  earth. 
We  hesitated;  when  we  did  come  to  adopt  them  in 
part  it  was  too  late.  Had  we  singled  out  highly  capa- 
ble men  from  our  ranks,  picking  them  out  as  does 
Standard  Oil  for  their  proficiencies  and  then  set  them 
in  the  high  places  to  do  their  utmost  to  make  us 
the  greatest  human  instrument  for  good  the  world 
affords,  we  would  today  be  realizing  to  the  fullest  the 
prophecy  of  Descartes.  We  would  control  health — 
therefore  everything.  They  might  call  us  a monopoly 
and  a trust.  I wish  they  could  speak  the  truth  when 
they  said  it.  The  burden  of  our  song  is  that  .we  are 
not.  Our  loose  business  methods,  our  promiscuous 
giving  away  of  our  services,  our  failure  to  effect  com- 
plete solidarity,  our  lack  of  vested  authority  at  the 
top  has  lost  us  the  control  of  the  places  we  work 
in,  some  of  the  selection  of  conditions  under  which 
we  heal,  and  a great  deal  of  prestige.  We  still  con- 
trol some  of  our  future,  and  one  of  the  reasons  why 
we  are  here  today  is  to  talk  over  conserving  what 
we  still  possess.  We  all  think,  I feel  sure,  that  we 
can  render  just  as  good  service  to  business  outside 
of  its  control  as  under  it.  We  cannot  be  classed  in 
as  skilled  labor  and  dictated  to  as  artisans  are  pro- 
scribed and  then  be  expected  to  make  the  new  dis- 
coveries and  progress  that  is  our  heritage.  We  are 
not  that  kind  of  men,  and  most  of  us  will  never  be. 
The  hidden  reserve  of  accumulated  experience  that 
is  in  us  all  needs  special  handling  to  do  its  best,  and 
any  attempt  to  dominate  it  as  so  much  potential 
motion  to  be  handled  at  will  must  end  in  disaster  to 
all  concerned. 

The  question  arises,  “Is  it  too  late  to  go  back  to 
complete  control?”  It  probably  is  too  late.  But  the 
only  way  to  find  out  is  to  investigate  and  see.  There 
are  no  instruments  of  precision  in  such  a case.  There 
is  a lot  of  buried,  latent  fight  in  every  doctor — even 
in  those  who  are  under  contract.  Constant  waging 
of  war  against  disease  puts  some  combativeness  in 
every  medical  man.  Physicians  and  surgeons  are  as 
universally  intelligent  to  a certain  degree  as  any  other 
group  of  men  in  the  world  today.  According  to 
Gustave  Le  Bon,  all  they  need  is  a common  emotion 
to  make  them  into  one  big  mass  which  might  be  bent 
on  a primitive  lynching  of  a negro,  or  on  a grand  and 
noble  accomplishment  like  saving  the  honor  and  dig- 
nity of  the  medical  profession.  Let  every  doctor  then 
have  the  possible  outcome  brought  home  to  him — and 
the  possible  outcome  is  always  to  be  considered  as 


state  medicine.  Let  us  weld  ourselves  into  a big 
corporation,  with  a head  after  the  fashion  of  Musso- 
lini but  without  his  defects,  heedless  of  those  who  cry 
that  the  people  will  not  tolerate  it.  That  the  people 
are  against  us  is  somewhat  of  a fiction.  They  care 
not  so  long  as  we  give  the  service.  Explain  to  no 
one,  realizing  that  explaining  is  a weakness  if  carried 
too  far  and  recalling  the  old  statement  that  our 
enemies  will  not  believe  in  us  whatever  we  do,  while 
our  friends  need  no  explanation.  There  are  many  of 
us  who  are  in  for  placing  our  heads  in  the  yoke  and 
accepting  the  whole  thing  as  economically  evolution- 
ary. These  men  argue  that  the  laymen  run  the  hos- 
pitals better  than  we  do.  They  would  accept  $500 
under*  contract  rather  than  a probable  $1000  they 
would  not  get.  We  shall  never  realize  the  prediction 
of  Descartes  by  so  doing,  and  it  should  be  otir  aim 
to  fulfill  that  destiny. 

A few  men  control  industry,  so  a few  men  will 
eventually  control  medicine  if  we  meekly  submit.  It 
is  scarcely  likely  without  an  upheaval  that  these  few 
men  would  ever  try  to  be  despotic,  but  one  of  them 
could  easily  launch  on  a sea  of  propaganda  against 
us  with  very  distressing  results.  With  a fancy  that 
he  had  been  cured  by  a faker  or  an  irregular  of  some 
kind,  he  might  feel  we  ought  to  include  the  system  in 
our  own.  Refusal  might  mean  displeasure,  and  from 
such  small  acorns  mighty  oaks  do  grow.  It  is  there- 
fore the  better  way  for  humanity  in  general  that  we 
keep  the  supervision  of  our  own  affairs. 

To  illustrate,  in  West  Virginia  contract  practice  is 
quite  common,  running  in  localities  from  25  to  50  per 
cent.  I offer  no  criticism  of  the  corporations.  They 
are  out  to  obtain  everything  as  cheaply  as  possible. 
The  fault  if  any  is  that  the  organization  of  doctors 
in  the  state  should  have  prevented  it  if  they  could 
and  felt  that  it  was  dangerous.  But  they  did  not,  so 
the  responsibility  is  entirely  on  the  doctors  them- 
selves. It  seems  apparent  that  part  of  the  medical 
profession  in  West  Virginia  approves  of  contract 
practice,  and  it  is  probable  that  this  is  a fact.  Its 
effect  on  the  general  profession  has  not  been  thought 
to  be  very  important.  Good  salaries  were  originally 
offered  and  no  doubt  accepted  with  alacrity  by  the 
great  and  the  near  great.  Opportunity  awaited  and 
was  swallowed  as  a fish  accepts  its  bait.  This  did 
not  matter  so  long  as  contract  surgeons  were  in  the 
minority,  but  when  it  reached  a strong  minority  some- 
thing happened.  I feel  that  the  same  drama  is  being 
enacted  in  some  fashion  in  every  other  state.  As 
West  Virginia  is  largely  an  industrial  state,  it  hap- 
pened to  be  more  easily  observed.  The  corporations 
felt  that  they  could  now  handle  matters  with  more 
decision.  The  inevitable  happened.  When  a steel  cor- 
poration or  a coal  company  falls  below  their  dividend 
requirements,  as  they  see  them,  retrenchment  speedily 
follows.  Wages  of  the  workers  are  cut  and  if  not 
accepted  a strike  or  quitting  are  the  only  recourses. 
The  contract  doctor  did  not  count  on  this  to  any 
extent.  He  simply  felt  he  would  not  be  included. 
I shall  give  three  examples  to  show  that  he  was  mis- 
taken. A young  intern,  on  completing  his  service, 
found  himself  comfortably  placed  in  the  employ  of 
a coal  company  at  a check-off  salary  of  $900  a month. 
Not  so  bad  for  a fledgling!  Some  time  later  he  was 
visited  by  an  official  of  the  company  who  promptly 
told  him  he  could  accept  a cut  of  $600  a month  or 
quit.  He  was  assured  a candidate  for  his  place  could 
immediately  be  secured  for  $300.  Another  older  phy- 
sician who  had  served  some  years  received,  if  I recall 
correctly,  $1.25  as  a check-off  for  each  married  em- 
ployee and  $1  for  each  single  one.  He  was  told  busi- 
ness was  not  so  good  and  he  accepted  $1  and  $0.75. 
In  both  cases  he  received  fees  in  addition  under  the 
Workman’s  Compensation  Act.  He  was  next  in- 
formed he  must  accept  $0.90  and  $0.60,  give  the  com- 
pany the  fees  or  resign.  They  informed  him  they 
could  easily  get  a substitute.  A third  company 
secured  a so-called  medical  director.  He  was  in- 
structed to  tell  all  the  medical  attendants  to  accept 


140 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


§250  a month  or  resign.  They  could  easily  replace 
them. 

If  all  this  differs  in  any  way  from  strike-breaking, 
I cannot  see  it.  Contract  practice,  as  I said,  is  held 
to  be  by  many  as  impossible  of  correction.  Many 
believe  it  is  an  evolutionary  matter,  purely  economi- 
cal, and  that  it  is  the  only  solution  of  a difficult  ques- 
tion. They  argue  that  this  is  a machine  age,  and  a 
machine  knows  neither  freedom  nor  liberty.  No  less 
a person  than  Mussolini  says  both  liberty  and  free- 
dom are,  in  the  last  analysis,  pernicious;  that  a re- 
public is  absurd  and  a democracy  farcical  and  that 
they  will  not  live  because,  in  the  main,  people  do  not 
know  how  to  accept  them,  being  made  to  be  led. 
Contract,  group,  community  practice  and  state  rtiedi- 
cine  all  follow  this  principle  in  that  they  mean  sub- 
servience of  the  several  to  a head  or  heads,  who  must 
necessarily  assume  some  autocratic  power.  Of  course, 
any  doctor  can  quit  at  any  time,  but  where  will  he  go? 

If,  then,  this  idea  of  Mussolini  is  right— which  is 
to  say  democracy  is  a failure — let  us  scrap  all  our 
ideals  of  the  past,  admit  they  are  wrong,  resign  our- 
selves to  the  order  of  things  and  make  the  best  of  it. 
But  if  we  do  not  agree  with  it,  let  us  start  a campaign 
of  medical  education  with  more  force  than  any  of  the 
past  attempts,  assuring  even  the  contract  men  that 
the  next  step  the  corporations  will  take  is  to  shed 
their  responsibility  for  medical  care  over  on  to  the 
taxpayers  and  then,  to  be  sure,  we  will  have  state 
medicine. 

Some  of  our  more  celebrated  colleagues  who  have 
reached  places  of  safety  at  the  head  of  something  or 
other  or  who  have  amassed  a fortune,  usually  by  some 
route  extraneous  to  medicine,  shake  their  heads  rather 
mournfully  and  say  we  are  headed  for  state  medicine. 
And,  of  course,  we  will  be  if  we  listen  to  them  or 
follow  their  gloomy  forebodings.  If  you  believe  liter- 
ally that  the  meek  shall  inherit  the  earth,  then  the 
only  consistent  thing  to  do  is  to  kneel  down  like  the 
lamb  to  the  slaughter.  If  you  believe  with  Roosevelt 
that  “Aggressive  fighting  for  the  Right  is  the  noblest 
sport  the  world  affords,”  there  never  will  be  state 
medicine. 

CONSIDERATION  OF  HIGH  COST  OF  MEDICAL  CARE 

Because  we  deal  with  people  only  in  times  of  stress 
and  trouble — in  other  words,  while  they  are  ill — our 
sympathies  are  appealed  to  and  we  have  been  tricked 
into  many  false  positions.  The  giving  away  of  our 
services  was  one  of  them.  The  analysis  cannot  here 
be  given,  but  it  can  be  shown  that  the  responsibilit 
for  the  care  of  the  indigent  is  a responsibility  of  the 
remainder  of  humanity,  and  if  we  ever  had  any  part 
in  the  matter,  it  is  only  our  fractional  part  as  a sec- 
tion of  the  population.  But  we  have  always  had  it  all. 
By  translating  our  services  in  the  past  into  some 
heavenly  abstract  administrations,  we  steadily  pro- 
tested against  the  idea  that  medicine  was  a high-class 
scientific  commodity  to  be  sold  as  is  law,  engineer- 
ing, education  and  every  other  human  endeavor,  and 
we  made  a mistake.  We  have  had  to  reverse  our- 
selves and  come  to  that  view  anyway,  and  in  doing 
so  the  public  has  been  slow  to  understand  us  and 
we  have  been  dubbed  as  “getting  commercial.”  Our 
education  was  commercial.  Our  instruments  and  para- 
phernalia are  commercial.  All  that  we  buy  is  com- 
mercial. Whatever  we  come  in  contact  with  is 
commercial.  Why  should  we  not  long  ago  have  come 
to  the  realization  that  we  had  “an  opinion  and  its 
placing  into  practical  application”  to  sell  and  act  ac- 
cordingly? The  clergy  have  sold  their  “birth  and  death 
services”  since  time  immemorial;  no  one  thought  the 
worse  of  them.  It  is  true  they  will  donate  them  at 
times,  but  there  are  exceptions  where  almost  every- 
thing is  found  to  be  given  away.  Had  we  always 
charged  for  our  services  and  had  no  systematized  free 
services,  no  one  would  have  ever  heard  of  reducing 
the  cost  of  medical  care,  for  a way  would  have  been 
found  to  have  the  poor’s  ministrations  paid  for  by 
funds  which  would  have  also  compensated  the  doctor. 


The  average  cost  of  a bed  in  hospitals  ranges  from 
§4  to  §6  a day.  Those  unable  to  pay  at  all  make  this 
rate  as  high  as  it  is.  Who  is  it  responsible  for  the 
poor?  Certainly  not  the  doctors.  The  medical  pro- 
fession had  nothing  to  do  with  their  poverty.  It  is  the 
economics  and  chaotic  living  conditions  of  the  outside 
world.  But  you  will  find  the  doctor  has  to  answer 
for  them  when  ill  as  if  he  were  responsible  for  them. 
They  cannot  obtain  a livelihood,  so  are  not  sheltered, 
fed  or  clothed.  They,  therefore,  through  lack  of  re- 
sistance fall  a prey  to  disease.  No  contractor  gave 
them  a house.  No  chain  store  gave  them  food.  No 
mail-order  house  gave  them  clothing.  No  automobile 
dealer  gave  them  an  old  car  to  obtain  a little  fresh 
air.  No  statesman  worked  out  a solution  for  their 
maintenance  with  self-respect.  No  politician  gave 
their  plight  a real  thought.  Mergers,  combines,  and 
chain  stores  threw  some  of  them  out  of  employment. 
It  was  too  late  to  get  anything  else.  Flotsam  and 
jetsam.  What  will  be  done  with  them?  Shoulder 
them  on  a hospital  and  let  the  doctors  do  what  they 
can,  but  how?  Free,  of  course.  Up  go  hospital  rates. 
Then  critics  dispose  of  us  in  sarcastic  terms  about 
the  high  cost  of  medical  care.  We  think  we  have  no 
part  at  all  in  the  high  cost  of  medical  care.  The  out- 
side world  is  responsible  socially  for  the  predicament 
of  the  poor.  Particularly  are  the  legislative  bodies 
and  the  systems  of  commerce  responsible.  We  need 
no  elaborate  figures  or  investigations  or  surveys  to 
tell  us  that  few  doctors  receive  handsome  incomes 
from  their  vocation.  Outstanding  surgeons  possessed 
of  great  skill  in  some  particular  line  may  make  big 
fees.  The  others  do  not,  and  there  are  men  in  the 
United  States  survey  who  know  this  even  better  than 
we  do.  Had  we  collected  our  accounts  and  had  no 
promiscuous  free  service  no  one  would  have  heard 
of  the  high  cost  of  medical  care.  Our  philanthropy 
was  really  the  cause  of  our  undoing. 

(To  be  continued  in  March  issue.) 


SERIO-LIG  HTER  VEIN 

“BITER  BIT” 

Close-up  of  a Doctor  on — Not  at — the  Table 

By  William  H.  Braddock,  M.  D. 

Jarbidge,  Nevada 

“Now,  you’ll  feel  this  prick,  and  after  that  you’ll 
feel  nothing.” 

Uh-huh.  I’ve  used  that  formula  myself,  and  always 
had  a doubt  of  it,  unless  one  was  meticulous  about 
keeping  the  needle  within  the  infiltrated  area.  There, 
I thought  so.  Every  single  sting  is  perceptible.  Poor 
technique,  to  tell— ah,  misstatements,  to  the  victim. 
He  wonders — like  me,  right  now — if  the  surgeon 
knows  his  business,  after  all. 

That  must  be  the  knife — ouch!  “Feel  that,  old 
man?”  A dull  jab,  then  the  knife  again;  skin,  super- 
ficial fascia,  superficial  layer  of  deep  fascia — yes,  the 
assistant  is  pulling  something,  retracting  the  muscle, 
doubtless.  Quick  work.  It  hasn’t  hurt  particularly, 
so  far,  but  it’s  kind  of  a general  strain;  hope  he  won’t 
be  long — would  hate  to  have  my  nerve  give  way. 

“Now,  this  may  hurt  a trifle.” 

“Go  ahead.  What  is  it?” 

“Outer  layer  of  the  muscle  fascia.” 

Humph!  Hasn’t  begun  yet.  Why  the  hell  is  he  so 
slow  about  it?  Nerve’s  liable  to  wear  out  if  he  takes 
too  long.  Wish  a fellow  could  watch  this;  could  be 
worked,  with  a large  mirror,  and  leaving  the  eyes 
uncovered.  Still,  one  feels  drowsy,  and  a little  dis- 
sociated after  that  morph;  just  as  well  lie  quiet,  and 
suck  that  iced  gauze  that  the  nurse,  or  anesthetist, 
or  whatever  she  is,  wipes  on  the  lips.  Mighty  refresh- 
ing. Ugh!  That’ll  be  the  muscle  sheath.  Feel  noth- 
ing more,  huh?  Wish  he’d  hurry — would  hate  to 
break  down  and  snivel — ’Tisn’t  the  pain,  exactly, 
for  it  doesn’t  hurt  much;  must  be  the  suspense,  and 


February,  1930 


MISCELLANY 


141 


the  cold-bloodedness  of  it  all,  waiting  for  him  to  hurt 
you. 

That’s  the  real  muscle  retraction,  no  mistaking  it. 
Deep  layer  and  peritoneum  next,  but  first,  of  course, 
he’ll  fiddle  around,  tieing  off  and  so  forth.  Ouch! 
That  one  hurt,  whatever  it  was. 

Funny  how  I'm  feeling  now.  No  particular  pain, 
but  every  last  fiber  of  me  seems  aware  that  something 
unusual  and  alarming  is  happening  to  me,  and  is  more 
than  a little  worried  about  it — 

“Do  you  know  where  I am  now?” 

“Nope,  lost  track  altogether.”  He  must  be  in  the 
belly  somewhere,  but  you  can’t  prove  it  by  me.  There 
are  no  particular  conscious  sensations,  except  that 
they  are  working  somewhere  in  my  appendical  area, 
but  I’m  tense  all  over.  Not  the  muscles;  they  seem 
relaxed  enough.  Its  a sort  of  general  somatic  anxiety, 
about  something  desperate  and  dangerous  going  on 
inside  me;  something  like  a building  with  all  the 
burglar  and  fire  alarms  going  full  tilt,  all  through  it, 
but  the  bells  ringing  silently.  It’s  hard  to  explain; 
consciously,  I know  what  is  going  on,  in  a general 
sort  of  way,  and  also  I am  aware  that  my  uncon- 
sciousness, or  subconsciousness,  is  full  of  feelings, 
which  are  probably  unpleasant.  Hope  they  don’t 
burst  through  into  my  consciousness;  would  hate  to 
have  my  nerve  give  out  and  disgrace  me. 

“Now  just  a moment.  I want  to  see  exactly  how 
things  lie  in  here.” 

Oh,  damn  his  scientific  soul!  “Take  your  time;  I’m 
all  right.”  Try  to  be  a good  guinea-pig,  since  I must 
be  one.  Ugh,  he  must  be  pesticating  around  inside, 
dragging  on  things.  No  pain,  but  that  general  sen- 
sation of  nervous  discharges  throughout  the  body  is 
getting  stronger  and  stronger;  if  it  were  electricity, 
I’d  prickle  all  over. 

Ow,  that  hurt!  In  the  umbilicus.  Felt  exactly  as 
if  he  were  hauling  on  the  falciform  ligament,  trying 
to  drag  my  navel  into  the  belly  by  its  roots.  But  the 
falciform  ligament  goes  to  the  liver  somewhere 
doesn’t  it?  There’s  some  hurting  in  the  general  ap- 
pendical region,  too. 

“Having  an  attack  now?” 

“Absolutely — and  it  hurts.”  An  attack  is  just  ex- 
actly what  it  is,  and  it  would  be  eased  a lot  if  I could 
only  pass  the  gas. 

“Well,  I guess  our  diagnosis  was  right.” 

Oh,  damn  your  diagnosis,  and  you  too!  Get  along, 
man,  and  get  done!  My  nerve  is  going  to  give  out  in 
a minute — 

“If  you’d  just  give  me — a little — rest.”  Hell,  if  I 
can’t  talk  straight,  better  shut  up! 

“Sure,  we’ll  give  you  a rest.” 

Gosh,  ain’t  it  a grand  and  a glorious  feeling!  Just 
about  here  is  where  that  fellow  who  tried  to  take  out 
his  own  appendix  must  have  had  to  quit.  Have  a 
notion  I could  have  gotten  down  through  the  peri- 
toneum, if  I’d  had  to,  but  no  further.  Think  of  the 
technical  difficulties  of  locating  the  thing,  lying  on 
your  back  like  this;  especially  if  it  were  buried  some- 
where. There  they  go  again,  hauling  on  the  mesen- 
tery or  something — it  hurts!  Don’t  believe  anybody 
could  haul  on  his  own  like  that — hurts  too  much — 
leastways,  I couldn’t — it’s  hurting  more  and  more, 
real  sensible  pain,  and  I don’t  believe  I can  stand 
much  more — 

“Ugrrh-rrh!”  There,  damn  it,  I knew  my  nerve 
would  go!  I’m  feeling  queer — sort  of  floating — things 
getting  distant — this  must  be  what  shock  feels  like, 
a sort  of  refuge  from  too  much  pain.  But  my  nerve 
isn’t  going  to  give  out,  thank  God,  for  now  I know 
that  I know  how  to  faint,  if  need  be.  They’re  still 
pulling  on  that  mesentery,  but  not  so  hard,  and  it 
doesn’t  seem  to  be  hurting  so  much;  the  purse-string, 
perhaps?  Dick  said  he  thought  they  had  dropped  the 
cautery  into  his  belly,  when  they  divided  the  ap- 
pendix, and  cauterized  the  stump;  nothing  like  that, 
so  far — though  it  wouldn’t  matter  now — 

Things  seem  to  refocus  themselves,  rather  sud- 
denly. I don't  believe  I fainted,  but  I wasn’t  far  from 
it;  just  began  to,  perhaps. 


“Now  I’m  going  to  sew  up  the  peritoneum.  The 
anatomists  say  there  are  no  pain  nerves  in  it.  How 
about  that?” 

“They — ugh — lie!”  Let  the  damn  fool  laugh!  Vis- 
ceral, perhaps  not,  but  parietal — ugh — it  hurts!  Un- 
less he’s  fooling  me  about  where  he  is? 

“Now  we’ll  take  the  superficial  layer  of  the  muscle 
sheath.  It’s  supposed  to  have  nerves.” 

It  has,  too.  I feel  every  prick  on  both  sides  of  the 
infiltrated  area.  If  that  area  were  wider — but,  pshaw, 
a fellow  can  stand  this  easily.  Ugh,  that  one  hurt! 
“What  was  that?” 

“The  muscle-tie.” 

Good,  he’s  nearly  through.  Skin  next.  Yes,  every 
prick  hurts;  and  then  he  has  to  fool  with  the  skin 
edges — hope  he  gets  ’em  right;  I was  always  fussy 
about  ’em.  Now  the  dressings — 

“Say,  would  you  mind  letting  me  see  the  thing?” 
Someone  brings  around  a little  bottle;  the  thing  is  in 
it,  but  the  eyes  won’t  focus  right,  somehow;  best  slide 
back,  and  let  the  morph  take  hold  now — it's  rather 
like  a dream,  till  we  get  back  into  bed,  and  relax  into 
a doze-—. 


“AS  OTHERS  SEE  US” 


CHESTER  ROWELL’S  COMMENT* 

The  Los  Angeles  Times  takes  Dr.  Morris  Fish- 
bein,  editor  of  the  Journal  of  the  American  Medical 
Association,  to  task  for  “arrogant  intolerance”  in 
claiming  a monopoly  of  “one  limited  school”  of  medi- 
cine, and  for  “branding  all  indiscriminately  as  quacks, 
faddists,  fakers,  and  impostors  who  do  not  subscribe 
to  his  narrow  views  of  what  constitutes  the  practice 
of  healing.’'  “Medical  diagnosis  under  the  canons  of 
the  regular  school  is  not  such  an  exact  science  as  to 
call  for  sneering  reference  to  the  substitution  of  the 
violet  rays  of  the  sun  for  the  old-time  allopathic  drug 
doping  in  the  treatment  of  tuberculosis.” 

* * * 

Since  there  is  not,  and  never  was,  any  such  thing 
as  “old-time  allopathic  drug  doping  in  the  treatment 
of  tuberculosis,”  and  since  Doctor  Fishbein  made  no 
“sneering  reference”  to  the  use  of  sunlight  in  its  treat- 
ment, but,  on  the  contrary,  uses  that  treatment  him- 
self, as  do  all  other  scientific  physicians,  the  illustra- 
tion is,  to  say  the  least,  unfortunate. 

* * * 

But  the  appeal  for  “tolerance,”  by  one  “school”  of 
another,  is  an  example  of  a common  fallacy.  There 
is  no  “tolerance”  of  astrology  by  astronomers.  There 
is  no  “tolerance”  of  fortune-telling  by  psychologists, 
nor  of  perpetual  motion  inventors  by  physicists. 
Geologists  do  not  locate  oil  or  water  by  dowsing  with 
a forked  stick,  nor  “tolerate”  those  who  do.  Entomolo- 
gists do  not  “tolerate”  those  who  would  exterminate 
insect  pects  by  interfering  with  their  spontaneous 
generation.  Scientific  agriculture  does  not  “tolerate” 
the  theory  that  potatoes  grow  wrong  unless  planted 
in  the  dark  of  the  moon.  All  these  “schools”  exist, 
and  they  are  all  rejected  outright  as  unscientific 
superstitions  by  every  scientist  in  the  world. 

* * * 

On  the  other  hand,  good  Catholics  tolerate  the 
Holy  Rollers,  and  Buddhists  tolerate  the  Mormons. 
Atheists  tolerate  the  faith  of  Christians  and  Christians 
the  unfaith  of  atheists.  Protestants  and  Christian 
Scientists  tolerate  each  other’s  religion,  each  respect- 
ing the  right  of  the  other  to  seek  God  in  his  own 
way.  But  the  law  of  the  land  did  not  tolerate  polyg- 
amy, when  the  Mormons  said  it  was  religion,  and  the 
regents  of  the  University  of  California  do  not  permit 


* This  article  appeared  in  the  opening  column  of  the 
second  section  of  the  San  Francisco  Chronicle  of  Satur- 
day, January  18,  1930.  See  second  editorial,  this  issue. 


142 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


an  antivaccinationist  student  to  endanger  the  health 
of  other  students,  even  though  he  calls  his  objection 
religious. 

* * * 

So  in  medicine.  If  it  were  a matter  of  faith,  dogma 
or  canons,  one  “school”  should  “tolerate”  another.  If 
it  is  a matter  of  science,  then  the  only  distinction 
is  that  of  scientific  and  unscientific.  And  between 
science  and  nonscience  there  is  no  equality  of  right, 
and  no  basis  for  tolerance.  The  fact  that  millions  of 
devout  people  in  India  believe  in  casting  their  horo- 
scopes by  the  stars  does  not  erect  them  into  a 
“school”  of  astronomy,  nor  impose  on  astronomy  any 
obligation  to  recognize  them.  They  are  neither  “regu- 
lar” nor  “irregular”  astronomers — they  are  not  as- 
tronomers at  all.  Neither  is  any  unscientific  theory 
or  practice  of  healing  any  part  of  the  science  of  medi- 
cine. There  are  only  two  sorts  of  medicine,  scientific 
and  unscientific.  And  of  the  unscientific  “schools,” 
science  has  only  this  to  say — that  they  are  unscientific. 

* * * 

How,  then,  shall  we  distinguish  which  principles 
and  practices  of  healing  are  scientific,  and  which  are 
not?  The  simplest  test  is  that  which  we  unhesitat- 
ingly apply  in  every  other  branch  of  knowledge.  That 
is  the  judgment  of  scientists.  If  the  scientists  say 
that  a certain  thing  is  scientific,  we  accept  it  as  such. 
If  they  all  say  it  is  unscientific,  we  say  likewise,  at 
least  until  it  has  succeeded  in  convincing  them.  Every 
scientific  university  in  the  world  teaches  astronomy, 
and  not  one  teaches  astrology.  All  of  them  teach 
chemistry  and  not  one  teaches  alchemy.  Every  uni- 
versity in  the  world  teaches  scientific  medicine,  and 
not  one  of  them — not  a single  one  in  the  whole 
world — teaches  or  recognizes  any  of  the  “schools”  or 
sects  for  which  the  Times  speaks.  If  the  unanimous 
voice  of  science  means  anything,  this  is  its  verdict. 

* * * 

The  next  test,  and  the  decisive  one,  is  that  of 
method.  Scientists  may  be  mistaken,  sometimes,  in 
their  results  and  conclusions.  Sometimes  a thing 
which  seems  true  in  the  light  of  incomplete  informa- 
tion becomes  only  partly  true  in  the  light  of  later  dis- 
coveries. But  science  is  not  mistaken  in  its  method. 
That  method  is  systematic  observation  and  experi- 
ment, and  the  submission  of  these  observations  and 
experiments  to  the  scientists  of  the  world,  for  them 
to  repeat,  to  test  and  to  scrutinize.  Whatever  pursues 
that  method  and  is  approved  by  that  test  is  scien- 
tific-including, in  medicine,  light  rays  for  tubercu- 
losis, diet  for  many  ailments,  and  hydrotherapy  for 
certain  mental  conditions.  Whatever  does  not  pro- 
ceed by  that  method,  or  fails  by  that  test,  is  unscien- 
tific— including  all  the  cults,  sects,  and  schools  which 
Doctor  Fishbein  rejects  and  the  Times  defends. 


TWENTY-FIVE  YEARS  AGO* 


EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  2,  February  1905 

From  some  editorial  notes: 

...  The  Meeting  at  Riverside. — The  next  annual 
meeting  of  the  state  society  will  be  held  on  April  18, 
19  and  20,  at  the  New  Glenwood  Hotel,  Riverside.  . . . 

. . . Some  Bad  Legislation. — Two  particularly  objec- 
tionable bills  have  been  introduced,  one  in  the  Senate 
and  the  other  in  the  Assembly.  . . . 

. . . Don’t  lose  an  hour’s  time  in  writing  to  the 
Senator  and  Assemblyman  from  your  district,  and 
get  every  voter  you  can  to  do  the  same  thing;  tell 
them  to  leave  these  two  laws  alone — the  vaccination 
law  and  the  Medical  Practice  Act.  If  these  two  bills 

* This  column  aims  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


are  allowed  to  become  laws,  the  scourge  of  smallpox 
and  the  pestilence  of  the  quack  will  soon  be  Cali- 
fornia's portion.  . . . 


From  an  article  on  “ The  Tonsils  as  Portals  of  Infec- 
tion” by  M.  IV.  Fredrick,  M.D.,  San  Francisco: 

Although  it  is  scarcely  fifteen  years  since  Gabbi 
called  attention  to  the  frequent  association  of  tonsilli- 
tis and  pneumonia,  the  importance  of  the  part  played 
by  the  tonsils  as  portals  of  infection  for  diseases  in 
distant  parts  of  the  body  is  so  great,  and  the  idea  such 
a plausible  one,  that  the  subject  speedily  gained  recog- 
nition, and  has  been  ably  expounded  in  its  different 
phases  by  a number  of  good  writers  and  observers.  . . . 


From  an  article  entitled  “Report  of  Cases  Simulating 
Grave  Mastoiditis”  by  Fred  Baker,  M.D.,  San  Diego: 

Strange  or  rare  conditions  involving  difficulties  of 
diagnosis  in  diseases  which  endanger  life  or  the  integ- 
rity of  important  function  are  always  worth  reporting. 
The  following  case  fulfills  these  conditions,  while  the 
succeeding  cases,  though  less  interesting  and  impor- 
tant, illustrate  another  phase  of  the  same  disease:  . . . 


From  an  article  on  “Posture  in  the  Treatment  of  Dis- 
ease” by  C.  M.  Cooper,  M.  B.: 

The  influence  of  disease  upon  attitude  and  position 
in  obedience  to  the  principles  enunciated  particularly 
by  Hilton  has  been  studied  to  some  extent;  though 
even  in  this  there  is  still  much  that  could  be  added 
to  our  knowledge  if  to  the  improved  armamentarium 
of  our  day  could  be  added  the  discerning  bedside 
acumen  of  the  older  clinicians.  . . . 


From  minutes  of  county  medical  societies: 

. . . Los  Angeles  County. — The  resolutions  passed  by 
the  Council  and  officers  of  the  state  society,  in  con- 
ference, relating  to  the  question  of  advertising  in  the 
Journal  of  the  American  Medical  Association,  were  then 
read  by  the  secretary  and,  after  some  little  discussion, 
endorsed  with  but  one  dissenting  vote.  . . . 

. . . San  Mateo  County. — In  response  to  an  invita- 
tion sent  out  by  the  secretary  of  the  state  society  a 
number  of  physicians  of  San  Mateo  County  met  at 
the  Union  Hotel  in  San  Mateo  on  the  evening  of 
December  22,  and  effected  organization  of  the  San 
Mateo  County  Medical  Society.  . . . 


From  the  minutes  of  the  California  Academy  of 
Medicine: 

Regular  meeting  held  in  San  Francisco,  Decem- 
ber 27,  1904,  the  president,  Dr.  Dudley  Tait,  being 
in  the  chair.  . . . 

. . . “An  Epidemic  of  Diphtheria  at  Stanford  Uni- 
versity.” Dr.  R.  L.  Wilbur  reported  his  personal  ex- 
perience in  the  recent  small  epidemic  of  diphtheria 
at  Stanford  University  and  Palo  Alto.  The  origin  of 
the  epidemic  could  not  be  definitely  traced.  Of  the 
forty-three  cases  which  came  under  his  observation, 
in  four  the  infection  involved  the  larynx,  in  three 
the  mouth,  in  one  the  nose,  and  in  one  the  con- 
junctiva. . . . 


From  a reprint  of  an  editorial: 

New  Jersey’s  Approval. — Doctor  Jones,  editor  of  the 
California  State  Journal  of  Medicine,  instead  of  receiv- 
ing the  support  and  encouragement  (in  regard  to 
advertising  of  secret  remedies  in  medical  journals), 
which  his  manly  and  unselfish  course  deserves,  seems 
to  get  abuse  from  some,  misrepresentation  from 
others,  and  the  cold  shoulder  from  all.  . . . 

. . . One  would  think  that  no  medical  man,  except 
Doctor  Jones,  was  ever  born  with  a sense  of  humor; 
otherwise,  rich  and  powerful  medical  societies  would 
not  make  themselves  ridiculous  and  stultify  them- 
selves for  gain.  ... 

. . . What  folly!  What  hypocrisy!  Like  the  Phari- 
sees of  old,  they  make  tithe  of  mint  and  cummin  and 
neglect  the  weightier  matters  of  the  law. — Journal  of 
the  Medical  Society  of  New  Jersey. 


February,  1930 


MISCELLANY 


143 


DEPARTMENT  OF  PUBLIC 
HEALTH 


By  W.  M.  Dickie,  Director 

Epidemic  Meningitis  Bears  Watching. — Nineteen 
cases  of  epidemic  meningitis  were  reported  in  Cali- 
fornia last  week;  in  fact,  the  present  trend  of  men- 
ingitis is  similar  to  the  trend  of  the  disease  during 
November  and  December  of  1928.  The  past  year  has 
brought  more  cases  and  more  deaths  from  epidemic 
meningitis  than  any  year  in  the  history  of  California. 
From  January  to  August,  inclusive,  1929,  302  deaths 
from  epidemic  meningitis  have  been  recorded  in  this 
state.  Thirty-two  per  cent  of  these  deaths,  118,  were 
among  Filipinos,  Mexicans,  Chinese,  and  Japanese. 
Of  these,  57  were  in  Filipinos,  39  in  Mexicans,  16  in 
Chinese,  and  6 in  Japanese.  Two  hundred  eighteen 
deaths  were  in  men  and  eighty-four  in  women.  The 
numbers  of  deaths  by  months  of  occurrence  were  as 
follows: 


January 43 

February  36 

March  55 

April  47 

May  51 

June  35 

July  19 

August  16 


It  will  be  noted  that  the  status  of  meningitis  at  the 
present  time  is  similar  to  the  status  of  the  disease  at 
the  same  time  last  year.  Health  officers  are  urged  to 
be  on  the  watch  for  cases  that  may  be  suspicious  of 
this  disease  and  to  report  promptly  to  the  State  De- 
partment of  Public  Health  any  such  cases  that  may 
occur. 


Winter  Season  Brings  Influenza  and  Measles. — 

From  the  reports  of  cases  of  influenza  and  pneumonia 
received  during  the  past  four  wreeks,  it  is  evident  that 
respiratory  infections  are  more  prevalent.  The  in- 
creased incidence  indicates  that  we  may  expect  an 
outbreak  of  influenza  during  February  and  March. 
In  the  past,  epidemics  of  influenza  and  pneumonia 
occurring  during  February  and  March  have  been  less 
extensive  than  those  in  the  fall  months.  Neverthe- 
less, the  disease,  with  all  of  its  debilitating  effects  and 
serious  sequelae,  is  always  to  be  regarded  with  appre- 
hension and  persons  are  urged  to  heed  the  advice  of 
avoiding  crowds,  going  to  bed  upon  appearance  of 
first  symptoms  and  taking  sufficient  rest  to  allow 
complete  recovery  before  resuming  activities.  A phy- 
sician should  be  in  attendance. 

Measles,  also,  is  on  the  increase.  During  1927, 
58,963'  cases  were  reported,  and  since  the  epidemics 
appear  with  definite  regularity,  this  increased  inci- 
dence of  the  last  few  weeks  leads  us  to  believe  that 
measles  will  be  one  of  the  leading  diseases  of  chil- 
dren during  January,  February,  and  March.  Scarlet 
fever  and  mumps  continue  to  prevail,  though  the  cases 
of  scarlet  fever  are  reported  to  be  very  mild  in  most 
instances. 


The  present  distribution  of  epidemic  meningitis  is 
somewhat  disturbing. 


The  trichinosis  season  is  upon  us. 


Smallpox  is  decidedly  in  evidence. 


Scarlet  Fever  Is  Prevalent. — A total  of  12,816  cases 
of  scarlet  fever  have  been  reported  during  the  period 
January  1,  1929  to  November  16,  1929.  This  is  more 
than  twice  as  many  cases  as  were  reported  during  the 
entire  year  of  1928.  The  relatively  low  number  of 
deaths  indicates  that  the  disease,  in  general,  is  not  of 
a severe  type.  There  were  fifty-four  scarlet  fever 
deaths  in  1928,  and  during  the  first  seven  months  of 
1929  there  were  seventy-four  such  deaths.  The  most 


alarming  feature  of  scarlet  fever  lies  in  the  complica- 
tions that  may  occur  and  which  may  be  productive 
of  terrific  damage  in  later  years.  The  ears  and  kid- 
neys are  commonly  involved  and  many  cases  of  deaf- 
ness and  of  kidney  diseases  have  their  beginnings  in 
scarlet  fever  which  was  contracted  during  childhood. 
Most  cases  of  scarlet  fever  occur  in  children  who  are 
under  ten  years  of  age,  but  a considerable  number  of 
cases  are  in  those  who  are  between  the  ages  of  ten 
and  fifteen  years.  All  persons  are  not  susceptible 
to  the  infection.  About  half  of  all  persons  who  are 
exposed  to  it  contract  the  disease. 

It  is  essential  that  all  cases  of  scarlet  fever  be  dis- 
covered early  and  placed  in  strict  isolation,  giving  par- 
ticular heed  to  the  destruction  of  all  discharges  from 
the  nose,  throat,  and  ears.  Scarlet  fever  is  spread  by 
the  transference  of  the  infection  in  the  discharges 
from  the  noses  and  throats  of  persons  who  may  be 
ill  with  the  disease  and  those  wffio  may  be  carriers 
of  the  infection.  In  order  to  contract  scarlet  fever 
the  susceptible  individual  must  be  within  “striking 
distance”  of  the  person  who  transmits  the  disease. 
The  spray  and  droplets  from  the  infected  person  may 
be  ejected  for  a distance  of  several  feet.  At  the  pres- 
ent time,  scarlet  fever  is  the  most  prevalent  of  the 
respiratory  infections. 


Crippled  Child  Act  Helps  Many. — The  so-called 
Crippled  Children’s  Act  has  now  been  in  effect  for 
two  years  and  during  that  period  a total  of  one 
hundred  and  forty-three  certificates,  enabling  physi- 
cally handicapped  children  to  receive  treatment  free 
of  charge,  have  been  issued.  Three  of  these  certifi- 
cates were  issued  in  1927,  sixty-eight  in  1928,  and 
seventy-two  have  been  issued  so  far  this  year.  The 
one  hundred  and  forty-three  children  for  whom  these 
certificates  were  issued  live  in  thirty-seven  counties 
of  the  state.  The  services  of  twenty-six  surgeons  have 
been  utilized  in  the  correction  of  their  physical  handi- 
caps and  the  patients  have  been  placed  in  twenty-four 
different  hospitals  scattered  throughout  the  state. 
About  half  of  these  children  are  no  longer  in  hospi- 
tals, but  are  still  under  observation  of  doctors  and 
nurses.  The  following  table  gives  full  information 
concerning  the  results  obtained  through  the  operation 
of  the  Crippled  Children’s  Act  during  the  two  years 
it  has  been  in  operation: 

Number  of  certificates  issued  

Cases  dismissed  as  cured 9 

Cases  no  longer  hospitalized,  but  still  under 

observation  70 

Cases  in  convalescent  homes.. 3 

Cases  pending  16 

Cases  which  have  not  been  hospitalized 12 

Cases  hospitalized  33 

Number  of  surgeons 

Number  of  hospitals  

Number  of  counties 


Prevention  of  Blindness  in  Babies. — During  the 
past  two  years  the  State  Department  of  Public  Health 
has  distributed  26,406  outfits  for  the  prevention  of 
blindness  in  babies.  These  outfits  consist  of  two  wax 
ampoules,  each  of  which  contains  two  drops  of  a two 
per  cent  solution  of  nitrate  of  silver.  The  eyes  of 
newly  born  babies  are  peculiarly  liable  to  infection 
and  the  nitrate  of  silver  is  placed  in  the  eyes  of  the 
infant  at  birth,  in  order  to  prevent  the  development 
of  infections  which  might  result  in  blindness.  The 
state  law  requires  the  State  Department  of  Public 
Health  to  distribute  this  product  gratuitously.  Many 
of  the  outfits  are  for  use  in  charity  institutions  and 
in  families  where  this  method  of  prevention  would  not 
otherwise  be  available.  The  policy  involved  in  this 
procedure  saves  the  state  vast  sums  of  money  that 
might  otherwise  be  required  in  the  care  of  blind  per- 
sons in  state  institutions.  The  cost  of  the  nitrate  of 
silver  is  negligible.  The  prevention  of  blindness  in 
babies  has  well  been  cited  as  an  instance  in  which 
“the  protection  of  the  citizen  from  the  assaults  of 
ignorance,  indifference,  or  neglect,  when  they  threaten 
his  well-being  and  even  his  economic  efficiency,  is  a 
duty  which  the  state  cannot  evade  and  which  he  has 
a right  to  exact.” 


143 


2(1 

24 

37 


144 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  2 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 


By  C.  B.  Pinkham,  M.  D. 

Secretary  of  the  Board 

News  Items,  February  1930 

The  annual  report  of  the  Board  of  Medical  Exam- 
iners, recently  submitted  to  Governor  Young,  shows 
that  during  the  year  1929  590  certificates  of  all  classes 
were  issued,  of  this  number  241  being  reciprocity 
certificates,  the  largest  number  of  applicants  coming 
from  Illinois,  while  Ohio  shared  second  place  with 
Missouri.  Forty-nine  California  licensed  physicians 
and  surgeons  have  sought  registration  in  other  states 
and  234  licentiates  died.  Thirty  licentiates  were  called 
before  the  board  for  various  derelictions,  the  judg- 
ment of  the  board  being  as  follows: 


Guilty — Revoked  ...  8 

Guilty — Probation  7 

Guilty — Penalty  suspended  2 

Dismissed  4 

Deferred  to  February,  1930  meeting 9 


Governor  Young  announced  appointments  of  the 
following  members  to  the  State  Board  of  Medical 
Examiners:  Dr.  Harry  V.  Brown,  Glendale,  who  suc- 
ceeds H.  M.  Robertson  of  Santa  Ana;  H.  A.  L. 
Ryfkogel,  succeeding  A.  W.  Morton,  both  of  San 
Francisco;  George  L.  Dock  of  Pasadena,  who  suc- 
ceeds Wilburn  Smith  of  Los  Angeles.  Those  re- 
appointed were  Dr.  Percy  T.  Phillips,  Santa  Cruz, 
president;  Charles  B.  Pinkham,  San  Francisco,  secre- 
tary and  executive  officer;  W.  R.  Molony,  Los  An- 
geles; and  J.  L.  Maupin,  Fresno  (San  Bernardino 
Telegram,  January  10,  1930). 


With  two  convictions  already  made  under  Cali- 
fornia’s new  diploma  mill  law,  inspectors  of  the  State 
Board  of  Medical  Examiners  today  were  investigat- 
ing reports  of  several  fake  doctors  operating  over 
the  state.  Albert  Carter,  Los  Angeles  investigator 
for  the  board,  was  searching  for  “Dr.”  Tsuneyoshi 
Koba,  a Japanese,  who  posed  as  a graduate  of  Johns 
Hopkins  Medical  School,  in  Baltimore.  Carter  re- 
cently seized  a diploma  from  the  Baltimore  school 
made  out  to  Doctor  Koba,  and  inquiry  at  the  school 
revealed  that  the  diploma  was  fraudulent.  Conviction 
under  the  new  law  is  a felony  (San  Francisco  Call- 
Bulletin,  January  3,  1930). 

For  the  first  time  in  the  history  of  California  law, 
a murder  case  was  decided  solely  on  briefs  submitted 
when  Dr.  Florence  Goodhall,  woman  chiropractor, 
was  acquitted  by  Superior  Judge  Carlos  Hardy  of 
the  killing,  through  an  alleged  illegal  operation,  of 
Mrs.  Zeruah  P.  Mahan.  The  case  was  submitted  to 
Judge  Hardy  thirty  days  ago.  Mrs.  Goodhall  was 
convicted  of  second  degree  murder  by  a jury  in  Su- 
perior Judge  Walton  Wood’s  court  last  April  23,  but 
Judge  Wood  granted  the  woman  a new  trial  on 
motion  of  her  counsel.  . . . The  theory  of  law  on 
which  Judge  plardy  based  his  acquittal  was  that  the 
uncorroborated  testimony  of  an  accomplice  was  in- 
sufficient for  conviction  (Hollywood  News,  December 
3,  1929). 


Among  others  who  have  been  called  before  the 
board  to  show  cause  why  their  licenses  should  not 
be  revoked  at  the  meeting  to  be  held  in  Los  Angeles, 
February  4,  are  the  following:  Francis  James  Bold, 
M.  D.,  Whittier,  alleged  illegal  operation;  F.  E. 
Cramer,  M.  D.,  alleged  federal  narcotic  charge; 
George  E.  Darrow,  M.  D.,  Artesia,  illegal  operation; 
Oscar  W.  de  Vaughn,  M.  D.,  Oakland,  alleged  illegal 
operation;  Clarence  E.  Edwards,  M.  D.,  San  Fran- 
cisco, alleged  illegal  operation;  William  A.  Lang, 
M.  D,  Los  Angeles,  alleged  illegal  operation. 


An  indictment  charging  Dr.  G.  Carl  H.  McPheeters, 
Fresno  physician  and  surgeon,  with  sending  obscene 
matter  through  the  mail,  which  was  voted  by  the 
Federal  Grand  Jury  in  November  1926,  has  been  dis- 
missed on  the  authority  of  Attorney-General  William 
D.  Mitchell  (Fresno  Bee,  January  7,  1930). 


According  to  the  San  Francisco  Examiner  of  De- 
cember 6,  1929,  Dr.  Shirley  W.  Wynne,  New  York 
Commissioner  of  Health,  has  written  a letter  to  the 
Federal  Radio  Commission  asking  whether  some 
means  cannot  be  found  to  stop  fake  doctors  and 
quack-healing  concerns  from  advertising  over  the 
radio.  Judging  from  the  complaints  that  come  to  the 
office  of  the  Board  of  Medical  Examiners,  some  mis- 
sionary work  along  this  line  can  be  done  in  California. 


The  last  gasp  of  the  Berkeley  Chiropractic  College, 
2158  Shattuck  Avenue,  Berkeley,  was  heard  today, 
when  the  Supreme  Court,  on  motion  of  Attorney- 
General  U.  S.  Webb  and  the  State  Board  of  Chiro- 
practic Examiners,  dismissed  a notice  of  appeal  on 
the  ground  that  it  had  not  been  perfected.  The  school 
was  ordered  closed  by  Superior  Judge  J.  J.  Trabucco, 
November  28,  1928,  when  it  was  shown  the  place  was 
operated  as  a “diploma  mill”  and  since  then  its  pro- 
prietor, Percy  Purviance,  has  battled  in  nearly  every 
court  in  the  region  to  continue  its  operation.  His 
license  to  practice  as  a chiropractor  was  revoked  by 
the  board  in  1926  . . . (Oakland  Tribune,  January  10, 
1930).  (Previous  entries,  December,  1925;  February, 
July,  September,  October,  1926;  February,  1927; 
March,  May,  and  July,  1928.) 


“Do  you  see  yourself  as  others  see  you?”  asked 
Mrs.  A.  E.  Burton,  1931  Fairview  Street.  As  a trade 
phrase  the  inquiry  may  have  registered,  but  it  had  no 
startling  effect  on  J.  W.  Davidson,  special  agent  for 
the  Board  of  Medical  Examiners.  His  reaction  was 
to  arrest  Mrs.  Burton.  Charged  with  practicing 
beauty  culture  and  surgery  without  a license,  Mrs. 
Burton  was  lodged  in  the  city  jail  to  be  released 
on  $500  bail  . . . (Oakland  Post-Inquirer,  January  7, 
1930.  On  January  11,  1930,  sentence  of  six  months’ 
probation  was  imposed,  with  the  additional  penalty 
that  Mrs.  Burton  refund  $80  of  the  original  fee  charged 
the  complaining  witness. 


“Declaring  that  there  are  chiropractors  in  California 
using  their  profession  as  merely  a cloak  and  subter- 
fuge for  vice,  Dr.  S.  J.  Howell,  secretary  of  the  State 
Board  of  Chiropractic  Examiners,  today  announced 
a vigorous  housecleaning  within  the  ranks  of  the 
profession.  Operating  in  Los  Angeles  as  the  first 
stroke  in  the  campaign,  investigators  of  the  Board 
have  acted  against  thirteen  chiropractors.  Most  promi- 
nent of  these  is  Dr.  Charles  A.  Cale,  president  of  the 
Cale  Chiropractic  College  of  Los  Angeles.  He  was 
charged  with  violating  Section  288-a  of  the  Penal 
Code,  a moral  charge,  and  was  released  on  $2,000 
bail  ...” 


According  to  reports,  the  California  license  of  a 
physician  who  died  in  1928  was  seized  by  the  police 
who  reported  its  having  been  found  hanging  on  the 
wall  of  a questionable  massage  and  alleged  bootleg 
establishment  in  the  California  Building,  Los  Angeles. 
The  Arizona  license  of  this  deceased  physician  was 
seized  at  the  same  time. 


L.  P.  Tso  on  December  30  was  sentenced  in  the 
courts  of  Los  Angeles  to  pay  a fine  of  $100  or  serve 
ninety  days  in  the  city  jail  following  his  plea  of 
guilty  to  a charge  of  violation  of  the  Medical  Practice 
Act.  All  of  said  sentence  except  $10  fine  was  sus- 
pended on  condition  that  he  close  his  place  of  busi- 
ness at  once  and  not  again  violate  the  Medical  Practice 
Act.  The  minimum  fine  under  Section  17  of  the 
Medical  Practice  Act  is  $100. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


Headquarters  for 

Modem  Office  Equipment 

Visit  Our  Large  Sales  Room 
MANY  BARGAINS  NOW  ON  DISPLAY 


Agents 

TRAVERS  SURGICAL  CO. 


Physicians’  and  Hospital  Supplies 


FRESNO 
933  Van  Ness 


SAN  FRANCISCO 
429  Sutter  Street 


Onvisa 


A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER. 


N 

■ Looks  like  a dress  silk  stocking.  A new  German 

V invention.  Gives  compression  when  drawn  up  at 

the  top.  Tightness  regulated  in  direct  relation  to 
vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treatment  of  varicose  veins 
and  swollen  limbs.  Neat  and  comfortable. 

Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 


PRICES 

Length  as  illustrated $ 7.00 

Half  thigh  length 9.00 

Full  length  10.00 


In  ordering  give  patient’s 
calf  measurement. 


SOLD  AND  FITTED  BY 


'JJ 9 S E .A. ©S 11 


323  W.  6TH  STREET 


LOS  ANGELES,  CALIF. 


Phone  MUtual  8081 


34 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


• • • powerful  and 
rapid  in  action.  Kills 
bacteria  almost 
instantly. 


Valuable  in  the  treatment 
of  all  open  wounds,  abra- 
sions, and  infections  of  the 
mucous  membranes 


immwm 


12  FLUID  OUNCES 


MJJTION  SJl 


LIQUOR  HCXURESORONOUS.  SAD' 

; l J'  IVblCATCS  A SOLUTION  LMlItini'C  i 

• t rcxsioN  or  nr  10  ,cs  i*£R  ■ 

GENERAL  ANTISEPTIC 

,„A; 5TABLE.  NON-TOXIC. 
lln'TAT|NG.  GERMICIDAL 

li  which  retains  ITS  ACT^ 
’ when  applied  to  tissu 
paTAces  and  destR' o’J 
LES^^EN'C  bacteria  0 

TAct  THAN  ,5  SECONDS  CO 


• • • especially  suggested,  at 
this  time  of  the  year,  as  a 
nasal  spray,  mouth  wash 
and  gargle. 


SHARP  & DOHME 

BALTIMORE 

NEW  YORK  CHICAGO  NEW  ORLEANS  ST.  LOUIS  ATLANTA 

PHILADELPHIA  KANSAS  CITY  SAN  FRANCISCO  BOSTON  DALLAS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


THE 

VERY 

LATEST 

IN 

STETHOSCOPES 

READING 
MATTER 
ON  REQUEST 


THE 

CARSBERG 

REVOLVING 

DUO-SCOPE 


The  chest  piece  is  fitted  at  one  side  with  a 
phonendoscope  disk  for  general  use,  and  at 
the  other  side  with  a small  ebonite  bell  for  in- 
tercostal spaces.  The  instrument  also  forms 
a very  effective  differential  stethoscope  be- 
cause the  volume  of  sound  can  be  graduated 
at  will  by  revolving  chest  piece  to  certain 
angles. 

WALTERS 

SURGICAL  COMPANY 
Phone  DOUGLAS  4017 

521  Sutter  Street  San  Francisco 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  31) 

ism  of  influenza  has  been  discovered  and  that  it  is 
hoped  to  prepare  a vaccine.  There  is  thus  far  little 
or  no  evidence  to  indicate  that  I.  S.  Falk,  Ph.D.,  and 
his  associates  have  progressed  any  further  toward  the 
solution  of  this  problem  than  have  workers  in  other 
parts  of  the  world,  now  or  in  the  past. — Jour.  A.  M.  A., 
December  21,  1929,  p.  1975. 

Collum’s  Dropsy  Remedy. — For  some  years  the 
Collum  Dropsy  Remedy  Company  of  Atlanta,  Ga., 
has  been  selling  on  the  mail-order  plan,  an  alleged 
cure  for  dropsy.  The  remedy  consists  of  three  boxes 
of  large  pills,  or  boluses,  and  five  bottles  of  liquid 
preparation.  The  pills,  or  boluses,  are  known  as 
“Remedy  No.  1’’;  then  there  are  two  bottles  of 
“Remedy  No.  5,’’  two  bottles  of  “Remedy  No.  6,”  and 
one  bottle  of  “Remedy  No.  7.”  The  preparations  were 
examined  in  the  American  Medical  Association  Chemi- 
cal Laboratory.  The  boluses  were  found  to  consist 
essentially  of  a phlobaphene — that  is,  of  anhydrids  of 
tannin — to  which  had  been  added  extract  of  licorice, 
a flavoring  agent  and  minute  traces  of  inorganic  salts. 
Remedy  No.  5,  sold  with  the  claim  that  it  will  purify 
the  blood  and  strengthen  the  entire  system,  was  evi- 
dently a syrup  of  ferrous  iodid.  Remedy  No.  6,  sold 
“for  the  stomach  and  digestion,”  was  found  to  be’  a 
syrup  of  ammonium  hypophosphite.  Remedy  No.  7, 
which  the  manufacturer  declares  will  “relieve  the 
cough  that  accompanies  dropsy  in  a few  days,”  was 
simply  syrup  to  which  had  been  added  muriate  of 
ammonia.  It  is  obvious  that  whatever  results  are 
obtained  in  the  reduction  of  the  dropsical  condition 
are  due  not  to  the  Collum  preparation,  but  to  the 
heavy  and  repeated  doses  of  Epsom  salt,  or  other 
salines,  that  the  victim  is  instructed  to  take  at  hourly 
intervals  following  the  ingestion  of  the  Collum 
boluses!  As  to  the  business  itself:  Dropsy,  being  a 
symptom  and  not  a disease  and  usually  the  result 

(Continued  on  Next  Page) 


Build  Resistance 
— Increase  Vitality 

with 


California  Grape  Juice 


Here  is  a pure  juice  just 
as  it  comes  from  the 
grape  — nothing  added, 
nothing  taken  away.  It 
brings  you  the  full 
healthful  quality  of 
vine-ripened  California 
grapes.  ’49  Brand  grape 
juice  actually  has  all  the 
properties  of  unfer- 
mented wine.  This  is 


for  patients  either  before 
or  after  operations  be- 
cause of  its  food  value, 
purity,  mellow,  delicious 
flavor  and  high  percent- 
age of  natural  invert 
sugar.  For  this  reason 
it  is  particularly  valu- 
able in  all  cases  where 
pure,  unsweetened  fruit 
juices  are  indicated. 


made  possible  by  an 
exclusively  controlled 
process. 

’49  is  the  ideal  beverage 

The  analysis  below  will 
indicate  the  value  of  ’49 
Brand  for  general  diet 
and  hospital  use. 

Laboratory  Certificate,  Nor.  25, 

1929 

CURTIS  Si  TOMPKINS, Ltd., San  Francisco 

No.  105914 

No.  105915 

Red 

White 

*49  Brand 

’49  Brand 

Reducing  Sugar  (as  Dextrose) 

18.84% 

18.18% 

Sucrose  (Cane  Sugar) 

Nil 

Nil 

Ash  (Mineral  Matter) 

0.34% 

0.35% 

Total  Solids  

19.61% 

19.32% 

Preservatives 

Sulfurous  Acid  

Nil 

Nil 

Salicylic  Acid  

Nil 

Nil 

Benzoates  

Nil 

Nil 

Borates  

Nil 

Nil 

Saccharin  

Nil 

Nil 

Calories  per  pound  (based  on 

sugar  content)  

350 

338 

Physicians,  dietitians  or 

hospitals  interested  in 

learning  more  about  ’49  Brand  Grape 

Juice  and 

its  uses  may 

write  to 

VITA  FRUIT  PRODUCTS,  INC 

RUSS  BUILDING,  SAN  FRANCISCO 
GRAPE  JUICE  PLANT  AT  LODI 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


36 


Rainier  Pure  Grain  Alcohol 

USP 

The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRAIN  ONLY 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 

RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calil. 


Dairy  Delivery  Company 

Successors  in  San  Francisco  to 

Millbrae  Dairy 

The  Milk  With  More  Cream 


We  deliver  daily  from 
San  Francisco 
to 

Menlo  Park 


PHONE  VALENCIA  TEN  THOUSAND 
and  BURLINGAME  3076 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Previous  Page) 
of  incompetent  heart  or  kidney  action,  is  quite  evi- 
dently not  a condition  that  should  be  self-treated.  The 
sale  of  remedies  for  the  alleged  treatment  of  dropsy 
is  without  justification. — Jour.  A.  M.  A.,  December  21, 
1929,  p.  1990. 

Composition  of  Ster-Tabs. — These  tablets,  to  be 
added  to  water  in  which  instruments  are  to  be  steril- 
ized, are  claimed  to  be  composed  of:  sodium  carbo- 
nate (monohydrated)  18  grains  and  sodium  nitrite 
7J4  grains  per  tablet. — Jour.  A.  M.  A.,  December  21, 
1929,  p.  1993. 

The  Etiology  of  Influenza.— I.  S.  Falk  and  his  col- 
leagues publish  a preliminary  report  of  their  work 
on  the  etiology  of  influenza  which  does  not  go  far 
beyond  previous  research  on  influenza.  The  difficulty 
in  interpreting  the  results  is  largely  due  to  the  fact 
that  it  is  difficult  to  distinguish  clinical  epidemic  in- 
fluenza from  acute  respiratory  infections  in  monkeys 
and,  indeed,  in  man.  In  1892  Pfeiffer  described  an 
organism  as  the  causative  organism  of  influenza  and 
since  that  time  other  allegedly  causative  organisms 
have  been  described.  The  green,  producing  strepto- 
coccus isolated  by  Mathers  and  Tunnicliffe  in  1918, 
the  one  isolated  by  Rosenow  in  1919,  the  filter-pass- 
ing organism  described  by  Meyer  in  1919,  and  the 
organism  discovered  by  Olitzky  and  Gates  called 
Bacterium  pneumosintes,  would  seem  to  deserve  as 
much  consideration  as  should  be  given,  at  least  on 
the  basis  of  the  available  evidence,  to  the  germ  re- 
cently announced  by  Falk. — Jour.  A.  M.  A.,  December 
28,  1929,  p.  2034. 

Mallophene.- — Mallophene  is  the  proprietary  name 
under  which  the  Mallinckrodt  Chemical  Works  mar- 
kets an  azo  dye  of  the  pyridin  series.  The  patents 
on  the  product  are  owned  by  another  corporation  and 
the  Mallinckrodt  firm  manufactures  it  under  license 
from  the  holding  company.  It  is  regrettable  that  the 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


Your  dealer  can  supply 
you  with  this  equip- 
ment. Complete  unit 
$52.50.  Clamp  only 
$15.00.  Write  today  for 
additional  information. 


Tycos  Surgical  Unit 


For  Blood  Pressure  Determination 
In  the  Operating  Room 


Anticipating  the  needs  of  anaesthetists  and  surgeons, 
who  are  finding  that  accurate  blood  pressure  read- 
ings are  invaluable  during  anaesthesia  and  surgery, 
we  have  designed  this  Tycos  Surgical  Unit. 

It  consists  of  a large  easy  reading 
type  Tycos  Sphygmomanometer  and 
a universal  clamp.  The  clamp  en- 
ables the  Sphygmomanometer  to  be 
adjusted  to  any  position  convenient 
for  the  anaesthetist  and  out  of  the 
way  of  surgeons  or  assistants.  The 
adjustments  can  be  made  instantly, 
but  once  made  the  instrument  is 
firm  as  the  table  itself.  If  it  is  in- 
convenient to  have  the  instrument 
attached  to  the  table,  the  clamp  will 
accommodate  it  to  the  anaesthesia 
equipment  or  instrument  stand. 

Modern  reliance  on  blood  pressure 
makes  it  extremely  important  to  in- 
clude the  Tycos  Surgical  Unit  in 
operating  room  equipment. 


Makers  of  Tycos  Sphygmomanometers,  Pocket, 
Office  and  Recording,  Tycos  Fever  Thermometers 

Taylor  Instrument  Companies 

ROCHESTER,  N.  Y.,  U.  S.  A. 


CANADIAN  PLANT 
TYCOS  BUILDING 
TORONTO 


MANUFACTURING  DISTRIBUTORS 
IN  GREAT  BRITAIN 
SHORT  & MASON.  LTD..  LONDON 


Diagram  shows  the 
universal  nature  of 
the  clamp.  Six  ad- 
justments accommo- 
date the  instrument 
to  any  position  of 
table,  anaesthetists  or 
surgeons. 


Mallinckrodt  Chemical  Works  sees  fit  to  use  for  this 
preparation  a different  proprietary  name  from  that 
used  by  the  patent  owners.  The  use  of  a number 
of  proprietary  names  for  identical  products  creates 
chaotic  conditions.  Mallophene  has  not  been  sub- 
mitted to  the  Council  on  Pharmacy  and  Chemistry, 
although  the  firm  which  owns  the  patent  has  sub- 
mitted its  product  to  the  Council.  The  Mallinckrodt 
firm  does  not  appear  to  have  presented  evidence  to 
justify  the  medical  claims  which  it  advances.  It  is  to 
be  regretted  that  the  Mallinckrodt  Chemical  Works 
offers  its  product  to  the  medical  profession  without 
first  submitting  it  to  the  Council  on  Pharmacy  and 
Chemistry — a recognized  body  working  in  the  best 
interests  of  both  the  profession  and  the  public  health. 
Jour.  A.  M.  A.,  December  28,  1929,  p.  2044. 


Prof.  Karl  Sudhoff. — Dr.  Karl  Sudhoff,  who  for- 
merly occupied  the  chair  of  medical  history  in  the 
University  of  Leipzig,  has  been  visiting  the  United 
States  for  the  first  time.  He  came  out,  on  the  invita- 
tion of  the  Johns  Hopkins  University,  Baltimore,  pri- 
marily to  give  an  address  at  the  inauguration  of  the 
new  department  of  medical  history,  of  which  Prof. 
W.  H.  Welch  is  the  head.  While  in  the  United 
States  Professor  Sudhoff  lectured  also  at  Harvard 
and  Yale  universities,  and  at  the  Rockefeller  Insti- 
tute, New  York. 

Doctor  Sudhoff  was  a medical  practitioner  in  Ger- 
many for  more  than  thirty  years;  a Prussian  sanitary 
councilor  for  four  years;  and  the  first  president  of 
the  German  Society  of  the  History  of  Medicine.  He 
was  the  creator  of  what  is  the  finest  institute  for  the 
study  of  the  history  of  medicine  in  the  world,  and  is 
himself  world-famous  for  his  researches  into  some  of 
the  obscure  corners  of  medical  history.  He  is  known 
for  his  translations  of  Arabian  and  ancient  Hebrew 
texts,  and  of  Egyptian  hieroglyphics,  and  has  written 
extensively  on  medical  subjects. — The  Canadian  Medi- 
cal Association  Journal,  December  1929. 


One  of 
America’s 
Leading  Hos- 
pital Supply 
Houses— 

Manufacturers  of  "Porcello” 
Aseptic  Steel  Furniture 


Reid 
Bros. 

Factory  at 
Irvington, 
California 

OFFICES 

91  Drumm  Street  San  Francisco,  Calif. 

Phone  DOuglas  1381 

1417  Fourth  Avenue,  Seattle,  Washington 


38 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Analyzed  and  Certified  Products 

NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 
INTRAMUSCULAR  MEDICATIONS 
PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


STATE  BOARD  REVIEW 

Preparation  for  State  Board 
Examination 

WRITTEN  OR  ORAL 

DR.  MORRIS  STARK 

4405  So.  Broadway 
LOS  ANGELES,  CALIFORNIA 


Creating  Joy 

(f  reate  joy  for  yourself  and  others 
hy  sending  flowers 


X-ray  Films  in  Relation  to  Safety. — The  recent 

New  York  City  disaster,  following  on  the  heels  of 
the  San  Francisco  fire  and  the  Cleveland  Clinic  catas- 
trophe earlier  in  the  year,  has  once  more  directed 
public  attention  to  the  film  hazard.  Hospital  man- 
agers have  written  to  the  Industrial  Accident  Com- 
mission for  help  in  meeting  their  different  problems. 

Conferences  were  held  during  December  between 
the  Commission’s  representatives,  the  San  Francisco 
Junior  Chamber  of  Commerce,  officials  of  the  city 
and  county  of  San  Francisco,  spokesmen  for  the 
National  Board  of  Fire  Underwriters,  the  Board  of 
Fire  Underwriters  of  the  Pacific,  and  engineers  who 
have  studied  fire  hazards.  A pending  ordinance  be- 
fore the  San  Francisco  Board  of  Supervisors  will 
probably  not  be  pressed  at  this  time,  owing  to  the 
unanimous  belief  that  the  Industrial  Accident  Com- 
mission’s safety  orders  will  best  meet  the  situation. 
The  San  Francisco  Fire  Department’s  delegates  have 
expressed  themselves  as  anxious  to  aid  hospitals  in 
other  parts  of  the  state,  and  uniformity  in  action  will 
lead  to  this  desired  end. 

The  regulations  of  the  National  Board  of  Fire 
Underwriters  for  the  storage  and  handling  of  photo- 
graphic and  x-ray  nitrocellulose  films  have  been  sent 
to  all  of  California’s  hospitals.  These  regulations 
were  prepared  by  the  National  Fire  Protection  Asso- 
ciation and  approved  by  the  national  board.  They 
are  in  printed  form  and  will  undoubtedly  be  the  basis 
of  the  permanent  requirement.  The  Industrial  Ac- 
cident Commission  has  circularized  the  hospitals, 
strongly  recommending  the  adoption  of  the  regula- 
tions, and,  with  the  assistance  of  the  fire  departments 
of  the  different  cities,  will  make  all  the  inspections 
possible  within  the  next  few  weeks. 

The  regulations  describe  proper  methods  of  storing 
unexposed  films,  or  negative  films,  whether  in  hospi- 
tals, warehouses,  or  in  portrait  and  commercial 
studios.  The  instructions  are  clear.  General  advice 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


39 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 
NEW  YORK,  NEW  YORK 
FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  haring  an  addict  problem  is 
invited  to  write  for  tr  Hospital  Treatment  for 
Alcohol  and  Drug  Addiction .** 


FRANK  F.  WEDEKIND  CO. 

SURGICAL  SUPPLY  CENTER 

First  Floor,  Medical  Building 

Opposite  St.  Francis  Hospital 
BUSH  AND  HYDE  STREETS 

Telephone  GRaystone  9210 

Main  Store  and  Fitting  Rooms 
2004-06  SUTTER  STREET  WEST  6322 

Corsets  . . Surgical  Appliances  . . Storm  Binders 
Orthopedic  Appliances  . . Elastic  Hosiery  . . Trusses 
California  Manufacturing  Agents  for 

The  "Storm  Binder”  and  Abdominal  Supporter 
( Patented ) 


is  given  at  the  end  of  the  pamphlet.  These  regula- 
tions do  not  cover  nitrocellulose  motion-picture  films. 

The  next  step  is  to  issue  permanent  safety  orders. 
The  Industrial  Accident  Commission  is  planning  the 
appointment  of  advisory  committees  to  assist  its  engi- 
neers in  preparing  the  standards  that  will  have  legal 
sanction.  It  is  proposed  to  use  the  National  Board 
of  Fire  Underwriters’  regulations  and  to  add  such 
additional  orders  as  may  seem  best  for  California. 


Early  or  Moderately  Advanced  Cases  of  Leprosy. — 

The  Public  Health  Service  has  recently  issued  a re- 
port on  leprosy  from  the  leprosy  research  station  of 
the  Service  in  Hawaii  that  should  be  of  special  value 
to  physicians  who  are  interested  in  diseases  of  the 
skin  and  of  the  nervous  system.  This  report  points 
out  that  leprosy  is  by  no  means  always  the  repulsive 
condition  that  it  is  traditionally  regarded  as  being,  but 
that  often  the  signs  and  symptoms  are  so  slight  or 
so  indefinite  that  there  is  required  great  discrimina- 
tion upon  the  part  of  the  physician,  and  perhaps  he 
may  require  repeated  examinations  before  coming  to 
a decision  in  some  cases.  The  microscope  is  often  of 
value  in  aiding  in  making  a diagnosis. 

The  general  public  is  accustomed  to  regard  leprosy 
as  abhorrent  in  every  respect  whereas,  in  fact,  many 
lepers  might  mingle  with  the  public  without  attract- 
ing the  slightest  attention. 

The  Public  Health  Service  study  is  based  upon  the 
minute  investigation  of  two  hundred  and  fifty  cases 
by  experts,  and  it  is  emphasized  that  the  onset  is 
usually  insidious  and  that  perhaps  two  years  on  an 
average  will  elapse  before  the  patient  is  admitted  to 
a hospital. 

A point  of  interest  is  seen  in  the  long  periods  of 
quiescence  of  the  disease  during  which  the  victim  is 
apparently  free  from  any  signs  of  the  infection. — 
Public  Health  Service,  January  17,  1930. 


_ SAVE  MONEY  ON  — 

YOUR  X-RAY  SUPPLIES 


W e Save  You  from  10 % to  25 % 

GET  OUR  PRICE  LIST  AND  DISCOUNTS 


Insures  finest  radiographs  on  heavy  parts,  such  as 
kidney,  spine,  gall-bladder  or  heads. 

Curved  top  style — up  to  17  x 17  size  cassettes $250.00 

Flat  top  style  for  11  x 14  size 175.00 

Flat  top  style  for  14  x 17  size 260.00 

X-RAY  FILM — Buck  Silver  Brand  or  Eastman  Super- 
speed Duplitized  Film.  Heavy  discounts  on  carton 
quantities.  Buck,  Eastman  and  Justrite  Dental  Films. 
BARIUM  SULPHATE — for  stomach  work,  purest 
grade.  Also  BARI-SUSP  MEAL.  Low  Prices. 
DEVELOPING  TANKS  — 4,  5 & 6 compartment 
soapstone,  EBONITE  2 1/2,  5 & 10  gallon  sizes. 
Enamel  Steel  and  Hard  Rubber  Tanks. 
COOLIDGE  X-RAY  TUBES— 7 styles.  Gas  Tubes. 
INTENSIFYING  SCREENS  & CASSETTES  for 
reducing  exposures.  Special  low  prices. 

JONES  BASAL  METABOLISM  UNITS, 

Most  accurate,  reliable,  portable — $235.00. 

If  you  have  a machine  $ Geo.  W.  Brady  & Co. 

have  us  put  your  name  Wj  781  s.  Western  Avc. 

on  our  mailing  list.  E&Chicago  - - - Illinois 


40 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Medico  - Dental 

Professional  Service 

AGREEMENTS 

t-As 

FINANCED  BY  OUR  ORGANIZATION  OFFER  MANY 
ADVANTAGES  TO  BOTH  DOCTOR  AND  PATIENT 

Organized  for  the  purpose  of  financing  the  installment  purchase  of 

Medical  and  Dental  services 

EXCLUSIVELY 

Our  service  takes  care  of  your  installment-paying  patient  in  a 
scientific  and  dignified  manner — whereby  the  doctor  is  paid  cash 
for  his  services , allowing  the  patient  to  pay  over  a period  of  months 
without  additional  cost. 

NO  INVESTMENT  REQUIRED  TO  USE  OUR  SERVICE 
For  Further  Information  Address 

Medico- Dental  Finance  Co. 

Russ  Building  Kearny  6250  San  Francisco 

OAKLAND  SACRAMENTO 


Thu  Business  Formerly  Conducted  Under  the  Name  United  Commercial  Securities  Corporation 


Johnston-Wickett 

Clinic 

ANAHEIM,  CALIFORNIA 


Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 
Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 


Veronal  Law  Became  Effective  August  14. — Drug- 
gists must  bear  in  mind  that  the  so-called  Veronal 
law,  passed  by  the  recent  legislature,  became  effec- 
tive August  14.  While  there  is  still  much  difference 
of  opinion  regarding  just  what  preparations  are  cov- 
ered under  the  provisions  of  the  law,  until  a test  can 
be  made  and  a judicial  ruling  can  be  obtained,  the 
list  of  preparations  which  may  be  sold  only  on  non- 
refillable  prescriptions  will  include:  Veronal  Soda  or 
Powder,  Veronal  Tablets  or  Powder,  Neonal  Tablets 
(Abbott),  Barbital  Tablets  or  Powder,  Barbital  Soda 
or  Powder,  Ipral  Tablets  (Squibb),  Amytal  Tablets. 
( Lilly) , Amytal  Compound  Capsules,  Luminal  Tab- 
lets, Luminal  Soda,  Allonal  Tablets,  Phanodorn  Tab- 
lets, Cibalgine  Tablets,  Peralgia  Tablets,  Medinal 
Tablets,  Hypnatol  (Wyeth),  Brominyl  and  Barbital 
(Upjohn),  Dial  Tablets,  Dial  Ampoules,  Dilacetin 
Tablets,  and  Cibalgine  Ampoules. 

The  following  preparations  contain  less  than  forty 
grains  to  the  ounce  and  can  be  sold:  Elixir  Amytal, 
Compound  Syrup  Amythme,  Adalin  Luminal  Tablets,. 
Lumaglin  Tablets,  Pyraminal  Tablets,  Elixir  Pyrami- 
nal,  Elixir  Luminal,  Elixir  Veronal,  Kres  Luminal, 
Neuronidia,  Elixir  Alurate,  Elixir  Dial,  and  Elixir 
Cibalgine. — West  Coast  Druggist,  November  1929. 


Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


Health  Hazards  in  Chrome  Plating. — Previous  to’ 
the  World  War  the  process  of  chrome  plating  was 
covered  by  patent  rights,  and  only  the  large  industries, 
were  in  a position  to  carry  on  the  work.  After  the 
war  the  federal  government  released  a number  of 
formulas  to  industry,  with  the  result  that  chromium 
as  a noncorroding  and  a fire-resisting  protective  for 
metal  was  universally  adopted,  so  that  even  the  small 
type  of  plating  shop  was  able  to  utilize  the  process. 

The  method  of  plating  consists  of  placing  the  metal 
(which  in  some  industries  may  have  already  been 
plated  with  a metal  such  as  nickel)  in  a tank  which 
contains  chrome  compounds  and  chromic  acid.  Elec- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


41 


CALSO  WATER 

PALATABLE  ALKALINE  SPARKLING 


Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Galso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Calso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Lot  Angelei 


trie  current  is  supplied  to  the  solution,  one  pole  of 
the  current  usually  terminating  in  a lead  plate,  the 
other  pole  attached  to  the  metal  rod  upon  which  the 
material  to  be  plated  is  suspended  in  the  solution. 

With  the  electric  current  on,  and  during  the  placing 
of  the  metal  in  the  tank,  oxygen  and  hydrogen  gases 
are  given  off ; also,  when  metal  is  placed  in  the  solu- 
tion or  removed,  some  fumes  are  also  noticeable. 

The  gases  in  escaping  carry  small  particles  of 
chrome  acid  into  the  air.  It  is  the  inhalation  or 
swallowing  of  the  acid  carried  from  the  tank  in  this 
manner  which  causes  the  greatest  damage  to  the  tis- 
sues of  the  workers. 

Attention  has  been  directed  principally  to  the  effect 
upon  the  skin  due  to  the  vapor  and  splashing  of  the 
liquid,  resulting  in  a dermatitis,  which  in  many  cases, 
develops  into  ulcers.  Later  it  was  found  that  the 
action  upon  the  mucous  membranes  caused  perfora- 
tion of  the  nasal  septum;  it  was  then  that  marked 
attention  was  directed  to  the  grave  health  hazard 
existing  in  the  industry. 

However,  this  condition  was  not  limited  to  the 
workers  directly  engaged  in  the  process.  At  one  fac- 
tory it  was  discovered  that  a number  of  female 
workers  in  the  same  room,  but  at  some  distance  from 
the  tanks,  also  suffered  from  nasal  trouble,  due  to  the 
chromic  acid  in  the  air  of  the  room. 

One  cause  of  the  injury  to  the  workers  was  trace- 
able to  the  lack  of  efficient  exhaust.  The  indirect 
effect  was  ascribed  to  inefficient  general  ventilation, 
due  to  the  air  currents  carrying  the  minute  amounts 
of  acid  increased  during  the  action  of  placing  material 
in  the  tank  as  well  as  in  removing  the  same,  to  remote 
portions  of  the  room. 

The  distressing  part  of  the  nasal  perforation  is  the 
irreparable  damage  which  results  to  the  cartilage  in 
the  nose.  The  ultimate  effect  upon  the  worker,  due 
to  the  presence  of  a small  opening  between  the  nares, 
can  readily  be  understood. — C.  T.  Graham-Rogers, 
M.  D.,  Industrial  Hygiene  Bulletin,  December  1929. 


^OJE...  A World  Mart 
of  Surgical  Supplies 

Brought  to  You  . . . 
...IN  LOS  ANGELES 

For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 

Send  (or  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 

KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


a milk  supply  in  powder  form 


r I THERE  are  very  few  physicians  who  will  not  re- 
commend  Klim  for  infant  feeding  once  they 
thoroughly  understand  that  Klim  is  simply  pure, 
fresh,  full-cream  cows’  milk,  powdered  for  con- 
venience. It  is  not  a formula,  nor  is  it  a specially 
prepared  baby  food.  It  is  just  milk. 

Klim  is  particularly  suited  for  infant  feeding  be- 
cause of  its  superior  digestibility.  Its  finely  divided 
casein,  precipitating  in  a small  friable  curd,  and  its 
small  butterfat  globule,  promote  digestion  and  in- 
sure a high  degree  of  assimilation.  Because  of  this 
characteristic,  Klim  will  feed  many  infants  that  fail 
to  thrive  on  fluid  cows’  milk. 

Literature  and  samples  including  spe- 
cialfeeding calculator  sent  on  request. 

Merrell-Soule  Co.,  Inc.,  350  Madison  Ave.,  New  York 


(Recognizing 
the  importance 
of  scien  t ific 
control,  allcon- 
tact with  the 
laity  is  predi- 
cated on  the 
policy  that 
KLIM,  and  its 
allied  products, 
be  used  in  in- 
fant feeding 
only  according 
to  a physician’s 
formula.) 


Merrell-Soule  Poivdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date • 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 

B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 

M 

Training  School  for 
Nurses 

n 


For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


Gratitude. — We  venture  to  say  that  the  highest  re- 
ward of  the  doctor  is  the  knowledge  that  he  has 
served  well  and  truly  the  afflicted  ones  who  have 
come  to  him  for  treatment  and  advice.  Serving  often 
for  nothing,  or  for  wholly  inadequate  compensation, 
the  physician  has  a right  to  expect  at  least  gratitude 
from  his  patients.  But,  many  times  in  exchange  for 
devotion,  charity  and  self-sacrifice  he  meets  with  un- 
just criticism  and  gross  ingratitude. 

Your  counsel  feels  well  qualified  to  write  on  this 
subject,  since  daily  in  court  and  out  he  is  defending 
the  profession  against  claims  and  suits,  many  of 
which  contain  elements  of  base  ingratitude  on  the 
part  of  the  patient.  To  your  counsel  one  of  the  most 
distressing  features  of  this  situation  is  the  effect  on 
the  physician’s  philosophy  of  life.  As  one  physician 
recently  said,  referring  to  a most  unjust  malpractice 
suit  which  had  been  brought  against  him,  “This  expe- 
rience is  enough  to  sour  the  milk  of  human  kindness. 
From  now  on  I am  hard-boiled.”  Of  course,  the 
doctor  did  not  really  mean  that,  but  one  can  under- 


stand and  sympathize  with  his  perfectly  natural  and 
human  reaction  to  the  ingratitude  of  his  patient. 

The  medical  profession  does  not  receive  the  grati- 
tude to  which  they  are  justly  entitled  for  their  untir- 
ing efforts  in  the  interests  of  suffering  humanity. 
Rarely  does  the  courage,  devotion,  and  self-sacrifice 
of  the  doctor  receive  even  a passing  comment  of 
praise.  The  world  forgets  that  the  doctor  must  meet 
the  material  obligations  of  life  in  exactly  the  same 
manner  as  those  outside  the  profession.  It  forgets 
that  in  common  with  all  the  rest  of  mankind  the 
doctor  needs  sleep,  rest,  recreation,  encouragement, 
and  loyalty. 

But  the  doctor  carries  on.  Neither  illness  nor  fa- 
tigue, discouragement,  or  financial  strain  can  swerve 
him  from  his  loyalty  to  the  ideals  of  his  calling.  Your 
counsel  is  proud  to  be  the  champion  and  advocate  of 
the  members  of  so  noble  a profession. — By  Lloyd 
Paul  Stryker,  Esq.,  Counsel,  Medical  Society  of  the 
State  of  New  York,  New  York  State  Journal  of  Medi- 
cine, December  1929. 


44 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Banning  Sanatorium  ^tlthnlf1 2 3 * * * * 8 


Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
Treatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


LIVERMORE  SANITARIUM 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
and  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 


GENERAL  FEATURES 


1.  Climatic  advantages  not  excelled  in  United  States. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge 
Department. 

3.  A resident  medical  staff.  A large  and  well  trained 

individual  attention. 

Information  and  circulars  upon  request 

Address:  CLIFFORD  W.  MACK,  M.  D. 

Medical  Director 
Livermore,  California 


Beautiful  grounds  and  attractive  surrounding  country, 
of  an  athletic  director.  An  excellent  Occupational 

nursing  staff  so  that  each  patient  is  given  careful 

CITY  OFFICES: 

San  Francisco  Oakland 

450  Sutter  Street  1624  Franklin  Street 


Telephone  7-J 


KEarny  6454 


GLencourt  5989 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


An  Effective  AlLip- 

in  the  Treatment  of  Pneumonia 


Anything  short  of  major  cali- 
bre in  a diathermy  machine  for 
the  treatment  of  pneumonia 
will  prove  disappointing.  The 
Victor  Vario-Frequency  Dia- 
thermy Apparatus  is  designed 
and  built  specifically  to  the 
requirements.  It  has,  first,  the 
necessary  capacity  to  create 
the  desired  physiological  ef- 
fects within  the  heaviest  part 
of  the  body;  secondly,  a re- 
finement of  control  and  selec- 
tivity unprecedented  in  high 
frequency  apparatus. 

In  the  above  illustration 
the  apparatus  proper  is  shown 
mounted  on  a floor  cabinet, 
from  which  it  may  be  lifted 
and  conveniently  taken  in 
your  auto  to  the  patient’s 
home. 


A REPORT  from  the  Department 
Tx.  of  Physiotherapy  of  a well- 
known  New  York  hospital,  dealing 
with  diathermy  in  pneumonia  and 
its  sequelae,  states  as  follows : 

“As  a rule  diathermy  is  indicated  in 
acute  pneumonia,  especially  so  when 
the  symptoms  are  becoming  or  already 
are  alarming:  the  temperature  is  high, 
the  patient  is  delirious,  the  pulse  is 
extremely  rapid,  cyanosis  is  deep,  the 
respiration  rate  is  high,  the  breathing 
is  very  shallow,  and  the  cough  remains 
unproductive.  Not  infrequently  in  a 
pneumonia  case  with  such  alarming 
symptoms,  after  a few  diathermy  treat- 
ments an  entire  change  of  the  picture 
takes  place:  cyanosis  lessens,  respira- 
tion becomes  deeper,  the  quality  of 
pulse  improves,  the  rate  decreases,  the 


temperature  is  lowered,  and  the  cough 
becomes  productive.  Auricular  fibril- 
lation that  develops  occasionally  in 
similar  pneumonias  or  other  types  of 
pneumonia  where  the  toxemia  is  great, 
has  been  changed  to  a perfect  normal 
rhythm  after  a few  diathermy  treat- 
ments.’’ 

You  will  value  diathermy  as  an 
ally  in  your  battles  with  pneu- 
monia  at  this  season,  aside  from 
the  satisfaction  derived  from  hav- 
ing utilized  every  proved  thera- 
peutic measure  that  present  day 
medical  science  offers. 

A reprint  in  full  of  the  article 
above  quoted,  also  reprints  of  other 
articles  on  this  subject,  will  be 
sent  on  request. 


VICTOR  X-RAY  CORPORATION 


Manufacturers  of  the  Coolidge  Tube 
and  complete  line  of  X-Ray  Apparatus 


J]  Physical  Therapy  Apparatus,  Electro* 
cardiographs,  and  other  Specialties 


2012  Jackson  Boulevard  Branches  in  all  Principal  Cities  Chicago,  111.,  U.S.A# 


A GENERAL  ELECTRIC 


ORGANIZATION 


San  Francisco:  Four-Fifty  Sutter 


Los  Angeles:  Medico-Dental  Bldg. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


4<> 


DIATHERMY 


GALVANIC 


SINE  WAVE 


X-RAY 


Dewar  & Hare  Electric  Co. 


386  Seventeenth  Street 


Oakland,  California 


THE  "THERMOTAX” 

A high  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 


THE  "ELECTROTAX” 

A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 


Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


San  Francisco  Home  for 
Incurables,  Aged  and  Sick 

2750  Geary  Street,  N.  E.  corner  Wood  Street 
Telephone  WEst  5700 

A non-profit  institution  for  the  service  of  persons  of 
limited  means.  Two  large  courts  with  gardens; 
solariums,  roof  garden  and  sun  room. 

Day  and  night  nursing  care — Staff  Physician  in  at- 
tendance— Private  Physician  if  desired. 

Convalescent  patients  received. 

No  mental,  alcoholic  or  contagious  cases  accepted. 
Formal  application  required  before  admission. 

DR.  GEO.  W.  COX 
(Johns  Hopkins)  Attending  Physician 
MISS  MARY  A.  TAUTPHAUS,  R.N.,  Superintendent 


The  William  H.  Welch  Medical  Library. — The  new 

medical  library  of  Johns  Hopkins  University,  Balti- 
more, and  the  department  of  the  history  of  medicine 
were  inaugurated  with  appropriate  and  delightful 
ceremony  on  October  17  and  following  days. 

The  building  is  situated  on  East  Monument  Street, 
not  far  from  the  School  of  Hygiene,  and  presents  a 
rich  and  dignified  appearance.  It  is  designed  in  a 
plain  Italian  Renaissance  style  which  is  singularly  at- 
tractive. It  is  well  laid  out  internally  and  much  of  the 
charming  effect  is  due  to  the  free  use  of  many  kinds 
of  richly  colored  marble.  The  cost  was  just  a little 
less  than  $600,000,  and  there  is  available  about  $55,000 
yearly  for  maintenance.  There  is  accommodation  for 
500,000  books. 

The  stacks,  which  are  identical  with  those  recently 
installed  at  the  Vatican,  occupy  the  center  of  the 
building  and  extend  for  the  full  three  stories.  The 
first  two  floors  are  taken  up  with  the  library  proper 
and  the  third  floor  is  devoted  to  the  department  of 
the  history  of  medicine.  In  this  building  are  concen- 


trated the  books  belonging  to  the  faculty  of  medicine, 
the  Johns  Hopkins  Hospital,  and  the  department  of 
the  history  of  medicine. — Canadian  Medical  Associa- 
tion Journal,  December,  1929. 


Livestock  Study  in  Relation  to  Human  Interests. — 

“The  livestock  industry  supplies  man  not  only  with 
food,  clothing,  leather,  and  many  other  necessities 
of  life,  but  it  also  serves  man  in  scores  of  other  ways. 
It  yields  fertilizer  to  maintain  the  fruitfulness  of  our 
fields,  gardens,  and  orchards,  and  contributes  many 
products  and  by-products  to  our  arts  and  industries. 
Certain  of  the  glands  of  animals  yield  many  valuable 
substances  used  in  human  medicine,  pepsin,  insulin, 
and  adrenalin  among  them.  Not  only  is  there  close 
relationship  between  animal  diseases  and  human 
health,  but  the  study  of  livestock  problems  and 
sciences  dealing  with  animal  diseases  contributes  in 
a surprising  degree  to  human  health  and  welfare.” — 
United  States  Department  of  Agriculture. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


Danger  of  Undulant  Fever 


? 


Not  If  You 
Prescribe  Dryco 


Protect  your  patients  from  this  wasting  fever  which 
may  mean  from  weeks  to  years  in  a sick  bed — or 
death.  Hundreds  of  cases  of  undulant  fever  were 
discovered  all  over  the  United  States  last  year. 

Undulant  fever  is  a milk-borne  infection. 

Milk  is  a necessary  factor  in  the  diet  of  adult  and  child. 

PRESCRIBE  DRYCO  - - THE  SAFE  MILK 


DRYCO 


is  free  from  all  pathogenic  bacteria!  Contains 
the  vitamins  unimpaired!  Is  well  tolerated 
and  easily  digested  by  the  most  delicate 
stomach!  The  protein  is  97  per  cent  as- 
similable! 


SEND  FOR  BULLETIN  "Some  Facts  Pertaining  to  Undulant  Fever” 

For  convenience,  pin  this  to  your  Rx  blank  or  letterhead  and  mail 

THE  DRY  MILK  CO.,  INC.  17  PARK  ROW,  NEW  YORK,  N.  Y. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


48 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 


FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  ✓ Excellent  Cuisine 


DR.  MAX  ROTHSCHILD 
Medical  Director 


DR.  HARRY  C.  WARREN 
Asst.  Medical  Director 


Rates  and  Prospectus  on  Request 


San  Francisco  Office 
384  Post  Street 
Phone  DAVENPORT  4466 


Address:  BELMONT,  CALIF. 
Phone  BELMONT  100 
(3  Trunk  Lines) 


No.  611 — 16"  Physician’s  Bag,  in  Black  or 
Brown,  Price  #13.00 


Bischoff’s  Surgical  House 

THE  HOUSE  OF  SERVICE 

427  20th  Street,  Elks  Bldg.,  Oakland,  Calif. 

Branch,  68  So.  1st,  San  Jose,  Calif. 

A COMPLETE  LINE  OF  PHYSICIANS’, 
HOSPITAL  AND  SICKROOM  SUPPLIES 


Important  Points  to  Consider  Regarding  Infantile 
Paralysis. — The  United  States  Public  Health  Service 
has  stated  recently  in  a conference  with  state  health 
officers  that  throughout  the  greater  part  of  the  coun- 
try it  may  be  expected  that  about  one  paralytic  case 
of  infantile  paralysis  per  one  hundred  thousand  popu- 
lation will  occur  between  the  first  day  of  December 
and  the  first  day  of  June  each  year,  and  in  the  other 
six  months,  about  four  to  fourteen  cases.  The  maxi- 
mum incidence,  an  average  of  two  cases  in  three 
weeks  per  one  hundred  thousand,  is  reached  in  mid- 
September. 

Ever  since  1916  health  officers  have  looked  with 
especial  concern  on  a definite  rise  during  the  month 
of  June,  but  there  have  been  several  examples  of  a 
notable  increase  in  reporting  which  was  not  paral- 
leled by  any  such  actual  increase  in  incidence.  In  the 
warmer  parts  of  the  United  States  fewer  cases  occur, 
though  the  distribution  follows  about  the  same  pro- 
portion by  seasons  as  in  the  North.  On  the  Pacific 
Coast  the  rise  appears  to  begin  a few  weeks  earlier 
and  reach  a less  abrupt  peak  somewhat  later,  with  a 
relatively  high  prevalence  maintained  longer  than  is 
usual  elsewhere.  It  would  seem  that  other  places 
which  have  a comparatively  even  temperature  range 
throughout  the  year,  with  a slightly  retarded  maxi- 
mum, should  show  the  same  characteristics. 

The  measures  through  which  might  be  expected  a 
real  diminution  of  incidence  are  those  which  diminish 
human  contacts  in  general,  but  the  drastic  closing  of 
all  places  of  assembly  is  justifiable  only  with  a very 
high  incidence  of,  say,  five  or  ten  times  the  usual, 
and  even  in  such  a case  the  long  incubation  period 
would  make  it  likely  that  in  a restricted  community 
the  actual  spread  of  the  infection  had  begun  to  di- 
minish before  the  alarm  was  sufficient  to  resort  to 
such  extremes. 

Every  help  should  be  given  to  the  medical  pro- 
fession and  the  public  to  aid  in  the  prompt  and  accu- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


Announcing 

The  new 

AUDIPHONE 

This  hearing  device  is  equipped  with  a small 
inconspicuous  earpiece  and  a powerful  light- 
weight battery  which  can  be  easily  concealed. 

The  Audiphone  was  developed  in  the  Bell 
Telephone  Laboratories,  and  is  manufactured 
by  the  Western  Electric  Company — a strong 
guarantee  of  its  reliability. 

Full  details  or  demonstration  upon  request 


W.  D.  FENNIMORE  . A.  R.  FENNIMORE 


177-181  Post  Street  San  Francisco 


rate  diagnosis  of  the  cases.  Pamphlets  are  available 
for  distribution  to  physicians  to  refresh  their  memo- 
ries on  the  early  suspicious  and  characteristic  signs 
of  the  disease. 

Organization  for  treatment  of  preparalytic  cases  by 
convalescent  serum  is  one  of  the  first  measures  to  be 
considered.  Since,  however,  this  is  adapted  more  for 
metropolitan  areas  than  for  widely  scattered  settle- 
ments, it  is  probable  that  in  most  cases  it  will  be  a 
function  of  medical  societies,  medical  schools,  and 
local  health  authorities  rather  than  of  the  state.  In 
any  case,  favorable  as  the  results  appear  to  be,  we 
must  remember  that  the  method  is  still  on  trial,  and 
every  effort  possible  should  be  used  to  secure  its 
practical  evaluation. 

Probably  the  greatest  good  that  the  state  depart- 
ment of  health  can  do  is  in  the  prevention  of  deformi- 
ties and  crippling  as  an  aftermath  of  recognized 
paralytic  cases.  The  early  treatment  should  certainly 
be  under  the  control  of  the  local  physician.  In  con- 
nection with  the  circularization  and  publicity,  to  aid 
in  the  early  diagnosis,  emphasis  should  be  placed  on 
the  necessity  of  absolute  and  prolonged  rest  in  bed, 
in  a position  to  forestall  and  prevent  any  tendency  to 
deformity,  by  fixation  if  necessary.  There  comes  a 
time  in  practically  every  case,  however,  and  it  may 
come  very  soon,  when  the  proper  care  becomes  too 
irksome  for  the  family  to  carry  on  without  the  moral 
support  and  stimulus  of  some  such  agency  as  a con- 
sultant orthopedist  with  nurses  or  physiotherapists 
particularly  skilled  and  trained  in  this  disease;  and  it 
is  a rare  family  which  can  afford  the  expense  of  such 
prolonged,  continuous,  and  special  skill  unless  the 
treatment  is  supervised  under  some  such  auspices  as 
those  of  the  state  or  municipal  department  of  health. 
Adequate  hospitalization  of  these  cases  is  out  of  the 
question.  A useful  pamphlet  on  muscle  training  is 
available  as  a reprint  from  the  United  States  Public 
Health  Service. — United  States  Public  Health  Service, 
October  29,  1929. 


EVERY  DOCTOR 

needs  our  Professional  Liability  In- 
surance— to  protect  him  with  as- 
sured certainty  against  damage  suits 
in  his  practice. 


EVERY  HOSPITAL 

and  every  doctor  employed  by  or 
otherwise  interested  in  a hospital 
needs  the  same  adequate  protection 
and  service  provided  by  our  Hos- 
pital Liability  Insurance. 

Over  $70,000,000  in  Resources 

We  insure  only  ethical  practitioners  and 
hospitals 


UNITED  STATES  FIDELITY 
AND  GUARANTY  COMPANY 

BALTIMORE,  MARYLAND 

BRANCH  OFFICES 

340  Pine  Street,  San  Francisco,  Calif. 

1404  Franklin  Street,  Oakland,  Calif. 

724  South  Spring  Street,  Los  Angeles,  Calif. 

602  San  Diego  Trust  & Savings  Building 
San  Diego,  Calif. 

Continental  Nat’I  Bank  Bldg.,  Salt  Lake  City,  Utah 


5° 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Doctor!  Have  You  a 
Collection  Problem? 


Our  bookkeeper  fails 
to  find  your  account 
settled  on  our  books. 
Please  help  him  out. 


pAST  DUE! 

iF  This  Account  has  no  doubt  escaped 
your  notice.  Will  you  please  favor  us  with 
a remittance  by  return  mail  and  oblige? 


THIS  ACCOUNT 

IS  PAST  DUE. 
PLEASE  REMIT. 


Regarding  Your  Past-Due  Account 

Our  records  show  that  several  statements  and  re- 
minders have  been  sent  you  regarding  the  enclosed 
statement. 

If  your  circumstances  have  made  it  impossible  for 
you  to  pay  the  amount  due,  kindly  write  us  promptly 
to  that  effect.  Our  office  will  then  endeavor  to  extend 
all  possible  courtesies. 

You  appreciate,  we  are  sure,  that  physicians,  like 
other  citizens,  must  pay  their  bills  promptly.  They 
can  only  do  so,  however,  when  their  own  clients  in 
turn  pay  them  promptly  for  such  professional  services 
as  may  have  been  rendered. 

A check  to  cover  your  account,  which  is  now  con- 
siderably overdue,  will  be  appreciated. 


Final  Notice 

In  practically  all  businesses  the  custom  which  is 
generally  followed  with  overdue  accounts  is  to  send 
such  to  a collecting  agency. 

Our  bookkeeper  has  nothing  in  the  records  of  the 
office  to  show  when  you  intend  to  pay  the  enclosed 
account.  Perhaps  the  previous  statements  and  remind- 
ers may  have  been  overlooked  or  ignored. 

Following  the  rule  of  this  office,  this  overdue  account 
will  be  sent  to  the  collecting  agency  within  ten  days 
if  arrangements  for  its  settlement  are  not  made  prior 
to  that  time. 

This  collection  bureau  method  is  disagreeable  to  us ; 
and  we  believe,  also  to  you.  By  promptly  sending  your 
check  all  this  can  be  avoided. 

When  an  account  is  sent  to  the  collecting  agency 
that  organization  takes  full  charge  of  it  thereafter. 


"The  doctor  who  does  not  collect  a goodly 
proportion  of  the  fees  he  has  earned,  is  more 
than  apt  to  be  faced  with  a column  in  the 
red;  and  no  man  can  do  justice  to  himself 
in  his  profession  and  give  expression  to  his 
best  work,  and  capacity  under  such  a handi- 
cap. . . . This  system  creates  a minimum  of 
antagonism  among  delinquent  patients  in  its 
results.” 

Reprinted  from  “California  and  Western 
Medicine,”  September,  1927. 


These  collection  stickers  and  notices  are 
now  stocked  by  us  and  the  numerous  repeat 
orders  speak  well  for  the  effective  manner 
in  which  they  have  stimulated  the  collection 
of  dormant  accounts. 

The  prices  quoted  below  are  for  the  com- 
plete series  — three  gum  stickers  and  two 
notices,  as  reproduced  in  this  ad.  The  price 
includes  postage: 

250  $ 6.75 

500  9.00 

1000  13.50 

We  shall  be  pleased  to  quote  you  on  any 
other  piece  of  printed  matter  for  which  you 
may  be  in  the  market. 


JAMES  H.  BARRY  COMPANY 


1122-24  MISSION  STREET 
SAN  FRANCISCO,  CALIFORNIA 
[Telephone  MArket  7900  ] 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5i 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  275  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newly  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


NON-TOXIC 


For  Your  Own  Surgery 

used  in  leading  NON-CAUSTIC 

PACIFIC  COAST  HOSPITALS 

Write  for  Sample 

HEXOL,  INC.,  1040  Larkin  Street,  San  Francisco,  California 

FRANKLIN  1012 


Federal  Court  Rules  on  Drug  Labels. — A far-reach- 
ing decision  on  the  labeling  of  medicinal  preparations 
has  been  handed  down  by  the  United  States  Court  of 
Appeals  for  the  Ninth  Circuit,  say  the  officials  of  the 
Food,  Drug  and  Insecticide  Administration,  of  the 
United  States  Department  of  Agriculture. 

According  to  the  decision  of  the  Court  of  Appeals, 
the  use  on  labels  of  medicinal  preparations  of  lan- 
guage which,  when  read  literally,  is  not  a statement 
of  curative  or  therapeutic  properties,  but  owing  to  at- 
tendant circumstances,  may  be  understood  as  such, 
brings  these  labels  within  the  scope  of  the  Federal 
Food  and  Drugs  Act  just  as  definitely  as  if  direct 
statements  appeared. 

This  decision  was  made  upon  appeal  by  the  United 
States  Government  from  a judgment  entered  in  the 
District  Court  for  the  Western  District  of  Washing- 
ton, dismissing  a case  brought  against  certain  medic- 
inal preparations  which,  the  government  alleged,  bore 
false  and  fraudulent  therapeutic  claims  on  the  labels. 
The  Federal  Food  and  Drugs  Act,  under  which  this 
action  was  brought,  is  designed,  among  other  things, 
to  prevent  the  sale  in  interstate  commerce  of  medic- 
inal preparations  bearing  false  and  fraudulent  state- 
ments concerning  their  efficacy  in  treating  disease. 

The  lower  court  dismissed  the  libel  on  the  ground 
that  it  failed  to  allege  facts  sufficient  to  show  a viola- 


tion of  the  law,  in  that  the  statements  on  the  labels 
to  which  the  government  took  exception  were  not 
therapeutic  or  curative  claims  but  were  merely  re- 
ports indicating  that  physicians  had  obtained  favor- 
able results  from  the  use  of  the  nostrum,  each  “re- 
port” being  preceded  by  the  statement  “We  have 
received  many  letters  from  physicians  reporting.” 

The  Circuit  Court  of  Appeals,  however,  held  that 
language  such  as  that  used  would  tend  to  engender  a 
belief  on  the  part  of  possible  buyers  that  the  use  of  the 
drugs  would  afford  relief.  “Unless  we  discredit  their 
mental  competency  such,  we  must  presume  was  the 
intent  and  expectation  of  the  proprietors,”  said  the 
Circuit  Court.  “Their  contention  is  that  they  have 
such  letters  or  reports  and  that  fact  constitutes  a 
competent  defense,  whatever  may  be  the  character  of 
the  drugs.  But  if,  as  is  alleged,  the  drugs  are  worth- 
less, the  proprietors  cannot  escape  responsibility  by 
hiding  behind  the  phrase  ‘the  doctors  say’.  Couched 
in  such  language  undoubtedly  the  printed  matter 
makes  a more  persuasive  appeal  to  the  credulity  of 
sufferers  from  these  diseases  than  if  the  representa- 
tions thus  implied  were  made  directly  upon  the  author- 
ity alone  of  the  proprietors,  and  for  that  reason  they 
are  not  less  but  more  obnoxious  to  the  law.” — Journal 
of  Iowa  State  Medical  Society,  September  1929. 


52 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


The 

Santa  Barbara  Clinic 


1421  State  Street 

SANTA  BARBARA,  CALIFORNIA 


Experienced  Technicians  in  Clinical  Laboratory 
and  Physiotherapy  Departments.  Electrocardio- 
graphic and  Basal  Metabolic  determinations  made. 


General  Surgery 

Rexwald  Brown,  M.  D. 

Irving  Wills,  M.  D. 

Internal  Medicine 

Hilmar  O.  Koefod,  M.  D. 

H.  E.  Henderson,  M.  D. 

Wm.  M.  Moffat,  M.  D. 

Neville  T.  Ussher,  M.  D. 
Obstetrics  and  Gynecology 

Benjamin  Bakewell,  M.  D. 
Lawrence  F.  Eder,  M.  D. 
Diseases  of  Children 

Howard  L.  Eder,  M.  D. 

Ear,  Nose  and  Throat 

H.  J.  Profant,  M.  D. 

Wm.  R.  Hunt,  M.  D. 

U rology 

Irving  Wills,  M.  D. 

Orthopedics 

Rodney  F.  Atsatt,  M.  D. 

Eye 

F.  J.  Hombach,  M.  D. 
Roentgenology 

M.  J.  Geyman,  M.  D.,  Consultant 


Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


Health  First 

SPRING  WATER 

Delivered 

to  Offices  and  Homes 
Entire  Bay  District 

Purity  Spring  Water  Co. 

2050  Kearny  Street 
San  Francisco 
Phone  DAvenport  2197 


Problem  of  Rehabilitation  of  the  Crippled  Child. — 

Resolutions  adopted  by  the  first  world  conference  on 
the  problem  of  the  cripple,  held  at  Geneva,  Switzer- 
land, August  1929. 

PUBLIC  STATEMENT  OF  POLICY 

Whereas,  In  the  discussions  of  this  conference  cer- 
tain clear  and  well-defined  propositions  have  been 
evolved  and  have  been  received  with  general  approval,-; 
and 

Whereas,  We  believe  it  to  be  our  duty  as  students 
of  the  problems  incident  to  the  relation  of  society  to 
the  crippled,  finding  him  and  securing  for  him  medi- 
cal examination  and  diagnosis,  treatment,  care,  edu- 
cation and  vocational  training  and  placement  as  well 
as  preventing  crippling  conditions;  and  as  workers 
for  the  solution  of  these  problems;  to  place  before 
the  public,  the  results  of  our  deliberations;  now,  there- 
fore be  it 

Resolved  by  the  World  Conference  for  Crippled 
Children  that  we  declare: 

First:  That  every  cripple  has  the  right  to  expect 
of  his  state  or  county  physical,  mental  and  social 
equality. 

Second:  That  assistance  to  crippled  persons  is  not 
only  a humanitarian  but  an  economic  social  responsi- 
bility. 

Third:  That  there  is  a regrettable  lack  of  accurate 
information  as  to  the  number  of  cripples  in  many  of 
the  countries:  that  in  these,  adequate  surveys  should 
be  made  without  delay  that  their  results  may  guide 
intelligent  comprehensive  action;  and  that  in  all  coun- 
tries where  such  legislation  does  not  now  exist  laws 
be  enacted  making  it  compulsory  upon  the  part  of 
physicians,  surgeons,  midwives,  nurses,  and  teachers 
to  report  crippling  conditions  to  the  proper  authorities. 

Fourth:  That  a great  need  exists  for  an  adequate 
number  of  competent  professional  workers,  both  sur- 
gical and  pedagogical,  and  that  universities  through- 
out the  world  be  urged  to  create  courses  where  they 
do  not  now  exist  for  the  training  of  a larger  number 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 


Los  Angeles  Office 

WILSHIRE  MEDICAL  BLDG. 
1930  Wilshire  Blvd. 


For  particulars  address : 

POTTENGER  SANATORIUM 

Monrovia,  California 


of  orthopedic  surgeons,  nurses,  and  teachers,  to  pro- 
vide for  compulsory  examinations  therein,  and  to 
establish  where  not  at  present  existing  Chairs  in 
Orthopedics. 

Fifth:  That  all  efforts  in  the  furtherance  of  the  edu- 
cation and  vocational  training  and  placement  of  the 
crippled  should  be  encouraged  and  assisted  in  every 
possible  way,  for  without  education,  training  and 
equipment  to  fit  the  cripple  to  take  his  place  in  the 
world  and  putting  him  where  he  can  have  an  equal 
opportunity,  much  of  the  remedial  effort  is  wasted. 

Sixth:  That  responsibility  does  not  end  with  remedy- 
ing existing  conditions  but  must  extend  to  preven- 
tive work  and  the  practical  eradication  ultimately  of 
crippledom. 

Be  it  further  Resolved,  that  copies  of  these  reso- 
lutions be  sent  to  all  known  societies  engaged  in  work 
for  the  crippled,  to  the  various  universities  through- 
out the  world,  to  the  health  departments  of  the  sev- 
eral governments,  to  all  medical  and  surgical  socie- 
ties and  journals,  and  to  the  leading  newspapers  and 
general  publications. 

* * * 

Whereas,  The  solution  of  the  problems  incident  to 
the  locating  or  finding,  treatment,  care,  education  and 
vocational  training  and  placement  of  crippled  persons 
is  a task  confronting  every  nation  in  the  world  today; 
and 

Whereas,  Much  progress  has  been  made  in  many 
countries  in  this  important  field  of  endeavor,  which 
involves  not  only  humanitarian  and  philanthropic 
considerations,  but  economic  welfare;  and 

Whereas,  The  International  Society  for  Crippled 
Children  is  making  a forceful  effort  to  bring  about  a 
unity  of  thought  and  action  in  this  connection,  and 
is  receiving  the  cordial  cooperation  of  many  agencies 
in  many  countries;  and 

Whereas,  The  Child  Welfare  Committee  and  the 
Health  Organization  of  the  League  of  Nations  are  in 
(Continued  on  Next  Page) 


A Thoroughly  Equipped 

PHYSICAL  THERAPY 
LABORATORY 


Available  to  patients  under  prescription  of 
licensed  physicians. 


DELMER  J.  FRAZIER 


426-427  Dalziel  Building 
OAKLAND 
PHONE  LAKESIDE  5659 


We  solicit  correspondence  from  physicians 
regarding  pharmaceutical  and  proprietary 
preparations. 

LENGFELD’S  PHARMACY 

216  Stockton  Street  San  Francisco,  Calif. 

Telephone  SUtter  0080 


54 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ST.  MARY’S  HOSPITAL  San  Francisco 


Conducted  by  Sisters  of  Mercy 

Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.  A.  C.  S. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Bums,  M.  D. 


Obstetrics 

Philip  H.  Arnot,  M.  D. 
Medicine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 

Stephen  Cleary,  M.  D. 

T.  T.  Shea,  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M.  D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M.  D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Chas.  C.  Mohun,  M.  D. 

Randolph  G.  Flood,  M.  D. 

Heart 
Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 

Dentistry 

Thos.  Morris,  D.  D.  S. 
Francis  L.  Meagher,  D.  D.  S, 


Trademark  UOHT/^D  1I/|M  Trademark 
Registered  ^ ^ J 1%  lYrM  Registered 

Binder  and  Abdominal  Supporter 


"Type  N” 

The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-Iliac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 

Katherine  L.  Storm,  M.  D. 

Originator,  Owner  and  Maker 
1701  Diamond  St.,  Philadelphia,  Pa.,  U.  S.  A. 


(Continued  from  Page  53) 

a position  to  further  this  activity  to  the  very  great 
advantage  of  its  member  nations,  and  thus  to  render 
a tremendous  service  to  the  whole  world;  therefore 
be  it 

Resolved  by  the  delegates  to  the  World  Confer- 
ence of  Workers  for  Crippled  Children  now  in  session 
in  the  city  of  Geneva,  Switzerland,  and  composed  of 
representatives  of  twelve  countries — Great  Britain, 
Sweden,  Belgium,  the  Netherlands,  Germany,  Czecho- 
slovakia, Austria,  Hungary,  Spain,  Switzerland,  Can- 
ada, and  the  United  States — that  we  join  in  an  earnest 
appeal  to  the  League  of  Nations  that  the  enumera- 
tion, treatment,  care,  education,  and  vocational  train- 
ing and  placement  of  the  crippled,  also  the  presenta- 
tion of  the  causes  of  crippling  conditions  among  chil- 
dren, be  made  subjects  of  investigation,  study,  report 
and  recommendation  at  the  earliest  time  consistent 
with  pending  activities;  and  that  the  League  of  Na- 
tions be  requested  to  establish  a department  in  the 
secretariat  of  the  League  for  the  accomplishment  of 
these  purposes. 

* * * 

Whereas,  A conference  of  representatives  of  twelve 
nations  has  been  assembled  and  is  in  session  in 
Geneva  for  the  consideration  of  the  problems  incident 
to  the  care,  treatment  and  education  of  the  crippled; 
and 

Whereas,  The  deliberations  of  the  conference  have 
demonstrated  the  great  desirability  of  a close  working 
union  for  the  solving  of  such  problems  on  a world 
basis;  and 

Whereas,  Such  a union  could  be  and  should  be 
formed  to  develop  an  international  plan  in  which  the 
representatives  of  all  agencies  in  all  countries  could 
participate  and  have  a voice  and  vote;  therefore  it  is 

Resolved,  By  this  conference  that  the  present  Com- 
mittee on  Resolutions  be  continued  as  an  Executive 
Committee,  with  the  right  of  substitution  and  with 
the  right  to  coopt  members  from  other  countries,  to 
develop  such  an  international  plan,  and  that  in  the 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

+ 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Tear  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


meantime  the  societies  of  the  several  countries  repre- 
sented in  the  conference  not  already  members  of  the 
International  Society  for  Crippled  Children  (and  any 
others  applying  for  membership)  be  admitted  as  asso- 
ciate members  of  such  society. — International  Society 
for  Crippled  Children,  Inc. 

The  foregoing  resolutions  adopted  unanimously. 
August  2,  1929. 


PECIAL  SALE 

of 


Claim  for  Funds  Covering  Medical  Treament  Denied. 

Appropriations  for  the  Veterans’  Bureau  are  not  avail- 
able for  the  payment  of  medical  care  and  treatment 
of  families  of  emergency  Army  officers  who  served 
during  the  World  War,  the  Comptroller-General, 
J.  R.  McCarl,  has  ruled,  it  was  stated  orally  Septem- 
ber 24  at  the  General  Accounting  Office. 

The  ruling  was  made  in  a case  involving  a claim 
of  a former  emergency  Army  officer  for  hospitaliza- 
tion treatment  for  his  wife,  a former  Red  Cross  nurse, 
who  had  seen  active  service  during  the  war.  The 
Comptroller-General  viewed  various  legislation  grant- 
ing certain  privileges  to  officers  of  the  Regular  Army 
who  have  been  retired  and  the  special  law  passed  by 
Congress  on  May  24,  1928,  which  granted,  in  certain 
instances,  similar  privileges  to  those  emergency  offi- 
cers who  served  only  during  the  World  War,  it  was 
pointed  out.  • 

Mr.  McCarl  concluded  as  a result  of  his  examina- 
tion of  the  retirement  privileges  granted  Army  offi- 
cers that  members  of  families  of  beneficiaries  of  the 
Veterans’  Bureau  are  not  found  to  be  included  among 
those  for  whom  medical,  surgical  and  hospital  treat- 
ment is  provided  under  the  World  War  Veterans’ 
Act. 

Viewing  the  subject  further,  the  Comptroller- 
General,  it  was  explained,  held  that  the  existing  law 
being  specific  for  medical  treatment,  it  was  obvious 
that  medical  treatment  is  not  included  as  one  of  the 
privileges  intended  to  be  extended  to  retired  emer- 
(Continued  on  Page  56) 


USED  EQUIPMENT 

Fine  surgical  instruments,  white  enameled  furniture, 
Electro-therapy  apparatus  and  accessories,  etc. 

PRICED  FOR  QUICK  SALE 

All  equipment  in  first  class  condition 

All  electrical  apparatus  carry  a year’s  guarantee 

Trade  in  what  you  dont  want 

Liberal  Allowances  Made,  and  Convenient 
Terms  Arranged 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Bldg. 

391  Sutter  Street  San  Francisco 

Telephone  SUTTER  5314 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5<5 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . . and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


NEW! 


KOMPAK  MODEL 


.iMilviiWr? 


STANDARD  FOR  BLOODPRESSURE 


Demonstration,  or  Sent  for  Inspection  Upon  Request 


RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


Look  at  your  ledger — WHAT  A MESS 

"WE  GET  THE  COIN ” "WE  PAY ” 

BITTLESTON  COLLECTION  AGENCY,  Inc. 

1211  Citizens  National  Bank  Bldg.  LOS  ANGELES  TRinity  6861 


SUGARMAN  CLINICAL  LABORATORY 

SUITE  1439 

450  Sutter  Street  San  Francisco,  Calif. 


Telephone:  DAvenport  0342 


Emergency:  WEst  1400 


(Continued  from  Previous  Page) 
gency  officers  as  a privilege  accruing  to  officers  of  the 
regular  establishment  retired  for  physical  disability. 

Nearly  half  of  the  approximately  28,000  veterans 
treated  in  this  country  under  the  hospitalization  pro- 
gram of  the  United  States  Veterans’  Bureau  are  non- 
service connected  patients,  or  patients  whose  present 
disability  was  not  incurred  in  service,  and  on  account 
of  the  present  inadequacy  of  housing  facilities  more 
than  7000  victims  of  mental  diseases  are  hospitalized 
in  institutions  unauthorized  by  the  bureau,  according 
to  an  oral  statement  made  available  September  24. 

The  congressional  privilege  of  hospitalizing  any 
veteran  of  a war  in  which  this  country  participated, 
plus  the  statutory  obligation  to  provide  hospital  at- 
tention for  every  physically  or  mentally  afflicted  vet- 
eran of  the  World  War,  and  certain  other  veterans 


of  preceding  wars,  has  resulted  in  an  overflow  of  pa- 
tients and  the  unavoidable  assignments  to  institutions 
not  specified  by  the  government  bureau  charged  with 
hospitalization,  it  was  explained. 

That  immediate  legislative  aid  is  needed  in  order  to 
correct  the  existing  situation  is  assured  by  a recent 
announcement  from  the  bureau  that  the  present  ap- 
propriation of  some  $15,000,000  will  not  defray  the 
costs  of  a program  contemplated  to  permanently 
remove  the  obstacles  encountered  since  authorized 
hospitalization  was  inaugurated.  According  to  the 
statement  about  $13,000,000  of  the  appropriation  is 
now  available,  and  while  this  sum  should  better  con- 
ditions for  a limited  time,  a thorough  correction  can- 
not be  realized  without' additional  expenditures. 

Approximately  13,000  patients  confined  to  Govern- 
(Continued  on  Page  59) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  An  Approved 

Clinical  Laboratory 

Definition 

"*  * * A clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application 
of  one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and 
methods,  for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in 
the  human  body.” 

“Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  person- 
nel and  records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed 
as  approved.’’ 

“ The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to 
be  properly  carried  out.” 

The  Director 

“The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college 
or  university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have 
specialized  in  clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for 
at  least  three  years.  He  must  be  a man  of  good  standing  in  his  profession.” 

“The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major 
part  of  his  time  to  the  supervision  of  the  laboratory  work.” 

“The  director  may  make  diagnoses  only  when  he  is  a licensed  graduate  of  medicine,  has  special- 
ized in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of 
disease  in  the  patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports.” 

“The  director  may  have  assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hemato- 
logic, biochemical,  serologic  and  pathologic  should  be  made  to  the  director.” 

Records 

“Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  labora- 
tory  should  have  appended  pertinent  clinical  data.” 

Publicity 

“Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bul- 
letins or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the 
name,  address,  telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel, 
fields  of  work  covered,  office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain 
misleading  statements.  Only  the  names  of  those  rendering  regular  service  to  the  laboratory  should 
appear  on  letter-heads  or  other  form  of  publicity.” 

Fees 

“*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director 
and  any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism,  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


5^ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


LAS  ENCINAS  - - - PASADENA,  CALIF. 

A Sanitarium  for  the  Treatment  of  General  and  Nervous  Diseases 

BOARD  OF  DIRECTORS:  George  Dock,  M.D.,  Pres.;  H.  G.  Brainerd,  M.D.,  Vice-Pres. ; W.  Jarvis  Barlow,  M.D. ; 

Stephen  Smith,  M.D. ; F.  C.  E.  Mattison,  M.D. 

BEAUTIFULLY  located  in  the  country,  two  miles  from  Pasadena.  Grounds  comprising  natural  live-oak  grove 
of  20  acres,  with  lawns  and  gardens,  ideally  adapted  to  rest  and  enjoyment.  Large  central  building  and 
cottages  all  modernly  equipped,  homelike  and  comfortable.  Light,  airy  rooms  with  or  without  private  bath  and 
sleeping-porch.  Physicians  and  nurses  in  constant  attendance.  Hydrotherapy,  Electrotherapy,  Occupational 
Therapy,  Massage  and  the  most  approved  modern  medical  and  hygienic  methods  employed.  Careful  individual- 
ization of  treatment.  Patients  educated  to  correct  physical  and  mental  habits.  Rigid  dietetic  supervision  and 
unexcelled  table.  Adequate  dairy  and  poultry  plant.  No  tuberculosis,  epilepsy  or  insanity  received. 


Address,  Stephen  Smith,  Medical  Director,  or  E.  D.  Kremers,  Associate  Medical  Director,  Pasadena,  California 


“TRADE  IN  SACRAMENTO” 

WITH 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 


Surgeons ’ Instruments  * Physicians’  and  Hospital  Supplies 


SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY 

Manufacturers  and  Fitters  of  Orthopedic  and  Surgical  Appliances 


Blades,  $1.50  dozen;  10  per  cent  off 


In  Gross  Lots 

SACRO-ILIAC,  SURGICAL,  MATERNITY  AND  POST-OPERATIVE  BELTS 

TRUSSES,  ELASTIC  HOSIERY,  ARCH  SUPPORTS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 

BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 
Consultants: 

Walter  F.  Schaller,  M.  D. 

Walter  B.  Coffey,  M.  D. 

Charles  Miner  Cooper,  M.  D. 

W'alter  W.  Boardman,  M.  D. 

Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSCH  & LOMB  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 

Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty-fourth  Avenue  Oakland,  Calif. 

Telephone  Fruitvale  488 


(Continued  from  Page  56) 

ment  care  are  psychiatric  sufferers,  it  was  stated,  and 
their  number  expands  each  year  despite  the  fact  that 
many  already  are  retained  in  institutions  not  author- 
ized by  the  bureau. 

Taking  advantage  of  the  privilege  extended  by 
Congress,  and  believing  its  action  warranted  by  sym- 
pathy and  humaneness,  the  bureau  during  certain 
periods  of  recent  years  has  kept  its  facilities  con- 
stantly taxed  to  a maximum  by  accepting  veterans 
of  wars  regardless  of  classification,  it  was  declared. 
However,  the  increase  in  the  number  of  patients  from 
the  World  War,  and  their  mandated  acceptance,  has 
brought  the  bureau  to  its  present  situation  of  having 
many  patients  under  care  who  are  not  dismissible, 
and  yet  needing  their  provisions  and  allotments  for 
service-connected  veterans  entitled  to  full  care.  When 
regularly  equipped  institutions  are  not  available  for 
the  housing  of  World  War  patients,  space  and  facili- 


ties must  be  contracted  by  the  Bureau,  and  paid  for 
from  the  appropriation,  it  was  explained. 

This  surplus  of  patients,  who  should  be  housed  in 
Government  hospitals,  must  necessarily  be  detained 
in  state-owned  institutions,  the  statement  pointed  out, 
and  in  nearly  every  instance  these  non-federal  con- 
fines are  overcrowded. — The  United  States  Daily,  Sep- 
tember 25,  1929. 


Storage  and  Preservation  of  Films. — Resolutions: 

Whereas,  The  storage  and  preservation  of  used 
x-ray  films  has  recently  become  an  economic  and  in- 
surance problem,  and 

Whereas,  The  reports  of  the  roentgenologists  re- 
sponsible for  the  diagnoses  are  of  decidedly  more 
value  and  importance  than  the  films,  and 

Whereas,  These  reports  are  filed  with,  and  become 
part  of,  the  records  of  each  case,  making  it  unneces- 

(Continued  on  Page  61) 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


LA  VIDA 

Minera  1 Water 

LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  $2.00  per  case  (4  gal.) 
Carbonated : $2.00  per  dozen 

(12  oz.)  bottles 

Tonic  Ginger  Ale:  $2.25  per  doz. 

(12  oz.)  bottles 


^CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

LABORATORIES 

Celestins 

LA 

VICHY 

Grains  per  gallon 

VIDA 

of  France 

Calcium  Bicarbonate  

3.74 

43.28 

0.98 

5.00 

252.6 

205.53 

94.0 

21.94 

0.07 

Trace 

0.13 

6.42 

2.63 

....  0.001 

Sodium  Sulphate 

14.97 

TOTAL  

357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


When  Steers  Had 
Long  Horns 

THE  medicinal  value  of  the 
glands  of  internal  secretion 
was  not  recognized. 

But  times  have  changed,  as  well 
as  cattle.  Now,  the  therapeutic 
value  of  certain  gland  products 
is  definitely  established,  and 
each  year  adds  to  our  knowl- 
edge in  this  important  field  of 
therapeutics. 

To  the  physician  prescribing 
gland  products  we  urge  specifi- 
cation of  “Wilson,”  because  it 
connotes  a product  made  at  the 
source  of  supply  from  fresh 
glands,  processed  promptly,  with 
the  aim  of  conserving  maximum 
hormone  activity,  in  a labora- 
tory devoted  exclusively  to  the 
endocrine  field. 


“Jhifcmcwk 


W A /7 


THE  WILSON  LABORATORIES 


\y  \y 


yjivi  ijuwuurdee' 


4221  S.  Western  Boulevard 
CHICAGO,  ILL. 


Manufacturers  of 

STANDARDIZED  ANIMAL  DERIVATIVES, 
LIGATURES  and  DIGESTIVE  FERMENTS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER  61 


Therapeutically  speaking  . . . two  remedies  are 
better  than  one,  provided  they  act  synergistically 


MILK  of  MAGNESIA  and  MINERAL  OIL 

Combine  Lubricant,  Laxative  and  Antacid  Properties 


Jlfagnesia-Mineral  0U  (25) 


HALEY 

formerly  HALEY’S  M-O,  Magnesia  Oil 

is  a pleasant,  permanent,  uniform,  unflavored  emulsion,  each  table- 
spoonful of  which  contains: 

Milk  of  Magnesia  (U.  S.  P.)  dram  iii 
Liq.  Petrolatum  (U.  S.  P.)  dram  i 

Accepted  for  N.N.R.  by  the  A.M.A.  Council  on  Pharmacy  and  Chemistry 
to  overcome  the  effects  of  intestinal  stasis,  such  as  constipation  and 
autotoxemia;  to  oppose  gastro-intestinal  hyperacidity  and  in  colitis  and 
hemorrhoids;  for  ante-  and  post-operative  use;  during  pregnancy  and 
maternity;  in  infancy,  childhood  and  old  age. 

AS  AN  EFFECTIVE  ANTACID  MOUTH  WASH 
Generous  sample  and  literature  on  request. 

THE  HALEY  M-O  COMPANY,  INC.,  GENEVA,  N.Y. 


Continued  from  Page  59) 

sary  that  large  numbers  and  quantities  of  old  and 
used  x-ray  films  be  preserved  and  retained  for  long 
periods  of  time,  it  is  therefore 

Resolved,  by  the  Council  of  the  Chicago  Roentgen 
Society,  That  it  is  the  sense  and  judgment  of  this 
Society,  that  it  is  not  necessary  to  preserve  any  x-ray 
films  for  a longer  period  than  two  years  after  their 
exposure,  and  that  in  all  cases  where  there  is  no  like- 
lihood of  legal  proceedings — such  as  ordinary  clinical 
cases,  medical  conditions,  gastro-intestinal  and  urinary 
tract  examinations — it  is  deemed  unnecessary  to  pre- 
serve or  retain  the  x-ray  films  for  a longer  period 
than  six  months  after  their  exposure. 

This  is,  however,  not  in  any  way  to  be  construed 
as  discouraging  the  preservation  of  films  of  specially 
interesting  or  unusual  conditions,  as  these  are  to  be 
preserved  because  of  their  value  for  comparative 
study  and  for  teaching  purposes.  And  it  is  further 

Resolved,  That  referring  physicians  desiring  to  pre- 
serve the  x-ray  films  of  their  own  patients,  be  en- 
couraged to  do  this,  and  it  is  hereby  declared  per- 
missible and  proper  practice  for  roentgenologists  to 
deliver  the  films  to  the  referring  physicians  in  such 
cases.  And  it  is  further 

Resolved,  That  a copy  of  these  Resolutions  be  sent 
to  the  Bulletin  of  the  Chicago  Medical  Society,  the 
Illinois  Medical  Journal,  the  Journal  of  the  American 
Medical  Association,  Radiology,  the  American  Journal 
of  Roentgenology  and  Radium  Therapy,  for  publica- 
tion, and  to  the  American  College  of  Radiology,  the 
American  College  of  Surgeons,  and  the  American  Col- 
lege of  Physicians  with  request  that  the  same  be 
published  in  their  official  journals,  and  to  the  Sections 
of  Radiology  of  the  American  Medical  Association 
and  of  the  Illinois  State  Medical  Society,  and  to  the 
Chief  of  the  Fire  Prevention  Bureau  of  Chicago  and 
the  Underwriters’  Laboratories,  Inc.,  of  Chicago,  and 
to  the  editors  of  Hospital  Management  and  The  Mod- 
ern Hospital. — Radiology,  September  1929. 


Semi-Centennial  to  Be  Celebrated  by  the  Univer- 
sity of  Southern  California  in  1930. — Founded  a half 
century  ago,  in  1880,  the  University  of  Southern  Cal- 
ifornia is  preparing  to  commemorate  its  fiftieth  birth- 
day by  a fitting  and  significant  Semi-Centennial 
Celebration  in  June,  1930.  Graphically  stressing  the 
university’s  highest  aims  and  achievements — scholas- 
tic endeavor,  academic  advancement,  worthy  research, 
and  moral  idealism — the  anniversary  celebration  will 
occupy  a week. 

Educators  of  note,  Trojan  alumni,  scientists  and 
citizens  of  this  and  other  countries  will  gather  in  Los 
Angeles  to  pay  homage  to  those  whose  work  con- 
tributed to  the  development  of  the  university,  and 
to  witness  the  re-enactment,  in  pageant  and  song, 
of  events  in  the  history  of  the  institution. 

It  was  in  August,  1880,  that  the  incorporation  of 
the  western  educational  institution  was  achieved. 
Then  a trio  of  donors  presented  308  lots  in  West  Los 
Angeles  to  a pioneer  board  of  directors  to  finance 
the  proposed  school.  By  the  articles  of  incorporation, 
the  State  of  California  granted  the  name,  The  Uni- 
versity of  Southern  California,  to  the  new  institution, 
and  the  policy  of  co-education  was  established. 

When  the  University  of  Southern  California  opened 
its  doors,  fifty-five  students  gathered  in  the  first  frame 
building  under  the  supervision  of  ten  instructors. 
Los  Angeles  was  at  that  time  a frontier  town  of  the 
Southwest  with  a population  of  11,183,  and  with  forty- 
three  teachers  in  its  school  system.  City  and  univer- 
sity have  grown  apace,  for  recent  figures  show  that 
with  one  exception,  the  population  of  Los  Angeles 
has  doubled  every  ten  years,  while  the  enrollment 
of  students  at  S.  C.  has  tripled  every  decade  except 
the  third.  Los  Angeles  has  changed  from  a village  to 
a metropolitan  center,  and  the  University  of  Southern 
California  has  evolved  from  a small  college  of  liberal 
arts  to  a many-sided  university. 

Twenty  schools  and  colleges  are  manned  by  more 
(Continued  on  Next  Page) 


62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Surgeon’s 


'W'WR"  Needles 


/ 


BRflNP 


/ s 

MADE  IN  US  A 


A.  Needle 

You  can  depend  on! 

Made  of  American  STAI NLESS  Steel,  it  will 
of  course,  never  rust,  tarnish  or  corrode. 

But  what  is  even  more  important, 
ANCHOR  NEEDLES  are  tougher,  sharper 
and  safer  than  any  you  ever  used  before. 

You  will  use  it  with  full  confidence  that  it 
will  perform  its  functions  smoothly,  easily 
and  always  safely.  It  will  never  break  or 
bend  in  use.  Write  for 

Free  Trial  Sample 


Special  Introductory  Offer 

2,  Dozen  Anchor  Needles  *3.00 

with  Fine  Nickel  Plated  Case  FREE 

S.  DONIGER  &>  CO.  Inc. 


Makers  of  KROME  PLATE  Surgical  Instruments,  X-ACTO 
Syringes  and  sole  distributors  of  ANCHOR  NEEDLES. 


S.  DONIGER  & CO.  Inc. 

23  East  21st  Street,  New  York  City 

Send  me  your  special  2 doz.  needles  in  case  for  which  I 

enclose  $ or  Q]  bill  thru  my  dealer.  QF reeSample. 

Doctor 

Address 

Dealer’s  Name . 

Please  give  dealer’s  name  in  either  case 


■ 

Fo 


ur  Fifty 
Sutter 

San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


(Continued  from  Previous  Page) 
than  400  faculty  members,  and  serve  a yearly  enroll- 
ment of  more  than  15,000  students. 

The  campus  of  S.  C.,  known  as  University  Park, 
adjoins  Exposition  Park,  which  contains  the  Los  An- 
geles Museum  (history,  art  and  science)  and  the 
California  State  Exposition  Building  (with  exhibits 
of  the  state’s  resources  and  industries). 

Dr.  R.  B.  von  KleinSmid,  president  of  Southern 
California  since  1921,  voices  the  pledge  of  the  trustees, 
the  administration  and  the  faculty  of  the  university 
as  follows:  “The  University  of  Southern  California 
will  hold  fast  to  its  conviction  that  education  is  a 
living  process,  as  adjustable  as  life  itself,  using  the 
materials  provided  by  the  past  to  make  the  products 
of  the  future.  It  will  continue  to  devote  itself  to  what 
it  conceives  to  be  the  urgent  problems  of  higher  edu- 
cation in  this  present  age — the  adapting  of  university 
facilities  to  the  needs  expressed  in  modern  society.” 


Heart  Disease  and  Accidents. — The  increase  in  seri- 
ous accidents  due  to  “heart  disease”  calls  attention 
to  the  phase  of  the  cardiovascular  diseases  which  ren- 
ders an  individual  suffering  from  such  a condition  a 
possible  menace  to  the  health  and  happiness  of  others. 
Frequent  accounts  of  such  accidents  may  be  read 
in  the  daily  press.  They  are  usually  attributed  to 
“sudden  heart  failure,”  but  the  name  “sudden  heart 
failure”  is  in  itself  paradoxical:  the  condition  nearly 
.always  occurs  in  persons  who  have  had  heart  disease 
for  some  time.  It  is  sudden  only  because  there  is  an 
acute  change  or  rearrangement  of  the  circulation. 

The  need  of  requiring  drivers  of  automobiles  and 
railroad  trains,  motormen,  elevator  operators,  and 
others  in  occupations  where  the  lives  of  many  are 
dependent  upon  perfect  mental  and  physical  function- 
ing, to  submit  to  an  examination  to  prove  their  ability 
to  cope  with  the  demands  of  their  work  without 
danger  to  themselves  or  others,  seems  obvious. 

(Continued  on  Page  64) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


63 


** 

* 

A 


Colfax  School  for  the 
Tuberculous 

Qoljaxy  Qalifornia 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


i Patients  are  given  individ- 

* ual  care  by  experienced 

tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 
individual  needs. 

O Patients  are  taught  how  to 

secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 

aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4  The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5  Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  fMedical  *1 Director 

Colfax,  California 


V 
¥* 

V 
¥* 

|v 

¥4 

V 

¥4 

IV 

¥4 


y* 


v 

¥4 

V 
W 

V 

¥4 

¥ 

¥4 

¥4 


W 

V 

m 

v 

¥4 

¥4 

¥4 

¥4 

IV 

¥4 

¥4 

¥4 

|V 

¥4 


¥4 

¥4 

V 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


64. 


In  pneumonia 

Optochin  Base 

For  the  specific  treatment  of  pneumonia  give 
2 tablets  of  Optochin  Base  every  5 hours, 
day  and  night  for  3 days.  Give  milk  with 
every  dose  but  no  other  food  or  drink. 
Start  treatment  early 


Literature  on  request 


MERCK  & CO.  inc. 


Rahway,  N.  J. 


(Continued  from  Page  62) 

Applicants  for  automobile  drivers’  licenses,  in  this 
state  at  least,  are  required  to  meet  certain  standards 
as  to  sight.  It  would  seem  equally  important  that 
persons  suffering  from  serious  heart  disease  be  pre- 
vented from  occupying  positions  where  attending 
stress  and  effort  might  prove  to  be  dangerous. — Ex- 
tract of  article  by  Dr.  Albert  S.  Hyman,  in  American 
Journal  of  Public  Health,  October  1929. 


Fellowship  Pledge. — Recognizing  that  the  Ameri- 
can College  of  Surgeons  seeks  to  develop,  exemplify, 
and  enforce  the  highest  traditions  of  our  calling,  I 
hereby  pledge  myself,  as  a condition  of  Fellowship  in 
the  College,  to  live  in  strict  accordance  with  all  its 
principles,  declarations,  and  regulations. 

In  particular,  I pledge  myself  to  pursue  the  prac- 
tice of  surgery  with  thorough  self-restraint  and  to 
place  the  welfare  of  my  patients  above  all  else;  to 
advance  constantly  in  knowledge  by  the  study  of  sur- 
gical literature,  the  instruction  of  eminent  teachers, 
interchange  of  opinion  among  associates,  and  attend- 
ance on  the  important  societies  and  clinics;  to  regard 
scrupulously  the  interests  of  my  professional  brothers 
and  seek  their  counsel  when  in  doubt  of  my  own 
judgment;  to  render  willing  help  to  my  colleagues  and 
to  give  freely  my  services  to  the  needy. 

Moreover,  I pledge  myself,  so  far  as  I am  able,  to 
avoid  the  sins  of  selfishness;  to  shun  unwarranted  pub- 
licity, dishonest  money-seeking,  and  commercialism 
as  disgraceful  to  our  profession;  to  refuse  utterly  all 
money  trades  with  consultants,  practitioners  or  others; 
to  teach  the  patient  his  financial  duty  to  the  physician 
and  to  expect  the  practitioner  to  obtain  his  compen- 
sation directly  from  the  patient;  to  make  my  fees 
commensurate  with  the  service  rendered  and  with  the 
patient’s  rights;  and  to  avoid  discrediting  my  asso- 
ciates by  taking  unwarranted  compensation. 

Finally,  I pledge  myself  to  cooperate  in  advancing 
and  extending,  by  every  lawful  means  within  my 
power,  the  influence  of  the  American  College  of 
Surgeons. 


Only  Fresh  Milk 

from  tuberculin  tested  cows,  from  dairy  farms  that  have  fulfilled 
the  sanitary  requirements  of  the  City  of  Cleveland  Board  of  Health, 
is  used  as  a basis  for  the  production  of  S.  M.  A.  In  addition, 
the  milk  must  meet  out  own  rigid  standards  of  quality. 


IN  ADDITION  S.  M.  A.  HAS  THESE  FEATURES 
Prevents  Rickets  and  Spasmophilia. 

No  modification  is  necessary  for  normal  full  term  infants. 
Resembles  breast  milk  both  physically  and  chemically. 
Simple  for  the  mother  to  prepare. 

Gives  excellent  nutritional  results  in  most  cases,  and  these 
results  are  obtained  more  simply  and  more  quickly. 


MAY  WE  SEND  YOU  SAMPLES? 


S.  M.  A.  was  developed  at  the  Babies  and  Childrens  Hospital 
of  Cleveland,  and  is  produced  by  its  permission  exclusively  by 


THE  LABORATORY  PRODUCTS  COMPANY  * ♦ CLEVELAND,  OHIO 

West  of  Rockies:  437-8-9  Phelan  Bldg.,  San  Francisco,  Cal.  ©lpc  In  Canada:  64  Oerrard  St.,  East,  Toronto 


tiering 
Pneumonia 
With  Vaccine 


The  combined  statistics  of  Lambert,  Sutton,  Tice  and  Wynn  show  the  very  marked 
influence  which  the  early  administration  of  vaccines  has  upon  the  fatality  rate. 


Vaccine  Treated  Control  Cases 


Per  Cent 


Per  Cent 


Cases  Coming  to  Treatment 

Within  48  hours  of  onset 

Within  72  hours  of  onset 

After  72  hours  from  onset  ... 


No.  Cases 

Deaths 

No.  Cases 

Deaths 

76 

7.9 

101 

47.5 

171 

8.8 

171 

42.1 

386 

30.4 

369 

40.0 

Sutton,  111.  Med.  Jo.,  1928-53-280 
In  all  cases  a stock  vaccine  was  used 

CUTTER  offers  Western  physicians  an  excellent  formula  (essentially  that  of  Sutton)  in  a 
vaccine  prepared  from  Western  strains. 

The  Cutter  Laboratory 

Established  1897 

Berkeley,  California 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 
E.  A.  TRENKLE,  Manager  Phone  GRAYSTONE  1200 


ANNUAL  SESSIONS — California  Medical  Association,  Del  Monte,  April  28-May  1,  1930;  American  Medical  Association, 
Detroit,  Michigan,  June  23-27,  1930;  Nevada  State  Medical  Association,  September  9-11,  1930;  Utah  State  Medical 
Association,  September  26-27,  1930. 


& 

& 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and  Published  ^Monthly  by  the  California  £ Medical  oAssociation 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUME  XXXII 
NUMBER  3 


MARCH  . 1930 


50  CENTS  A COPY 
S5.00  A YEAR 


CONTENTS  AND  SUBJECT  INDEX 


SPECIAL  ARTICLES: 

Aschheim-Zondek  Test  for  Pregnancy 
— Its  Present  Status.  By  Herbert 
M.  Evans  and  Miriam  E.  Simpson, 

Berkeley  145 

The  Future  of  Medical  Practice — Med- 
ical Service  Organizations.  By  C.  M. 

Cooper,  San  Francisco 148 

Eczema — Some  Recent  Contributions 
to  Its  Study.  By  Samuel  Ayres,  Jr., 
Los  Angeles  153 

Discussion  by  Irving  R.  Bancroft,  Los  An- 
geles; C.  Ray  Lounsberry,  San  Diego;  Hiram 
E.  Miller,  San  Francisco ; Stanley  O.  Cham- 
bers, Los  Angeles. 

Capsulotomy  Method  of  Lens  Expres- 
sion. By  Delamere  F.  Harbridge, 
Phoenix,  Arizona  158 

Discussion  by  Lloyd  Mills,  Los  Angeles ; 
Dohrraann  K.  Pischel,  San  Francisco. 

Bladder  Care  After  Abdominal  Opera- 
tions. By  Robert  Glenn  Craig,  San 
Francisco  162 

Discussion  by  Homer  C.  Seaver,  Los  An- 
geles ; H.  K.  Bonn,  Los  Angeles ; William 
Henry  Gilbert,  Los  Angeles ; H.  N.  Shaw, 

Los  Angeles. 

Urology — Some  General  Observations. 

By  Wilbur  B.  Parker,  Los  Angeles.,165 

Long  Wave  X-Rays  in  Dermatology. 

By  Laurence  R.  Taussig,  San  Fran- 
cisco   166 

Discussion  by  George  D.  Culver,  San  Fran- 
cisco ; William  E.  Costolow,  Los  Angeles ; 
Moses  Scholtz,  Los  Angeles. 

Bronchopneumonia  in  Early  Childhood 
— Its  Treatment.  By  E.  P.  Cook, 
San  Jose  170 

Discussion  by  Edward  J.  Lamb,  Santa  Bar- 
bara ; William  A.  Beattie,  Sacramento ; Ade- 
laide Brown,  San  Francisco. 

Surgical  and  Nonsurgical  Facial  Neu- 
ralgias. By  Mark  Albert  Glaser,  Los 

Angeles  174 

Discussion  by  Samuel  D.  Ingham,  Los  An- 
geles; H.  Douglas  Eaton,  Los  Angeles; 
Walter  F.  Schaller,  San  Francisco. 

Tuberculosis  in  School  Children.  By 

E.  W.  Hayes,  Monrovia  178 

Discussion  by  William  M.  Happ,  Los  An- 
geles; Lloyd  B.  Dickey,  San  Francisco. 

Hippocratic  Medicine  (Part  I) — The 

Lure  of  Medical  History.  By  Langley 

Porter,  San  Francisco 181 

CLINICAL  NOTES  AND  CASE  REPORTS: 

A Rare  Sequel  to  Gastro-Enterostomy. 

By  E.  Eric  Larson,  Woodland 183 


The  Specific  Gravity  of  the  Blood.  By 

John  Martin  Askey,  Los  Angeles 184 

Surgical  Treatment  of  Staphylococcus 
Meningitis.  By  George  H.  Sciaroni, 

Fresno  186 

BEDSIDE  MEDICINE: 

Pelvic  Inflammatory  Disease 187 

Discussion  by  H.  N.  Shaw,  Los  Angeles ; 
Karl  L.  Schaupp,  San  Francisco ; Clarence  A. 

De  Puy,  Oakland ; Edward  N.  Ewer,  Oakland. 

EDITORIALS: 

Two  Recent  California  Researches — 
The  Aschheim-Zondek  Pregnancy 
Test  and  the  Coffey-Humber  Cancer 

Experiments  190 

Narcotic  Prescriptions — California  Nar- 
cotic Laws — Federal  Narcotic  Act — 

Proposed  Porter  Narcotic  Act 192 

Construction  and  Maintenance  Costs  in 
the  New  Unit  of  the  Los  Angeles 
County  General  Hospital — What  of 
Ultimate  Results?  193 

MEDICINE  TODAY: 

Neurocirculatory  Asthenia.  By  Louis  Baltimore, 

Los  Angeles  196 

Treatment  of  Anaerobic  Toxemia  in  Bowel  Ob- 
struction and  Peritonitis.  By  Edmund  Butler, 

San  Francisco  196 

Increasing  Weight  in  the  Nondiabetic  by  Means 
of  Insulin.  By  Frederic  Waitzfelder,  Los 

Angeles  197 

New  Theories  About  Common  Colds.  By  Ben- 
jamin Katz,  Los  Angeles 198 

STATE  MEDICAL  ASSOCIATIONS: 

California  Medical  Association 199 

Woman’s  Auxiliary  204 

Nevada  State  Medical  Association  205 

Utah  State  Medical  Association 206 

MISCELLANY: 

News  208 

Correspondence  209 

Descartes  Was  Right  210 

Public  Policy  and  Legislation 213 

Twenty-five  Years  Ago 214 

Department  of  Public  Health 215 

California  Board  of  Medical  Examiners. .216 
Directory  of  Officers,  Sections,  County 
Units  and  Woman’s  Auxiliary  of  the 

California  Medical  Association 

Adv.  page  2 

Book  Reviews  Adv.  page  11 

Truth  About  Medicines Adv.  page  26 

ADVERTISEMENTS— INDEX: 

Adv.  page  8 


"Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


GREENS’ 

EYE  HOSPITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


Resident  Staff 

Aaron  S.  Green,  M.  D. 
Louis  D.  Green,  M.  D. 
Martin  lcove  Green,  M.  D. 
Einar  V.  Blak,  M.  D. 


THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in  the  A.  M.  A. 
Facilities  are  especially  designed  for  Ophthalmology  and  include  X-Ray, 
Radium,  Physio-Therapy  and  Clinical  Laboratories. 

A private  out  patient  department  is  conducted  daily  between  the  hours  of 
9 a.  m.  and  5p.m.  A report  of  findings  and  recommendations  for  treatment 
are  returned  with  the  patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for  patients  of  limited 
income.  Examination  fees  in  the  clinic  are  $2.50  for  the  first  visit  and 
$1.50  for  subsequent  visits.  Moderate  fees  for  drugs,  laboratory  work, 
X-Rays.  Operating  fees  are  arranged  according  to  the  circumstances  of 
each  individual. 

Bush  at  Octavia  Street  • Telephone  WEst  4300  • San  Francisco,  California 

Address  communications  to  Superintendent 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


BUSH  ELECTRIC  CORPORATION 


334  Sutter  Street 

San  Francisco,  Calif. 
SUtter  6088 


1207  West  Sixth  Street 

Los  Angeles,  Calif. 
MUtual  6324 


Burdick  Portable  Air-Cooled  Quartz  Lamp 
FOR  ULTRA  VIOLET  RADIATION 

These  lamps  ?nay  be 
obtained  upon  rental. 
Information  upon 
request. 


Produces  heat  deep  in  the  tissues  for  Local  or 
General  application.  Infra  Red  Radiation  is 
Decongestive,  Analgesic  and  Sedative 


U 8 


Patronize  Your  Home  Firm 

Because  We  Are  Progressive 


Z 1 2 Zoalite 

Infra  Red  Generator 


2 


Officers  of  the  California  Medical  Association 


General  Officers 


President — Morton  R.  Gibbons,  515  Union 
Square  Building,  350  Post  Street,  San 
Francisco. 

President-Elect — Lyell  C.  Kinney,  510  Med- 
ico-Dental Building,  233  A Street,  San 
Diego. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

Vice-Speaker  of  House  of  Delegates — John 


H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw  Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 


Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 


Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  5th  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam Duffield  (1930),  516  Auditorium 

Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1930),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Cruz. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Junius  B.  Harris  (1930), 
Medico-Dental  Building,  1127  Eleventh 
Street,  Sacramento. 


Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 
lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1930),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large— T.  Henshaw  Kelly  (1930),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Robert  A.  Peers  (1931),  Colfax. 


Standing  Committees 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker  of  the  House 
of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair- 
man of  the  Auditing  Committee.  (Committee  Chairman,  T. 
Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego 1932 

William  Bowman  (Chairman),  Los  Angeles 1931 

George  H.  Kress,  Los  Angeles 1930 

Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego , 1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach 1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco ..1932 

William  T.  McArthur,  Los  Angeles 1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education  and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 

Committee  on  Medical  Defense 

George  G.  Reinle  (Chairman),  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno ....1931 

Mott  H.  Arnold,  San  Diego 1930 


Committee  on  Membership  and  Organization 

Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks  (Chairman),  San  Francisco 1931 

Jesse  W.  Barnes,  Stockton 1930 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Charles  D.  Ball  (Chairman),  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

Emmet  Rixford,  San  Francisco 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 1932 

Percy  T.  Magan  (Chairman),  Los  Angeles 1931 

Frederick  F.  Gundrum,  Sacramento 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

Joseph  Catton,  San  Francisco 1930 

The  President Ex-officio 

The  President-Elect Ex-officio 

Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland - 1931 

Robert  V.  Day,  Los  Angeles - 1930 

Ernest  H.  Falconer,  Sec’y  Sect.  Med.,  San  Francisco 1930 

Sumner  Everingham,  Sec’y  Sect.  Surg.,  Oakland 1930 


Committee  on  Arrangements 

1930  Annual  Session — Del  Monte,  April  28  to  May  1,  1930 
T.  Henshaw  Kelly  (Chairman),  San  Francisco. 

Joseph  Catton,  San  Francisco. 

Martin  McAulay,  Monterey. 

Garth  Parker,  Salinas. 

William  H.  Bingaman,  Salinas. 

Alfred  Phillips,  Santa  Cruz. 

The  Secretary Ex-officio 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland 

Albert  Soiland,  Los  Angeles 

Fitch  C.  E.  Mattison,  Pasadena. 

Victor  Vecki,  San  Francisco 

Percy  T.  Magan,  Los  Angeles.. 
Junius  B.  Harris,  Sacramento.. 


ALTERNATES 

(1930-1931) Joseph  Catton,  San  Francisco 

(1930-1931) William  H.  Gilbert,  Los  Angeles 

(1930-1931)— James  F.  Percy,  Los  Angeles 

(1929-1930) William  E.  Stevens,  San  Francisco 

(1929-1930) Charles  D.  Lockwood,  Pasadena 

(1929-1930) John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


Special  Motorcycle  Service 

HOURS:  Week  Days,  8 A.  M.  to  9 P.  M.;  Sundays,  9-1,  6-8  Phones:  GArfield  4417-4418-4419 

For  Emergencies  Only — Phone  WEST  1400 

DIGITALIS 

FOR  YOUR  USE  WE  ARE  DISPENSING 

DIGITALIS  FOLIA  ELECT 
Selected  Digitalis  Leaves  (Allen’s)  in  One  Grain  Capsules 

These  are  selected  leaves  of  Digitalis  purpurea  collected  only  from  plants  grown  in  England. 
The  fresh  leaves  are  dried  at  a low  temperature  under  conditions  calculated  to  retain  the 
potent  glucosides  of  Digitalis  unimpaired.  POTENCY  CERTIFICATION — According  to 
Stafford  Allen  8C  Sons,  Ltd.,  0.84  gramme  of  this  Digitalis  Leaf  is  equivalent  in  activity  to 
1.0  gramme  of  the  International  Standard  Digitalis  Powder,  as  determined  by  a biological  test 
carried  out  by  the  Pharmaceutical  Society  of  Great  Britain.  The  high  potency  should  be  taken 
into  account  by  the  prescriber. 

Available  at 

Broemmel’s  Prescription  Pharmacy 

SERUMS  VACCINES  ANTITOXINS 

Free  Delivery 

Fitzhugh  Building,  Rooms  201-202-203  Post  and  Powell  Streets,  San  Francisco,  Calif. 


Radium  and  Oncologic  Institute 

1052  West  Sixth  Street,  Los  Angeles 

An  institution  providing  adequate  facilities  for  the  scientific  study,  diagnosis, 
and  treatment  of  cancer  and  other  neoplastic  diseases. 

Recognized  therapeutic  measures  for  the  treatment  of  cancer  are  radium, 
high  voltage  x-ray  and  surgery. 

Results  in  cancer  therapy  are  entirely  dependent  upon  early  diagnosis, 
thorough  study  and  proper  application  of  such  of  the  above  methods  of 
treatment,  either  alone  or  in  combination,  as  each  case  may  indicate. 

We  desire  to  confer  and  cooperate  with  the  medical  profession  in  the 
diagnosis  and  treatment  of  cancer  and  other  neoplastic  diseases. 

DR.  REX  DUNCAN  DR.  H.  H.  HATTERY 

AND  STAFF 

Office  Hours:  10  a.m.  to  4 p.m.  TRinity  3683 
1052  West  Sixth  Street  Los  Angeles 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  Lorruli  A.  Rethwilm,  2217  Web- 
ster Street,  San  Francisco. 

Secretary,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 

Chairman  of  Section  Program  Committee 
Q.  O.  Gilbert,  301  Medical  Building,  1904 
Franklin  Street,  Oakland. 

Pathology  and  Bacteriology 

Chairman,  W.  T.  Cummins,  Southern  Pacific 
Hospital,  San  Francisco. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
H.  A.  Thompson,  907  Medico-Dental 
Building,  233  A Street,  San  Diego. 

General  Surgery 

Chairman,  Clarence  G.  Toland,  902  Wilshire 
Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Secretary,  Northern  Division,  Sumner  Ever- 
ingham,  400  29th  St.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Dermatology  and  Syphilology 
Chairman,  Samuel  Ayres,  Jr.,  517  Westlake 
Professional  Building,  2007  Wilshire 
Boulevard,  Los  Angeles. 

Vice-Chairman,  Stuart  C.  Way,  320  Medico- 
Dental  Bldg.,  490  Post  St.,  ^an  Francisco. 
Secretary,  George  F.  Koetter,  812  Medical 
Office  Bldg.,  1136  W.  6th  St.,  Los  Angeles. 
Vice-Secretary,  Merlin  T.  Maynard,  408 
Medico-Dental  Building,  San  Jose. 

Pediatrics 

Chairman,  Guy  L.  Bliss,  1723  East  First 
Street,  Long  Beach. 

Secretary,  Donald  K.  Woods,  5 th  and 
Laurel  Streets,  San  Diego. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Industrial  Medicine  and  Surgery 
Chairman,  Charles  A.  Dukes,  601  Wakefield 
Building,  426  17th  Street,  Oakland. 
Secretary,  Edmund  J.  Morrissey,  201  Med- 
ical Bldg.,  909  Hyde  St.,  San  Francisco. 
Chairman  of  Program  Committee,  Arthur  L. 
Fisher,  212  Medical  Building,  909  Hyde 
Street,  San  Francisco. 

Eye,  Ear,  Nose  and  Throat 
Chairman,  Barton  J.  Powell,  510  Medico- 
Dental  Building,  Stockton. 

Vice-Chairman,  Frederick  C.  Cordes,  817 
Fitzhugh  Building,  384  Post  Street,  San 
Francisco. 

Secretary,  Andrew  B.  Wessels,  1305  Medico- 
Dental  Building,  233  A Street,  San  Diego. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Irving  S.  Ingber,  321  Medico- 
Dental  Building,  490  Post  Street,  San 
Francisco. 

Secretary,  William  H.  Sargent,  Franklin 
Building,  1624  Franklin  Street,  Oakland. 
Chairman  of  Section  Program  Committee, 
W.  E.  Chamberlain,  Stanford  Hospital, 
San  Francisco. 

N europsychiatry 

Chairman,  Thomas  G.  Inman,  2000  Van  Ness 
Avenue,  San  Francisco. 

Secretary,  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

General  Medicine 

Chairman,  Walter  P.  Bliss,  407  Professional 
Bldg.,  65  North  Madison  Ave.,  Pasadena. 
Secretary,  Ernest  H.  Falconer,  316  Fitzhugh 
Building,  384  Post  Street,  San  Francisco. 

Obstetrics  and  Gynecology 

Chairman,  Karl  L.  Schaupp,  835  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  Clarence  A.  De  Puy,  Strad  Build- 
ing, 230  Grand  Avenue,  Oakland. 

Urology 

Chairman,  Charles  P.  Mathe,  Room  1831, 
450  Sutter  Street,  San  Francisco. 

Secretary,  Harry  W.  Martin,  1010  Quinby 
Building,  650  S.  Grand  Ave.,  Los  Angeles. 

Officers  of  County  Medical  Associations 

Alameda  County  Medical  Association 

2404  Broadway,  Oakland 

President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Monterey  County  Medical  Society 
President,  Charles  H.  Lowell,  Carmel. 
Secretary,  John  A.  Merrill,  308  Spazier 
Building,  Monterey. 

San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Santa  Barbara  County  Medical  Society 
President,  Hugh  F.  Freidell,  1525  State 
St.,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment, Santa  Barbara. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Secretary,  J.  O.  Chiapella,  Chiapella  Build- 
ing, Chico. 

Orange  County  Medical  Society 
President,  H.  Miller  Robertson,  212  Medical 
Bldg.,  Santa  Ana. 

Secretary,  Harry  G.  Huffman,  615  First 
National  Bank  Bldg.,  Santa  Ana. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building,  San  Jose. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 

Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary,  C.  J.  Durand,  Colfax. 

Santa  Cruz  County  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldg..  Santa  Cruz. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son Building,  Fresno. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block, 
Riverside. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Glenn  County  Medical  Society 
President,  Etta  S.  Lund,  143  North  Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Sacramento  Society  for  Medical 
Improvement 

President,  Gustave  Wilson,  609  California 
State  Life  Building,  10th  and  J Streets, 
Sacramento. 

Secretary,  Frank  W.  Lee,  510  Physicians 
Bldg.,  1027  Tenth  St.,  Sacramento. 

Siskiyou  County  Medical  Society 
President, 

Secretary,  Ruth  C.  Hart,  Fort  Jones. 

Humboldt  County  Medical  Society 
President,  Charles  C.  Falk,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street, 
Vallejo. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol. 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Eytinge,  47  East  Vine 
Street,  Redlands. 

Kern  County  Medical  Society 
President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

Stanislaus  County  Medical  Society 
President,  R.  S.  Hiatt,  Beaty  Bldg.,  1024 
J Street,  Modesto. 

Secretary,  Donald  L.  Robertson,  1003  12th 
Street,  Modesto. 

Lassen-Plumas  County  Medical  Society 
President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

San  Diego  County  Medical  Society 
Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 

President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey,  Red  Bluff. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 

1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 
Street,  Los  Angeles. 

San  Francisco  County  Medical  Society 

2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street,  San  Francisco. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary,  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  D.  G.  Clark,  130  N Tenth  St., 
Santa  Paula. 

Secretary,  C.  A.  Smolt,  23  S.  California  St., 
Ventura. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary,  L.  L.  Robinson,  Larkspur. 

San  Joaquin  County  Medical  Society 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Yolo-Colusa  County  Medical  Society 

President,  Leo  P.  Bell,  Woodland  Clinic, 
Woodland. 

Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Mendocino  County  Medical  Society 
President,  L.  K.  Van  Allen,  Ukiah. 

Secretary,  Paul  J.  Bowman,  Fort  Bragg. 

Merced  County  Medical  Society 
President,  Chester  A.  Moyle,  6 Bank  of 
Italy  Bldg.,  Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building. 
Merced. 

San  Luis  Obispo  County  Medical  Society 
President,  Gifford  L.  Sobey,  214  Bank  of 
Italy  Building,  Paso  Robles. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 

Yuba-Sutter  County  Medical  Society 
President,  Philip  Hoffman,  404  D Street, 
Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 


A//UCE  TEEIE 

E//ENTI4L  VITAMIN/  IN  THE 


EESIMEN  BY  UXING 


Maltine 

WITH  COD  LIVER  OIL 


Council 

Accepted 


In  your  medical  journals  as  well  as  in  general 
magazines,  you  have  read  advertisements  of 
many  preparations  featuring  a single  vitamin. 
But  there  is  a food-combination  which  provides 
not  just  one  but  jour  vitamins.  This  is  the 
standard  product,  Maltine  With  Cod  Liver  Oil 
. . . taken  with  orange  juice  (or  any  other 
antiscorbutic)  in  adequate  dosage. 

The  presence  of  these  four  essential  vitamins 
in  the  above  food-combination  has  been  indi- 
cated, conclusively,  by  the  laboratory  experi- 
ments of  a leading  biological  chemist.  TheVita- 
min  A potency  is  at  least  230  U.S.P.  units  per 
gram.  Maltine,  a concentrated  extract  of  the 
nourishing  elements  of  malted  barley,  wheat 
and  oats,  contains  both 
the  antineuritic  and  t 
antipellagric  Vitamin 


B.  The  Vitamin  D potency  is  such  that  rachi- 
tic rats,  fed  20  mg.  daily,  showed  perceptible 
to  distinct  healing  of  rickets  in  from  6 to  10 
days  by  the  line-test  method. 

No  matter  how  carefully  you  plan  a diet  of 
the  accepted  vitamin  foods,  it  is  difficult  to 
provide  unvarying  vitamin  content.  But  in 
this  simple  combination,  you  can  be  sure  of 
balanced  vitamin  potency.  Maltine  With  Cod 
Liver  Oil  is  much  more  palatable  than  plain 
cod  liver  oil  (by  clinical  tests) . Easily  admin- 
istered. Readily  digested,  even  by  infants.  It 
is  accepted  by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical  Association. 
Caution  your  patients  to  avoid  substitutes. 

The  Maltine  Company,  20 
;sey  Street,  New  York. 
Established  1875. 


6 


State  Board  of  Health 

San  Francisco,  337  State  Building 

Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.  Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 

Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 

Secretary,  Albert  K.  Dunlap,  Sacramento 
Hospital,  Sacramento. 

Treasurer,  Walter  E.  Bates,  Davis. 

Southern  California  Medical  Association 
President,  Joseph  K.  Swindt,  Pomona. 
Secretary,  William  J.  Norris,  509  Medical 
Office  Bldg.,  1136  W.  6th  Street,  Los 
Angeles. 

Better  Health  Foundation 

President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 

State  Board  of  Medical  Examiners 

San  Francisco,  623  State  Building 

Los  Angeles,  821  Associated  Realty  Bldg., 
510  West  Sixth  Street 

Sacramento,  908  Forum  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 

California  Northern  District  Medical  Society 
President,  J.  D.  Lawson,  Woodland  Clinic, 
Woodland. 

Vice-President,  Dan  H.  Moulton,  Chico. 

Woman’s  Auxiliary  of  the  California  Medical  Association 

State  Auxiliary  Officers 

President,  Mrs.  H.  S.  Rogers,  Sunny  Slope 
Road,  Petaluma. 

First  Vice-President,  Mrs.  W.  H.  Geistweit, 
810  Medico-Dental  Building,  San  Diego. 
Second  Vice-President,  Mrs.  John  Hunt 
Shephard,  145  South  Twelfth  Street,  San 
Jose. 

Secretary-Treasurer,  Mrs.  R.  A.  Cushman, 
632  North  Broadway,  Santa  Ana. 

Officers  of  County  Auxiliaries 

Contra  Costa  County — President,  Mrs.  J.  M. 
McCullough,  Crockett ; Secretary-Treasurer, 
Mrs.  S.  N.  Weil,  Rodeo. 

Los  Angeles  County — President,  Mrs.  James 
F.  Percy,  Los  Angeles ; Secretary-Treas- 
urer, Mrs.  Martin  G.  Carter,  Los  Angeles. 
Kern  County — President,  Mrs.  F.  A.  Hamlin, 
Bakersfield ; Secretarv-Treasurer,  Mrs.  C.  S. 
Compton,  Bakersfield. 

Orange  County — President,  Mrs.  F.  E.  Coul- 
ter, Santa  Ana ; Secretary-Treasurer,  Mrs. 
Dexter  R.  Ball,  Santa  Ana. 

San  Bernardino  County — President,  Mrs. 
F.  E.  Clough,  San  Bernardino ; Secretary- 
Treasurer,  Mrs.  C.  L.  Curtiss,  Redlands. 

Sonoma  County — President,  Mrs.  Leslie  G. 
Spear,  Santa  Rosa ; Secretary-Treasurer, 
Mrs.  Sara  J.  Pryor,  Santa  Rosa. 

W.  A.  SHAW,  Elko 

R.  P.  ROANTREE,  Elko 

H.  W.  SAWYER,  Fallon 

E.  E.  HAMER,  Carson  City 


President 

President-Elect 

First  Vice-President 


Second  Vice-President 


HORACE  J.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 


Place  of  next  meeting.. 


Reno,  September  26-27,  1930 


H.  P.  KIRTLEY,  Salt  Lake  City President  J.  U.  GIESY,  701  Medical  Arts  Building, 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect  Salt  Lake  City Associate  Editor  for  Utah 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary  Place  of  next  meeting Salt  Lake  City,  September  9-11,  1930 


The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 

Belmont,  Calif. 

FRANKLIN  HOSPITAL 

Limited  General  Hospital 

Fourteenth  and  Noe  Streets,  San  Francisco 

SAN  FRANCISCO  HOME  FOR 
INCURABLES.  AGED  AND  SICK 

2750  Geary  Street,  San  Francisco 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 

San  Jose,  California 

GREENS’  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  of 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

ANDERSON  SANATORIUM 

Mental  and  Nervous  Diseases 

2535  Twenty-fourth  Avenue 

Oakland,  Calif. 

JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

BANNING  SANATORIUM 

Treatment  of  Tuberculosis  and  Throat 
Diseases 

Banning,  Calif. 

JOSLIN’S  SANATORIUM 

Nervous  and  Mental 

Lincoln,  Calif. 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Belmont,  San  Mateo  County,  Calif. 

LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 

ST.  JOSEPH’S  HOSPITAL 
Limited  General  Hospital 

Buena  Vista  and  Park  Hill  Avenues 

San  Francisco,  Calif. 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

CHILDREN'S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 

ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 

27th  and  Valencia  Streets,  San  Francisco 

OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Los  Gatos,  Calif. 

ST.  MARY’S  HOSPITAL 

General  Hospital 

2200  Hayes  Street,  San  Francisco,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

POTTENGER  SANATORIUM 

AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

DANTE  SANATORIUM 

Limited  General  Hospital 

Van  Ness  and  Broadway,  San  Francisco 

RADIUM  AND  ONCOLOGIC 
INSTITUTE 

Diagnosis  and  Treatment  of  Neoplastic 
Diseases 

1052  West  Sixth  Street,  Los  Angeles,  Calif. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


Vitamin  T") 

(Antirachitic,  Antispastic)  S 

. . in  concen- 
trated form 


Cod-liver  Oil  contains  more  vitamin  D than 
any  other  natural  available  product,  but 
always  in  association  with  vitamin  A and, 
of  course,  with  the  characteristic  taste  of  the 
oil.  Now  a synthetic  vitamin  D preparation 
is  available — one  that  has  only  the  physiologic 
effect  of  this  particular  vitamin.  It  is  Viosterol 
in  Oil-- 100  D. 

This  product  has  100  times  the  vitamin  D 
potency  of  high-grade  cod-liver  oil.  It  is 
administered  by  drops  instead  of  by  spoonfuls; 
is  bland  and  tasteless;  can  be  mixed  with 
different  foods. 

Parke,  Davis  <Sl  Co.’s  Viosterol  in  Oil- 
100  D is  the  remedy  par  excellence  for  rickets.  It 
is  a preventive  of  this  condition  if  given  in  time 
to  the  expectant  mother,  and  to  breast  or  bottle- 
fed  infants. 

It  will  help  to  check  or  prevent  dental  caries 
due  to  defective  calcium  metabolism,  and  has 
a curative  effect  in  osteomalacia. 

Its  value  in  tetany  has  been  demonstrated, 
and  owing  to  the  stabilizing  effect  of  calcium 
on  the  nervous  system,  it  is  recommended  in 
spasmophilia  and  chorea. 

Calcium  metabolism  is  a most  favorable 


r 


Lsik i 

Parke,  Davis  & Co’s.  Viostero  1 in  Oil  - - 100  D is  supplied  in  5 cc . 


and  50  cc.  packages , with  dropper . 

factor  in  the  healing  of  ulcerous  conditions,  and 
Viosterol  stimulates  calcium  metabolism. 

The  dose  ranges  from  10  to  20  drops  (3  to  7 
minims)  a day,  or  in  exceptional  cases  25  or 
possibly  30  drops.  Specify  on  your  orders  and 
prescriptions:  “Parke,  Davis  <Sl  Co.’s  Viosterol 
in  Oil-- 100  D.” 

This  product  has  been  accepted  for  inclusion 
in  N.  N.  R.  by  the  Council  on  Pharmacy  and 
Chemistry  of  the  A.  M.  A. 

•> --<• 

PARKE,  DAVIS  & COMPANY 

DETROIT,  MICHIGAN 

NEW  YORK  KANSAS  CITY  CHICAGO  BALTIMORE  NEW  ORLEANS 
ST.  LOUIS  MINNEAPOLIS  SEATTLE 

In  Canada:  walkerville  Montreal  Winnipeg 


'W  Y PARKE,  DAVIS  & CO.’S 

Viosterol 

IN  OIL'-lOO  D (Council  Accepted) 


s 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 


Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 

*3* KT^Dt 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

Anderson  Sanatorium,  The 59 

Approved  Clinical  Laboratories..  57 

Banning  Sanatorium  44 

Bard-Parker  Co.,  Inc 29 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  and  Rackerby 61 

Benjamin,  M.  J 33 

Bischoff’s  Surgical  House 48 

Bittleston  Collection  Agency 56 

Brady  & Co.,  George  W 39 

Broemmel’s  Prescription  Phar- 
macy   3 

Brown  Press  52 

Bush  Electric  Corporation 1 

Butler  Building  16 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co 41 

Camp  & Co.,  S.  H 30 

Canyon  Sanatorium  18 

Certified  Laboratory  Products....  38 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 

Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co 35 

Dante  Sanatorium 4 Cover 

Dewar  & Hare 46 

Doctors’  Business  Bureau 19 

Dry  Milk  Co.,  The 47 

Four  Fifty  Sutter 60 

Franklin  Hospital  43 

Frazier,  Delmer  J 53 

Furscott,  Hazel  E. 24 

Gane,  Henry  S 36 

General  Electric  X-Ray  Corp 45 

Golden  State  Milk  Products  Co.  30 
Graduate  School  of  Medicine, 

Tulane  University  of  La 14 

Greens’  Eye  Hospital 2 Cover 

Gunn,  Herbert,  Stool  Examina- 
tion Laboratory  24 


VM 


Page 

Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Haley  M-O  Company  61 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H 10 

Hoffmann -La  Roche,  Inc 13 

Holland- Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning.  ..  11 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic 35 

Joslin’s  Sanatorium  31 

Keniston-Root  Corporation  41 

Knox  Gelatin  Laboratories 25 

Laboratory  Products  Co 3 Cover 

La  Vida  Mineral  Water  Co 60 

Lederle  Antitoxin  Laboratories..  23 

Lengfeld’s  Pharmacy  53 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 14 

Livermore  Sanitarium  44 

Maltbie  Chemical  Co.,  The 28 

Maltine  Company,  The 5 

Mead  Johnson  & Co 21 

Medical  Protective  Co 15 

Medico-Dental  Finance  Co 40 

Mellin’s  Food  Co 40 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc 42 

Monrovia  Clinic  43 

National  Ice  Cream  and  Cold 

Storage  Co 12 

New  York  Polyclinic  Medical 

School  and  Hospital  9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital 12 

Nichols  Nasal  Syphon 14 

Nonspi  Company  28 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 
ical Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 

O’Keeffe  & Co. 16 

Park  Sanitarium  24 

Parke,  Davis  & Co 7 

Petrolagar  Laboratories 58 

Podesta  and  Baldocchi  38 


Page 

Pollard’s  High  Tension  Stetho- 


scope, Dr 14 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 52 

Radium  and  Oncologic  Institute  3 

Rainier  Brewing  Co 36 

Reid  Bros ' 37 

Richter  & Druhe 56 

Riggs  Optical  Company 31 

San  Francisco  Home  for  Incur- 
ables, Aged,  and  Sick 46 

Sanitarium  For  Sale 36 

Santa  Barbara  Clinic,  The 52 

Scherer  Co.,  R.  L 26 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  18 

Sharp  & Dohme 34 

Sharp  & Smith 51 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription 

Pharmacies  24 

Soiland  (Albert,  Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stark,  Dr.  Morris,  State  Board 

Review  38 

St.  Joseph’s  Hospital 52 

St.  Luke’s  Hospital 23 

St.  Mary’s  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugar  Institute  Co 62 

Sugarman  Clinical  Laboratory....  56 

Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies....  37 

Towns  Hospital,  Charles  B 39 

Trainer- Parsons  Optical  Co 26 

Travers’  Surgical  Co 33 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Vita-Fruit  Products,  Inc 35 

Vitalait  Laboratory  64 

Waiss  Hollow  Needle  & Holder....  20 

Wallace,  Sidney  J 55 

Walters  Surgical  Company 43 

Wedekind,  Frank  F 39 

White,  Arthur  H.,  Quiz  Course..  24 


lew 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


9 


The  Oaks  Sanitarium  Los  Qatos , California 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 

WILLIAM  C.  VOORSANGER,  M.  D.  PAUL  C.  ALEXANDER,  M.  D. 

Medical  Director  Asst.  Medical  Director 

San  Francisco  Office  490  Post  Street 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 

COMPTON,  CALIF. 

30  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  bed  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 
P.  J.  Cunnane,  M.  D.  J.  F.  Vavasour,  M.  D. 
Office:  1052  West  6th  St.,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

(Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 

UROLOGY — Including 

SURGICAL  ANATOMY  OPERATIVE  UROLOGY  (cadaver)  DERMATOLOGY  and  SYPHILIS 

CYSTOSCOPY  and  ENDOSCOPY  DIAGNOSIS  and  OFFICE  TREATMENT  ROENTGENOLOGY 
PATHOLOGY  REGIONAL  ANESTHESIA  PROCTOLOGY 

NEUROLOGY  MEDICINE  DIATHERMY 

For  information  address  MEDICAL  EXECUTIVE  OFFICER:  345  W.  50th  St.,  New  York  City 


T en  A cres  of  Beautiful  Grounds 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


NEW  COLLECTING  APPARATUS  FOR 
THE  TRANSPLANTED  URETER 


To  be  used  for  ureterostomy  in  the  skin  of  the  lower 
abdomen  for  permanent  diversion  of  the  urinary  stream. 

Made  either  single  or  double  to  accommodate  one  or  more 
ureteral  orifices.  Fitted  with  inflatable  rings  to  form  tight 
approximation  against  skin. 

In  ordering  state  whether  single  or  double  and  give  cir- 
cumference of  the  body. 

PRICES — Single  $20.00;  Double  $35.00 

C.  H.  HITTENBERGER  CO. 

MArket  4244 

1115  Market  Street  460  Post  Street 


"CALCIUM  rSANDOZ” 

Oral  Intramuscular 
Intravenous 

"Calcium  Gluconate  Sandoz”  (a  calcium  salt  of 
gluconic  acid)  has  many  advantages  over  the  chlor- 
ide or  lactate. 

In  powder  form  it  is  bland  and  tasteless,  easily  ac- 
cepted even  by  fastidious  patients,  and  does  not 
nauseate  or  constipate. 

Also  available  in  the  form  of  tasty  chocolate  tablets. 
In  ampule  solution,  "Calcium  Gluconate  Sandoz”  is 
better  tolerated  in  intravenous  injection  than  any 
other  form  of  calcium.  Furthermore,  it  is  the  only 
calcium  salt  that  can  be  injected  intramuscularly  in 
adequate  doses  without  causing  local  reaction,  thus 
opening  a new,  convenient  route  hitherto  closed 
to  calcium  therapy. 

Supplied  as  follows:  TABLETS,  1.5  gm.  tins  of 
30’s  and  150’s.  POWDER,  cartons  of  50  and 
100  gm.  AMPULES,  boxes  of  5’s,  10  cc.,  10%. 

Literature  on  request 

Supplied  by 

C.  C€D€LPIi  GUTH 

BIOLOGICS  &.  THERAPEUTIC  SPECIALTIES 
WILLIAM  H.  BANKS,  M.  D.,  Medical  Director 

Phone  KEarny  3644 
811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

FRATES  ft  LOVOTTI.  PROFESSIONAL  PHARMACISTS 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less; 
additional  words  5 cents  each. 


WANTED  POSITION  AS  LABORATORY  TECHNICIAN. 

Competent  in  blood  chemistry,  Wassermann,  blood  typing,  basal 
metabolism,  bacteriological  and  all  biological  procedure.  Address, 
Miss  O.  P.  Boustead,  1626  Broderick  Street,  San  Francisco. 

FOR  SALE  AT  SACRIFICE— 1 NEARLY  NEW  CASTLE 
electric  sterilizer ; 1 nearly  new  Sorensen  Tonsil  machine ; 1 nearly 
new  oscillating  electric  fan,  16-inch,  110  volt  alternating  current. 
Address,  Box  606,  Weimar,  California. 

FOR  SALE  IN  CENTRAL  SOUTHERN  CALIFORNIA— 
General  medical  and  surgical  practice.  Thirty  thousand  yearly 
collections.  Fine  opportunity  for  making  money  from  the  start. 
Price  $6,000  with  equipment.  Will  introduce.  Address  Box  1110, 
California  and  Western  Medicine. 

EDITORIAL  ASSISTANCE— MEDICAL  PAPERS  EDITED 
and  revised,  for  society  meetings  and  publication,  by  physician  now 
engaged  in  medical  editorial  work  and  member  of  American  Medical 
Editors’  Association.  Address  Box  506,  Hagerstown,  Maryland. 
SPANISH  PHYSICIAN— GEORGETOWN  UNIVERSITY 
Graduate,  age  29,  licensed  in  the  District  of  Columbia  and  the 
State  of  California,  desires  position.  Available  March,  1930.  Ex- 
cellent experience  and  best  of  references.  Address  c/o  Consulate  of 
Honduras,  58  Sutter  Street,  San  Francisco,  California. 

A PHYSICIAN,  A POST  GRADUATE  I N PHYSICAL 
Therapy,  and  who  is  at  present  studying  with  men  prominent  in 
this  field — also  a trained  business  executive — is  open  for  engagement. 
Address  N.  W.  Brown,  M.  D.,  1705  35th  Ave.,  Seattle,  Washington. 

YOUNG  MAN  THIRTY  YEARS  RESIDENT  OF  SAN 

Francisco  desires  position  driving  physician  part  time  or  all  day. 
Address  Box  300,  California  and  Western  Medicine,  or  mail  reply 
to  2380  Washington  Street,  San  Francisco.  Telephone  WAlnut 
1112,  between  hours  of  5 to  8 p.  m. 

FOR  SALE  DUE  TO  ILLNESS— ITALIAN  DOCTOR’S 
practice,  established  eighteen  years ; all  equipment  including  of- 
fice furnishings  and  complete  X-ray  laboratory.  Fine  opportunity 
for  young  Italian  doctor  if  taken  at  once.  Priced  reasonably.  Ad- 
dress  Box  310,  California  and  Western  Medicine. 

WANTED— A POSITION  AS  AN  X-RAY  TECHNICIAN 
and  Physiotherapist  by  a refined  young  woman.  Have  had 
three  years’  experience  in  doctor’s  office  in  this  line  of  work.  I 
would  be  interested  in  a position  where  I might  have  an  opportunity 
to  learn  laboratory  work  in  connection  with  my  regular  work.  Ad- 
dress.  Box  320,  California  and  Western  Medicine. 

HOSPITAL  FOR  SALE— GOOD  PAYING  GENERAL  HOS- 
pital  of  12  beds  and  equipment,  five  acres  of  land,  400  fruit 
trees,  situated  in  the  Valley  of  the  Moon  near  Sonoma,  60  miles 
from  San  Francisco.  Opportunity  for  expansion.  Owner  retiring 
due  to  poor  health.  Write  Burndale  Hospital,  Vineburg,  Sonoma 
County,  California. 

FOR  SALE— AN  ’IDEAL  PLACE  FOR  SANATORIUM. 

Wonderful  chance  for  doctor  or  group  of  doctors.  Health  resort; 
beautiful  location;  most  even  climate  in  the  heart  of  orange  groves; 
elevation,  1300  feet;  one  mile  from  good  town,  38  miles  to  Los 
Angeles.  Good  buildings,  well  furnished ; sun  parlors,  sun  baths. 
For  full  particulars,  write,  P.  O.  Box  261,  Upland,  California. 
FOR  SALE— UNOPPOSED  LOCATION  IN  PROSPEROUS 
dairy  community.  Income  $9,000.  Increase  with  surgery.  Near- 
est competition  seven  miles  each  way.  Collections  excellent.  Drug 
stock,  office  and  modern  living  quarters  same  building.  Drugs 
optional.  Rent  reasonable.  Lease.  Definite  income  from  start. 
Address,  Box  340,  California  and  Western  Medicine. 
SITUATION^- WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 
FOR  SALE— SPENCER  AUTOMATIC  LABORATORY  Mi- 
crotome No.  880.  Complete  with  one  knife,  object  clamp  for 
paraffin  nr  celloidin,  and  No.  930  freezing  stage  for  CO2.  In 
A-l  condition.  Cost  $116.  Small  electric  bacteriological  incubator, 
complete  with  thermometer  and  thermostat.  Good  condition.  Cost 
$35.  F.  A.  Hardy  Trial  Case,  No.  4457.  Containing  33  pr.  + 
and  — snheres,  prisms,  cylinders,  etc.,  \ V\ -in.  lenses  and  two  trial 
frames.  In  good  condition.  Cost  $166.  Life  Time  Baumanometer, 
desk  model.  In  practically  new  condition.  Cost  $36.  Effects  of 
deceased  physician.  All  or  any  part  sold,  no  reasonable  offer  re- 
fused.  Dr.  R.  A.  Workman.  Pacific  Grove.  Calif. 

REAL  BARGAIN  FOR  OUICK^ SALE— TEN  BED,  MOD- 

ern,  completely  equipped  hospital,  including  private  practice.  Ideal 
climate,  1000  feet  elevation,  county  seat,  5000  population.  Central 
California.  Equipment  includes  X-rav,  darkroom,  laboratory,  phar- 
macy ($500  stock).  Quartz-Lite,  diathermy,  tonsillectomy  outfit, 
gas-anesthetic  machine,  operating  tables,  instruments,  linen,  dishes, 
etc.  Everything  for  major  surgery.  Four-room  apartment,  fur- 
nished. Will  transfer  several  industrial  contracts  which  will  alone 
more  than  pay  monthly  payments  to  me.  Over  $25,000  cash  re- 
ceived last  year,  with  very  little  surgery.  Competent  surgeon  could 
realize  $50,000  yearly.  No  other  doctor  within  20  miles.  Nearest 
hospital  45  miles.  Reason  for  selling,  going  East  to  postgraduate, 
then  specialize.  $8000  will  handle  d^al,  $3000  down,  balance, 
monthly  payments.  Address  Box  330,  California  and  Western 
Medicine. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


11 


BOOK  REVIEWS 

List  of  Books  Received 


BOOKS  RECEIVED 

The  Hebrew  Physician.  By  Moses  Einhorn,  M.  D.,  and 
L.  M.  Herbert,  M.  D.,  New  York.  Vol.  1,  No.  2.  Paper. 
Pp.  176.  New  York:  The  Trio  Press,  Inc. 


Proceedings  of  the  Twenty-Third  Annual  Convention 
of  the  Association  of  Life  Insurance  Presidents.  Held  in 
the  Hotel  Astor,  New  York,  N.  Y.,  December  12  and  13, 
1929. 


Research  and  Medical  Progress  and  Other  Addresses. 

By  J.  Shelton  Horsley,  M.  £>.,  Attending  Surgeon,  St. 
Elizabeth’s  Hospital,  Richmond,  Virginia.  Cloth.  Pp.  208. 
Price,  $2.  St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


Nursing  in  Emergencies.  By  Jacob  K.  Berman,  A.  B., 
M.  D.,  P.  A.  C.  S.,  Assistant  in  Surgery  Indiana  Univer- 
sity School  of  Medicine.  Cloth.  Pp.  160,  with  109  illus- 
trations. Price,  $2.25.  St.  Louis:  The  C.  V.  Mosby  Com- 
pany, 1929. 


Hypertension  and  Nephritis.  By  Arthur  M.  Pishberg, 
M.  D.,  Adjunct  Attending  Physician  to  Mount  Sinai  and 
Montefiore  Hospitals,  New  York  City.  Cloth.  Pp.  566, 
illustrated  with  thirty-three  engravings  and  one  colored 
plate.  Price,  $6.50  net.  Philadelphia:  Lea  & Febiger,  1930. 


A Textbook  of  Physiology  for  Nurses.  By  William  Gay 
Christian,  M.  D.,  Professor  of  Anatomy,  Medical  College 
of  Virginia,  and  Charles  C.  Haskell,  B.  A.,  M.  D.,  Pro- 
fessor of  Physiology  and  Pharmacology,  Medical  College 
of  Virginia.  Second  edition.  Cloth.  Pp.  153.  Price,  $2. 
St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


The  Mechanism  of  the  Larynx.  By  V.  E.  Negus,  M.  S., 
London,  F.  R.  C.  S.,  England,  Junior  Surgeon  for  Dis- 
eases of  the  Throat  and  Nose,  King’s  College  Hospital, 
London.  With  an  Introduction  by  Sir  Arthur  Keith, 
F.  R.  S.  Cloth.  Pp.  528,  with  illustrations.  Price,  $13.50. 
St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


Essentials  of  Medical  Electricity.  By  Elkin  P.  Cumber- 
batch,  M.  A.,  B.  M.,  (Oxon.),  D.  M.  R.  E.,  (Camb.), 
M.  R.  C.  P.,  Medical  Officer  in  Charge  Electrical  Depart- 
ment, St.  Bartholomew’s  Hospital,  University  of  Cam- 
bridge. Sixth  edition,  revised  and  enlarged.  Cloth. 
Pp.  443,  with  eleven  plates  and  116  illustrations.  Price, 
$4.25.  St.  Louis:  The  C.  V.  Mosby  Company,  1929. 


Getting  Well  and  Staying  Well.  A Book  for  Tubercu- 
lous Patients,  Public  Health  Nurses,  and  Doctors.  By 
John  Potts,  M.  D.,  Forth  Worth,  Texas.  Introduction  by 
J.  B.  McKnight,  M.  D.,  Superintendent  and  Medical  Di- 
rector, Texas  State  Tuberculosis  Sanatorium.  Second 
edition.  Cloth.  Pp.  221.  Price,  $2.  St.  Louis:  The  C.  V. 
Mosby  Company,  1930. 


Exclusively 


PHYSICIANS  i SURGEONS  v DENTISTS 
350  Post  Street,  Facing  Union  Square 
GAr  field  1014 


As  a General  Antiseptic 

in  place  of 

TINCTURE  OF  IODINE 


Diseases  Transmitted  from  Animals  to  Man.  By  Thomas 
G.  Hull,  Chief  Bacteriologist,  Illinois  Department  of  Pub- 
lic Health,  Assistant  Professor  of  Pathology  and  Bacteri- 
ology, University  of  Illinois  College  of  Medicine.  With  an 
Introduction  by  Veranus  A.  Moore,  Director,  New  York 
State  Veterinary  College,  Cornell  University.  Cloth. 
Pp.  350,  with  twenty-nine  illustrations.  Price,  $5.50  post- 
paid. Springfield:  Charles  C.  Thomas,  1930. 


The  Essentials  of  Histology.  Descriptive  and  Practical 
for  the  use  of  Students.  By  Sir  Edward  Sharpey  Schafer, 
F.  R.  S.,  Professor  of  Physiology  in  the  University  of 
Edinburgh.  Twelfth  edition,  revised  by  the  author,  with 
the  cooperation  of  H.  M.  Carleton,  Ph.  D.,  Lecturer  on 
Histology  in  the  University  of  Oxford.  Cloth.  Pp.  628, 
illustrated.  Price,  $5  net.  Philadelphia:  Lea  & Febiger, 
1929. 


Symptoms  of  Visceral  Disease.  A Study  of  the  Vegeta- 
tive Nervous  System  in  Its  Relationship  to  Clinical  Medi- 
cine. By  Francis  Marion  Pottenger,  A.  M.,  M.  D.,  LL.  D., 
F.  A.  C.  P.,  Medical  Director,  Pottenger  Sanatorium  for 
Diseases  of  the  Lungs  and  Throat,  Monrovia,  California. 
Fourth  edition.  Cloth.  Pp.  426,  with  eighty-seven  text 
illustrations  and  ten  color  plates.  Price,  $7.50.  St.  Louis: 
The  C.  V.  Mosby  Company,  1930. 


Recent  Advances  in  Medicine.  Clinical  Laboratory 
Therapeutics.  By  G.  E.  Beaumont.  M.  D.,  D.  M.  (Oxon.), 
F.  R.  C.  P.,  D.  P.  H.  (Lond.),  physician,  with  charge  of 
out-patients,  Middlesex  Hospital,  and  E.  C.  Dodds, 
M.  V.  O.,  M.  D.,  Ph.  D.,  B.  Sc.,  M.  R.  C.  P.  (Lond.),  Court- 
auld  Professor  of  Biochemistry  in  the  University  of 
London.  Fifth  edition.  Cloth.  Pp.  442,  with  forty-nine 
illustrations.  Price,  $3.50  net.  Philadelphia:  P.  Blakis- 
ton’s  Son  & Company,  Inc.,  1930. 

(Continued  on  Next  Page) 


Try 

Mercurochrome  - 220  Soluble 

( Dibrom-oxymercuri- fluorescein.) 

2%  Solution 

It  stains,  it  penetrates,  and  it 
furnishes  a deposit  of  the  germ- 
icidal agent  in  the  desired  field. 

It  does  not  burn,  irritate  or  injure 
tissue  in  any  way. 

Hynson,  Westcott  & Dunning 

Baltimore,  Maryland 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


New  York  Post-Graduate  Medical  School  and  Hospital 

Offers  Courses  in  DERMATOLOGY  AND  SYPHILOLOGY — Including 

Practical  instruction  in  the  diagnosis  and  treatment  of  diseases  of  the  skin,  syphilis  and  cutaneous  cancer;  embracing  special 
syphilotherapy,  physical  therapy,  topical  therapy,  mycology,  pathological  histology  and  internal  aspects  of  cutaneous  medicine. 
These  courses  are  adapted  to  the  needs  of  the  practitioner  of  medicine  as  well  as  the  specialist. 

Physicians  from  approved  medical  colleges  are  admitted  to  these  courses. 

Enrollment  is  from  six  weeks  to  six  months,  and  instruction  is  continuous  throughout  the  year. 

For  those  desiring  a thorough  education  in  dermatology,  a course  of  two  years  may  be  arranged  for. 

For  further  information  and  descriptive  booklet , address 

THE  DEAN  i 313  East  Twentieth  Street  y New  York  City 


BOOKS  RECEIVED 


(Continued  from  Preceding  Page) 

A Textbook  on  Orthopedic  Surgery.  By  Willis  C.  Camp- 
bell, M.  D.,  F.  A.  C.  S.,  Professor  of  Orthopedic  Surgery, 
University  of  Tennessee,  College  of  Medicine,  Memphis. 
Cloth.  Octavo  volume  of  705  pages,  with  507  illustrations. 
Price,  $8.50.  Philadelphia:  W.  B.  Saunders  Company,  1930. 


Treatment  in  General  Practice.  By  Harry  Beckman, 
M.  D.,  Professor  of  Pharmacology,  Marquette  University 
Medical  School,  Milwaukee,  Wisconsin.  Cloth.  Octavo 
volume  of  899  pages.  Price,  $10  net.  Philadelphia:  W.  B. 
Saunders  Company,  1930. 


BOOK  REVIEWS 

The  History  of  Nursing.  By  James  J.  Walsh.  Pp.  293. 

New  York:  P.  J.  Kenedy  & Sons,  1929.  Price,  $2. 

It  would  seem  a beautiful  tribute  to  the  age-old  art  of 
nursing  that  the  author  of  this  history,  after  many  years 
of  research  and  writing  on  the  history  of  hospitals  and 
medicine,  should  in  the  evening  of  his  life  cull  from  these 
writings  and  compile  a history  of  nursing.  In  the  fasci- 
nating and  simple  style  which  has  characterized  the 
works  of  Doctor  Walsh,  he  takes  the  reader  far  back  in 
history,  even  to  the  beginning  of  the  Christian  period,  and 
shows  that  nursing  in  one  form  or  another  has  always  been 
existent  and  as  much  a part  of  civilization  as  religion  or 
the  art  of  medicine. 

In  his  opening  paragraph  Doctor  Walsh  introduces  the 
foundation  ideal  upon  which  has  been  built  the  structure 
of  nursing,  namely,  the  brotherhood  of  man — the  great 
human  motive  which  has  actuated  nurses  through  the 
vicissitudes  of  ages,  through  the  rise  and  fall  of  civiliza- 
tions and  up  to  the  era.  of  so-called  modern  nursing; 
modern  only  in  the  sense  that  it  is  a part  of  evolution. 

This  is  more  than  a historical  tracing  of  nursing;  it  is 
a picture  of  the  care  of  the  sick,  the  poor  and  the  out- 
cast, as  it  has  been  followed  through  the  centuries  from 
the  time  of  Christ  until  “the  industrial  revolution  which 
introduced  the  so-called  era  of  prosperity  and  brought  a 
change  in  the  status  of  populations.”  It  is  also  a history 
of  hospitals;  nursing  history  can  never  be  separated  from 
that  of  hospitals,  in  studying  one  we  study  the  other. 

In  the  chapter  on  medieval  surgery  and  nursing  is 
shown  the  development  of  this  great  era  of  surgery  and 
the  fact  that  there  must  have  been  good  nurses,  “for 
otherwise  surgeons  would  not  have  been  able  to  accom- 
plish the  surgical  interventions  which  they  actually  did.” 
Doctor  Walsh,  always  an  admirer  of  the  thirteenth  cen- 
tury, writes:  “The  supreme  development  in  hospitals  and 
nursing  came  during  the  thirteenth  century.”  Who  has 
not  read  his  “The  Thirteenth,  Greatest  of  Centuries”  has 
a treat  in  store. 

The  history  of  nursing  in  America  begins  about  half- 
way in  the  book  with  a short  mention  of  its  early  con- 
dition which  even  the  author  dismisses  with  the  words 
“the  less  said  about  nursing  the  better.”  He  picks 
up  the  thread  after  the  introduction  of  the  Nightingale 
nurses  in  Bellevue  in  1872,  when  so-called  modern  nurs- 
ing came  from  England  through  the  influence  of  Dr. 
Valentine  Seaman  at  the  New  York  Hospital.  He  follows 
it  through  its  difficult  way  opposed  continually  and  often 
by  physicians  for  whom  it  was  the  greatest  assistance. 
He  is  frank  in  showing  the  reasons  for  the  decadence 
of  hospitals  and  the  consequent  lowered  standard  of  nurs- 
ing which  did  not  improve  until  Lister’s  contribution  to 
surgery  and  the  introduction  of  the  training  of  nurses. 
In  this  day,  when  we  are  so  deeply  concerned  with  the 
functioning  of  hospitals,  it  is  refreshing  to  read  of  Vir- 
chow’s discussion  on  hospitals  and  his  desire  to  have 
these  “true  humanitarian  institutions”  which  they  were 
not  at  that  time  in  Germany.  Although  Virchow  was  not 
a religious  man  “he  appreciated  how  much  the  mainte- 
nance of  nursing  efficiency  might  be  helped  by  the 
motives  which  come  from  the  religious  life.”  The  de- 
velopment of  sisters’  hospitals  in  the  United  States  is 
most  interestingly  shown  together  with  the  advance  of 
the  schools  of  nursing  in  these  institutions.  Mercy  Hospi- 
tal, Chicago,  and  St.  Mary’s  Hospital,  Rochester,  Minne- 
sota, both  noted  as  the  scene  of  great  progression  in 
surgery  are  likewise  important  in  the  education  of  nurses. 

Like  the  true  historian,  Doctor  Walsh  enjoys  to  dwell 
on  the  past,  and  in  this  book  he  dismisses  the  present 
with  somewhat  scant  mention.  Reading  his  book  one 
feels  a sense  of  disappointment  that  he  devoted  such 
short  space  to  the  stirring  events  in  the  past  decade  of 


nursing  progress  about  which  there  is  so  much  to  be 
recorded.  In  his  concluding  chapter  he  gives  mention 
to  the  part  nursing  has  had  and  will  continue  to  have 
in  the  control  of  communicable  diseases.  “The  progress  of 
medicine,  instead  of  lessening  the  demand  for  nurses  in 
the  hospitals,  is  increasing  it  all  of  the  time  and  will 
continue  to  increase  it  for  years  to  come.”  Doctor  Walsh 
with  keen  perception  visualizes  the  need  of  part-time 
nursing,  such  as  visiting  nursing,  hourly  and  group  nurs- 
ing in  this  present  stage  of  our  economic  development. 
He  is  even  sufficiently  modern  as  to  advocate  a day  con- 
sisting of  eight  hours  of  work,  eight  hours  of  recreation, 
and  eight  hours  of  sleep  as  carrying  out  “the  old  rule  of 
good  King  Alfred.” 

In  this  last  chapter  he  brings  forth  some  good  ideas 
on  providing  nursing  service  for  country  towns  and  farm- 
ing districts. 

Doctor  Walsh  has  not  written  solely  for  nurses.  This 
is  a fascinating  narrative  of  the  history  of  hospitals  as 
well  as  of  nursing,  and  will  interest  physicians  and  their 
patients  as  well  as  nurses.  While  it  establishes  the  back- 
ground of  what  is  termed  “the  youngest  profession,”  it 
likewise  shows  its  close  relation  to  medicine  as  it  pro- 
gressed and  retrograded  through  the  centuries  to  the 
present  time;  it  may  well  encourage  us  in  dealing  with 
some  of  the  difficulties  with  which  we  are  today  con- 
tending. A.  C.  J. 


A Surgical  Diagnosis.  By  J.  Lewi  Donhauser.  Pp.  797. 
Illustrated.  New  York  and  London:  D.  Appleton  and 
Company,  1929. 

This  book  is  written  essentially  for  medical  students 
and  hospital  interns.  The  author  covers  the  etiology, 
signs,  symptoms,  and  differential  diagnosis  of  all  the 
(Continued  on  Page  16) 

TinnnnrmTnrinrrirm 


For  Medicinal,  Industrial  and  Drinking  Purposes 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


13 


£ PANTOPON 

[panfopium  hydr»c‘hloricuin] 


a water-soluble,  injectable  preparation  of  opium 
. . containing  not  one  but  all  the  alkaloids  . . 
. . . . for  oral  as  well  as  hypodermic  use  . . . . 


In  place  of  Morphine  try 
Pantopon  in  all  comlitions  in  which 
yon  usually  use  Morphine  • • • See 
whether  yon  do  not  prefer  its  action 


in  infections  diseases  (encephali- 
tis, grippe,  pneumonia,  typhoid). 

Analgesic:  in  all  forms  of  pain, 
fractures,  injuries,  inoperable  con- 
ditions, cancers,  gall  stone  and 
renal  colics,  cystitis;  surgical 
cases,  pre-  and  post-operatively; 
obstetrics. 

Some  Special  Uses:  in  diarrhea  co- 
litis, enteritis,  dysentery,  intestinal 
colics,  gastro-intestinal  spasm. 


^3gr.  Pantopon  is  usually 
given  instead  of  \ gr. 
morphine.  ........ 

for  SEDATION: 

from  to  Vt2  gr. 
(Most every  prescrip- 
tion pharmacy  has 
Pantopon  Powder  in 
stock.) 

for  PAIN  RELIEF: 

from  % to  M gr. 

Try  ^4  gr.  Pantopon  to 
the  dose  as  sedative  in 
your  cough  remedy  in 
place  of  codeine  and 
note  how  quickly  it  con- 
trols the  cough 


Sedative:  in  cough,  asthma,  bron- 
chitis, dyspnea  of  myocarditis, 
angina  pectoris,  arteriosclerosis, 
pleurisy,  tuberculosis,  eclampsia; 
in  neurology  and  psychiatry  for 
apprehension, excitation,  paralysis 
agitans,  delirium  tremens. 


Hypnotic:  in  insomnia,  due  to  se- 
vere pain  or  aggravated  mental 
and  psychic  disturbances;  or  in 
cardiovascular  complications;  or 


COUNCIL 

ACCEPTED 

For  your  complimen- 
tary trial  supply  send 
Narcotic  Blank 
( 1923 ) made  out  for 
one  tube  12  x 'A  gr. 
hypo,  tablets  and  one 
tube  20  xl/(,  gr.  oral 
tablets  Pantopon. 


Powder:  vials  of  1,  pi, 
% and  l/t  oz.  . „ . . . 

Oral  tablets:  Ye.gr.,  vials 
of  20 


Hoffmanri'La Roche  .Inc. 

^Makers  ofJdedicin.es  of  Hare  Qualify 

NUTLEY  NEW  JERSEY 


Ampuls:  l.lcc.,  cartons 

of  6 and  12 

Hypo,  tablets:  Yi  SK> 
tubes  of  20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


H 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 
Telephone  Main  7676 

Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


Graduate  School  of  Medicine 

The  Tulane  University  of  Louisiana 

Approved  by  the  Council  on  Medical  Education 
of  the  A.  M.  A. 

Post-graduate  instruction  offered  in  all  branches  of 
medicine.  Courses  leading  to  a higher  degree  have 
also  been  instituted. 

For  bulletin  furnishing  detailed  information 
apply  to  the 

DEAN 

Graduate  School  of  Medicine 
1551  Canal  Street  New  Orleans,  La. 


listers 

CAS  E I fM  - PALMNUT 

Dietetic  Flour 

Starch-free  Diabetic  Foods  that  are  ap- 
petizing are  easily  made  in  the  patient’s 
home  from  Listers  Flour.  It  is  self-rising. 
Ask  for  nearest  depot  or  order  direct. 

LISTER  BROS.  Inc.,  41  East  42nd  St.,  NEW  YORK 


ELASTIC  HOSIERY 

Seamed  or  Seamless 


Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 


Dr.  Pollard’s  High  Tension  Stethoscope 


Postpaid  Price  #6.00 


A SCOPE  with  which  you 
can  hear  the  heart  sounds 
through  an  overcoat,  coat  and 
vest,  and  with  which  you  can 
easily  hear  the  fetal  heart 
sound.  The  regulation  bin- 
aurals  are  furnished  with  this 
stethoscope. 

TRY  IT  a week;  if  not  sat- 
isfied, return  and  your  money 
will  be  cheerfully  refunded. 


JOHN  D.  POLLARD,  M.  D. 

3603  Flournoy  Street  Chicago,  111. 


Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  r TRUSSES  r ELASTIC  WEAR 

Clark-Gandion  Go.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
522  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


NICHOLT  POWDER 


We  want  every  physician  to 
ti'y  Nichols  Nasal  Syphon. 
Powdei'-IIS  newand  unusual- 
ly fine  for  use  with  the  Nichols 
Nasal  Syphon -oi' wherever 
nasal  cleansing  is  indicated, 

NICHOl/ 

NA/AL  yVPHON.INC. 
159  East  34?’ St.-  N.Y.C. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/5 


The  chain  i 
than  its 


tronger 
t 


Professional  Protection  is  a chain  of  many  links. 

The  soundness  of  the  Company,  the  verbiage  of  its  contract, 
its  interpretation  of  the  written  provisions,  its  experience  in 
defending  malpractice  suits,  its  training,  its  record,— these  all 
are  links,  each  lending  its  own  individual  strength  to  the 
common  task  of  safeguarding  professional  interests. 

To  secure  a balanced  chain  of  uniform  strength,  providing  an 
unquestionably  sound  Company,  the  simplest  and  most  com- 
plete coverage  devisable,  the  broadest  interpretation  of  mal- 
practice, the  advantage  of  specialized  service,  the  experience 
of  thirty-one  years  in  the  defense  of  more  than  30,000  claims 
and  suits,  the  expert  technique  of  exclusive  application,  and 
the  most  liberal  liability  acceptance  record,  there  is  but  one 
answer  — the  Medical  Protective  Contract. 


Specialized  Service 
eliminates  the  second  cost 


30C 


Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Boulevard  J Chicago,  Illinois 


MEDICAL  PROTECTIVE  CO. 
360  North  Michigan  Blvd. 
Chicago,  111. 

Address 

Kindly  send  details  on  yot.r  plan  of 
Complete  Professional  Protection 

3-30 

i6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ANNOUNCEMENT 


OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION,  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION,  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FULGURATION  OF  BLADDER  TUMORS,  ETC., 
WILL  BE  GIVEN. 


LOUIS  CLIVE  JACOBS,  M.  D.,  Urologist 


FOURTEENTH  FLOOR-FOUR-FIFTY 
SUTTER 

SAN  FRANCISCO,  CALIFORNIA 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  DAvenport  7322 


CABLE  WARP  f 
TOWELS 
Westinghouse 
MAZDA  LAMPS 


O’KEEFFE  & COMPANY  t 

Incorporated 

WHOLESALE  DEALERS 
BEDDING  r BED  LINENS  / CURTAINS 
Carpets  i Towels  i Table  Linens  i Furniture 
7 88  Mission  Street  San  Francisco  * 


Telephones 
SUtter  7599 
SUtter  3458 


BOOK  REVIEWS 


(Continued  from  Page  12) 

surgical  conditions  from  the  infections  through  all  the 
diseases  of  the  various  systems.  The  data  are  arranged 
as  an  outline  and  numerous  charts  are  used  throughout 
the  text. 

For  the  most  part  the  definitions  are  exceptionally  good, 
otherwise  the  book  contains  nothing  remarkable  for  the 
practicing  surgeon.  However,  it  does  fulfil  its  purpose 
as  a guide  to  surgical  diagnosis  for  the  beginner. 

L.  R.  C. 


Clinical  Medicine  for  Nurses.  By  Paul  H.  Ringer.  Pp.  330. 
Illustrated.  Third  edition.  Philadelphia:  F.  A.  Davis 
Company,  1929.  Price,  $3. 

Clearness  and  avoidance  of  unnecessary  details  are  the 
main  essentials  in  the  teaching  of  nurses,  who  are  usually 
overburdened  with  much  knowledge  to  be  absorbed  in  a 
short  time.  “Clinical  Medicine  for  Nurses’’  certainly 
meets  this  need. 

As  the  title  implies,  it  is  clinical  medicine,  not  an  ex- 
haustive textbook,  and  a book  of  this  size  cannot  cover 
every  disease  which  the  nurse  may  have  to  deal  with. 
Nothing  essential  has  been  omitted  and  those  diseases  in 
which  the  nursing  care  is  of  paramount  importance — 
typhoid,  diphtheria,  and  rheumatic  fever — have  been  fully 
discussed. 

The  sections  on  treatment  of  each  disease  are  up  to  date, 
and  enough  pathology  and  symptomatology  have  been 
included  to  allow  the  nurse  to  meet  each  case  with  a clear 
idea  of  what  she  can  do  to  further  the  comfort  and 
recovery  of  the  patient.  H.  M.  D. 


The  Nose,  Throat,  and  Ear  and  Their  Diseases.  In  origi- 
nal contributions  by  American  and  European  authors. 
Edited  by  Chevalier  Jackson  and  George  Morrison 
Coates,  assisted  by  Chevalier  L.  Jackson.  Pp.  1177. 
Illustrated.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1929.  Price,  $13. 

A valuable  book  for  laryngologists  and  those  who  have 
had  special  training  in  otolaryngology.  It  is  entirely  too 
massive  and  lengthy  to  allow  its  recommendation  as  a 
text  for  medical  students. 

The  volume  itself  is  a collection  of  essays,  some  of 
which  closely  assume  the  cloak  of  a monograph,  con- 
tributed by  men  especially  selected  to  present  the  subject- 
matter  of  their  respective  chapters.  The  weakness  of 
collected  writings  of  various  authors,  namely,  lack  of 
continuity  and  lack  of  uniformity  in  diagnosis  and  treat- 
ment of  allied  or  closely  allied  pathology,  although  present 


in  this  volume  is  not  as  distressingly  evident  as  has  been 
the  case  heretofore. 

The  volume  is  rich  in  illustrations  of  excellent  selec- 
tion and  quality.  In  some  instances  the  list  of  reference 
material  is  scant,  in  others  rather  extensive,  depending 
somewhat  upon  the  reaction  of  the  individual  contributor. 
The  index  is  complete,  logical  and  workable. 

In  general  the  articles  are  at  once  lucid,  concise,  and 
up  to  date,  and  the  work  as  a whole  forms  a worthy 
volume  of  otorhinolaryngology.  L.  F.  M. 


William  Harvey.  By  Archibald  Malloch.  Illustrated.  New 
York:  Paul  B.  Hoeber,  1929.  Price,  $1.50. 

A deeply  interesting  and  very  human,  as  well  as  an 
unusually  authoritative  life  of  William  Harvey,  whose 
master  work  on  the  movements  of  the  heart  and  blood 
was  written  just  three  hundred  and  three  years  ago,  has 
come  from  the  pen  of  Dr.  Archibald  Malloch,  the  distin- 
guished librarian  of  the  New  York  Academy  of  Medicine. 
His  “William  Harvey”  is  made  doubly  interesting  with 
thirteen  admirably  reproduced  illustrations  of  contempo- 
rary documents  and  portraits.  Knowing  Doctor  Malloch 
personally,  I am  not  surprised  to  find  a graphic  quality 
in  this  brief  biography  which  is  a salient  feature  of  the 
man’s  conversation.  Doctor  Malloch,  in  a hundred  pages, 
gives  a better  picture  of  the  man  and  his  work  than  most 
biographers  would  in  ten  times  that  space.  He  shows  us 
Harvey  as  one  of  the  first  defenders  of  vivisection,  as  a 
vigorous  opponent  to  the  witchcraft  and  quackery  of  that 
day  (1578-1657),  writes  entertainingly  of  Harvey’s  per- 
sonal eccentricities,  and  mentions  some  of  his  early  dis- 
sections performed  under  the  direction  of  Fabricius  by 
candlelight.  In  a word,  the  book  is  well  worth  buying. 

E.  L.  G. 


Imperative  Traumatic  Surgery  With  Special  Reference  to 
After-Care  and  Prognosis.  By  C.  R.  G.  Forrester. 
Pp.  464.  Illustrated.  New  York:  Paul  B.  Hoeber,  1929. 
Price,  $10. 

The  text,  illustrations,  and  index  of  this  book  cover 
four  hundred  and  sixty-four  pages.  It  is  written  in  a well 
organized  form,  and  the  author  has  attempted  to  give  a 
standard  treatment  for  the  more  common  injuries.  The 
book  is  written  from  the  practical  standpoint  throughout. 
The  methods  of  the  author,  after  a rich  experience  of 
twenty-six  years  in  industrial  practice,  are  given  in  detail 
and  no  attempt  is  made  to  cover  all  the  methods  in  use 
for  treating  different  injuries. 

Routine  thorough  physical  examination  is  emphasized 
and  a printed  “Record  Form”  is  presented  which  the 
author  uses  and  advocates  for  the  sake  of  brevity. 

(Continued  on  Page  18) 


c After  Seven  Years  of 

lletin  ( Insulin , Lilly) 


THERE  are  records  of  many  patients  who  have  been  treated 
with  IJetin  (Insulin,  Lilly)  throughout  all  or  a major  part 
of  the  seven  years  in  which  it  has  been  available. 

By  faithful  use  of  Insulin  and  adherence  to  proper  diet,  children 
have  continued  in  school,  young  men  and  women  have  completed 
college,  artisans  have  followed  their  trades,  business  and  pro- 
fessional men  have  pursued  their  daily  routine,  and  mothers  have 
been  saved  to  the  home. 

On  account  of  its  characteristic  uniformity,  purity,  and  stabil- 
ity lletin  (Insulin,  Lilly)  may  be  relied  upon  whenever  Insulin 
is  needed. 

Supplied  through  the  drug  trade  in  5 cc.  and  10  cc.  vials. 

ELI  LILLY  AND  COMPANY 

INDIANAPOLIS,  U.  S.  A. 


U-10 

ILETIN 
'SULIN,  LILL 

19  Units  in  Each  cc. 

the  Islttlp 

edOct.9.1’- 
COOL' 

INDIAN^ 


irn 


t.t.  U-80  yn,n 
ILETIN 

■nsulin.  lillv 


'"'Ulin  jj  s,  |'*t  Off 
d ld.q.A  i a 12-23-2* 


lu-9-23  & 12-23-2* 

JO  Units  in  Each  c.c- 
AX.zjs 

EM.L|I-LY  AND  COMPAQ 
w’miANJ  A l*» >i  10  II  S A 


lletin  ( Insulin , Lilly ) was  the 
first  Insulin  commercially  avail- 
able in  the  United  States . 

Write  for  pamphlet  and  diet  chart. 


PROGRESS  THROUGH  RESEARCH 


I Vi' 
A \| 

m 

H 1 1 

I i yst  I 

Will 
f ft  1 1 
fill  I 

1*1  - f 

r Jk . I 

1 r\l 

M iff 

py] 

fi 

1%h 

pill 


Liver  Extract  No.  343 

Specific  in  Pernicious  Anemia 

(A  Highly  Potent  and  Uniform  Product) 

EACH  lot  of  Liver  Extract  No.  343  is  tested 
clinically  on  a patient  with  primary  per- 
nicious anemia  who  has  not  received  treatment 
and  whose  red  blood-cell  level  is  i. 5 million  or 
below.  This  test  provides  the  only  known  method 
for  observing  the  response  of  the  reticulocytes 
(young  red  blood-cells)  and  the  rate  of  red  blood- 
cell production,  which  determine  the  potency  of 
the  extract. 

Liver  Extract  No.  343  is  supplied  through  the 
drug  trade  in  boxes  containing  two  dozen  vials 
of  powdered  extract.  The  content  of  each  vial 
represents  material  derived  from  100  grams,  or 
about  3J2  ounces,  of  fresh  raw  liver. 


PROGRESS  THROUGH  RESEARCH 


Write  for  further 
information. 


* * 


ELI  LILLY  AND  COMPANY,  Indianapolis,  U.  S.  A. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


COUNCIL  ACCEPTED” 


DIGIFOLINE,  “CIBA 

TABLETS 

Each  tablet  of  Digifoline, “Ciba”  represents  0.1  gm.  (1%  grains) 
of  digitalis  leaves  standardized  by  the  Focke  method 

1.  Accuracy  of  Dosage 

2.  Stability 

3.  Ready  Absorbability 

4.  Convenience  of  Administration 

5.  Pleasant  to  Taste 

Digifoline,  “Ciba”  Tablets  are  issued  in  tubes  of  25, 
and  in  bottles  of  100.  Your  own  druggist  carries 
Digifoline,  “Ciba”  in  stock. 

We  will  gladly  send  you  a complimentary  supply  of 
Digifoline,**  Ciba” . Write  us,  using  your  letterhead. 


55 


CIBA  COMPANY,  INC.,  NEW  YORK  CITY 


i8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


CANYON  SANATORIUM  the  Treatment  of  Tuberculosis 

REDWOOD  CITY,  CALIFORNIA 


NESTLED  IN  THE  FOOTHILLS 

For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  Douglas  4486 


The  Scripps 
Metabolic  Clinic 

For  the  treatment  and  investigation  of: 

Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


BOOK  REVIEWS 


(Continued  from  Page  16) 

There  are  five  hundred  and  ninety-eight  illustrations, 
all  of  which  have  some  practical  value.  The  author  has 
attempted  to  give  a practical  and  efficient  type  of  treat- 
ment for  all  of  the  more  common  industrial  injuries,  and 
to  this  end  the  reviewer  feels  that  he  has  succeeded. 
The  subject-matter  and  illustrations  are  worthy  of  atten- 
tion from  anyone  doing  industrial  surgery.  L.  B. 


An  Introduction  to  the  Study  of  Physic.  (Now  for  the 
first  time  published.)  By  William  Heberden.  A prefa- 
tory essay  by  LeRoy  Crummer,  with  a reprint  of 
Heberden’s,  some  account  of  a disorder  of  the  breast. 
Pp.  159.  Illustrated.  New  York:  Paul  B.  Hoeber,  Inc., 
1929.  Price,  $2. 

One  can  say  nothing  except  in  praise  of  Doctor  Crum- 
mer’s  delightful  essay  on  Heberden.  The  discovery  of  a 
previously  unknown  work  by  an  old  master  and  the  re- 
production of  it  in  pleasing  form  are  obviously  matters 
of  importance  to  all  medical  bibliophiles.  The  "Introduc- 
tion to  the  Study  of  Physic”  is  itself  replete  with  interest 
and  can  be  read  with  profit  today  by  every  medical  stu- 
dent and  teacher.  A.  L.  B. 


A Diabetic  Manual  for  the  Mutual  Use  of  Doctor  and 
Patient.  Fourth  edition.  Illustrated.  Pp.  248.  Phila- 
delphia: Lea  and  Febiger,  1929.  Price,  $2. 

Successive  editions  have  registered  progress  in  dia- 
betes, education  of  the  patient,  prevention  of  diabetes  by 
avoidance  of  obesity,  more  recently  the  proper  use  of 
insulin.  This  book  deservedly  continues  to  lead  the  pro- 
cession of  handbooks.  It  excels  in  its  credit  to  other  stu- 
dents, in  its  consideration  of  the  views  of  others,  in  its 
thorough  reliability  and  soundness,  in  its  incessant  im- 
provements in  each  edition,  in  its  lively  illustrations 
(especially  the  little  girl  on  page  114  giving  herself  an 
injection  of  insulin),  in  its  presentation  of  the  normal 
diet  in  simple  and  orthodox  lines  following  evidence  of 
authorities  such  as  Benedict,  Chittenden,  DuBois,  Holt, 
Lusk,  Mendel,  Osborne,  McCollum,  and  Simmonds.  Dia- 
betic diets  are  set  forth  simply  in  some  places  for  begin- 
ners, and  more  in  detail  in  other  places  for  patients  who 
have  learned  the  absolute  essentials  and  wish  to  know 
more  in  order  to  obtain  variety.  The  questions  and  an- 
swers are  simple,  important,  and  reveal  the  actual  ques- 
tions raised  by  patients. 

Conservative  doctrines  regarding  the  amount  of  carbo- 
hydrates and  of  insulin  are  noteworthy,  generally  less 
than  a hundred  grams  and  less  than  thirty  units  a day 
respectively:  these  practices  are  believed  to  help  avoid- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19 


The  Doctors  Business  Bureau 

701-705  Balboa  Building 

SAN  FRANCISCO,  CALIFORNIA 

Fourteen  years  of  successful  and  satisfactory  service  to  doctors. 

More  than  eighteen  hundred  members  of  the  California  Medical  Association  are  using  the 
Bureau  to  their  advantage. 

At  the  urgent  solicitation  of  doctors  in  Sonoma  County  and  vicinity  an  office  has  been  estab- 
lished at  Santa  Rosa. 

(Ask  the  Sonoma  County  Medical  Society  about  it.) 

Collection  stamps  service  for  your  own  office  use  is  recommended  for  economy  and  efficiency. 
Every  account  referred  to  the  Bureau’s  Collection  Department  receives  the  most  careful  and 
confidential  personal  attention. 

TELEPHONE  OR  WRITE  FOR  PARTICULARS 

COLLECTION  DEPARTMENT 

THE  DOCTORS  BUSINESS  BUREAU 

Balboa  Building,  San  Francisco,  California 

SANTA  ROSA  Phone  GARFIELD  0460  LOS  ANGELES 

BONDED  LICENSED 


ance  of  reactions,  edema,  obesity  and  consequent  drastic 
thinning  treatments  notoriously  undertaken  by  not  a few 
so-fed  patients,  some  without,  some  even  with  advice  of 
a physician. 

Special  topics  receive  special  chapters:  care  of  teeth, 
skin,  feet,  acidosis  and  coma,  constipation,  diarrhea,  sur- 
gery, marriage,  pregnancy,  body  weight,  obesity,  preven- 
tion, dogs,  food  recipes  and  tables,  urine  tests.  There  is 
an  index. 

This  manual  has  no  equal,  either  for  the  practitioner 
to  have  on  hand  for  reference,  or  for  him  to  recommend 
to  his  patients.  H.  G. 


Bodily  Changes  in  Pain,  Hunger,  Fear,  and  Rage — An 
Account  of  Recent  Researches  into  the  Function  of 
Emotional  Excitement.  By  Walter  B.  Cannon.  Second 
edition.  Pp.  404.  Illustrated.  New  York  and  London: 
D.  Appleton  and  Company,  1929.  Price,  ?3. 

The  book  is  fundamentally  an  exposition  of  the  sympa- 
thetico-adrenal  system,  in  which  the  author  “has  tried 
to  eliminate  or  incidentally  explain  technical  terms  so 
that  the  exposition  will  be  easily  understood  by  any  in- 
telligent reader  even  though  not  trained  in  the  medical 
sciences.” 

In  times  of  stress  “purposive  automatisms,”  having  the 
nature  of  reflexes,  with  the  center  located  in  the  optic 
thalamus,  are  brought  into  play;  typical  reaction  patterns 
“nicely  adopted  to  the  welfare  and  preservation”  of  the 
animal  at  such  times,  tapping  the  “reservoirs  of  power,” 
causing  suspension  of  alimentary  function,  mobilization 
of  sugar  for  energy,  offsetting  of  fatigue,  increasing  blood 
pressure,  hastening  of  the  coagulation  time  of  blood,  in- 
creasing number  of  red  cells  in  circulation,  etc. ; all  very 
well  summarized  in  Chapter  Twelve,  a chapter  well  worth 
reading  for  the  person  who  wants  in  brief  the  present 
knowledge  of  the  sympathetico-adrenal  system,  and  then 
of  interest  to  the  clinician  the  practical  application  of 
this  knowledge  in  Chapter  Fourteen. 

The  latter  part  of  the  book  deals  with  the  physiology 
of  hunger,  thirst,  and  the  center  of  the  emotions  in  the 
optic  thalamus,  and  finally,  briefly,  the  philosophy  of  the 
emotions. 

Finally,  it  should  be  added,  that  this  book  affords  the 
layman  an  insight  into  the  methods  and  intricacies  of 
medical  research  in  a lucid  manner,  being  of  especial 
value  in  this  day  of  exaggerated  claims  by  quacks  and 
charlatans.  B.  S. 

(Continued  on  Page  23) 


Alum  Rock  Sanatorium 

TUBERCULOSIS 


Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 


RATES  AND  FOLDER  ON  APPLICATION 


Consultants : 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


* 


MTS 


Depositing  a 

single  strand  of 
suture  within  the 
wound  or  incision  and 
leaving  it  in  situ  . . • 
obviating  the  necessity 
of  pulling  a double 
suture  through  a small 
aperture  . . . offering 
heretofore  unknown 


speed,  ease  and  pre- 
cision in  suturing,  the 
Waiss  Hollow  Surgical 
Needle  and  Holder 
brings  to  the  medical 
profession  a modern 
adaptation  of  an  an- 


cient art. 


We  have  prepared  a 
small  booklet  giving 
photographic  pictures 
and  descriptions  of  the 
Waiss  Hollow  Surgical 
Needle  and  Holder. 
Send  for  it  today.  You 
will  be  highly  inter- 
ested in  this  new  and 
more  efficient  method 
of  suturing. 


HOLLOW 
NEEDLE 


and 

HOLDER 

For 

Modern 

Suturing 


WRITE  FOR  LITERATURE 

Brackwood  Corp  + Ltd* 
6331  Hollywood  Blvd  + 
HoLi  Ywoon  Calif  ♦ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


21 


INFANT  DIET  MATERIALS 


Dextri-Maltose 


For  two  decades,  the  pediatrician’s  choice  for  mod- 
ifying cow’s  milk,  because  of  its  consistent  clinical 
results,  its  ethical  character,  and  because  it  em- 
bodies the  fundamental  principle  of  the  flexible 
formula  adapted  to  the  individual  requirements 
of  the  individual  baby. 


DEXTRI-MALTOSE  NOS  1,  2 AND  3,  SUPPLIED  IN  1-LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITERATURE  ON 
REQUEST,  MEAD  JOHNSON  & CO.,  EVANSVILLE.  IND.,  U S A 


Dextri-Maltose  for 
Modifying  Evaporated  Milk 

In  sections  where  fresh  cow’s  milk 
is  not  readily  available,  physicians 
often  rely  upon  evaporated  milk  for 
infant-feeding. 

Dextri-Maltose  is  as  important  for 
modifying  evaporated  milk  as  it  is 
for  fresh  cow’s  milk,  supplying  the 
correct  proportion  of  carbohydrate 
without  nutritional  upset  to  the  baby. 

The  assimilation  limit  of  Dextri- 
Maltose  is  twice  that  of  cane  or  milk 
sugar.  Dextri-Maltose  is  absorbed 
high,  in  the  intestinal  tract,  so  that 
it  is.  least  likely  to  cause  fermenta- 
tive diarrhea  and  nutritional  disturb- 
ances. 


DEXTRI-MALTOSE  NOS  1,  2 AND  3,  SUPPLIED  IN  I-LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITERATURE  ON 
REQUEST.  MEAD  JOHNSON  & CO  , EVANSVILLE.  IND  USA 


Dextri-Maltose  for 
Modifying  Lactic  Acid  Milk 

In  using  lactic  acid  milk  for  feeding 
infants,  physicians  find  Dextri- 
Maltose  the  carbohydrate  of  choice: 

To  begin  with,  Dextri-Maltose  is  a 
bacteriologically  clean  product,  un- 
attractive to  flies,  dirt,  etc.  It  is  dry, 
and  easy  to  measure  accurately. 

Moreover,  Dextri-Maltose  is  prepared 
primarily  for  infant  - feeding  pur- 
poses by  a natural  diastatic  action. 

Finally,  Dextri-Maltose  is  never  ad- 
vertised to  the  public  but  only  to  the 
physician,  prescribed  by  him  ac- 
cording to  the  individual  require- 
ments of  each  baby. 


DEXTRI-MALTOSE  NOS  1,  2 AND  3,  SUPPLIED  IN  1-LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITERATURE  ON 
REQUEST,  MEAD  JOHNSON  & CO  , EVANSVILLE.  IND  . U S A 


“•In  Rickets,  Tetany  and  Osteomalacia— 


IN  OIL. lOO  D-ORIGINALLY  ACTEROL 


AMERICAN  PIONEER  STANDARDIZED  ACTIVATED  ERGOSTCROU 

(I)  The  standard  of  vitamin  D po- 
tency (100  times  that  of  Cod 
Liver  Oil)  set  by  Mead  Johnson 
& Co.,  in  1927  for  Mead’s  Vio- 
sterol  in  Oil,  100  D (originally 
Acterol)  is  now  the  standard 
accepted  by  both  the  Wisconsin 
Alumni  research  Foundation 
and  the  Council  on  Pharmacy 
and  Chemistry,  American 
Medical  Association. 

Specify  the  American  Pioneer  Product — 
MEAD’S  Viosterol  in  Oil,  100  D 
Mead  Johnson  &.  Co.,  Evansville,  Indiana 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 


by  mouth.” 

ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 


ALQUA  WATER— In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 


ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 


Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 


The  Shasta  Water  Company 

Bottlers  and  Controlling  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 

At  All  Druggists 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


23 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


BENJAMIN  H.  DIBBLEE 

President 


I.  C.  KNOWLTON 

Secretary 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


W.  G.  Moore,  M.D. 


Harold  P.  Hill,  M.D. 


Geo.  D.  Lyman,  M.D. 


Howard  H.  Johnson, 
M.  D„  Med.  Dir. 
Secretary,  Executive 
Committee. 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 


BOOK  REVIEWS 


(Continued  from  Page  19) 

Pathogenic  Microorganisms — A Practical  Manual  for  Stu- 
dents, Physicians,  and  Health  Officers.  By  William 
Hallock  Park,  Anna  Wessels  Williams,  and  Charles 
Krumwiede.  Ninth  edition.  Pp.  819.  Illustrated.  Phila- 
delphia: Lea  and  Febiger,  1929. 

This  recently  revised  book,  which  is  an  accepted  stand- 
ard text  of  bacteriology,  requires  neither  introduction  nor 
criticism. 

Attention  is  drawn  to  the  more  important  changes 
which  are  the  additions  of  newer  knowledge  of  scarlet 
fever,  yellow  fever,  tularemia,  and  undulant  fever.  De- 
tails of  the  new  precipitin  tests,  staining  reactions,  and 
cultural  methods  are  given  in  full.  The  chapter  on  pneu- 
monia includes  the  new  classification  of  pneumococci. 

The  bibliography  has  been  enlarged  to  include  the  addi- 
tional sources  of  information. 

The  general  arrangement  and  presentation  of  the  mate- 
rial, except  for  minor  changes,  and  the  illustrations,  are 
the  same  as  found  in  the  eighth  edition. 

It  is  a valuable  book  for  the  medical  practitioner,  lab- 
bratory  worker,  and  student.  E.  M.  B. 


Indigent  May  Have  Their  Own  Physicians. — A new 

plan  to  provide  medical  care  for  the  indigent  of  a 
progressive  county  in  another  state  recently  became 
effective  under  a contract  signed  by  the  county  medi- 
cal society  and  the  county  board  of  supervisors.  By 
this  plan  an  indigent  person  may  select  his  own  phy- 
sician from  the  members  of  the  county  society.  The 
supervisors  pay  the  society  a total  of  $3500  for  caring 
for  the  sick  poor  one  year,  and  the  society,  in  turn, 
pays  the  individual  member  in  accordance  with  the 
amount  of  work  which  he  did.  Calls  for  medical  aid 
must  come  first  through  the  supervisors.  Under  the 
old  system,  three  physicians  were  given  all  of  the 
so-called  pauper  practice. — The  Health  Messenger 
(Seattle). 


HAY 

FEVER 

has  been  prevented  in 
thousands  of  cases  with 

Pollen  Antigen 

J&ectevle 

Each  year  has  added  evidence  to  the  value 
of  this  product  in  the  prevention  or  relief 
from  symptoms  of  Hay  Fever,  and  each 
year  an  increasing  number  of  physicians 
have  familiarized  themselves  with  the  Hay 
Fever  problem  and  are  relieving  patients 
of  their  seasonal  attacks. 

Full  information  upon  request 

Lederle  Antitoxin  Laboratories 

New  York 


24. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  MArket  0331 

Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with 
especial  reference  to  parasites. 

Containers  will  be  fur- 
nished upon  request. 

HERBERT  GUNN,  M.  D. 

2000  Van  Ness  Avenue 

San  Francisco  Telephone:  GRaystone  1027 

THE  HILL- YOUNG  SCHOOL 

OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi- 
culty. Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child's 
physician.  Testimonials  from  physicians. 

School  Publications — $2.00  each:  "Overcoming  Cleft 

Palate  Speech,”  "Help  for  You  Who  Stutter.” 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 

2309-15  South  Hoover  Street  WEstmore  0512 

Hazel  E.  Furscott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  DOuglas  9124  380  Post  St. 

San  Francisco,  California 

Shumate’s 

PRESCRIPTION  PHARMACIES 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 

Refrigerated  Biologies  Prescription 

Technique 

Catering  to  the  Medical  Profession  Since  1890 

SAN  FRANCISCO 

QUIZ  COURSE, 

Preparation  For  Medical  Boards, 
Post-Graduate  Medical  Lectures. 

ARTHUR  H.  WHITE,  M.  D. 

1005  Market  Street  San  Francisco 

Phone  Market  3362 

HOLLAND-RANTOS 
COMPANY,  Inc. 

Gynecological  and  Obstetrical 
Specialties 

Descriptive  Leaflets,  Reports  and  Price  List 

Sent  on  Request 

156  FIFTH  AVENUE  NEW  YORK  CITY 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


DIET  QUESTIONS  have  GELATINE  ANSWERS 


CAN  GELATINE  PUT  MORE 
DIGESTIBILITY  INTO  MILK-AND 
MORE  NOURISHMENT  INTO 
UNDERFED,  UNDERWEIGHT  BABIES? 


KIM  OX 

is  the,  real 

GELATIN  IE 


You  undoubtedly  know  that  many  eminent  physicians 
have  written  much  on  the  value  of  gelatine  as  an  aid  to 
the  digestibility  of  cow’s  milk  for  babies. 

The  protective  colloid  in  Knox  Gelatine  modi- 
fies the  curdling  of  the  milk  by  the  natural  acids  and 
the  enzyme  rennin  of  the  infant  stomach — thereby  tend- 
ing to  reduce  colic,  regurgitation,  the  passing  of  un- 
digested curds,  etc. 

It  has  been  proved  by  actual  test  cases  time  and  again 
that  the  addition  of  1%  of  Knox  Sparkling  Gelatine  to 
the  baby’s  milk  reduces  stomach  disturbances  and  helps 
to  increase  weight. 

Knox  Gelatine  is  an  excellent  protein  — uncolored, 
unsweetened,  unflavored,  unbleached.  It  has  been  pre- 
scribed by  the  medical  profession  for  more  than  40  years 
in  cases  of  infant  malnutrition.  Be  sure  you  specify  Knox 
Gelatine— the  real  gelatine— when  you  prescribe  gelatine. 

The  following  is  the  formula  prescribed  by  authorities 
on  infant  feeding:  Soak,  for  about  10  minutes,  one  level 
tablespoonful  of  Knox  Sparkling  Gelatine  in  one-half  cup 
of  milk  taken  from  the  baby’s  formula ; cover  while  soaking; 
then  place  the  cup  in  boiling  water,  stirring  until  gelatine 
is  fully  dissolved ; add  this  dissolved  gelatine  to  the  quart 
of  cold  milk  or  regular  formula. 

We  believe  the  booklets  listed  below  may  prove 
helpful  in  your  practice.  Please  fill  out  the  coupon  for 
Complete  data. 


KNOX  GELATINE  LABORATORIES 
417  Knox  Avenue,  Johnstown,  N.  Y. 

Please  send  me,  without  obligation  or  expense,  the  booklets  which  I have 
marked.  Also  register  my  name  for  future  reports  on  clinical  gelatine  tests 
as  they  are  issued. 

□ Varying  the  Monotony  of  Liquid  and  Soft  Diets.  □ Recipes  for  Anemia. 
D Diet  in  the  Treatment  of  Diabetes.  □ Reducing  Diet. 

□ Value  of  Gelatine  in  Infant  and  Child  Feeding. 

Name 

Address — 

City 

State 


26 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SERVICE  and  the  MONEX 


One  of  the  major  considerations  in  the  selection  of 
an  X-Ray  machine  is  the  service  required  by  it  to  insure 
continued  operation  without  any  delay  for  repairs, 
adjustments  or  overhauling. 

Wappler  sales  and  service  agents 
throughout  the  country  have  com- 
mented on  how  the  MONEX  has 
almost  entirely  eliminated  these 
costly  delays.  We  ourselves  have 
noted  how,  with  the  elimination  of 
all  moving  parts  on  the  MONEX, 
service  calls  have  diminished. 

Let  us  tell  you  more;  how  it 
operates  in  silence,  is  economical  in 
space  as  well  as  in  operation,  and 
of  its  ample  capacity  for  ALL 
radiographic  and  fluoroscopic  re- 
quirements. Send  for  Bulletin 
No.  107. 


R.  L.  Scherer  Go. 

QUALITY  and  SERVICE 

SAN  FRANCISCO  LOS  ANGELES 
679  Sutter  St.  736  So.  Flower  St. 
PRospect  3248  TRinity  6377 


CARL  ZEISS,  JENA 

MICROSCOPES 

Represent  the  finest  possible  craftsmanship,  opti- 
cally and  mechanically,  in  the  microscope  field. 
Priced  from  #128.00  up.  Terms  if  desired. 

Trainer-Parsons  Optical  Co. 

228  POST  STREET  SAN  FRANCISCO 


TRUTH  ABOUT  MEDICINES 

New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

Abbott  Laboratories. — Butesin  Picrate  Eye  Oint- 
ment. 

Lakeside  Laboratories,  Inc. — Ampoules  Dextrose 
(d-Glucose)  10  grams,  20  cubic  centimeters;  ampoule 
No.  51,  Sodium  Cacodylate  0.243  gram  (3)4  grains), 
five  cubic  centimeters. 

H.  K.  Mulford  Co. — Pneumococcus  Antibody  Solu- 
tion, Types  I,  II,  and  III,  Combined  (Mulford),  four 
50  cubic  centimeter  double-ended  vials. 

The  following  articles  have  been  exempted  and  in- 
cluded with  the  List  of  Exempted  Medicinal  Articles 
(New  and  Nonofficial  Remedies,  1929,  p.  481): 

Davies,  Rose  & Co.,  Ltd. — Pil.  Digitalis  (Davies, 
Rose). 

Kings  County  Packing  Co. — Sac-A-Rin  Brand  Cali- 
fornia Bartlett  Pears;  Sac-A-Rin  Brand  California 
Tidbits  Hawaiian  Pineapple;  Sac-A-Rin  Brand  Cali- 
fornia Royal  Anne  Cherries. 

Lakeside  Laboratories,  Inc. — Ampoule  No.  64  Cal- 
cium Chlorid  10  per  cent. 

Diphtheria  Toxoid  (National). — A diphtheria  toxoid 
(New  and  Nonofficial  Remedies,  1929,  p.  368),  pre- 
pared from  seven-day  cultures  of  the  diphtheria  bacil- 
lus that  yield  a toxin  having  an  L plus  dose  of  not 
less  than  0.25  cubic  centimeter.  The  toxin  is  treated 
with  formaldehyd.  The  finished  product  is  tested  for 
antigenic  potency.  The  product  is  marketed  in  pack- 
ages of  three  vials  (one  immunization  treatment);  in 
(Continued  on  Page  28) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


EVERY  PHYSICIAN 

should  be  familiar  with  these  two 

SQUIBB  ANTITOXINS 


Erysipelas  Streptococcus 
Antitoxin  Squibb 

As  erysipelas  antitoxin  is  being  more  and 
more  widely  used  its  value  in  erysipelas  is 
being  recognized. 

Erysipelas  Streptococcus  Antitoxin 
Squibb  is  accepted  by  the  Council  on 
Pharmacy  and  Chemistry  of  the  American 
Medical  Association.  It  is  prepared  ac- 
cording to  the  principles  developed  by 
Dr.  Konrad  E.  Birkhaug.  Its  early  admin- 
istration ensures  a prompt  reduction  in 
temperature  and  toxicosis,  clearing  the 
lesions  and  effecting  uncomplicated  recov- 
ery. 

Erysipelas  Streptococcus  Antitoxin 
SQUIBB  is  distributed  only  in  concentrated 
form  in  syringes  containing  one  average 
therapeutic  dose. 


Tetanus  Antitoxin  Squibb 

Every  wound  in  which  skin  continuity  is 
destroyed  is  a possible  route  of  tetanus 
infection.  Just  as  routine  practice  of  in- 
jecting anti-tetanic  serum  during  the  World 
War  practically  eradicated  tetanus  so  in 
civil  practice  this  disease  might  be  stamped 
out  by  the  same  routine  practice. 

Tetanus  Antitoxin  Squibb  is  small  in 
bulk,  high  in  potency,  low  in  total  solids, 
yet  of  a fluidity  that  permits  rapid  absorp- 
tion. It  is  remarkably  free  from  serum- 
reaction  producing  proteins. 

Tetanus  Antitoxin  Squibb  is  supplied  in 
vials  or  syringes  containing  an  immunizing 
dose  of  1500  units.  Curative  doses  are 
marketed  in  syringes  containing  3,000,. 

5,000,  10,000  and  20,000  units. 


( Write  to  the  Professional  Service  Department  for  Literature) 

E-R;Squibb  & Sons.  New  York 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858. 


28 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Remember/  c\ohen  treating 


CALCREOSE  offers  the  full 
expectorant  action  of  creosote 
in  a form  agreeable  to  the 
patient. 

Each  4 gr.  tablet  contains  2 grs. 
of  creosote  combined  with 
calcium  hydroxide. 


available 


stubborn  coughs 
gou  have 


Meeting  the  de- 
mand for  a cough  syrup 
containing  Calcreose  is  the  new 
Compound  Syrup  of  Calcreose 
a tasty,  effective  remedy  for  minor 
respiratory  affections. 

Each  fluid  ounce  represents  Calcreose  Solution, 
160  minims  (equivalent  to  10  minims  of  pure  creosote)! 
Alcohol,  24  minims;  Chloroform,  approximately  3 minims; 
Wild  Cherry  Bark,  20  grains;  Peppermint,  Aromatics  and 
Syrup  q.s.  Samples  of  Tablets  and  Syrup  to  Physicians  on  Request . 


MALTBIE  CHEMICAL  COMPANY 

NEWARK,  N.J. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  26) 

packages  of  one  vial  (fifteen  immunization  treatments); 
in  packages  of  forty-five  vials  (fifteen  immunization 
treatments).  The  National  Drug  Co.,  Philadelphia. 

Scarlet  Fever  Streptococcus  Antitoxin  (Cutter). — 
A scarlet  fever  streptococcus  antitoxin  (New  and 
Nonofficial  Remedies,  1929,  p.  350),  prepared  by  the 
method  of  Doctors  Dick  by  license  of  the  Scarlet 
Fever  Committee,  Inc.  It  is  marketed  in  packages 
of  one  syringe  containing  2000  units,  and  in  pack- 
ages of  one  syringe  containing  6000  units.  Cutter 
Laboratory,  Berkeley,  California. 

Typho-Bacterin  Mixed  (Triple  Vaccine  TAB). — 
This  product  (New  and  Nonofficial  Remedies,  1929, 
p.  380),  is  also  marketed  in  packages  of  thirty  one 
cubic  centimeter  vials,  being  ten  immunizations  of 
three  doses  each.  H.  K.  Mulford  Company,  Philadel- 
phia.— Jour.  A.  M.  A.,  January  4,  1930,  p.  31. 

Ampoules  Sodium  Cacodylate  (Mulford),  Three- 
Fourths  Grain,  One  Cubic  Centimeter. — Each  am- 
poule contains  sodium  cacodylate  (New  and  Non- 
official Remedies,  1929,  p.  73),  0.05  gram  ()4  grain) 
in  one  cubic  centimeter  of  sterile  solution,  with  one 
per  cent  of  benzyl  alcohol.  H.  K.  Mulford  Company, 
Philadelphia. 

Ampoules  Sodium  Cacodylate  (Mulford),  Three 
Grains,  One  Cubic  Centimeter. — Each  ampoule  con- 
tains sodium  cacodylate  (New  and  Nonofficial  Reme- 
dies, 1929,  p.  73),  0.2  gram  (three  grains)  in  one  cubic 
centimeter  of  sterile  solution,  with  one  per  cent  of 
benzyl  alcohol.  H.  K.  Mulford  Company,  Philadelphia. 

Ampoules  Sodium  Cacodylate  (Mulford),  Five 
Grains,  One  Cubic  Centimeter. — Each  ampoule  con- 
tains sodium  cacodylate  (New  and  Nonofficial  Reme- 
dies, 1929,  p.  73),  0.32  gram  (five  grains)  in  one  cubic 
centimeter  of  sterile  solution,  with  one  per  cent  of 
benzyl  alcohol.  H.  K.  Mulford  Co.,  Philadelphia. 

(Continued  on  Page  30) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


29 


30 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Soiland  Clinic 

Drs.  Soiland,  Costolow  and 
Meland 

1407  South  Hope  Street,  Los  Angeles,  Calif. 
Telephone  WEstmore  1418 
HOURS:  9:00  to  4:00 


An  institution  fully  equipped  for  the  study, 
diagnosis  and  treatment  of  neoplastic  disease. 
Radiation  therapy  and  modern  electro- 
surgical  methods  featured. 


ALBERT  SOILAND,  M.  D. 
WM.  E.  COSTOLOW,  M.  D. 
ORVILLE  N.  MELAND,  M.  D. 
EGBERT  J.  BAILEY,  M.  D. 

A.  H.  WARNER,  Ph.  D.,  Physicist 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  28) 

Erysipelas  Streptococcus  Antitoxin — Concentrated 
(Mulford).  — This  product  (New  and  Nonofficial 
Remedies,  1929,  p.  349),  is  also  marketed  in  packages 
of  one  10  cubic  centimeters  syringe  containing  500,000 
protective  units.  H.  K.  Mulford  Company,  Philadel- 
phia.— Jour.  A.  M.  A.,  January  11,  1930,  p.  105. 

Curdolac  Casein-Bran  Improved  Flour. — A flour 
prepared  from  casein,  carbohydrate-free  bran,  and 
soya  bean,  to  which  leavening  and  flavoring  have  been 
added.  It  may  be  used  for  the  preparation  of  muffins 
or  bread  having  a comparatively  low  carbohydrate 
content  and  low  food  value,  with  bulk.  Curdolac 
Food  Company,  Waukesha,  Wisconsin. 

Curdolac  Soya-Bran  Flour.- — A flour  prepared  from 
soya  bean  and  a starch-free  bran  with  a leavening 
mixture.  It  may  be  used  for  the  preparation  of  bread 
and  muffins  for  use  in  diets  in  which  a comparatively 
low  carbohydrate  content  is  desired.  Curdolac  Food 
Company,  Waukesha,  Wisconsin. 

Curdolac  Breakfast  Cereal. — A medicinal  food  pre- 
pared from  soya  beans  blended  with  wheat  products, 
including  starch-free  bran.  It  may  be  used  as  a hot 
food  in  diets  in  which  a comparatively  low  carbo- 
hydrate content  is  desired.  Curdolac  Food  Company, 
Waukesha,  Wisconsin. 

Curdolac  Casein  Compound. — A flour  prepared  from 
casein,  vegetable  fiber,  and  a leavening  mixture  to 
which  sodium  chlorid  and  gluside  are  added.  It  may 
be  used  for  the  preparation  of  carbohydrate-free 
bread,  muffins,  cake,  etc.,  for  use  in  diets  in  which 
a relatively  low  carbohydrate  content  is  desired. 
Curdolac  Food  Company,  Waukesha,  Wisconsin. 

Curdolac  Soya  Flour. — A flour  prepared  from  the 
soya  bean.  It  may  be  used  for  the  preparation  of  foods 
in  diets  in  which  a relatively  low  carbohydrate  con- 
tent is  desired.  Curdolac  Food  Company,  Waukesha, 
Wisconsin. 


kW  Supporting  (garments 


upporting  (garments 

Something  Entirely  New 

A Combination 
Maternity  Garment 

Ready  now  for  your  approval.  It  em- 
braces all  therapeutic  requirements 
and  provides  a perfect  ensemble  for 
the  woman  who  prefers  the  “all-in- 
one”  garment.  Reinforced  lower  por- 
tions provide  firm  support  to  the  lower 
abdomen.  The  cup-form  brassiere, 
with  inner  sling,  gives  uplift  to  the 
breast.  A flexible  upper  front  gives 
softness  and  with  side  lacings  allows 
for  figure  increase.  Habit  back,  well 
down  over  gluteus  muscles,  with 
Camp  Patented  Adjustment  for  splen- 
did sacro-iliac  support.  This  design, 
the  first  of  the  kind  on  the  market, 
will  completely  meet  your  idea  of 
what  a combination  maternity  sup- 
port should  be. 

Sold  by  surgical  houses,  department 
stores,  and  the  better  drug  stores 

Write  for  our  physician's  manual 


S.  H.  CAMP  AND  COMPANY, 

Manufacturers.  JACKSON.  MICHIGAN 
CHICAGO  LONDON  N*W  YOBS 

69  B.  Madison  St.  252  Regent  St. . W.  380  Fifth  Ave. 


Satisfying  the  Most 
Discriminating  ♦ ♦ ♦ 

Qolden  State 


Rigid  safeguarding  of  the 
purity  and  richness  of  its 
products — combined  with 
efficient  service — has  gain- 
ed for  Golden  State  milk 
products  an  enviable 
reputation. 


Its  satisfied  customers  are  Golden 
State’s  best  endorsement 


Golden  State 
Milk  Products  Company 

MILK  / CREAM  ✓ BUTTER 
ICE  CREAM  r COTTAGE  CHEESE 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3i 


ORT HOGON  lenses  represent  the 
most  advanced  application  of  precision 
and  practicability.  ORTHOGON 
lenses  are  semi-finished  by  Bausch  and 
Lomb  with  the  same  mathematical 
accuracy  as  fine  camera  and  microscope 
lenses . They  are  brought  exactly  to 
your  prescription  in  the  shops  of  care- 
fully selected  and  licensed  jobbers , 
under  factory  methods  and  supervision. 


HE  WILL  call  for  an  examination  tomorrow.  How  will 
you  proceed?  Will  you  "sell”  him  a pair  of  glasses, 
or  will  you  thoroughly  "sell”  him  on  the  idea  that  sight 
is  priceless  and  that  Optical  Science  is  one  of  the  greatest 
of  modern  sciences? 

Far  too  many  people  think  that  the  fitting  of  glasses 
is  "nothing  much.”  They  have  not  been  told  of  the  sixteen 
tiny  eye  muscles  and  of  the  fine  and  delicate  functions  of 
the  human  eye.  They  do  not  know  of  the  precision  with 
which  lenses  are  made.  They  think  that  mountings  are 
just  semi-ornamental  contrivances  to  hold  lenses  before 
the  eyes. 

So,  when  this  Potential  Patient  arrives,  tell  him  about 
his  eyes;  show  him  the  various  forms  of  lenses  and  mount- 
ings; explain  sensible  eye  care  and  the  art  and  science  of 
refraction.  . . . And  don’t  forget  to  mention  ORTHOGON 
lenses!  He  will  insist  upon  a pair,  and  he  will  leave  your 
office  with  an  appreciation  of  the  value  of  his  eyes,  a 
wholesome  respect  for  Optical  Science  and  the  notion  that 
glasses  are  not  merely  merchandise. 


LIGCT 


OAKLAND 
SAN  FRANCISCO 


OPTICAL  CCMPANy 

Featuring  Prompt  Orthogon  Service 

FRESNO  OGDEN 

RENO  SALT  LAKE  CITY 


Curdolac  Wheat-Soya  Flour. — A flour  prepared  from 
soya  beans,  starch-free  bran,  and  a small  proportion  of 
wheat,  with  leavening  and  flavoring.  It  may  be  used 
for  the  preparation  of  muffins,  cakes,  waffles,  etc.,  of 
well-balanced  food  value  for  use  in  restricted  diets. 
Curdolac  Food  Company,  Waukesha,  Wisconsin. 

Curdolac  Soya-Cereal  Johnny  Cake  Flour. — A flour 
prepared  from  soya  beans  and  cereal  products  to 
which  leavening  and  flavoring  have  been  added.  It 
may  be  used  in  the  preparation  of  muffins,  cakes, 
waffles,  etc.,  for  use  in  diets  relatively  low  in  carbo- 
hydrates, designed  for  those  who  cannot  use  products 
made  with  bran.  Curdolac  Food  Company,  Waukesha, 
Wisconsin. 

Curdolac  Soya-Bran  Breakfast  Food. — A medicinal 
food  prepared  from  soya  beans  and  a starch-free  bran, 
to  which  has  been  added  leavening,  flavoring,  gluside, 
and  oils  without  food  value.  It  may  be  used  in  diets 
in  which  a low  carbohydrate  content  is  desired. 
Curdolac  Food  Company,  Waukesha,  Wisconsin.— 
Jour.  A.  M.  A.,  January  18,  1930,  p.  185. 

PROPAGANDA  FOR  REFORM 

Ampoule  No.  61  Sodium  Salicylate  15^2  Grains, 
Ampoule  No.  59  Sodium  Iodid  15^2  Grains,  Ampoule 
No.  66X  Sodium  Salicylate,  Sodium  Iodid  1514  Grains 
Each,  Ampoule  No.  66  Sodium  Salicylate,  Sodium 
Iodid  and  Colchicin,  and  Ampoule  No.  50  Iron  and 
Arsenic  (Iron  Cacodylate)  One  Grain — Not  Accept- 
able for  New  and  Nonofficial  Remedies. — -The  Council 
on  Pharmacy  and  Chemistry  reports  that  these  are 
included  in  the  list  of  ampoules  for  intravenous  use 
marketed  by  the  Lakeside  Laboratories,  Inc.,  Mil- 
waukee. In  1921,  in  reporting  on  “Some  of  Loeser’s 
Intravenous  Solutions,”  the  Council  stated  the  objec- 
tions to  the  intravenous  administration  of  sodium 
salicylate  and  sodium  iodid  and  of  mixtures  of  drugs 
in  fixed  proportions.  Since  this  time  no  evidence  in 
favor  of  the  routine  intravenous  administration  of 
(Continued  on  Page  37) 


J oslin’s  Sanatorium 

For  Treatment  of 

Nervous  and  Mental 
Disorders 

Home  for  Aged  and 
Infirm 

A quiet,  secluded  place  in  the  country 
RATES  REASONABLE 

Phone  118F2  Lincoln,  Calif. 


32 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SPECIFIC  THERAPY  OF 

ERYSIPELAS 


ERYSIPELAS  ANTITOXIN 

LILLY*  A90 


ADEQUATE  doses  of  Erysipelas 
Streptococcus  Antitoxin,  Lilly, 
when  given  early  usually  control 
the  immediate  attack.  In  the  favor- 
able responses  there  is  prompt 
relief  from  the  toxemia,  improve- 
ment in  temperature  and  pulse  rate 
with  arrest  and  fading  of  the  lesion. 


Erysipelas  Streptococcus  Anti- 
toxin, Lilly,  is  a purified,  concen- 
trated globulin  of  high  antitoxic 
potency.  The  dosage  volume  is 
small,-  the  protein  and  solids  con- 
tent low.  Supplied  by  the  drug 
trade  in  convenient  syringe  con- 
tainers of  5000  units. 


Write  for  further  information 


ELI  LILLY  AND  COMPANY 

INDIANAPOLIS,  INDIANA,  U.S.A. 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXII  MARCH,  1930  No.  3 


ASCH HEIM -ZONDEK  TEST  FOR  PREG- 
NANCY— ITS  PRESENT  STATUS’*' 

By  Herbert  M.  Evans,  M.  D. 

AND 

Miriam  E.  Simpson,  M.  D. 

Berkeley 

¥ N 1926  Bernard  Zondek  and,  almost  immedi- 

ately  thereafter,  our  former  associate,  P.  E. 
Smith,  discovered  that  the  implantation  of  small 
bits  of  the  anterior  lobe  of  the  hypophysis  would 
provoke  sexual  maturity  in  immature  animals. 
When  the  animals  are  taken  on  the  day  of  wean- 
ing, these  remarkable  changes  can  be  produced 
within  four  days.  A simple  chain  of  reasoning  led 
S.  Aschheim,  an  associate  of  Zondek,  to  discover 
that  the  same  chemical  substance  which  in  hypo- 
physeal implants  so  rapidly  matures  animals  is 
unusually  abundant  in  the  body  fluids  (blood  and 
urine)  during  pregnancy.  It  has  been  known  since 
the  classical  work  of  Erdheim  and  Stumme  that 
the  anterior  hypophysis  hypertrophies  in  preg- 
nancy. Zondek  had  just  previously  shown  that 
the  ovarian  substance,  folliculin,  occurs  in  high 
concentration  in  the  body  fluids  of  pregnancy.  It 
was  therefore  natural  to  inquire  whether  the  new 
hypophyseal  hormone  was  not  also  similarly  abun- 
dant in  pregnancy.  Their  positive  findings  were 
quickly  extended  by  the  Berlin  investigators  and 
now  constitute  perhaps  the  most  reliable  known 
test  for  pregnancy  and  the  only  reliable  early  test. 

TEST  WORTHY  OF  USE  IN  GENERAL  PRACTICE 

It  seems  remarkable  that  the  medical  profession 
of  this  country  has  not  made  wider  use  of  the 
Aschheim-Zondek  test  for  pregnancy.  This  is  the 
justification  offered  for  a survey  of  the  present 
status  of  the  test.  An  attempt  will  be  made  to 
discuss  briefly  both  the  technique  of  the  test  as 
used  by  the  discoverers  and  by  others,  the  accu- 
racy or  dependability  of  the  test  and  the  sphere 
in  which  the  test  is  useful. 

TECHNIQUE 

As  used  by  Aschheim  and  Zondek  1-10  the  test 
is  performed  as  outlined  below. 

The  morning  urine  is  sent  into  the  laboratory 
in  clean  bottles.  They  recommend  the  addition 
of  one  drop  of  tricresol  per  25  cubic  centimeters 
of  urine  if  it  is  necessary  for  the  sample  to  be 
sent  by  mail.  A group  of  five  mice,  each  weigh- 
ing six  to  eight  grams,  is  used  to  test  each  urine 
specimen.  The  total  volume  of  urine  injected  into 
each  mouse  varies  from  1.2  to  2.4  cubic  centi- 
meters. This  total  dosage  is  distributed  in  six 
doses  during  forty-eight  hours.  It  is  administered 
subcutaneously  in  increasing  amounts  of  0.2  to  0.4 

* From  the  Anatomical  Laboratory  of  the  University 
of  California. 


cubic  centimeters  each.  On  the  fifth  day,  i.  e., 
ninety-six  to  one  hundred  hours  after  injections 
are  begun,  the  animals  are  autopsied  and  the 
genital  system  is  examined,  preferably  with  a 
hand  lens  or  binocular  microscope.  The  ovaries 
of  untreated  animals  of  this  age  are  always  very 
small  smooth  glandules,  containing,  at  most,  small 
follicles.  In  case  the  ovaries  show  further  devel- 
opment, the  type  of  reaction  can  be  classified  as 
follows,  according  to  Aschheim  and  Zondek: 

Reaction  I — Enlarged  follicles. 

Reaction  II  — Hemorrhagic  follicles  — “blood 
points.” 

Reaction  III — Corpora  lutea. 

COMMENTS  ON  REACTIONS  AND  TECHNIQUE 

The  presence  of  Reaction  II  or  III,  or  both,  is 
an  almost  certain  indication  of  the  presence  of 
the  anterior  hypophyseal  sex  hormone  in  the 
urine,  characteristic  of  pregnancy  in  the  case  of 
human  beings.  The  reaction  is  considered  positive 
if  only  one  hemorrhagic  follicle  or  one  corpus 
luteum  is  observed  in  one  experimental  animal, 
that  is,  if  either  Reaction  II  or  III,  or  both,  are 
present  in  any  one  of  the  five  animals  used  for 
the  test  for  pregnancy.  However,  if  Reaction  I 
is  given  and  the  animals  show  evidence  of  heat 
(cornification  of  the  vagina  and  enlarged  uterus), 
the  test  is  repeated  with  a second  sample  of  urine. 

If  there  is  urgent  reason  to  get  results  in  an 
interval  shorter  than  five  days,  the  Berlin  investi- 
gators increase  the  number  of  experimental  ani- 
mals used  in  the  test  and  autopsy  them  in  sixty 
to  seventy  hours.  By  this  method  they  cut  down 
the  inaccuracy  introduced  by  the  variability  in 
reaction  of  individual  mice,  and  feel  they  can 
reach  fairly  accurate  conclusions.  The  ovaries  are 
studied  in  serial  section  if  for  any  reason  the 
macroscopic  findings  are  dubious. 

The  modifications  in  technique  introduced  by 
other  workers  have  not  been  numerous ; most 
workers  have  adhered  closely  to  the  conditions  of 
the  test  as  prescribed  by  the  discoverers.  Kraus  14 
of  Prague  shortens  the  test  somewhat  by  autopsy- 
ing  on  the  fourth  day  and  examining  the  ovaries 
in  glycerin  under  the  microscope.  He  believes  he 
can  recognize  the  development  of  hemorrhagic 
follicles  and  corpora  lutea  at  an  earlier  stage  by 
this  method  than  by  macroscopic  observation. 

Some  workers,  e.  g.  Mayer  35  and  Vogt 22  do 
not  trust  macroscopic  findings,  but  always  study 
stained  serial  sections. 

METHOD  USED  AT  UNIVERSITY  OF  CALIFORNIA 

In  the  laboratory  at  Berkeley,  sexually  imma- 
ture rats  have  been  substituted  for  mice  with 
satisfactory  results.  The  test  as  performed  is  as 
follows : The  morning  urine  is  neutralized,  fil- 


146 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


tered  and,  during  the  test,  stored  below  0 degrees 
C.  so  as  to  be  actually  frozen.  Six  rats,  twenty- 
four  to  twenty-six  days  of  age,  weighing  forty 
to  fifty  grams,  are  injected  to  test  each  urine. 
Each  rat  receives  a subcutaneous  dose  of  one 
cubic  centimeter  daily  for  four  days  (Monday, 
Tuesday,  Wednesday,  Thursday).  The  animals 
are  autopsied  ninety-six  hours  after  beginning 
the  injection  (Friday).  The  ovaries  are  examined 
under  binoculars,  eventually  dissected  free  from 
the  oviducts,  and  weighed.  If  observations  are 
made  by  immediately  swinging  the  binoculars  over 
the  opened  body  of  the  animal  with  the  ovaries 
in  situ  and  only  the  bursa  ovarica  opened  but  the 
blood  supply  left  intact,  then  the  detection  of 
corpora  lutea  is  much  facilitated.  The  positive 
test  for  pregnancy  in  the  rat  is  the  presence  of 
corpora  lutea — Zondek’s  Reaction  III.  Hemor- 
rhagic follicles,  Reaction  II.  are  not  common  in 
the  ovaries  of  precociously  matured  rats.  Though 
the  expense  of  maintenance  of  a rat  colony  is 
greater  than  that  of  a mouse  colony,  and  rats 
would  not  have  been  used  except  that  our  colony 
was  established,  use  of  the  rat  has,  however,  one 
advantage.  Rats  are  sturdier  than  mice.  Zondek 
and  Aschheim  have  15  per  cent  mortality  among 
their  urine-injected  test  animals.  So  far  we  have 
lost  no  animals  from  use  in  the  test. 


ACCURACY  OF  THE  TEST 

The  error  involved  in  the  Aschheim-Zondek 
pregnancy  test  is  small  enough  to  admit  the  test 
as  a most  important  diagnostic  aid.  Twenty-four 
groups  of  workers  and  over  three  thousand  tests 
are  cited  in  Table  1.  In  almost  no  cases  did  the 
error  exceed  two  per  cent;  in  fact  the  majority 
of  workers  have  found  the  error  to  lie  between 
one  and  two  per  cent. 


Table  1. — Accuracy  of  the  Aschheim-Zondek 
Pregnancy  Test 


Number 

of 

Investigator  Cases 

Ascheim  and  Zondek,1-10  Berlin 1000 

K.  Ehrhardt,11  Frankfurt..- 400 

E.  Solms  and  E.  Klopstock,12  Berlin 349 

F.  Wermbter  and  E.  Schultze,13  Wien...  30 

E.  J.  Kraus,14  Prag 


Briihl,15  Gottingen, 


192 


Martius,16  Gottingen 


51 


Praude,17  Moscow 100 

Brouha  and  Simmonet,18  Paris 30 

Odeschati,10  Italy 

Louria  and  Rosenzweig,20  New  York......  86 

H.  E.  Kaplan,21  Stockton 

Siebke,24  Kiel .’ 51 

Fiith,25  Koln 139 

Hornung,2*  Berlin 

Kriele,27  Berlin-Neukolln 12 

Schmidt,28  Dtisseldorf 171 

Pankow,29  Freiburg 

Gragert  and  Wittig,30  Greifswald  46 

Kehrer,31  Marburg 97 

Karg,32  Miinchen 110 

Esch,33  Munster  Westf 49 


Hellmuth,34  Wurzburg ' 36 


Percent- 

age 

Error 

1.2 

2. 

1. 

0 

0 preg- 
nancy 
cases 
3.75  non- 
pregnancy 
cases 
’ 1.2  Preg- 
nancy 
cases 
0 non- 
pregnancy 
cases 


1 

0 

1 

2 

8 

0 

0 in  normal 
pregnancy 
0 

1 

1 

0 except 
tubal 

pregnancy 
0 except 
tubal 

pregnancy 


Total  number  of  cases 3088 


All  investigators  who  have  applied  the  test  have 
found  it  a reliable  criterion  for  normal  uncompli- 
cated pregnancy.  Many  wish  to  say  the  test  yields 
100  per  cent  results  in  all  normal  cases,  where 
applied  after  one  or  more  missed  menstruations. 
Several  workers  have  noted  a positive  test  seven 
to  eight  days,  and  one  only  three  days  after  the 
first  missed  menstruation.  Zondek  cites  two  cases 
of  young  women  who  were  tested  before  a men- 
struation had  been  missed.  The  test  was  negative 
for  pregnancy,  only  large  follicles  were  found  in 
the  ovaries  of  the  test  animals  ( Reaction  I ).  When 
retested  four  to  five  days  after  the  expected  men- 
struation, the  reaction  was  positive  (II  and  III). 
Zondek’s  rationalization  is  that  implantation  must 
occur  before  the  test  becomes  positive.  The  test 
continues  to  be  positive  throughout  the  remainder 
of  pregnancy  and  persists  to  the  seventh  day  of 
the  puerperium.  Zondek  reports  the  test  to  be 
negative  on  the  eighth  day. 

The  errors  recorded  in  the  table  are  attributable 
to  relatively  few  causes.  The  test  is  strongly  posi- 
tive in  cases  of  hydatid  mole,  and  remains  so  after 
removal  of  hydatid  mole  if  only  small  fragments 
are  left.  Chorio-epithelioma  also  gives  a positive 
reaction. 

A few  instances  of  inaccuracy  have  been  re- 
ported in  cases  of  tubal  implantation.  A positive 
test  seems  to  be  almost  coincident  with  the  per- 
sistence of  life  of  the  fetus,  a point  emphasized 
by  Radtke  36  and  others.  Instances  of  a negative 
test,  in  cases  later  proved  to  be  tubal  pregnancies, 
were  probably  due  to  death  of  the  fetus  before 
the  time  of  the  test.  Esch,33  however,  cites  a case 
of  tubal  rupture  in  which  a positive  Aschheim- 
Zondek  test  was  obtained  two  days  after  the  fetus 
was  expelled  into  the  peritoneal  cavity.  In 
Schmidt’s  28  experience  the  reaction  in  tubal  preg- 
nancy has  always  been  positive  except  in  two  cases 
of  old  hematoceles. 

In  cases  of  abortion,  positive  results  have  been 
reported  to  occur  as  late  as  the  sixth  to  the  eighth 
day  after  abortion.  The  test  has  hence  important 
medico-legal  value.  It  is  probable  that  the  results 
from  the  test  in  cases  of  abortion  and  partial 
abortion  depend,  just  as  in  tubal  pregnancy,  on 
the  time  of  death  of  the  ovum  or  fetus  with  re- 
spect to  the  time  of  the  test. 

Tests  have  been  reported  where  large  follicles 
(Reaction  I)  were  found  after  the  injection  of 
urine  from  nonpregnant  women  in  whom  carci- 
noma was  present,  but  such  a finding  should  not 
be  counted  among  the  errors  of  the  method,  as  a 
pregnancy  diagnosis  is  never  based  on  Reaction  I. 

No  conditions  save  pregnancy  and  its  associ- 
ated phenomena  have  given  Reactions  II  and  III, 
and  among  the  conditions  which  have  been  in- 
vestigated have  been  uterine  myoma,  carcinoma 
of  the  body  of  the  uterus,  tumor  of  the  adnexa, 
cystoma,  x-ray  amenorrhea,  unexplained  amenor- 
rhea, hypophyseal  tumor,  and  acromegaly. 

In  summary  of  the  accuracy  of  the  test  it  can 
therefore  be  said : A positive  Aschheim-Zondek 
test  is  not  only  given  by  pregnancy  but  by  hydatid 
mole  and  by  chorio-epithelioma.  A negative  test 
is  an  almost  certain  indication  of  the  absence  of 


March,  1930 


ASCH H El M -ZONDEK  TEST — EVANS  AND  SIMPSON 


147 


pregnancy,  at  least  of  pregnancy  of  longer  dura- 
tion than  one  month. 

IMPORTANCE  OF  THE  TEST — THE  APPLICATIONS 

Of  first  importance  in  the  applications  of  the 
Aschheim-Zondek  test  is  the  early  diagnosis  of 
pregnancy — before  clinical  signs  are  available  or 
dependable.  This  is  not  the  only  clear  indication 
for  the  test. 

Of  next  importance  is  the  use  of  the  test  in  the 
differential  diagnosis  of  cases  in  which  pregnancy 
is  simulated ; for  instance,  the  differential  diag- 
nosis between  cystic  myoma  and  pregnancy  as 
cited  by  Wagner.23  Clinically  this  case  simulated 
pregnancy.  After  opening  the  peritoneal  cavity 
the  enlarged  uterus  was  not  distinguishable  from 
a normal  pregnant  uterus.  Even  when  the  mass 
was  incised  a bag  of  fluid  was  encountered  similar 
in  appearance  to  fluid-filled  fetal  membranes.  The 
uterus  was  removed,  however,  because  of  two 
clearly  negative  Aschheim-Zondek  tests  which 
had  previously  been  performed.  Section  of  the 
uterine  mass  showed  a cystic  softened  myoma. 

The  test  has  been  suggested  as  an  aid  in  the 
detection  of  the  death  of  the  fetus,  but  the  results, 
at  least  those  reported  by  Esch,33  do  not  confirm 
this  hope.  He  finds  too  great  a lag  after  the  death 
of  the  fetus  to  make  the  test  valuable.  In  one  case 
of  a seven-month  pregnancy  reported  by  him,  the 
heart  of  the  fetus  was  not  audible.  For  this 
reason  they  believed  the  fetus  to  be  dead.  Ten 
days  after  this  observation  the  Aschheim-Zondek 
test  was  positive.  Four  days  later  a macerated 
fetus  was  expelled.  In  another  case  of  incomplete 
abortion  the  test  was  positive  eight  days  after 
expulsion  of  the  products  of  gestation.  Schmidt28 
describes  a rapid  disappearance  of  the  test  after 
spontaneous  abortion  of  a fetus  dead  from  syphi- 
litic or  renal  disease  in  the  mother,  but  by  rapid 
disappearance  he  means  a negative  reaction  six 
days  after  abortion. 

The  test  promises  to  be  of  importance  in  the 
diagnosis  of  hydatid  mole  and  chorio-epithelioma. 
In  cases  where  the  test  remains  positive  too  far 
into  the  puerperiuin  (i.  e.,  after  seven  days)  or  too 
long  after  abortion  (i.  e.,  after  six  days),  these 
pathological  conditions  need  to  be  remembered. 
Zondek,  Aschheim,  Wagner,23  and  others  empha- 
size the  importance  of  following  patients  in  whom 
hydatid  moles  have  been  removed  by  frequent 
tests  as  a check  on  the  completeness  of  removal. 
Wagner  and  others  find  that  repeated  positive 
tests  after  removal  of  a hydatid  mole,  though  indi- 
cating the  need  of  very  careful  study,  do  not 
necessarily  indicate  the  development  of  a chorio- 
epithelioma.  If,  however,  the  test  becomes  posi- 
tive after  an  interval  of  negative  tests — and  preg- 
nancy can  be  excluded — then  the  development  of 
chorio-epithelioma  is  likely. 

The  fact  that  the  urine  from  cases  having  a 
hydatid  mole  is  so  much  more  potent  in  anterior 
hypophyseal  sex  hormone  than  urine  from  cases 
of  normal  pregnancy  suggests  the  minimum  dose 
method  as  of  possible  aid  in  distinguishing  be- 
tween normal  pregnancy  and  this  condition.  Only 


one-tenth  the  usual  dosage  is  required  to  give  a 
positive  test  in  cases  of  hydatid  mole. 

Just  as  the  Aschheim-Zondek  test  is  of  aid  in 
the  differential  diagnosis  of  pregnancy,  so  also  it 
is  of  aid  in  the  exclusion  of  pregnancy  in  the 
study  of  amenorrheas.  The  test  has  been  found 
negative  in  each  of  one  hundred  and  fifty-one 
cases  of  amenorrhea  studied  in  the  Charite- 
Frauenklinik,  Berlin.  As  an  instance  of  such  use 
of  the  test  a case  will  be  cited  from  Zondek’s 
discussion  of  hyperhormonal  and  oligohormonal 
amenorrheas.  In  some  amenorrheas,  hyperhor- 
monal, the  urine  is  characterized  by  large  amounts 
of  folliculin,  but  not  of  the  hypophyseal  hormone. 
Some  of  these  cases  have  cystic  follicles  in  the 
ovary.  In  the  latter  case  the  condition  can  be  im- 
proved by  expression  of  the  cyst.  Folliculin  is 
excreted  in  increased  amounts  in  the  amenorrhea 
of  pregnancy  as  well  as  in  these  peculiar  amenor- 
rheas of  nonpregnant  women.  In  the  study  of 
such  a case,  therefore,  one  would  wish  to  be  en- 
tirely sure  of  the  absence  of  pregnancy  by  the 
use  of  the  Aschheim-Zondek  test. 

SUMMARY* 

1.  The  Aschheim-Zondek  test  is  remarkably 
dependable  in  cases  of  normal  pregnancy. 

2.  It  is  positive  a few  days  after  the  first  missed 
period. 

3.  The  test  is  useful  in  differential  diagnosis  of 
pregnancy  from  other  amenorrheas,  tumors  of  the 
uterus,  etc. 

4.  There  is  also  a distinct  province  for  the  test 
in  the  diagnosis  of  hydatid  mole  and  chorio- 
epithelioma. 

Anatomical  Laboratory,  University  of  California. 

REFERENCES 

1.  Zondek,  B.:  Zeitsch.  Geb.  u.  Gyn.,  94,  190,  1928. 

2.  Zondek,  B.:  Endocrinologie,  5,  425,  1929. 

3.  Zondek,  B.:  Die  Naturwissensch.,  16,  1088,  1928. 

4.  Zondek,  B.:  Klin.  Wochensch.,  8,  48,  2229,  1929. 

5.  Aschheim,  S.:  Zentralbl.  f.  Gynak.,  53,  15,  1929. 

6.  Aschheim,  S.:  Zeitsch.  Geb.  u.  Gyn.,  94,  190  and 
203,  1928. 

7.  Aschheim,  S.:  Zeitsch.  f.  artzl.  Fortbild,  26,  5, 
1929. 

8.  Aschheim,  S.,  and  Zondek,  B.:  Klin.  Wochensch., 
28,  1927. 

9.  Aschheim,  S.,  and  Zondek,  B.:  Klin.  Wochensch., 

30,  1404,  1928. 

10.  Aschheim,  S.,  and  Zondek,  B.:  Klin.  Wochensch., 

31,  1453,  1928. 

11.  Ehrhardt,  K.:  Klin.  Wochensch.,  8,  2044,  1929. 

12.  Solms,  E.,  and  Klopstock,  E. : Deut.  med. 
Wochensch.,  55,  1919,  1929. 


* It  is  to  be  hoped  that  the  present  summary  will  en- 
courage routine  use  of  the  new  test  and  that  the  tech- 
nique of  its  performance  is  described  with  sufficient  detail 
to  encourage  any  diagnostic  laboratory  to  include  the  test 
in  the  service  it  renders  physicians.  The  equipment  is 
very  simple,  but  unfortunately  involves  a continuous 
supply  of  litters  of  the  test  animals  (rats  or  mice)  known 
with  certainty  to  be  not  younger  than  twenty-one  nor 
older  than  twenty-six  days  of  age  when  the  test  is  begun. 
Pending  equipment  of  the  usual  laboratories  for  the  test, 
as  a convenience  for  the  physicians  of  the  state,  and  for 
a fixed  charge,  the  anatomical  laboratory  of  the  Uni- 
versity  of  California  will  continue  to  carry  out  the  test  in 
all  cases  requested.  Merely  100  cubic  centimeters  of 
morning  urine  are  required.  If  a postal  journey  of  a day 
or  longer  is  necessary,  four  drops  of  tricresol  should  be 
added  to  this  quantity  of  urine.  Otherwise  any  preserva- 
tive is  preferably  omitted. 


148 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


13.  Wermbter,  F.,  and  Schultze,  E.:  Klin. 
Wochensch.,  21,  970,  1929. 

14.  Kraus,  E.  J.:  Klin.  Wochensch.,  16,  731,  1929. 

15.  Briihl:  Deut.  med.  Wochensch.,  17,  1929. 

16.  Martius:  Deut.  med.  Wochensch.,  51,  2128,  1929. 

17.  Praude  (Russian) : Cit.  Zondek.2 

18.  Brouha  and  Simmonet,  Compt.  rend.  Soc.  de 
Biol.,  99,  1384,  1928. 

19.  Odeschati  (Italian)  : Cit.  Zondek.2 

20.  Louria,  H.  W.,  and  Rosenzweig,  M.:  J.  A.  M.  A., 
91,  1988,  1928. 

21.  Kaplan,  H.  E.:  Cal.  and  Western  Med.,  31,  412, 
1929. 

22.  Vogt,  E.:  M.  KL,  45,  1725,  1929. 

23.  Wagner:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

24.  Siebke:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

25.  Frith:  Deut.  med.  Wochensch.,  51,  2125-30,  1929. 

26.  Hornung:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

27.  Kriele:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

28.  Schmidt:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

29.  Pankow:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

30.  Gragert  and  Wittig:  Deut.  med.  Wochensch., 
51,  2125-30,  1929. 

31.  Kehrer:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

32.  Karg:  Deut.  med.  Wochensch.,  51,  2125-30,  1929. 

33.  Esch:  Deut.  med.  Wochensch.,  51,  2125-30,  1929. 

34.  Hellmuth:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

35.  Mayer:  Deut.  med.  Wochensch.,  51,  2125-30, 
1929. 

36.  Radtke:  Niederrheinisch  Westfiilischen  Gesell- 
schaft  fur  Gynakologie,  July  13,  1929  (cit.  Esch31). 


THE  FUTURE  OF  MEDICAL  PRACTICE — 
MEDICAL  SERVICE  ORGANIZATIONS 

By  C.  M.  Cooper,  M.  B. 

San  Francisco 

npODAY  the  individual  practitioner  of  medi- 
cine  works  under  many  disadvantages.  People 
are  taken  sick  at  night  and  suffer  equally  during 
holidays  and  over  the  week-end,  as  on  other  days. 
He  is  thus  called  upon  to  give  a service  which 
only  the  most  enduring  can  satisfactorily  render. 
When  he  is  sick  and  during  his  vacations  his 
expenses  continue  and  his  income  ceases.  Often 
he  has  little  time  to  do  the  essential  laboratory 
work  and,  to  get  the  reports  he  requires,  he  has 
to  send  his  patients  from  pillar  to  post.  At  times, 
much  overworked  and  frequently  poorly  recom- 
pensed, he  is  also  troubled  in  spirit,  for  he  sees 
many  patients  who  can  ill  afford  to  follow  the 
advice  he  should  give  them  and,  however  much 
he  financially  sacrifices  himself,  he  can  do  little 
to  prevent  the  high  costs  of  serious  sickness  from 
crippling  many  of  the  families  he  attends.  If  suc- 
cessful, he,  from  small  beginnings  and  after  many 
years  of  practice,  acquires  a considerable  follow- 
ing. If  he  then  becomes  incapacitated  or  dies,  his 
office  closes,  no  successor  reaps  the  benefit  of  his 
labors,  and  those  who  have  put  their  faith  in  him 
have  as  a body,  no  one  to  whom  to  turn.  Phy- 
sicians and  patients  thus  jointly  suffer  and  equally 
desire  relief  from  such  a situation. 

To  quite  a number  state  medicine  appeals  as  a 
remedy.  This,  if  it  comes,  would  mean  that  the 


sick  would  be  taken  care  of  by  the  state  and  that 
physicians,  surgeons,  and  nurses  would  become 
employees  of  the  state. 

If  it  were  possible  to  evolve  a plan  in  which 
politics  and  patronage  played  no  part  and  which 
would  continue  to  attract  the  same  degree  of  in- 
tellectuality as  the  profession  now  attracts,  there 
would  be  much  that  could  be  said  in  its  favor. 
Past  experience,  however,  with  bureaucratic  man- 
agement of  shipping,  railroad,  and  public  utilities 
business  does  not  speak  well  for  its  likely  success 
in  this  new  field.  Nevertheless  there  is  a distinct 
trend  toward  it,  and  a social  trend,  like  a secular 
trade  trend,  gains  ever  increasing  impetus  and 
wins  ever  widening  support,  unless  the  causes  that 
lead  to  its  inception  be  removed.  Finally,  it  is  apt 
to  attain  such  a force  that  it  is  able  to  bring  about 
a trial  adoption  of  its  tenets  in  spite  of  its  dis- 
advantages. 

If  the  medical  profession  is  to  avoid  such  a con- 
tingency, it  must  take  the  lead  in  remedying  the 
existing  conditions.  As  the  writer  sees  it  a satis- 
factory plan  must  provide : 

1.  That  all  sick  people  can  obtain  competent 
medical  and  surgical  service  without  undue  delay. 

2.  That  this  must  not  cost  more  than  the  re- 
cipient can  afford  to  pay. 

3.  That  those  who  give  the  service  would  re- 
ceive a just  return  for  their  work. 

4.  That  the  rendering  of  the  service  would  not 
involve  undue  or  excessive  strain  upon  the  mem- 
bers of  the  profession. 

5.  That  it  should  remain  possible  for  physicians 
and  surgeons  who  achieve  unusual  success  to  earn 
incomes  comparable  with  those  of  the  leading 
lawyers  and  business  executives  in  the  same 
community. 

With  the  above  in  mind,  the  writer  visualizes 
a time : 

1.  When  it  will  be  the  recognized  duty  of  the 
state  and  municipality  to  provide  such  a service 
for  all  the  indigent  sick,  and  to  pay  those  who 
give  the  service. 

2.  When  the  great  mass  of  the  people  will  pay 
a health  rate  just  as  they  now  pay  a water  or 
gas  or  electric  rate,  and  that  this  rate  will  insure 
them  competent  ever  available  medical  and  surgi- 
cal service.  He  hopes  that  private  corporations, 
who  in  their  standing  and  efficiency  will  compare 
with  the  great  public  utility  companies,  will  arise 
to  organize  and  develop  and  give  this  service.  He 
questions  whether  the  members  of  the  medical 
profession  alone  are  fitted  by  training,  experience 
or  bent  to  successfully  develop  or  manage  such 
corporations  but  believes  that  this  could  be  suc- 
cessfully done  if  representatives  of  the  profession 
associated  with  themselves  men  of  the  same  order 
of  training  and  intelligence  as  those  who  have 
developed  the  big  life  insurance  companies.  With 
such  a system  in  existence,  he  would  expect  to  see  : 
( a ) hospitals  and  service  stations  built  on  in- 
expensive sites;  ( b ) corps  of  medical  men  of  all 
types,  on  duty  at,  let  us  say,  eight-hour  intervals, 
giving  their  whole  time  to  this  work,  they  pre- 


March,  1930 


FUTURE  OF  MEDICAL  PRACTICE — COOPER 


149 


ferring  a sure,  adequate  income  and  an  old-age 
pension  to  the  vicissitudes  of  private  practice ; 
(c)  perhaps  also  a number  who  gave  a certain 
appointed  time  each  day  to  this  work,  they  re- 
ceiving in  return  compensation  but  no  ultimate 
pension. 

3.  When  there  would  still  be  room  for  men 
who  preferred  to  try  their  fortune  in  private  prac- 
tice, and  who  would  have  the  same  opportunities 
as  now  exist,  provided  they  could  supply  some- 
thing which  people  believed  they  could  not  get 
elsewhere. 

While  the  profession  expectantly  awaits  such  a 
plan,  the  writer  believes  its  members  could  greatly 
improve  existing  conditions  if  they  could  see  their 
way  to  group  themselves  into  small  unit  service 
organizations.  As  he  conceives  them,  each  unit 
would  do  one  line  of  work  and  would  remain 
small  enough  to  keep  in  human  touch  with  all  its 
patients.  Thus  there  would  be  medical  unit  or- 
ganizations and  unit  organizations  pertaining  to 
the  specialties.  Under  such  a system  the  indi- 
vidual members  of  each  unit  would  have  common 
offices  and  a common  diagnostic  and  therapeutic 
armamentarium,  thus  considerably  reducing  ex- 
penses ; and  they  would  pool  their  service  capaci- 
ties, thus  giving  their  patients  an  organized  and 
ever  available  service.  In  the  treatment  of  those 
needing  both  medical  and  surgical  attention,  cor- 
responding units  would  work  together  and,  if 
experience  suggested  that  it  would  be  of  benefit 
to  themselves  and  to  their  patients,  units  could, 
if  they  so  desired,  combine  to  form  group  service 
organizations. 

Unit  service  organizations  of  the  type  outlined 
would  probably  fall  into  two  classes : 

(a)  Those  formed  by  older  men  who  already 
had  a considerable  following.  These  older  men 
would  assume  all  the  expenses  and  take  in  as  their 
associates  men  who  till  then  had  not  been  in  prac- 
tice. They  naturally  would  become  the  directors 
and  develop  their  organizations. 

( b ) Those  in  which  men  of  more  or  less  equal 
age  and  experience  assumed  equal  liabilities, 
shared  the  running  expenses  and  pooled  their  ser- 
vice capacities.  Whether  the  members  of  units  of 
this  type  formed  partnerships  or  loosely  bound 
associations,  whether  they  pooled  and  shared 
equally  the  returns  or  divided  them  according  to 
the  demonstrated  earning  capacity  of  the  mem- 
bers, or  whether  a common  secretary  sent  out 
separate  bills  for  each  member,  would  be  matters 
of  detail  for  a unit  to  decide  for  itself.  The 
essential  thing  would  be  that  the  members  com- 
bined to  diminish  expenses,  to  lessen  professional 
strain  and  to  give  an  organized  service,  and  the 
unifying  urge  would  be  found  in  the  people’s 
demand  for  a type  of  service  which  the  average 
lone  practitioner  is  not  able  to  give. 

It  is  now  six  years  since  the  writer  decided  to 
try  to  form  one  of  these  unit  service  organiza- 
tions. At  that  time  he  had  been  in  practice  some 
twenty-five  years,  his  work  being  of  a diagnostic 
and  advisory  kind.  Though  the  monetary  returns 
had  been  amply  compensatory,  he  had  become 


much  dissatisfied  with  his  system  of  service.  Of 
its  deficiencies  he  had  been  made  very  conscious 
by  watching  the  working  of  a rather  unusual  type 
of  service  developed  by  a Japanese  interpreter. 
This  individual  had  been  for  many  years  bring- 
ing, and  still  brings,  patients  to  the  office.  For 
them  he  acts  as  an  interpreter  and  is  paid  by  them 
for  the  service  he  renders.  He  is  keenly  interested 
in  having  his  clients  get  well,  knows  what  a com- 
plete clinical  examination  includes  and  means,  and 
is  anxious  to  have  done  all  the  laboratory  work, 
etc.,  that  is  essential  to  the  elucidation  of  the  case. 
At  specified  times  he  brings  back  these  patients  to 
report.  He  has  also  on  his  list  a number  of  sur- 
geons and  specialists  to  whom  he  takes  his  clients. 
These  he  has  chosen  because  of  their  operative 
results,  because  they  are  habitually  courteous  to 
his  people  and  because  they  are  glad  to  accommo- 
date their  charges  to  the  economic  position  of  his 
clients.  Further,  he  sees  that  a Japanese  patient, 
taken  acutely  sick,  gets  competent  service  with- 
out undue  delay.  His  people  pay  for  the  services 
immediately  after  they  receive  them ; thus  no  ac- 
counts are  kept  and  no  bills  are  sent.  This  method 
saves  bookkeeping  expenses  and  permits  a lesser 
charge  to  these  patients.  In  other  words,  he  has 
provided  an  economic,  organized,  collective  and 
ever  available  service  of  a high  type  for  his  fellow 
nationals.  The  results  obtained  in  the  treatment 
of  these  patients — and  the  writer,  in  the  course 
of  years,  has  had  hundreds  under  his  care — -have 
been  extraordinarily  good,  this  in  a large  meas- 
ure being  due  to  their  interpreter’s  efficient 
shepherding. 

The  unit  thus  suggested  has  now  been  devel- 
oped to  such  a point  that  its  future  seems  assured 
and,  since  it  has  removed  much  of  his  former 
dissatisfaction,  it  occurs  to  the  writer  that  it 
might  be  of  value,  if  he  said  a few  words  con- 
cerning such  a unit. 

It  has  seemed  preferable  to  build  it  gradually 
rather  than  to  form  it  all  at  once,  as  the  provid- 
ing of  service  for  which  there  is  a demand  is 
somewhat  different  from  creating  a demand  for 
a surplus  of  service.  In  the  former  case  the  neces- 
sary expenditures  can  be  freely  and  confidently 
made. 

In  any  extensive  system  of  unit  formations,  it 
is  probable  that  individuals  who  were  friends  and 
of  like  professional  habits  would  tend  to  group 
themselves  together.  In  this  unit  the  writer  sought 
as  associates  men  of  whose  work  he  knew  and 
who  were  personally  acceptable  to  him  and  to 
one  another.  He  further  considered  it  of  advan- 
tage that  they  should  have  or  acquire  sufficient 
skill  in  the  specialties  to  be  able  to  recognize  in 
these  fields,  if  not  the  nature,  at  least  the  presence 
of,  an  abnormal  condition,  for  such  ability  would 
enable  them  to  save  many  patients  unnecessary 
visits  to  the  various  specialists. 

It  is  suggested  that  each  prospective  member 
act  as  an  assistant  for  six  months.  During  that 
time  he  can  make  up  his  mind  whether  or  not  he 
wishes  to  become  a member  of  the  unit,  and  the 
unit,  in  turn,  can  determine  whether  he  is  accept- 
able to  them.  If  he  leaves,  it  should  be  his  privi- 


150 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


lege  to  take  with  him  the  patients  who  prefer  to 
continue  under  his  care.  It  would  seem  a wise 
plan  for  the  director  and  the  associates  to  be  privi- 
leged to  terminate  their  relationship  at  any  time, 
the  leaving  member  again  being  permitted  to  take 
with  him  any  and  all  patients  who  desire  to  follow 
him. 

Four  members  seem  to  the  writer  to  be  neces- 
sary and  adequate.  The  director,  with  his  hospi- 
tal and  office  consultation  work  and  with  his 
directing  duties,  can  have  little  time  for  house 
visits,  and  so  he  cannot  hope  to  substitute  for  an 
associate  who  may  be  absent.  With  three  other 
members,  however,  two  can,  when  circumstances 
demand,  do  the  work  ordinarily  done  by  the  three. 
Each  one  can  thus  get  a satisfactory  yearly  holi- 
day, and  perhaps  each  one  can  have,  every  few 
years,  an  opportunity  to  visit  distant  clinics  for 
special  work.  If  four  members  be  adequate,  the 
addition  of  others  would  mean  a desire  to  obtain 
a larger  clientele,  which  should  not  be  the  primary 
aim  of  the  organization.  Moreover,  with  four 
members  there  should  exist  no  difficulty  in  keep- 
ing in  human  touch  with  the  patients  and  not  a 
whit  of  this  valued  relationship  should  ever  be  or- 
ganized or  “department-stored”  out  of  existence. 

In  considering  the  suitable  location  for  a unit, 
it  must  be  borne  in  mind  that  it  will  need  plenty 
of  working  room,  and  that  it  should  be  situated 
where  it  is  easy  of  access,  with  plenty  of  parking 
space  in  its  vicinity.  In  many  cities  there  is,  on 
foot,  a movement  of  the  doctors  away  from  down- 
town business  districts  where  rents  are  prohibi- 
tive and  where  ever  increasing  congestion  causes 
ever  increasing  delay.  The  writer  believes  that 
this  is  a wise  plan  and  has  followed  it  with  satis- 
factory results. 

If  a unit  of  the  type  considered  is  to  fulfill  its 
purpose,  its  offices  should  be  thoroughly  equipped, 
diagnostically  and  therapeutically,  in  a modern 
sense.  It  will  then  be  unnecessary  to  send  ambula- 
tory patients  to  hospitals  for  purposes  of  diag- 
nosis and  treatment.  They  will  thus  incur  no 
hospital  and  no  nursing  expenses,  and  since  in 
hospitals  there  are  so  many  calls  upon  the  diag- 
nostic equipment,  each  call  necessitating  a prelimi- 
nary appointment,  the  investigations  at  the  office 
can  be  carried  out  much  more  expeditiously,  and 
thus  considerable  time  be  saved  to  the  patients. 
It  should  be  the  aim  to  extend  this  service  so  that 
in  case  of  necessity  bed  patients  can  stay  at  home 
and  yet  have  available  the  essential  diagnostic  and 
therapeutic  facilities. 

The  number  of  nurses  and  technicians  which  a 
unit  will  need  will  depend  upon  the  amount  and 
kind  of  service  it  is  called  upon  to  give. 

It  would  be  of  advantage : 

1.  If  one  of  the  nurses  had  had  special  training 
in  a diet  school  so  that  she  could  be  of  help  to 
patients,  both  in  a dietetic  and  culinary  sense. 

2.  If,  when  necessary,  a nurse  could  be  sent 
to  the  homes  of  bed  patients  for  short  periods  of 
service,  or  to  give  instruction  to  the  lay  attendants 
who  desire  it. 

3.  If  one  of  the  laboratory  technicians  could 


daily  call  upon  the  bed  sick  to  get  the  required 
blood  specimens,  etc. 

4.  If  one  of  the  nurses  and  one  of  the  techni- 
cians were  on  call  for  urgent  cases  over  the  week- 
end, the  called  individual  receiving  an  equivalent 
time  off  during  the  following  week. 

Such  a unit  will  need  the  services  of  a secre- 
tary and  directress,  who  has  a difficult  position 
to  fill,  for  she  must  be  an  economist  and  a con- 
server  of  the  unit’s  supplies,  an  agreeable  and 
acceptable  supervisor,  and  a natural  peacemaker, 
for  quite  an  important  part  of  her  duties  may  be 
of  a harmonizing  nature. 

These  auxiliary  members  of  the  unit  should 
receive  salaries  as  large  as  those  generally  paid 
to  corresponding  workers  in  the  locality  of  the 
unit.  An  additional  yearly  compensation  is  much 
more  appreciated  than  the  assurance  of  future 
benefits.  The  payment  of  such,  particularly  if  the 
recipients  will  use  it  for  insurance  or  investment 
purposes,  is  an  excellent  way  of  promoting  satis- 
faction and  of  inculcating  a habit  of  thrift  and 
forethought  for  the  future. 

The  service  which  a unit  of  this  kind  might 
consider  giving  can  perhaps  be  classified  into : 

1 . Service  pertaining  to  the  diagnosis  and  treat- 
ment of  the  ailments  of  private  patients. 

2.  Service  in  the  field  of  preventive  medicine. 

3.  Near-free  and  free  service. 

4.  Educational  service. 

SERVICE  PERTAINING  TO  THE  DIAGNOSIS 
AND  TREATMENT  OF  AILMENTS  OF 
PRIVATE  PATIENTS 

In  quite  a percentage  of  patients  a complete 
clinical  examination  and  the  examination  of  the 
blood  and  excretions  will  be  all  that  is  necessary 
for  the  elucidation  of  the  case.  Merely  inquisitive 
diagnostic  procedures  should,  of  course,  be  dis- 
countenanced. In  a few  persons  a most  intensive 
investigation,  which  will  require  all  the  modern 
procedures  and  methods,  will  be  essential.  Be- 
tween these  extremes  there  comes  the  large  major- 
ity of  patients  who  need  investigations  of  varying 
extent. 

The  director  will  have  to  determine  what  is  a 
fair  and  legitimate  charge  for  these  different 
kinds  of  investigation,  and  this  will  depend  upon 
the  economic  standards  in  the  locality  of  the  unit 
and  upon  the  extent,  nature  and  value  of  the 
services  rendered. 

The  charges  made  for  taking  care  of  grave  and 
acute  cases  and  for  special  therapeutic  procedures 
will  depend  upon  the  nature  of  the  work,  the  diffi- 
culties encountered,  the  time  consumed  and  the 
responsibilities  involved  it  being  a good  working 
principle  never  to  charge  more  than  fair-minded 
patients  consider  just  and  within  their  means  to 
pay. 

Many  patients  have  employees  or  unrelated  de- 
pendents whom  they  desire  to  help  to  get  the 
same  kind  of  investigation  that  they  received.  It 
would  be  in  keeping  with  the  spirit  of  a service 


March,  1930 


FUTURE  OF  MEDICAL  PRACTICE — COOPER 


151 


organization  for  it  to  meet  such  patients  halfway 
and  to  itself  absorb  half  the  usual  charge,  it  send- 
ing to  the  employer  a hill  so  figured. 

The  writer  has  already  referred  to  the  service 
which  the  Japanese  interpreter  seeks  for  his 
fellow  nationals.  A unit  could  well  render  a 
similar  service  to  others  of  like  economic  situa- 
tion for  an  equivalent  fee. 

SERVICE  IN  THE  FIELD  OF  PREVENTIVE 
MEDICINE 

Preventive  medicine,  in  its  application  to  com- 
munities as  a whole,  is  largely  of  federal,  state, 
or  municipal  concern.  Antityphoid  inoculations, 
antismallpox  vaccinations,  antidiphtheria  and  anti- 
scarlet fever  injections,  which  belong  to  this  field, 
come,  however,  within  the  province  of  practicing 
physicians.  It  might  well  he  the  duty  of  one  of 
the  members  of  the  unit  to  keep  in  touch  with  the 
public  health  situation  of  the  locality  so  that  the 
unit’s  patients  can  at  once  be  given  the  benefit  of 
any  information  or  procedure  that  may  have  pre- 
ventive value. 

But  there  is  a further  development  of  preven- 
tive medicine  which  is  coming  more  and  more  into 
use  and  which  consists  in  the  early  recognition  of 
incipient  disease  and  the  institution  of  methods 
to  prevent  or  hinder  its  further  progress.  Its 
principle  depends  upon  the  examination  of  sup- 
posedly healthy  people,  and  this  at  such  recurrent 
intervals  as  to  preclude  the  probability  of  the 
development  in  the  interims  of  an  irremediable 
condition.  Many  corporations  who  have  a con- 
siderable number  of  indoor  employees  are  coming 
to  recognize  the  advantages  to  the  employees  and 
the  economic  value  to  themselves  of  such  periodic 
examinations.  Perhaps  the  writer  may  be  per- 
mitted to  illustrate. 

For  six  years  the  unit  has  examined  annually 
all  the  employees  and  applicants  for  positions  in 
one  of  the  large  banks  of  this  city.*  Most  of  these 
employees  consider  themselves  healthy  and,  on 
inquiry,  have  few  or  no  complaints.  They  come 
at  prearranged  hours,  they  are  examined  clinically 
just  as  thoroughly  as  are  any  other  patients,  and 
a routine  examination  of  the  urine  and  of  the 
blood — which  includes  the  serum  reactions — is 
made.  If  upon  any  individual  a further  diagnostic 
procedure  is  indicated,  that  is  also  permitted  by 
the  bank.  A complete  record  of  the  first  exami- 
nation is  made  and  kept,  and  to  this  are  added 
the  findings  of  succeeding  years.  A short  report 
of  the  findings,  with  comment,  is  sent  to  the  bank. 
I he  bank  gives  a copy  of  his  or  her  report  to  the 
employee.  The  employees  are  left  at  liberty  to 
decide  whether  or  not  they  wish  to  follow  the 
advice  given.  No  attempt  is  ever  made  to  induce 
them  to  become  patients  of  the  office,  but  quite 
frequently  it  is  suggested  that  they  present  the 
reports  to  their  own  physicians. 

Because  of  the  number  involved,  because  they 
come  at  prearranged  times,  and  because  of  the 

* Instituted  by  Mr.  J.  J.  Fagan  of  the  Crocker  First 
National  Bank. 


large  proportion  who  have  little  or  no  disease  his- 
tory, a rate  can  he  made  which  will  appeal  to 
corporations  as  eminently  fair  for  the  kind  of  ser- 
vice that  is  given.  For  the  reexamination,  a fee 
of  one-half  the  amount  charged  for  the  first 
examination  is  made. 

The  unit  has  reason  to  believe  that  these  exami- 
nations have  been  of  much  value  to  the  bank  and 
to  its  employees,  and  other  business  organizations 
have  recently  expressed  their  intention  of  availing 
themselves  of  a similar  service. 

Only  a small  proportion  of  the  time  of  a unit, 
such  as  this  aims  to  be,  can  be  given  to  such  work, 
but  the  writer  believes  there  is  likely  to  be  a rather 
widespread  call  for  such  service,  and  that  a medi- 
cal unit  is  well  adapted  to  render  it. 

Similarly,  more  and  more  individuals  are  re- 
questing the  same  kind  of  service  and  it  seems 
only  rational  to  assume  that  in  time  such  periodic 
examinations  will  become  the  rule. 

NEAR-FREE  SERVICE 

The  formation  of  unit  service  organizations  of 
the  kind  outlined  is,  of  course,  no  solution  of  the 
crying  need  for  inexpensive  yet  efficient  medical 
and  surgical  service  for  the  great  mass  of  people. 
For  a time  this  organization  welcomed  this  class 
during  its  office  hours,  though  recognizing  their 
inability  to  pay  a proper  return  for  the  work 
done  on  them.  A continuation  of  this  policy 
would  have  rapidly  resulted  in  the  economic 
failure  of  the  unit.  Then,  an  attempt  was  made 
to  render  this  service  one  night  a week,  the  unit 
also  arranging  that  friendly  specialists  and  a drug- 
gist kept  the  same  evening  hours.  This  plan  was 
not  a success,  and  now  each  member  of  the  unit 
is,  like  other  individual  physicians,  trying  to  help 
those  members  of  this  class  who  seek  his  aid  in 
the  best  way  he  can. 

FREE  SERVICE 

The  free  service  that  the  medical  profession 
renders  may  perhaps  be  classified  into  involuntary 
free  service  and  voluntary  free  service. 

INVOLUNTARY  FREE  SERVICE 

There  is  quite  a percentage  of  people  who  do 
not  and  will  not  pay  for  the  medical  and  surgical 
service  they  have  requested  and  received,  though 
they  are  well  able  to  do  so.  They  seemingly  take 
advantage  of  the  reluctance  of  doctors  to  make 
use  of  legal  procedures,  and  apparently  experience 
no  shame  in  eluding  their  incurred  just  medical 
obligations.  Judging  from  circulars  lately  re- 
ceived, a praiseworthy  attempt  to  list  these  un- 
desirables is  in  prospect.  Such  listing  would  lead 
to  their  gradual  elimination. 

VOLUNTARY  FREE  SERVICE 

The  rendering  of  free  medical  and  surgical  ser- 
vice to  those  in  need  has  ever  been,  in  the  minds 
of  the  profession  at  large,  a valued  privilege.  No 
unit  or  organization  would  be  willing  to  forego 


152 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  J 


its  share  of  this  privilege.  The  problem  is  how 
best  to  do  it  for  the  benefit  of  the  local  com- 
munity. In  a community  in  which  there  is  a 
scarcity  of  free  clinics,  the  unit  might  advantage- 
ously initiate  such  a clinic,  but  in  a community 
where  an  abundance  of  organized  well-conducted 
free  clinics  already  exist,  it  is,  the  writer  believes, 
a better  policy  for  the  associate  members  of  the 
unit  to  give  their  time  at  one  of  these  clinics. 

EDUCATIONAL  SERVICE 

It  is  only  necessary  to  listen  to  lay  people  as 
they  express  their  views  concerning  symptoms 
and  ailments  to  recognize  how  much  there  is  for 
education  to  do.  Meanwhile  cults  and  quacks 
flourish,  and  among  their  patrons  and  followers 
are  lawyers,  hankers  and  business  men  of  high 
position,  and  apparently  the  more  extravagant  the 
curative  claims  for  useless  articles  and  products 
the  more  rapidly  do  they  sell.  Commendable 
books  and  popular  lectures  and  magazine  articles 
make  but  slow  progress  in  modifying  the  wishful 
beliefs  that  the  mass  of  the  people  possess.  Phy- 
sicians in  general  have  been  so  busy  in  their  more 
urgent  work  that  perhaps  they  have  not  been  able 
to  make  full  teaching  use  of  their  unique  relation- 
ships. If  patients  were  shown  how  closely  inter- 
locked are  the  vertebrae  of  an  articulated  skeleton, 
there  would  be  less  belief  in  the  frequency  of 
vertebral  “slips,”  and  if  they  were  taught  a few 
simple  anatomical  and  physiological  facts  there 
would  be  less  acceptance  of  the  healing  virtues, 
in  serious  sickness,  of  so-called  adjustments.  If 
they  were  made  acquainted  with  the  simple  princi- 
ples of  dietetics  there  would  he  fewer  followers 
of  harmful  fad  diets.  And  if  they  were  taught 
a right  and  helpful  psychology  there  would  be 
fewer  devotees  of  the  various  cults. 

Efforts  in  these  directions  are  well  worthy  of 
trial,  and  in  a unit  organization  there  could  well 
be  a systematic  endeavor  along  these  lines,  it  ever 
being  remembered  that  a sympathetic  tolerance,  an 
earnest  sincerity  and  an  utter  simplicity  of  the 
spoken  and  written  word  are  essential  to  success. 

There  is  perhaps  another  educational  service 
which  units  could  advantageously  render.  In  the 
medical  schools  the  students  of  today  are  excel- 
lently taught  the  science  of  medicine.  They  have 
less  opportunity  to  acquire  its  humanizing  art, 
and  still  less  to  become  acquainted  with  the  many 
problems  that  beset  its  practice.  Chosen  units 
might  well  serve  as  prepractice  schools  to  give  to 
near  and  recent  graduates  these  opportunities. 

In  formulating  a working  plan,  the  director  of 
the  unit  must  realize  that  at  first  most  of  the 
patients  who  come  to  the  organization  come  to 
consult  him.  They  will  appreciate  it  if  he  person- 
ally sees  them,  takes  the  history,  clinically  exam- 
ines them  and  maps  out  the  necessary  laboratory 
and  technical  work.  When  all  the  required  data 
are  at  hand,  he  asks  an  associate  to  see  the  patient 
with  him.  He  rapidly  summarizes  the  history,  the 


clinical,  laboratory  and  technical  findings,  and  the 
diagnostic  possibilities.  The  associate  is  then 
asked  to  suggest  the  most  advantageous  line  of 
treatment,  and  a definite  program  is  outlined.  The 
associate  is  then  requested  to  initiate  the  program 
and  to  take  charge  of  the  patient.  The  patient  is 
told  that  the  associate  is  at  his  call  day  and  night, 
and  that  the  director,  in  turn,  without  additional 
charge,  is  at  the  associate’s  call,  and  that  the  two 
of  them  will  thus  attend  him.  The  readiness  with 
which  the  patient  accepts  this  arrangement  will 
largely  depend  upon  the  attitude  of  the  director 
toward  the  associate.  If  it  be  an  attitude  of 
superiority,  he  cannot  expect  to  instill  the  neces- 
sary confidence  in  the  patient,  but  if  it  be  one  of 
medical  comradeship,  no  difficulty  occurs.  Gradu- 
ally the  patient  becomes  acquainted  with  the  other 
members  of  the  unit  and  thus  he  feels  he  always 
has,  in  time  of  need,  someone  he  knows  to  whom 
to  turn.  The  patient,  if  he  be  later  taken  acutely 
sick,  is  almost  sure  to  send  for  the  associate,  and 
it  is  the  experience  of  this  unit  that  he  is  very  apt 
to  refer  his  sick  relatives  and  friends  to  the  same 
associate. 

It  is  perhaps  unnecessary  to  say  that  there 
should  be  no  patients  whom  the  director  is  not 
glad  to  have  his  associates  attend,  however  rich 
and  influential  they  may  be,  and  no  patients,  how- 
ever lowly  their  circumstances,  whom  the  director 
is  not  more  than  willing  to  see  with  the  associates. 

The  director  of  this  particular  unit  has  found 
it  of  advantage  to  spend  Sunday  mornings  mak- 
ing rounds  and  calling  upon  the  patients  who  are 
sick  with  the  associate  who  happens  to  be  on  duty, 
no  charge  being  made  by  him  for  his  accompany- 
ing the  associate.  The  associate  members,  in  their, 
turn,  will  make  one  another  acquainted  with  the 
patients  whom  they  are  attending,  and  will  natu- 
rally assist  one  another  in  any  work  that  requires 
a combination  of  efforts. 

In  considering  the  incomes  which  they  should 
receive  the  director  should  endeavor  to  always 
make  them  larger  than  they  would  be  apt  to  re- 
ceive after  a like  number  of  years  as  lone  practi- 
tioners in  that  locality.  If  they  leave  at  any  time, 
they,  as  previously  mentioned,  should  be  privi- 
leged to  take  with  them  any  patients  who  desire 
to  follow  them,  and  those  who  have  rendered 
efficient  service  will  naturally  take  a goodly  fol- 
lowing. Such  an  arrangement  is  perhaps  to  the 
disadvantage  of  the  director,  since  the  associate 
could  leave  and  take  with  him  not  only  the  pa- 
tients who  have  come  to  him  personally,  but  also 
many  who  have  been  directly  and  indirectly  placed 
under  his  care  by  the  director.  However,  an 
understanding  of  this  sort  protects  the  associate 
and  is  evidence  that  the  director  is  seeking  him 
in  good  faith  as  a permanent  associate  and  suc- 
cessor. To  enable  both  parties  to  make  other  con- 
nections, a three  months’  notice  of  an  intended 
severance  should  be  given.  As  an  incentive  to 
keep  intact  a satisfactory  functioning  unit,  an 
arrangement,  to  take  effect  upon  the  death  or  re- 
tirement of  the  director,  which  should  be  defi- 


March,  1930 


ECZEMA — AYRES 


153 


nitely  favorable  to  the  associates,  might  well  be 
provided.  If,  however,  after  the  organization  has 
been  completely  built  and  is  working  smoothly, 
the  associates  should  prefer  to  become  junior 
partners,  it  should  be  the  aim  of  the  director  to 
evolve  a plan  which  would  fully  satisfy  their 
aspirations.  This  has  been  done  in  this  particular 
unit,  and  it  is  arranged  that  the  successive  direc- 
tors automatically  retire  on  reaching  the  age  of 
sixty-five,  though,  if  the  retiring  director  should 
still  desire  to  work,  it  would  seem  practical  for 
a successful  unit  to  continue  to  use  him  for  some 
years  in  a consultant  capacity. 

As  the  unit  develops  the  question  will  probably 
arise,  should  it  endeavor  to  attach  to  itself  a sur- 
geon and  other  specialists,  thus  entering  the  field 
of  group  medicine?  The  director  of  this  unit  is 
afraid  that  by  doing  so  it  would  lessen  its  capacity 
to  render  the  kind  of  service  for  which  it  was 
formed.  Much  rather  would  he  prefer  to  work 
with  a similarly  constructed  surgical  unit  with 
which  he  had  no  economic  connection.  At  the 
present  time,  being  located  in  a large  city,  the  unit 
is  able  to  choose  from  a large  field  of  competent 
surgeons  and  specialists  those  with  whom  it  can 
work  to  the  best  advantage  of  its  patients,  and 
this  privilege  its  members  would  be  unwilling  to 
forego. 

Units,  to  continue  to  exist,  must  be  financially 
successful.  To  insure  this  it  is  necessary  that  they 
be  conducted  with  the  same  regard  for  economy 
as  are  the  higher  types  of  business  organizations. 
A capable  directress  can  aid  much  in  this  direc- 
tion, and  the  patients  themselves  can  cooperate 
by  meeting  their  accounts  with  the  same  prompt- 
ness that  they  attend  to  their  other  financial 
obligations. 

The  organizing  capacity  of  an  individual  is  evi- 
denced by  his  ability  to  create  an  organization 
which  can  dispense  at  any  time  with  the  services 
of  any  member  without  losing  any  of  its  effi- 
ciency. A director  of  a unit  service  organization 
can  feel  he  is  really  successful  in  his  efforts  when 
he  has  brought  it  about  that  he  himself  is  no 
longer  essential  to  its  efficient  carrying  on.  When 
that  occurs  the  unit  will  approximate  type  “b.” 

In  conclusion,  the  writer  would  like  to  say  to 
older  physicians  that  the  formation  of  a unit  of 
the  kind  considered  is  well  worthy  of  their  con- 
sideration, for — - 

To  the  director  it  brings  the  consciousness  of  a 
larger  usefulness  and,  through  daily  association 
with  younger  men,  tends  to  keep  his  mind  plastic 
and  youthful. 

To  the  associates  it  gives  the  opportunity  to 
practice  their  profession  under  ideal  conditions, 
it  brings  them  in  daily  contact  with  one  from 
whom  they  can  learn  something  at  least  of  the 
“art  of  medicine,”  and,  to  those  who  perform  their 
duties  efficiently,  it  assures  a bright  future. 

And  to  the  patients  it  brings  a service  organ- 
ized, relatively  economic,  collective  and  ever 
available. 

2000  Van  Ness  Avenue. 


ECZEMA — SOME  RECENT  CONTRIBUTIONS 
TO  ITS  STUDY*' 

By  Samuel  Ayres,  Jr.,  M.  D. 

Los  Angeles 

Discussion  by  Irving  R.  Bancroft,  M.D.,  Los  Angeles; 
C.  Ray  Lounsberry,  M.D.,  San  Diego;  Hiram  E.  Miller, 
M.D.,  San  Francisco ; Stanley  O.  Chambers,  M.D.,  Los 
A ngeles. 

A REVIEW  of  the  literature  during  the  past 
five  years  reveals  the  fact  that  an  astounding 
wealth  of  new  ideas  has  greatly  broadened  our 
conception  of  the  clinical  entity  known  as  eczema. 
In  using  the  term  “clinical  entity,”  I wish  to  em- 
phasize a fact  which  has  been  pointed  out  many 
times  but  which  is  frequently  ignored,  that  eczema 
is  not  a disease  entity  in  the  sense  that  diphtheria, 
smallpox,  or  tuberculosis  are  disease  entities,  but 
rather  is  a clinical  symptom  with  multiple  etiology 
in  much  the  same  category  as  a headache. 

Much  unnecessary  debate  has  been  waged  over 
the  relative  value  of  the  terms  “eczema”  and 
“dermatitis.”  Either  diagnosis  would  be  inade- 
quate without  a parenthetical  notation  of  the  eti- 
ology, if  known,  or  a definite  statement  of  “cause 
undetermined”  in  cases  of  obscure  etiology.  Since 
the  word  “dermatitis”  means  literally  inflamma- 
tion of  the  derma,  a definition  which  is  broad 
enough  to  include  erysipelas,  carbuncles,  and 
many  other  non-eczematous  inflammations,  it 
would  seem  that  eczema  or  eczematoid  dermatitis 
might  convey  more  specific  information. 

When  one  considers  the  varied  stages  through 
which  a typical  case  of  eczema  may  pass — pruritus, 
erythema,  edema,  vesiculation,  exudation,  crust- 
ing, subsidence,  desquamation,  with  the  occasional 
development  of  papules,  pustules,  or  lichenified 
thickening,  and  the  necessity  of  varied  treatment 
according  to  the  stage  presented  by  the  individual 
patient,  it  is  small  wonder  that  eczema  consti- 
tutes one  of  the  major  problems  not  only  for  the 
dermatologist  but  for  the  general  practitioner  as 
well. 

BASIC  PRINCIPLES  IN  DIAGNOSIS 

Let  it  be  repeated  that  no  case  of  eczema  may 
be  regarded  as  properly  treated  unless  the  diag- 
nosis includes  a definite  statement  of  etiology 
either  known  or  undetermined ; which  implies 
that  a careful  search  has  been  or  will  be  made 
in  order  to  determine  the  cause,  which  may  be 
either  an  external  irritant  such  as  some  chemical 
or  physical  agent,  bacterial  or  fungus  infection, 
or  some  constitutional  disorder  of  a functional  or 
organic  nature.  Aside  from  mere  curiosity,  the 
rather  obvious  reasons  for  determining  the  eti- 
ology of  the  eruption  are  that  the  attack  for  which 
the  patient  comes  for  treatment  may  be  more 
rapidly  cleared  up,  that  recurrences  may  be  pre- 
vented, and  that  possible  underlying  constitutional 
disorders  of  which  the  cutaneous  manifestation 
may  be  a signal  may  be  discovered  and  remedied. 

The  first  problem,  then,  which  confronts  the 
physician  who  is  dealing  with  a patient  with 

* Read  before  the  Dermatology  and  Syphilology  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


154 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


eczema  is  to  know  when  to  be  an  internist  and 
when  not  to  be.  If  one  were  to  apply  every  known 
diagnostic  test  to  every  patient  presenting  an 
eczematous  eruption,  very  few  patients  would 
have  the  money  or  the  perseverance  to  go  through 
with  the  examination.  A careful  history  and 
cutaneous  inspection  will  often,  but  by  no  means 
always,  indicate  the  appropriate  line  of  investi- 
gation. 

Eczemas  which  have  sharply  defined  borders 
and  which  give  a history  of  having  begun  with 
one  or  two  small  lesions  which  have  gradually 
enlarged  and  multiplied  suggest  an  external  in- 
fection, due  either  to  bacteria,  yeasts,  or  ring- 
worm fungi.  The  picture  known  as  epidermophy- 
tosis, characterized  by  scaly  or  vesicular  eruptions 
of  the  hands,  feet,  or  genitocrural  region,  can  be 
confirmed  by  finding  the  ringworm  fungus  in 
direct  microscopic  examination  of  scales  or  ex- 
cised vesicles.  - Failure  to  find  the  organism  should 
serve  as  a warning  against  too  vigorous  treat- 
ment, since,  as  Mitchell  1 points  out,  many  of 
these  cases  may  be  due  to  bacteria  or  to  toxic 
causes.  The  eczematoid  condition  known  as  dys- 
hidrosis or  pompholyx  may  closely  simulate  epi- 
dermophytosis. Recently  C.  J.  White  2 and  Cleve- 
land White  3 have  pointed  out  that  many  of  the 
cases  hitherto  regarded  as  toxic  eczemas  were  in 
reality  due  to  a very  small  yeast-like  organism, 
the  Cryptococcus,  and  that  treatment  instituted 
along  the  lines  indicated,  as  the  result  of  micro- 
scopic examination,  has  converted  many  hitherto 
obstinate  cases  into  conditions  that  have  promptly 
cleared  up.  This  work  is  so  new  that  it  has  had 
very  little  confirmation,  but  the  character  of  the 
men  who  brought  out  these  pictures  justifies  the 
belief  that  a major  contribution  has  been  made  to 
dermatology.  Many  of  the  dry,  scaly  types  of 
eczema,  especially  flexural  eczemas,  apparently 
belong  in  this  group. 

SOME  LOCALIZED  ECZEMAS 

Hand  Eczemas. — Eczemas  which  are  confined 
to  the  hands  are  often  caused  by  local  chemical 
irritants ; a complete  list  is  almost  unattainable 
since  almost  any  substance  may  constitute  an  ex- 
ternal irritant  in  a susceptible  individual.  Every 
day,  however,  new  items  are  being  added  to  the 
list  of  local  irritants.  Some  of  the  irritants  most 
often  met  with  include  paints,  dyes,  polishes,  oil 
products,  lacquer,  novocain,  formaldehyd,  prim- 
rose, various  vegetables  and  plant  leaves  and  fruit 
juices,  and  ink.  Very  recently  E.  A.  Oliver  4 re- 
ported a series  of  fifteen  cases  of  an  eczematous 
eruption  of  the  face  and  hands  due  to  rotogravure 
ink  in  the  pictorial  supplement  of  the  Sunday 
paper.  Cole 5 has  compiled  a list  of  cosmetics 
which  may  produce  eczematous  eruptions  about 
the  face,  head,  and  neck.  Many  hair  dyes  and 
tonics  contain  such  irritants  as  lead  acetate,  mer- 
cury, wood  alcohol,  paraphenylendiamin,  resor- 
cin, phenol,  salicylic  acid,  silver  compounds,  and 
pyrogallic  acid.  Skin  bleaches  may  contain  high 
concentrations  of  mercury;  face  enamels  often 
contain  lead  and  bismuth,  but  even  such  ordinarily 
harmless  substances  as  orris  root  or  rice  powder 


may  provoke  an  eczema  in  an  individual  hyper- 
sensitive to  these  proteins.  Depilatories  usually 
contain  calcium  or  barium,  and  eyelash  mascara 
may  contain  paraphenylendiamin.  Face  or  lip 
rouge  is  sometimes  colored  with  an  anilin  dye. 

Neck  Eczemas. — Eruptions  about  the  neck  may 
be  due  to  a fur  which  has  been  dyed  black  with 
paraphenylendiamin,  or  brown  with  quinone,  or 
may  be  due  to  the  roughness  of  a wool  scarf. 
Some  eczemas  of  the  face  and  exposed  parts  of 
the  neck  and  arms  are  caused,  in  part  at  least,  by 
hypersensitiveness  to  the  ultra-violet  rays  of  the 
sun.  This  suggests  the  caution  that  must  be  exer- 
cised in  treating  eczema  with  quartz  light. 

The  predilection  of  an  eczema  for  the  face  or 
hands  does  not  necessarily  prove  that  the  cause 
is  external,  but  should  at  least  serve  as  a stimulus 
to  rule  out  such  a cause.  Such  eczemas  may  be 
seen  in  individuals  who  possess  delicate  skins  and 
are  addicted  to  daily  hot  soap  and  water  baths, 
especially  if  they  have  passed  middle  life  and  the 
season  happens  to  be  winter.  The  cases  that  began 
as  scabies,  or  fungus  infections  that  have  become 
converted  into  eczema  as  the  result  of  too  strenu- 
ous treatment,  must  also  be  remembered. 

Eczemas  from  Constitutional  Causes.- — The  his- 
tory may  at  times  serve  as  a valuable  clue  to  the 
eczemas  of  constitutional  origin ; but  is  often  of 
no  help.  Beinhauer,®  in  a series  of  one  hundred 
and  fourteen  private  cases  of  eczemas  in  which 
series  he  excluded  infantile  eczema  and  any  case 
in  which  an  external  causative  factor  was  known, 
found  that  every  patient  revealed  some  definite 
constitutional  disorder  of  which  impaired  func- 
tion of  the  excretory  or  metabolic  systems  were 
the  commonest ; whereas  23.6  per  cent  of  a series 
of  one  hundred  and  fourteen  cases  of  non-eczema- 
tous  dermatoses  revealed  constitutional  disorders. 

PROTEIN  HYPERSENSITIVENESS 

A history  of  repeated  attacks  of  eczema  since 
infancy,  especially  if  accompanied  by  allergic 
manifestations  in  the  patient  or  the  family,  such 
as  eczema,  urticaria,  hay  fever,  or  asthma,  should 
immediately  suggest  the  possibility  of  protein 
hypersensitiveness  and  should  call  for  a complete 
testing  of  the  food  proteins.  Occasionally  brilliant 
results  will  be  achieved  by  isolating  one  or  more 
offending  proteins  and  excluding  them  from  the 
diet.  On  the  other  hand,  disappointment  may  be 
the  only  result  of  such  an  investigation. 

A careful  checking  over  of  the  entire  gastro- 
intestinal tract  may  reveal  the  hidden  pathology. 
Alden  7 has  recently  reported  two  cases  of  gen- 
eralized eczema  of  several  years  duration  in  whom 
marked  improvement  followed  the  removal  of 
pathologic  gall  bladders.  The  gall-bladder  dye 
test  revealed  the  abnormality  in  both  instances. 
Highman 8 has  recently  reported  a case  of  uni- 
versal eczema  of  fourteen  months  duration  which 
cleared  completely  within  a few  weeks  following 
the  removal  of  an  infected  kidney.  Other  foci 
of  infection,  such  as  teeth,  tonsils,  sinuses,  pros- 
tate, appendix,  large  bowel,  may  also  be  possible 
sources  of  certain  cases  of  eczema. 

Gundrum  9 has  reported  an  interesting  example 
of  a case  of  eczema  apparently  due  to  what  might 


March,  1930 


ECZEMA — AYRES 


155 


be  termed  a focus  of  irritation.  The  patient  had 
suffered  from  a universal  eczema  as  well  as  severe 
asthma  for  about  ten  years.  Although  no  obvious 
infection  was  discovered  in  the  sinuses,  cocain- 
ization  of  the  sphenopalatine  ganglion  temporarily 
stopped  both  the  asthma  and  the  eczema  on  five 
separate  occasions.  Permanent  cessation  of  both 
conditions  followed  alcohol  injections  of  the 
ganglion. 

Both  Urbach 10  and  Ehrman  11  have  found  a 
low  gastric  acidity,  in  some  cases  amounting  to  an 
almost  complete  achylia,  in  more  than  half  of  a 
fairly  large  series  of  cases  of  eczema  studied.  The 
fractional  method  of  gastric  analysis  was  used. 
Waller,12  however,  in  a much  smaller  series  of 
cases  found  a predominance  of  hyperchlorhydria. 
It  is  easy  to  see  how  the  failure  of  adequate  gas- 
tric digestion  might  lead  to  the  formation  of 
abnormal  or  toxic  metabolic  products  in  the  lower 
bowel.  Failure  of  pancreatic  digestion  could  do 
the  same  thing.  Rueda 13  reports  a series  of 
seventy-five  cases  of  infantile  eczema  and  sebor- 
rheic eczema  which  were  cured  in  a striking 
manner  within  one  to  four  weeks  by  the  feeding 
of  pancreas  in  tablet  or  pulverized  form.  The 
author  has  recently  seen  a striking  example  of 
such  a result  in  a six-year-old  boy  who  had  suf- 
fered from  severe  and  generalized  eczema  almost 
from  birth,  in  whom  many  food  proteins  gave 
strongly  positive  reactions.  Yet  within  less  than 
two  months  after  treatment  began,  the  eruption 
disappeared  completely  on  pancreatic  substance, 
even  though  the  diet  indicated  by  food  sensiti- 
zation was  not  strictly  adhered  to. 

Burgess  14  feels  that  endogenous  irritants,  es- 
pecially from  the  gastro-intestinal  tract,  in  the 
form  of  amino-acids  and  other  protein  decom- 
position products,  may  produce  eczema.  Exclud- 
ing histamin,  which  gives  positive  cutaneous 
reactions  in  almost  everyone,  he  obtained  posi- 
tive reactions  in  16.6  per  cent  of  a series  of  one 
hundred  and  nine  consecutive  cases  of  eczema, 
against  2 per  cent  of  a control  series  of  one  hun- 
dred and  two  non-eczema  cases.  Therapeutically 
such  cases  responded  fairly  well  to  Bacillus  acid- 
ophilus cultures  and  small  doses  of  salines,  even 
in  the  absence  of  constipation. 

A number  of  investigators15 16  have  established 
the  fact  that  disturbances  in  the  carbohydrate  me- 
tabolism, as  revealed  by  the  glucose  tolerance  test, 
constitutes  another  important  cause  of  eczema. 
In  patients  of  this  group  the  history  is  often 
valueless ; a routine  urine  test  is  frequently  nega- 
tive for  sugar,  and  a single  fasting  blood  sugar 
determination  may  be  well  within  normal  limits. 
The  author  has  seen  several  instances  in  which 
the  fasting  sugar  was  under  110  milligrams  per 
100  cubic  centimeters,  but  in  which  values  as  high 
as  250  to  300  milligrams  per  100  cubic  centi- 
meters were  recorded  in  one-half  to  one  hour 
after  the  oral  administration  of  glucose.  Usher 
and  Rabenowitch  17  have  found  glucose  to  be  a 
normal  constituent  of  sweat.  The  rate  of  excre- 
tion and  the  amount  excreted  were  increased  in 
cases  showing  a low  glucose  tolerance. 

Schamberg  and  Brown 18  found  a high  blood 
uric  acid  in  44  per  cent  of  two  hundred  and  eighty 


eczema  patients,  and  Michael  19  in  40  per  cent 
of  seventy-five  patients.  In  both  series  of  cases 
improvement  followed  a low  purin  diet,  although 
Michael  does  not  feel  that  uric  acid  per  se  is  a 
dermal  irritant. 

CALCIUM-POTASSIUM  RATIO 

Klauder  and  Brown,20  in  a series  of  studies 
extending  over  a period  of  four  or  five  years, 
have  contributed  some  very  interesting  data  bear- 
ing on  the  calcium-potassium  ratio  in  relation  to 
cutaneous  irritability.  They  regard  eczema  as  “a 
pathologic  process  in  which  the  cutaneous  neuro- 
cellular  mechanism  is  out  of  balance.  The  cutane- 
ous sensibility  in  rabbits  and  cats  was  tested  by 
applications  of  croton  oil.  The  calcium  and  potas- 
sium content  of  the  entire  skin  of  the  animal  was 
determined,  not  merely  the  blood  calcium. 

Some  of  their  more  important  findings  were 
as  follows : 

1.  Rabbits  varied  considerably  in  individual 
cutaneous  irritability,  but  the  degree  of  irritability 
varied  inversely  with  the  calcium  content  of  the 
skin  and  directly  with  the  potassium  content  in 
the  majority  of  cases.  Eighteen  rabbits  were  used. 

2.  Blood  chemistry.  The  cutaneous  sensibility 
could  not  be  correlated  with  the  blood  chemistry 
studies,  especially  calcium,  but  could  be  correlated 
with  the  skin  calcium. 

3.  Diets.  The  cutaneous  sensibility  decreased 
after  an  all-green  diet  for  ten  days,  increased 
after  an  oat  and  hominy  diet ; remained  unchanged 
after  one  week  of  starvation.  The  cutaneous 
sensibility  was  correlated  with  the  calcium  and 
potassium  content  of  the  skin  in  the  majority  of 
cases. 

4.  Injection  of  calcium  chlorid  produced  a 
striking  decrease  of  cutaneous  sensibility. 

5.  Injection  of  acids.  The  daily  injection  of 
N10  II Cl  and  of  3 per  cent  solution  of  oxalic  acid, 
which  killed  the  animal,  did  not  alter  the  cutane- 
ous sensibility. 

6.  Nephritis  and  hepatitis.  Experimentally  pro- 
duced nephritis  and  hepatitis  resulted  in  a marked 
increase  in  cutaneous  sensibility  even  before 
changes  appeared  in  the  blood  chemistry. 

7.  Splenectomy,  etc.  Removal  of  the  spleen, 
pancreas  (one-half  to  three-fourths)  and  supra- 
renals  caused  no  change  in  cutaneous  sensibility 
even  when  death  ensued  from  removal  of  both 
suprarenals. 

8.  Narcosis.  Administration  of  chloral  hydrate 
by  rectum  resulted  in  a striking  decrease  of 
cutaneous  sensibility. 

9.  Injections  of  serum  of  eczema  patients  and 
normal  individuals  produced  a definite  decrease 
of  cutaneous  sensibility. 

10.  Injections  of  milk  and  sterile  water  gave 
conflicting  results. 

11.  Injections  of  starch  and  sodium  sulphate 
produced  no  change,  but  the  injection  of  gelatin 
decreased  the  cutaneous  sensibility. 

12.  Arsenic  (neoarsphenamin)  when  injected 
in  a sublethal  dose  caused  a definite  although  not 
striking  increase  in  cutaneous  sensibility. 

13.  Injection  of  pilocarpin  (stimulation  of  the 
parasympathetic  or  vagus  system)  led  to  an  in- 


156 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


crease  in  cutaneous  sensibility.  Autopsy  after  a 
series  of  such  injections  revealed  a low  skin  cal- 
cium and  a high  skin  potassium. 

14.  Injection  of  ephedrin  (stimulation  of  the 
sympathetic)  and  atropin  (paralysis  of  the  para- 
sympathetic) produced  a decrease  in  cutaneous 
sensibility  with  autopsy  showing  a high  skin  cal- 
cium and  a low  skin  potassium. 

These  experiments  are  to  be  regarded  as  intro- 
ductory rather  than  final,  and  they  open  a new 
chapter  in  the  study  of  cutaneous  pathology.  As 
far  as  they  go,  there  seems  to  be  some  justifica- 
tion for  the  time-honored  custom  of  administer- 
ing calcium  in  certain  cutaneous  disorders  such 
as  eczema  and  urticaria.  However,  it  has  recently 
been  shown  that  in  order  to  secure  a maximum 
absorption,  calcium  should  be  administered  in 
rather  large  amounts  (four  or  five  grams)  as  a 
powder  dissolved  in  water  and  given  on  an  empty 
stomach,  rather  than  as  five-grain  tablets  after 
meals,  as  is  frequently  done. 

OTHER  STUDIES 

Before  concluding  this  review,  mention  must 
be  made  of  the  work  of  Throne,  Van  Dyck, 
Marples,  and  Myers,21  who  have  found  arsenic 
in  pathologic  amounts  in  a large  number  of  their 
patients  with  eczema.  The  arsenic  can  be  acquired 
through  medication,  occupational  contact,  food 
contamination,  and  in  unknown  ways.  In  these 
cases  of  arsenical  eczema,  brilliant  results  usually 
follow  the  administration  of  sodium  thiosulphate 
intravenously. 

It  is  realized  that  the  above  remarks  do  not 
include  all  of  the  contributions  to  the  study  of 
eczema  which  have  appeared  during  the  past  five 
years.  Attention  should  be  called  to  the  work  of 
Burnett,22  whose  studies  on  the  intestinal  rate 
lead  him  to  believe  that  some  cases  of  eczema 
are  due  to  faulty  absorption  of  essential  food 
elements  due  to  a too  rapid  peristaltic  rate ; also 
to  the  observations  of  Klauder  23  on  improvement 
in  generalized  eczema  following  therapeutically  in- 
duced sleep;  and  the  similar  work  of  Lebedjew,24 
who  produced  marked  benefit  through  intrave- 
nous bromid  treatment.  Much  has  been  accom- 
plished with  nonspecific  protein  therapy  by  the 
injection  of  whole  blood  or  other  colloidal  sub- 
stances. Correction  of  glandular  deficiencies,  thy- 
roid, ovarian  25  and  testicular,  have  given  satis- 
factory results  in  a few  carefully  selected  cases. 
Pruritus  and  eczema  ani  have  been  reported  as 
being  caused  in  some  instances  by  an  idiosyn- 
crasy to  mineral  oil 26  used  in  treating  chronic 
constipation. 

SUMMARY 

A review  of  the  literature  dealing  with  eczema 
during  the  past  five  years  emphatically  reinforces 
the  idea  that  eczema  is  a symptom  complex  hav- 
ing many  possible  causes  both  external  and  in- 
ternal, and  that  treatment  in  order  to  be  success- 
ful must  be  directed  along  etiologic  lines.  Notable 
contributions  to  our  understanding  of  eczema  in- 
clude : experimental  studies  of  calcium-potassium 
ratio  with  reference  to  the  sympathetic-parasym- 
pathetic nervous  system ; observations  on  the 
carbohydrate  and  protein  metabolism ; on  foci  of 


infection  and  foci  of  irritation;  on  the  gastric 
secretion,  pancreatic  and  other  glandular  defi- 
ciencies ; sedative  measures ; local  chemical  irri- 
tants; and  bacterial  and  fungus  infections. 

Enough  has  been  said  to  indicate  the  need  for 
highly  specialized  dermatologic  knowledge  on  the 
one  hand,  and  close  cooperation  with  the  practi- 
tioner of  internal  medicine  on  the  other;  with  the 
constant  assistance  of  the  laboratory  worker  and 
experimental  investigator,  if  the  eczema  sufferer 
is  to  find  the  relief  which  he  seeks. 

315  Westlake  Professional  Building. 

REFERENCES 

1.  Mitchell,  James  Herbert:  Arch.  Derm,  and  Syph., 
19:659,  April  1929. 

2.  White,  C.  J.,  and  Swartz,  J.  H.:  Arch.  Derm, 
and  Syph.,  18:692,  November  1928. 

3.  White,  Cleveland:  Arch.  Derm,  and  Syph.,  18: 
429,  September  1928. 

4.  Oliver,  E.  A.:  J.  A.  M.  A.,  91 :870-74,  Septem- 
ber 22,  1928. 

5.  Cole,  H.  N.:  J.  A.  M.  A.,  June  14,  1924. 

6.  Beinhauer,  L.  G. : Arch.  Derm,  and  Syph.,  16:12, 
July  1927. 

7.  Alden,  Eliot:  Unpublished  paper  on  Generalized 
Eczema  Due  to  Chronic  Cholecystitis. 

8.  Highman:  Arch.  Derm,  and  Syph.,  18:983,  De- 
cember 1928. 

9.  Gundrum,  L.  K. : Arch.  Otolaryng.,  8:564-66, 
November  1928. 

10.  Urbach,  E.:  Arch.  f.  Derm.  u.  Syph.,  142:29, 
July  10,  1922. 

11.  Ehrman:  Arch.  f.  Derm.  u.  Syph.,  138:346,  1922. 

12.  Waller:  Zenbralbl.  f.  Haut  u.  Geschlechtskr., 
3:269,  1921. 

13.  Rueda:  Semana,  Med.  2:1190,  November  20, 
1924. 

14.  Burgess,  J.  F.:  Arch.  Derm,  and  Syph.,  16:131, 
August  1927. 

15.  Ayres,  S.,  Jr.:  Arch.  Derm,  and  Syph.,  11:623, 
May  1925. 

16.  Klauder,  J.  V.:  Arch.  Derm,  and  Syph.,  14:610, 
November  1926. 

17.  Usher,  B.,  and  Rabenowitch,  I.  M.:  Arch.  Derm, 
and  Syph.,  16:706,  December  1927. 

18.  Schamberg  and  Brown:  Arch.  Derm,  and  Syph., 
18:801,  December  1923. 

19.  Michael,  J.  C. : Arch.  Derm,  and  Syph.,  14:294, 
September  1926. 

20.  Klauder,  J.  V.,  and  Brown,  H.  S.:  Arch.  Derm, 
and  Svph.,  1 1:283,  March  1925;  (A)  15:1,  January 
1927;  (B)  19:52,  January  1929. 

21.  Throne,  Van  Dyck,  Marples  and  Myers:  N.  Y. 
State  J.  Med.,  July  15,  1927. 

22.  Burnett,  F.  L.:  Am.  J.  Med.  Sc.,  166:415,  Sep- 
tember 1923. 

23.  Klauder,  J.  V.:  Arch.  Derm,  and  Syph.,  11:560, 
April  1925. 

24.  Lebedjew:  Dermat.  Wchnschr.,  79:1003,  Au- 
gust 30,  1924. 

25.  Szego,  P. : Lancet,  52:1593,  June  1928. 

26.  Gibson,  R.:  Brit.  Med.  J.,  1:876,  May  1927. 

DISCUSSION 

Irving  R.  Bancroft,  M.  D.  (812  Detwiler  Building, 
Los  Angeles). — Doctor  Ayres’  review  of  recent  litera- 
ture on  eczema  should  remind  us  that  there  is  a defi- 
nite eczema  threshold  and  that  this  threshold  varies  in 
different  individuals  and  also,  in  the  same  individual, 
under  different  conditions. 

As  the  author  states,  the  different  conditions  which 
modify  this  threshold  or  this  eczema  susceptibility  are 


March,  1930 


ECZEMA — AYRES 


157 


chiefly  internal.  Any  glandular,  excretory,  digestive, 
or  nervous  dysfunction  is  liable  to  have  the  power  of 
modifying  the  susceptibility  to  eczema.  To  ferret  out 
the  definite  basic  cause  requires  a profound  knowl- 
edge of  internal  medicine,  fortified  by  a knowledge  of 
physiologic  chemistry.  The  immediate  cause  of  the 
eczema  eruption  is  often  very  evident,  but  to  find 
the  cause  of  the  lowered  threshold  is  another  and 
more  difficult  matter,  and  without  a knowledge  of  the 
basic  cause  no  permanent  cure  can  be  made.  The 
mere  prescription  of  an  ointment  is  like  stopping  up 
the  rat  hole  without  trying  to  kill  the  rat. 

It  would  be  interesting  to  see  whether,  in  the  light 
of  modern  investigation,  the  theory  originally  pro- 
mulgated by  Brock  that  certain  objective  forms  of 
eczema  arise  from  certain  definite  etiologic  causes  will 
be  proved.  Can  it  be  definitely  stated  that  eczema 
which  is  characterized  by  a papulovesicular  erup- 
tion comes  from  gastro-intestinal  fermentation,  that 
eczema  characterized  by  excessive  itching  and  licheni- 
fication  comes  from  external  irritants,  or  that  the 
erythematous,  scaly  form  comes  from  nutritional  dis- 
turbances and  an  excess  of  alimentary  nitrogenous 
products? 

The  very  interesting  animal  experiments  of  Klauder 
and  Brown  would  seem  to  indicate  that  starvation 
does  not  modify  the  cutaneous  susceptibility  to  eczema, 
but  we  all  know  that  the  eczematous  baby  is  a fat 
baby,  and  it  is  authoritatively  stated  that  during  the 
late  war,  in  starving  Germany  and  Russia,  that  ecze- 
matous eruptions  were  very  rare. 

Eczema,  according  to  all  these  recent  investiga- 
tions, is  merely  a weathervane  which  should  serve  to 
point  the  way  to  further  investigations  so  that  the 
underlying  causes  may  be  found  and  remedied;  and 
if  possible,  that  further  exposure  to  the  immediate 
cause  will  not  be  followed  by  any  troublesome  erup- 
tions of  eczematous  dermatitis. 

At 

C.  Ray  Lounsberry,  M.  D.  (Medico-Dental  Building, 
San  Diego).- — The  author  has  presented  my  concep- 
tion of  the  misnomer,  “eczema.”  I have  felt  for  years 
that  this  term  was  used  to  mask  our  ignorance  in 
diagnosing  certain  skin  lesions.  Just  as  jaundice  many 
times  is  a symptom  of  a deeper  seated  process  within 
the  abdomen,  so  eczema  is  a symptom  complex  of 
some  underlying  condition  which  manifests  itself  by 
oozing,  inflammation,  vesiculation,  and  pustulation, 
combined  with  itching.  It  is  not  a disease. 

I especially  appreciate  the  effort  that  Doctor  Ayres 
has  made  in  giving  us  the  review  of  the  literature 
on  eczema,  as  it  is  presented  today.  These  reviews 
show  definitely  the  trend  of  the  times  in  modern 
dermatologic  thinking.  Causation  seems  to  be  the 
keynote  which  is  presented  by  most  of  the  writers  on 
this  subject.  For  by  going  carefully  into  the  etiology 
of  all  difficult  cases,  by  using  every  known  laboratory 
test,  by  giving  the  patient  a good  physical  examina- 
tion, then  in  diagnosing  a given  state,  we  can  ulti- 
mately arrive  at  a conclusion  as  to  definite  treatment. 

To  illustrate  this  point:  A patient  came  into  my 
office  complaining  of  all  of  the  symptoms  of  a classi- 
cal eczema.  After  a complete  survey  of  her  case  from 
every  angle  by  myself  and  my  colleagues,  her  only 
positive  finding  was  a bad  pair  of  tonsils.  She  cleared 
up  immediately  after  a tonsillectomy  had  been  per- 
formed. Another  case  with  the  same  classical  symp- 
toms cleared  up  after  an  old  chronic  appendix  was 
removed.  So  it  behooves  us  to  go  carefully  into  all 
of  these  cases,  and  by  finding  the  causal  foci  of  the 
trouble  many  times  the  symptoms  of  the  disease  can 
be  relieved. 

Working  on  such  a theory,  in  those  allergic  cases 
which  had  associated  with  their  eczema-like  symp- 
toms, hay  fever  and  asthma  complications,  a blood 
calcium  estimation  was  made.  In  a series  of  ten  cases 
the  blood  calcium  was  below  normal.  These  cases 
were  treated  with  10  cubic  centimeters  of  sterile  10 
per  cent  calcium  gluconate  solution  (Sandoz)  intra- 
venously, until  seven  ampoules  were  given,  after 


which  a blood  calcium  reading  was  made.  The  record 
proved  that  six  of  these  ten  cases  responded  to  logical 
supplementary  treatment  in  proportion  to  the  rise  in 
the  blood  calcium.  The  other  four  cases  in  the  series 
were  not  helped  by  calcium  therapy.  I have  observed 
very  little  benefit  from  calcium  therapy  when  given 
by  mouth. 

■» 

Hiram  E.  Miller,  M.  D.  (384  Post  Street,  San 
Francisco). — Doctor  Ayres  has  given  us  a good 
resume  of  the  recent  studies  on  the  etiology  of 
eczema.  In  his  preliminary  discussion  he  includes 
under  the  heading  of  eczema,  eruptions  due  to  ex- 
ternal irritants,  due  to  fungi,  yeasts,  etc.  From  a 
didactic  standpoint  most  authors  prefer  to  classify 
these  as  dermatitis  venenata,  dermatophytosis,  etc., 
and  reserve  the  term  “eczema”  for  an  eruption  of 
which  the  cause  is  generally  not  known,  but  is  as- 
sumed to  be  an  internal,  constitutional  one. 

I am  extremely  interested  in  this  type  of  investi- 
gative work,  but  have  not  found  the  practical  appli- 
cation of  it  to  be  particularly  helpful.  One  investigator 
will  take  one  hundred  cases  of  so-called  eczema  and 
find  a low  gastric  acidity  in  one-half  of  them;  another 
will  find  a preponderance  of  hyperchlorhydria  in  a 
similar  number  of  patients,  a dysfunction  of  the  pan- 
creas, a disturbed  carbohydrate  metabolism,  a high 
blood  uric  acid,  etc.,  etc.  This  reveals  the  various 
metabolic  changes  associated  with  “eczema”  and  per- 
haps the  effect  of  the  personal  equation  or  the  indi- 
vidual interests  of  the  man  doing  this  type  of  investi- 
gative work. 

The  number  of  eruptions  classified  as  eczema  have 
been  greatly  reduced  in  number  in  the  past  ten  or 
fifteen  years.  This  has  been  accomplished  mainly  by 
bacteriologic  and  allergic  studies  and  not  through  bio- 
chemic  investigations.  However,  I feel  certain  that 
this  type  of  experimental  work  will  ultimately  solve 
some  of  the  remaining  etiologic  problems  of  eczema, 
as  the  men  that  are  most  interested  are  well  trained 
in  biochemic  and  dermatologic  investigation. 

* 

Stanley  O.  Chambers,  M.  D.  (1260  Roosevelt  Build- 
ing, Los  Angeles). — Eczema  still  remains  the  derma- 
tologic Waterloo  for  both  the  student  and  the  practi- 
tioner of  medicine.  The  bulging  literature  crammed 
with  ideas,  methods,  drugs,  and  etiologic  bogies  is 
only  too  well  known  by  those  who  constantly  search 
for  the  light. 

Most  assuredly  the  presentation  of  Doctor  Ayres 
gives  the  listener  an  appreciation  that  a certain 
relationship  of  metabolic  processes  to  dermatologic 
consequences  acutely  exists.  Yet  a degree  of  uncer- 
tainty cannot  fail  to  creep  in  where  results  are  so 
inconsistent.  The  keynote  would  seem  to  be  the  ab- 
sence of  a single  cause  in  the  explanation  for  a dis- 
ease which  apparently  is  an  entity  in  its  clinical  sense. 
Such  a view  has  been  held  by  certain  of  those  engaged 
in  the  study  of  eczema  and  the  allergic  phenomena, 
and  so  far  their  work  evidences  a progression  toward 
this  very  point. 

I myself  believe  that  the  products  of  metabolism, 
normal  or  abnormal,  are  not  the  causes  of  eczema 
per  se,  but  that  such  products  disturb  the  balance  of 
a more  basic  causative  mechanism,  which  results  in 
the  cutaneous  manifestations  which  we  term  “eczema.” 

If  this  be  true  the  dermatologist  will  be  no  less  an 
internist  than  he  is  now. 

That  knowledge  which  we  now  have  at  our  com- 
mand, knowledge  given  to  us  by  investigators  whose 
reports  Doctor  Ayres  has  so  thoroughly  reviewed, 
should  be  utilized. 

* 

Doctor  Ayres  (Closing). — I appreciate  the  discus- 
sion which  this  review  has  stimulated.  Another  new 
contribution  which  was  not  mentioned  in  the  paper 
or  by  the  discussers  is  the  fact  that  a fungus  infection 
of  the  feet  may  produce  a toxic  vesicular  or  scaly 
eruption  of  the  hands  strongly  resembling  the  original 
condition  of  the  feet,  but  free  of  parasites. 


158 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


CAPSULOTOMY  METHOD  OF  LENS 
EXPRESSION* 

By  Delamere  F.  Harbridge,  M.  D. 

Phoenix,  Arizona 

Discussion  by  Lloyd  Mills,  M.D.,  Los  Angeles;  Dohr- 
mann  K.  Pischel,  M.  D.,  San  Francisco. 

Ophthalmologic  literature  discusses 

from  every  conceivable  angle  the  cataract 
problem.  What  the  essayist  writes  may  to  some 
seem  academic,  or  the  repetition  of  mere  plati- 
tudes. The  very  fact  that  so  much  has  been  writ- 
ten and  that  such  a variety  of  measures  have  been 
proposed  in  the  treatment  of  cataracts  is  infer- 
ential evidence  that  the  ideal  procedure  has  not 
yet  been  attained. 

Of  a conservative  temperament  and  having  de- 
veloped in  conservative  medical  surroundings  and 
with  the  ever  present  thought  that  a patient’s  eye- 
sight is  the  goal,  the  writer,  perforce  has  elected 
the  capsulotomy  method,  with  a preliminary  irid- 
ectomy, as  the  preferable  method  in  dealing  with 
the  removal  of  a senile  cataract.  The  manner  of 
doing  this  operation  in  many  details  is  individual 
in  style. 

Relevant  to  this  matter,  the  author  quotes  the 
pertinent  statement  made  by  Doctor  Zentmayer, 
his  teacher  and  ophthalmic  guide.  Doctor  Zent- 
mayer states  that  “the  utility  of  an  operative  pro- 
cedure must  be  estimated,  not  by  the  technique 
and  results  of  its  most  skillful  interpreter,  but 
by  those  likely  to  be  attained  by  a surgeon  of  aver- 
age ability.”  Wilder  observes  that  the  value  of 
any  cataract  procedure  is  not  proved  by  the  visual 
acuity  obtained,  statistically  recorded,  but  rather 
by  how  little  reaction  to  the  trauma  results. 

Having  fixed  upon  the  capsulotomy  operation, 
and  judging  by  his  personal  experience,  the  writer 
has  no  reason  to  delve  into  the  mysteries  of  other 
methods,  but  is  quite  content  to  await  a better 
procedure  which  will  come  as  the  numerous 
heterodox  methods  crystallize  into  an  orthodox 
procedure. 

PREPARATION  OF  PATIENT 

This  embraces  a proper  preparation  of  the  field 
of  operation : a well-chosen  assistant,  fully  com- 
petent to  control  the  lids ; the  needed  assortment 
of  instruments ; and  a cooperative  mental  attitude 
of  the  patient.  The  field  is  prepared  in  the  usual 
manner,  with  the  possible  difference  that  the  cili- 
ary borders  of  the  lids  are  not  scrubbed,  simply 
gently  wiped.  Wilder’s  suggestion  is  valuable. 
Remove  the  cilia  with  scissors,  leaving  the  cen- 
tral ones  to  be  used  as  a handle,  for,  as  he  points 
out,  the  operator’s  attention  should  be  centered 
precisely  upon  the  corneal  section,  and  in  doing 
so  it  is  quite  possible  that  the  point  of  the  knife, 
unobserved,  is  likely  to  come  in  contact  with  a 
few  stray  cilia  at  the  extremities  of  the  lids.  The 

* Read  before  the  Eye,  Ear,  Nose,  and  Throat  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


possible  infection  from  the  lid  borders,  or  the 
danger  of  interference  by  the  cilia,  the  writer 
largely  guards  against  by  the  use  of  solid  and 
rather  broad  lid  retractors,  they  being  retained 
in  position  by  a competent  assistant  until  com- 
pletion of  the  entire  operation,  thus  avoiding  all 
unnecessary  manipulation  of  the  lids.  Particular 
attention  should  be  directed  to  the  lacrimal  sac. 
Culture  and  examine  the  conjunctival  secretions, 
and  when  indications  seem  to  warrant  it  examine 
the  conjunctival  scrapings.  Examination  of  the 
comparative  ratio  between  the  systolic  and  dias- 
tolic blood  pressure,  with  especial  attention  to  the 
latter,  is  of  vital  importance.  As  a preliminary 
step,  but  of  no  less  importance,  is  the  cultivation 
in  the  patient  of  a proper  mental  attitude,  so 
necessary  for  complete  cooperation.  This  is  en- 
couraged by  a full  confidence  between  surgeon 
and  patient.  Do  not  request  too  much  of  the 
patient,  but  rather  encourage  him  to  assume  a 
passive  frame  of  mind.  One  under  the  stress  of 
a cataract  operation  should  not  be  burdened  with 
too  many  admonitions,  or  his  equilibrium  is  liable 
to  be  so  disturbed  that  he  will  be  unable  to 
properly  coordinate.  During  the  operation  there 
should  be  absolute  silence.  Not  only  is  it  un- 
becoming for  the  surgeon  to  assume  a bombastic, 
domineering  demeanor,  but  it  is  fatal  to  the  best 
interests  of  his  patient.  How  purposeful  are  the 
words  of  Ammar  of  Mosul,  that  Egyptian  eye 
surgeon  who  originated  suction  in  soft  cataract, 
now  known  as  Daviel’s  extraction.  He  was  very 
solicitous  for  the  welfare  of  his  patient,  shud- 
dered with  desperation  if  the  operation  did  not 
progress  favorably.  He  recommends  “to  proceed 
with  caution  and  circumspection,  addressing  kind 
words  to  his  patient  when  the  cataract  needle 
enters  the  eye.”  He  makes  great  demands  upon 
the  eye  surgeon — that  he  should  be  provided  with 
sharp  senses,  a sure  hand,  and  greatest  experience. 

ANESTHESIA 

Too  much  emphasis  cannot  be  placed  on  the 
matter  of  thorough  anesthesia.  Not  only  surface 
anesthesia,  but  complete  lid  anesthesia  is  essential. 
Van  Lint’s  method  of  injecting  a 2'  per  cent  novo- 
cain solution  along  the  lower  orbital  rim,  in  the 
neighborhood  of  the  external  canthus  and  over 
the  site  of  the  lacrimal  sac,  is  ideal.  The  greatest 
single  advance  in  cataract  surgery  is  undoubt- 
edly due  to  proper  lid  control.  Satisfactory  lid 
anesthesia,  together  with  full  confidence  between 
patient  and  surgeon,  represents  90  per  cent  of 
success. 

OPERATIVE  PROCEDURES 

It  is  the  writer’s  practice  to  do  a preliminary 
iridectomy.  It  guards  against  the  iris  falling  in 
front  of  the  knife  when  later  making  the  corneal 
section.  It  facilitates  the  capsulotomy.  It  over- 
comes the  need  for  the  patient  to  look  downward 
at  the  time  of  lens  expression.  It  is  a possible 
aid  in  maturing  not  fully  ripe  lenses.  In  some  it 
may  temporarily  improve  vision.  It  is  a safe- 


March,  1930 


LENS  EXPRESSION  BY  CAPSULOTOMY— HARBRIDGE 


159 


guard  against  glaucoma.  It  avoids  extra  trauma 
at  the  time  of  lens  expression,  thus  obviating  a 
disturbing  bleeding  which  would  seriously  incon- 
venience further  manipulations.  The  most  impor- 
tant feature,  however,  is  the  fact  that  the  patient 
receives  an  education  as  to  the  required  conduct 
necessary  for  successful  cooperation.  In  turn  the 
surgeon  learns  the  temperamental  peculiarities  of 
his  patient,  and  how  his  tissues  react  to  the  insult 
inflicted.  In  a discussion  with  one  of  our  coun- 
try’s most  distinguished  eye  surgeons  on  this 
matter  of  preliminary  iridectomy  that  surgeon 
stated  that  while  he  used,  upon  occasions,  some 
of  the  newer  methods,  yet  if  his  eye  was  to  be 
operated  upon  for  cataract,  he  certainly  would 
desire  a preliminary  iridectomy,  followed  later  by 
capsulotomy  and  expression. 

An  interval  of  three  or  four  weeks  is  allowed 
to  elapse  before  making  the  corneal  section.  A 
well-made,  clean  incision,  properly  placed,  lends 
much  to  success.  Unmindfulness  of  this  feature 
may  precipitate  serious  consequences.  The  in- 
cision must  be  of  such  length  as  to  permit  the 
lens  to  escape  readily,  without  stripping  the  corti- 
cal material  from  the  nucleus  'or  breaking  of  the 
lens.  Leaving  an  undue  amount  of  cortical  sub- 
stance within  the  eye  has  a distinct  disadvantage, 
subjecting  the  eye  later  to  possible  serious  posi- 
tive lens  reaction. 

The  incision  must  be  so  placed  as  to  give  the 
required  length  without  invading  important  uveal 
structures,  and  also  avoid  the  possibility  of  later 
gaping  of  the  wound.  While  the  use  of  sutures 
is  advocated  by  some,  it  has  many  inconvenient 
features.  The  placing  of  the  incision  in  that  por- 
tion of  the  cornea  which  is  best  nourished  aids 
much  in  the  future  healing  process.  Primary 
healing  of  the  wound  is  essential.  An  incision 
placed  entirely  in  the  sclerocorneal  limbus,  oc- 
cupying about  two-fifths  of  the  circumference  of 
the  cornea,  will  meet  more  nearly  the  needs;  if 
placed  wholly  in  the  cornea,  a much  larger  in- 
cision will  be  necessary,  thus  courting  the  dangers 
from  a gaping  wound.  A small  conjunctival  flap 
is  desirable  in  that  it  heals  more  promptly  and 
thus  seals  the  wound..  If  a small  hemorrhage  is 
encountered,  it  can  be  controlled  by  the  use  of 
epinephrin. 

After  the  corneal  puncture  is  made,  the  blade 
of  the  knife  is  pressed  forward,  making  the  coun- 
ter puncture  and  without  hesitation  cutting  up 
in  the  line  of  the  limbus  deftly  and  promptly. 
Immediately  before  completing  the  section,  less 
aggressive  action  is  essential.  The  entire  pro- 
cedure requires  the  nerve  of  a lion  and  the  tactile 
delicacy  of  a lady’s  hand.  The  writer  is  accus- 
tomed to  use  a knife,  the  belly  of  which  is  two 
and  one-half  millimeters  in  width,  and  straight 
up,  to  within  four  millimeters  of  the  point. 
Daviel,  who  in  1753  really  was  the  inventor  of 
the  intracapsular  method,  devised  this  semicircular 
incision.  Since  that  time  it  has  undergone  many 
modifications,  only  to  return  to  its  original  form. 


Couching,  which  showed  a 40  per  cent  loss  of 
eyes,  was  thus  reduced  to  10  per  cent,  and  later 
Albrecht  von  Graefe’s  introduction  of  the  capsu- 
lotomy method  further  reduced  the  loss  to  be- 
tween 2 and  4 per  cent. 

In  performing  the  capsulotomy,  the  method  of 
incision  is  quite  individual  to  the  operator.  Knapp 
suggests  an  incision  paralleling  the  corneal  sec- 
tion. Crucial  incisions  of  A and  V type  are 
recommended.  The  writer’s  practice  is  an  attempt 
to  join  two  semicircular  incisions.  In  recent  years 
forceps  have  come  into  greater  use  than  formerly 
in  the  removal  of  the  central  portion  of  the  cap- 
sule. Certain  distinct  advantages  are  gained  with 
this  method  in  preventing  the  wound  closing,  and 
thus  retaining  some  of  the  lens  material.  The 
disadvantage  of  the  retention  of  an  undue 
amount  of  lens  material  is  obvious.  In  the  use 
of  forceps  the  danger  of  a sudden  upward  move- 
ment of  the  eye  is  to  be  guarded  against.  Fischer 
has  devised  a special  forceps  for  this  purpose. 

In  the  removal  of  the  lens,  three  anatomical 
features  are  presented : the  capsule,  the  cortex, 
and  the  nucleus.  Immediately  we  are  confronted 
by  one  of  two  procedures,  whether  delivery  of 
tbe  entire  lens  in  its  capsule,  “the  intracapsular 
method,”  or  the  delivery  of  the  lens,  cortex  and 
nucleus,  leaving  much  of  the  capsular  membrane, 
“the  capsulotomy  method.”  The  writer  elects  the 
latter.  For  the  purpose  of  lens  expression,  two 
spatulae  of  two  millimeters  in  width  are  used, 
one  curved  on  the  flat  at  the  outer  half  at  about 
forty-five  degrees.  One  guards  the  wound ; and 
with  the  convex  surface  of  the  curved  spatula, 
pressure  toward  the  interior  of  the  eye  is  applied, 
just  inside  the  lower  limbus,  opposite  the  lower 
lens  border.  The  pressure  should  be  firm,  steady 
and  definite  at  first,  cautiously  and  gradually  in- 
creasing in  force.  This  causes  the  wound  to  gape 
and  the  lens  to  start.  Such  directed  and  controlled 
pressure  is  continued  until  just  before  the  greatest 
thickness  of  the  lens  is  about  to  be  engaged  in 
the  wound.  At  this  time  it  is  well  to  pause  a 
moment  to  allow  the  tissues  to  accommodate 
themselves  to  the  decreasing  tension.  The  suc- 
ceeding pressure  is  to  be  directed  upward  toward 
the  wound,  bringing  along  with  the  spatula  the 
nucleus  and  as  much  of  the  soft  cortex  as  pos- 
sible. The  first  pressure  tilts  and  displaces  the 
lens,  causing  the  edge  to  present.  The  second 
pressure  forces  the  lens  out  of  the  eyeball.  To 
accomplish  this  phase  of  a cataract  operation  re- 
quires a trained  eye  and  a hand  capable  of  exert- 
ing with  delicate  precision  just  the  right  pressure 
to  achieve  the  desired  results.  As  the  lens  is  de- 
livering, the  pressure  is  lessened,  but  the  same 
level  is  maintained  and  the  spatula  turned  slightly, 
so  that  the  convexity  will  receive  the  lens  nucleus 
and  as  much  of  the  cortex  as  may  come  away. 
Remaining  soft  cortex  or  lens  debris  may  be  re- 
moved by  repeating  the  corneal  pressure  two  or 
three  times.  Many  operators  accomplish  this  by 
irrigating  the  anterior  chamber.  It  is  the  writer’s 
habit  to  “get  in  and  get  out”  with  the  least  amount 


160 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


of  manipulation.  At  no  time  is  the  patient  com- 
manded or  unduly  urged  to  change  the  position 
of  his  eye  from  the  primary  position.  This  more 
or  less  passive  position  is  much  in  accord  with 
the  passive  attitude  of  the  patient.  Should  there 
be,  after  delivery  of  the  lens,  undue  gaping  of 
the  wound,  or  the  presentation  of  uveal  tissue,  or 
perchance  vitreous,  further  manipulation  is  im- 
mediately stopped  and  the  lids  allowed  to  gently 
close.  After  a rest  of  several  minutes  the  field 
of  operation  is  again  exposed  and  the  toilet  of 
the  eye  completed. 

Prompt  and  uncomplicated  recovery  is  greatly 
facilitated  by  a well-conducted  toilet.  The  com- 
pleteness with  which  these  measures  may  be  car- 
ried out  depends  greatly  upon  the  conduct  of  the 
patient.  In  the  tractable,  this  program  can  be  con- 
ducted successfully,  but  in  the  utterly  intractable 
patient  it  is  far  safer  to  attempt  only  the 
most  imperative  measures.  Removal  of  any  re- 
maining cortical  material,  if  not  successfully  ac- 
complished by  stroking  the  cornea,  may  be  at- 
tempted by  irrigation.  Probably  the  safest  ap- 
paratus is  an  all-glass  syringe  with  a small  metal 
pipe  such  as  a dentist  uses  in  irrigating  a dental 
canal.  The  tip  should  be  placed  at  the  lips  of 
the  wound,  certainly  not  beyond  the  inner  edge. 
Occasionally  a spatula  or  a Daviel  spoon  is  of 
service.  Reposition  of  the  iris,  freeing  the  angles 
and  smoothing  out  the  pillars  of  the  coloboma 
are  best  done  by  the  spatula.  The  incision  is  to 
be  cleansed,  freeing  it  from  all  debris,  and  with 
forceps  gently  removing  any  shreds  of  clotted 
blood.  Careful  coaptation  of  the  lips  of  the  in- 
cision and  placing  in  position  the  narrow  con- 
junctival flap  completes  the  procedure. 

Both  eyes  are  covered  with  a light  dressing  and 
a pad  of  four  or  five  thicknesses  of  gauze,  with 
four  tapes,  two  longer  so  that  they  may  be  tied 
in  the  neighborhood  of  the  ear,  the  whole  being 
held  in  position  by  two  strips  of  adhesive.  No 
heavy  or  cumbersome  masks  or  dressings  are 
used.  In  perfectly  smooth  cases  the  eye  is  not 
inspected  or  the  dressing  changed  for  four  days. 

RESULTS 

In  selected  cases  of  cataract  85  to  90  per  cent 
of  the  operations  will  yield  first-class  results.  In 
unselected  cases,  probably  15  to  20  per  cent  will 
show  indifferent  results  or  loss;  about  5 per  cent 
are  failures.  Many  of  the  difficulties  are  due  to 
intractable  patients,  diseased  conditions,  inade- 
quate lid  control,  poor  instrumentation,  particu- 
larly improper  knives,  and  lenses  with  large  nuclei 
and  small  sections. 

After-cataract  is  a complication  present  in 
probably  75  per  cent  of  cases.  Knapp,  together 
with  others,  advocates  early  discission.  The 
writer  feels  more  confident  to  wait  six  weeks  to 
two  months.  By  either  the  Knapp  or  Ziegler 
method,  or  the  small  de  Wecker  scissors,  he  has 
always  found  it  a difficult  procedure  to  produce 
a good  opening  in  the  capsule.  However,  since 
\\  heeler  has  given  us  his  method  of  dealing  with 


after-cataract,  the  question  has  been  simplified  to 
almost  100  per  cent  ideal. 

OPERATIVE  PROCEDURES  COMPARED 

In  1911  the  Chicago  Ophthalmic  Society  pre- 
sented a very  exhaustive  symposium  on  the  ex- 
pression of  senile  cataract.  This  symposium  was 
taken  part  in  by  nineteen  distinguished  ophthalmic 
surgeons.  All  phases  of  the  subject  were  dis- 
cussed, based  on  the  best  information  obtainable 
up  to  that  time.  It  was  a time,  many  will  re- 
member, when  intracapsular  methods  were  being 
actively  discussed.  One  hundred  and  sixty  replies 
to  a questionnaire  received  from  ophthalmic  sur- 
geons throughout  this  country  relative  to  the 
comparative  merits  of  the  capsulotomy  and  intra- 
capsular methods  were  analyzed.  It  is  somewhat 
interesting  to  observe  that  (knowing  the  person- 
nel, to  a large  extent,  of  the  list  that  replied  to 
the  questionnaire)  one  can  associate  the  intracap- 
sular operation  with  those  of  a more  venturesome 
turn  of  mind.  Of  the  one  hundred  and  sixty 
replies,  only  30.6  per  cent  had  performed  the 
intracapsular  operation,  34.6  per  cent  of  this 
number  considered  the  intracapsular  method  in- 
ferior. Some  of  the  objections  offered  were: 
greater  difficulty  in  performing  the  operation,  loss 
of  vitreous,  lack  of  safety  for  the  operator  of 
average  ability,  and  a greater  percentage  of  poor 
cosmetic  results.  Of  the  percentage  that  had  per- 
formed the  operation,  22.4  per  cent  reported 
poorer  vision.  Those  doing  the  capsulotomy 
method  reported  from  40  to  80  per  cent  of  their 
cases  required  a discission.  Eight  noted  iritis,  one 
glaucoma,  and  four  reported  infection.  Since  that 
time  much  experience  has  been  accumulated.  The 
writer  selected  eight  of  the  outstanding  surgeons 
who  answered  the  questionnaire  and  to  these  he 
addressed  communications  calling  attention  to 
their  answers  in  1911,  and  requested  their  fur- 
ther opinion  based  upon  subsequent  developments. 
Their  replies  were  as  follows : 

Jackson,  Edzvard. — His  opinion  has  not  changed. 
The  intracapsular  methods  have  failed  to  do  what 
was  hoped  from  them.  For  his  own  eyes  he  would 
not  submit  to  the  intracapsular  method. 

Zentmayer,  William.  — • Capsulotomy  method 
safer.  Looks  with  favor  on  the  Knapp’s  intra- 
capsular method,  but  does  not  do  any  of  the  intra- 
capsular operations. 

Wiirdemann,  Henry. — Does  about  60  per  cent 
of  his  cases  by  the  intracapsular  method.  About 
five  hundred  cases  since  1908. 

Fisher,  William. — Has  changed  his  intracap- 
sular methods  of  operation.  Does  not  do  the 
Smith  operation  any  more.  Does  a modified 
Barraquer  method.  States  if  surgeons  would  be 
fair  and  noted  amount  of  postoperative  inflamma- 
tion and  poor  vision  due  to  retained  capsule,  they 
would  not  stress  the  complications  which  some- 
times follow  the  intracapsular  methods. 

Wilder,  William. — Does  an  intracapsular  opera- 
tion similar  to  the  Knapp  method.  If  it  were  his 


March,  1930 


LENS  EXPRESSION  BY  CAPSULOTOMY — HARBRIDGE 


161 


own  eyes  he  would  prefer  a preliminary  iridec- 
tomy, followed  by  a capsulotomy  and  expression. 

Green,  John. — Believes  the  capsulotomy  method 
a better  and  safer  procedure  for  eye  surgeons  of 
average  ability  than  any  intracapsular  method  so 
far  devised. 

De  Schweinitz,  George. — Believes  cystotome 
should  be  abandoned.  Uses  capsular  forceps.  Be- 
lieves Knapp’s  method  the  best  intracapsular 
method,  if  advising  an  intracapsular  operation. 
Personal  experience  too  limited. 

Cradle,  Harry  S. — Has  abandoned  intracap- 
sular methods  owing  to  slow  closure  of  wounds, 
ruptured  capsule,  drawn  pupils,  poor  cosmetic  re- 
sults. Regards  combined  capsulotomy  method 
only  safe  procedure. 

SUMMARY 

The  above  procedures  reflect  much  of  the 
writer's  views  regarding  the  cataract  problem.  It 
is  to  be  remembered,  however,  that  expedience 
and  community  conditions  govern  or  modify 
many  accepted  principles  of  eye  surgery.  It  is 
almost  axiomatic  in  eye  surgery  that  subsequent 
complications  are  minimized  by  the  fewer  steps 
to  an  operation  and  the  least  amount  of  trauma 
inflected. 

It  may  be,  perchance,  that  dealing  with  certain 
types  of  cataract,  or  with  certain  classes  of  pa- 
tients, such  as  Colonel  Smith  came  in  contact 
with,  or  clinic  patients  in  large  cities  of  this  coun- 
try, the  intracapsular  operation  may  fulfill  the 
needs  of  a limited  number.  However,  in  the 
practice  of  the  ophthalmic  surgeon  of  average 
ability,  or  in  the  average  community,  it  seems 
to  the  writer  very  ill  advised  to  undertake  such 
a procedure. 

Goodrich  Building. 

DISCUSSION 

Lloyd  Mills,  M.  D.  (609  South  Grind  Avenue,  Los 
Angeles). — Patients  have  the  right  to  expect  that 
every  measure  which  safeguards  them  from  complica- 
tions during  and  after  cataract  extractions  will  be 
used  provided  the  risks  of  operation  are  not  increased 
thereby.  Certain  cases  clearly  are  capable  of  almost 
ideal  operative  measures  such  as  the  various  forms 
of  extraction  within  the  capsule  may  be  in  skilled 
hands.  Other  cases  manifestly  demand  combined 
extraction. 

Men  who  do  ten  or  twelve  cataracts  a year  never 
acquire  the  skill  or  judgment  necessary  to  separate 
these  cases.  It  is  generally  recognized  that  the  safest 
procedure  for  these  occasional  operators  is  the  com- 
bined extraction  done  with  blocking  of  the  facial 
nerve.  It  is  not  clear  how  many  surgeons  still  can 
persist  in  leaving  their  cataract  wounds  open  to  infec- 
tion and  to  all  the  complications  which  delayed  heal- 
ing and  unusual  strain  can  cause  during  convales- 
cence. Nowhere  else  in  the  body  do  surgeons  have 
the  temerity  to  leave  the  wounds  of  vital  areas  open 
to  any  and  every  possible  mischance.  To  prevent  this 
the  use  of  the  full  conjunctival  flap  and  its  complete 
suture  have  been  introduced  and  are  unqualifiedly 
urged  by  those  who  have  had  sufficient  experience 
with  both  methods  to  know  the  protective  value  of 
the  full  suture.  By  its  means  secondary  infection  and 
secondary  glaucoma  almost  have  been  eliminated  and 
practically  all  other  complications  save  those  arising 
from  the  retention  of  lens  material  have  been  reduced 
almost  to  the  vanishing  point.  Most  of  the  younger 


eye  surgeons  throughout  the  world  are  adopting  this 
measure,  which  is  applicable  to  nearly  all  forms  of 
adult  cataract  operation. 


Dohrmann  K.  Pischel,  M.  D.  (490  Post  Street,  San 
Francisco). — In  discussing  the  advantages  of  the  cap- 
sulotomy method  of  lens  expression  we  must  cer- 
tainly emphasize  the  important  advances  of  the  past 
decade  or  two,  which  have  so  vastly  improved  the 
end  results.  Therefore  I was  surprised  that  the  author 
dismissed  the  subject  of  capsule  forceps  with  a few 
sentences.  The  importance  of  this  subject  is  brought 
out  in  one  of  the  replies  to  his  questionnaire  which 
the  author  quotes  as  follows:  “De  Schweinitz  be- 
lieves cystotome  should  be  abandoned.  Uses  capsule 
forceps.” 

The  advantages  of  the  capsule  forceps  can  hardly 
be  overestimated,  and  should  certainly  be  stressed. 
The  removal  of  a large  central  piece  of  the  anterior 
capsule  accomplishes  several  things.  It  removes  that 
portion  of  the  capsule  just  in  front  of  the  pupil  which 
furthermore  might  be  opaque  and  thus  interfere  with 
good  vision.  By  substituting  a lacerated  wound  in  the 
capsule  for  an  incised  one,  it  does  not  allow  the  cap- 
sule to  rapidly  close  again  and  thus  seal  off  the 
retained  cortex  which  will  form  a dense  secondary 
cataract.  Naturally,  with  a proper  hole  in  the  anterior 
capsule,  it  never  closes  in  the  pupillary  area.  Thus 
the  aqueous  has  free  access  to  any  retained  lens  cortex 
there  and  quickly  absorbs  it.  The  result  is  the  ap- 
pearance of  a black  pupil  in  a surprisingly  short  time, 
even  when  a large  amount  of  cortex  has  been  left 
behind.  The  contrary  was  true  when  a linear  incision 
was  made  with  the  cystotome,  for  the  capsule  wound 
was  quickly  sealed  and  no  absorption  of  cortex  could 
take  place. 

I do  not  believe  that  there  are  any  valid  objections 
to  the  use  of  the  capsule  forceps.  As  they  can  be 
withdrawn  very  easily  and  quickly,  the  danger  of  a 
sudden  upward  movement  of  the  eye  is  less  when  they 
are  employed  than  when  the  cystotome  is  used.  The 
possibility  of  luxating  the  lens  into  the  vitreous  cavity 
by  too  great  pressure  on  it  when  attempting  to  grasp 
the  anterior  capsule  is  so  remote  when  done  properly 
that  it  can  be  entirely  disregarded. 

The  high  incidence  of  secondary  cataract  after  cap- 
sulotomy operations  of  the  older  type  (so  heavily 
stressed  by  the  intracapsular  advocates)  has  always 
been  considered  the  chief  disadvantage  of  this  opera- 
tion. Its  prevention  has  been  eagerly  sought  by  many 
means.  Here  we  have  the  crux  of  the  whole  situa- 
tion. With  the  capsule  forcep  technique  the  compli- 
cation of  secondary  cataract  is  practically  removed, 
and  with  it  such  unnecessarily  high  incidence  of  opera- 
tions for  after-cataracts  as  75  per  cent  will  disappear. 
Twenty  to  25  per  cent  will  then  be  much  nearer  the 
correct  figure. 

In  closing,  I might  also  mention  the  use  of  Hess’ 
spoons  in  the  delivery  of  retained  cortex.  This  in- 
strument was  designed  by  that  master  operator,  the 
late  Professor  Hess  of  Munich.  These  broad  spoons 
enable  one  to  massage  out  considerable  material  and 
thus  hasten  convalescence. 


Doctor  Harbridge  (Closing). — The  writer  wishes  to 
express  his  appreciation  to  the  colleagues  who  have 
discussed  his  paper.  He  wishes  especially  to  thank 
Doctor  Pischel  for  the  emphasis  he  has  placed  upon 
the  importance  of  doing  a proper  capsulotomy.  The 
use  of  capsule  forceps  perhaps  should  be  the  pro- 
cedure of  election.  The  author  described  the  tech- 
nique he  has  been  accustomed  to  use  and  therefore 
described  the  method  which  had  for  its  object  the 
same  end  as  suggested  by  Doctor  Pischel,  namely, 
the  obliteration  of  the  central  portion  of  the  anterior 
capsule,  thus  allowing  more  complete  absorption  of 
any  remaining  cortex. 


162 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


BLADDER  CARE  AFTER  ABDOMINAL 
OPERATIONS* * 

By  Robert  Glenn  Craig,  M.  D. 

San  Francisco 

Discussion  by  Homer  C.  Seaver,  M.D.,  Los  Angeles; 
H.  K.  Bonn,  M.D.,  Los  Angeles;  William  Henry  Gilbert, 
M.D.,  Los  Angeles;  H.  N.  Shaw,  M.  D.,  Los  Angeles. 

HPHE  technique  of  surgical  operations  is  now 
becoming  so  well  standardized  that  further 
improvement  along  this  line  will  probably  be  slow. 
As  this  is  becoming  better  recognized,  more  at- 
tention is  being  directed  to  the  preoperative  and 
postoperative  care  to  lessen  the  postoperative  mor- 
bidity and  to  make  more  pleasant  the  postopera- 
tive convalescence.  One  source  of  anxiety  to  the 
surgeon,  and  more  especially  to  the  gynecologist, 
is  the  care  of  the  bladder  immediately  after  opera- 
tion. As  evidence  of  this  anxiety  we  have  only 
to  recollect  the  frequency  with  which  the  question, 
“Has  the  patient  voided?”  is  asked  during  the 
first  twenty-four  to  forty-eight  hours  after  oper- 
ation, and  the  sigh  of  relief,  audible  or  inaudible, 
when  the  answer  is  in  the  affirmative.  In  gyne- 
cology, where  the  operations  are  carried  out  in 
close  proximity  to  the  bladder,  or  which  may 
involve  that  organ,  distention  of  the  bladder  is 
more  apt  to  cause  a disturbance  in  the  postopera- 
tive anatomical  relations  which  may  lead  to  serious 
postoperative  complications.  For  this  reason,  the 
gynecologist  has  not  felt  justified  in  allowing  the 
bladder  to  become  overdistended  before  catheter- 
ization, as  can  be  done  with  safety  after  opera- 
tions within  the  upper  abdomen,  thus  increasing 
his  anxiety. 

While  it  has  been  stated  that  it  is  difficult  to 
infect  a normal  bladder  by  the  use  of  a catheter, 
it  is  undoubtedly  true  that  any  procedure  which 
will  lessen  the  incidence  of  postoperative  cathe- 
terization will  also  lessen  the  incidence  of  post- 
operative cystitis. 

PROCEDURES  PROMOTING  NONRETENTION 

Numerous  procedures  have  been  and  are  being 
advocated  which  will  cause  the  patient  to  void 
after  a postoperative  retention  with  distention  has 
occurred.  These  may  be  grouped  under  three 
headings : 

1.  Intravesical  instillations. 

2.  Internal  medication,  either  oral,  subcutane- 
ous, or  intravenous. 

3.  Psychic  stimuli. 

None  of  these  recommendations  are  directed 
primarily  to  the  prevention  of  catheterization, 


* From  the  Department  of  Gynecology,  Johns  Hopkins 
University  and  Hospital,  Baltimore,  Md. 

I would  like  to  take  this  opportunity  to  thank  Dr. 
Thomas  S.  Cullen,  Professor  of  Gynecology,  for  the  priv- 
ilege of  undertaking  this  study  on  his  service.  I am  also 
indebted  to  members  of  the  resident  house  staff  and  to 
Miss  Ruth  Doran  for  their  valuable  assistance. 

* Read  before  the  Obstetrics  and  Gynecology  Section  of 
the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


thus  causing  the  patient  to  void  spontaneously 
before  the  bladder  becomes  distended.  This  re- 
port is  concerned  with  the  prevention  of  a disten- 
tion rather  than  with  the  correction  of  a retention. 

CATHETERIZATION  AND  POSTOPERATIVE 
CYSTITIS 

The  results  to  be  reported  were  first  called  to 
our  attention  during  a study  of  postoperative  cys- 
titis begun  in  Baltimore  in  1925.  At  that  time 
it  was  felt  that  catheterization  was  of  major  etio- 
logic  importance  in  postoperative  cystitis  and  that 
an  instillation  given  at  the  time  of  catheterization 
would  probably  lessen  the  incidence  of  infection. 
The  commoner  solutions,  such  as  silver  nitrate, 
argyrol,  and  mercurochrome,  were  used.  We 
were  pleasantly  surprised  to  find  that  the  neces- 
sity for  catheterization  after  mercurochrome  was 
much  less  than  after  any  other  solution  used. 
The  results  after  the  use  of  mercurochrome  to 
prevent  postoperative  catheterization  are  given  in 
this  paper.  In  order  that  a patient  may  have  suffi- 
cient fluid  in  the  bladder  to  void  after  an  opera- 
tion, it  is  necessary  that  the  fluid  intake  within 
twenty-four  hours  after  operation  be  sufficiently 
great.  We  now  take  measures  to  increase  this 
intake  by  allowing  the  patient  fluids  before  oper- 
ation and  by  giving  him  fluids  immediately  after 
operation. 

CLASSIFICATION  OF  RESULTS 

The  results  which  are  to  be  reported  have  been 
divided  into  four  groups : 

1.  Control  group,  in  which  nothing  was  done — - 
ninety-nine  patients. 

2.  Group  two,  in  which  one  ounce  of  one  per 
cent  mercurochrome  was  instilled  into  the  bladder 
at  the  time  of  operation — seventy-eight  patients. 

3.  Group  three,  in  which  one  ounce  of  one-half 
per  cent  mercurochrome  was  instilled  into  the 
bladder  at  the  time  of  operation — ninety-three 
patients. 

4.  Group  four,  in  which  one  ounce  of  one-half 
per  cent  mercurochrome  was  instilled  into  the 
bladder  at  the  time  of  operation  plus  one  liter  of 
fluid  per  rectum — thirty-nine  patients. 

All  the  patients  reported  in  these  groups  had 
laparotomies  in  which  some  pelvic  operation  had 
been  done. 

COMMENT  ON  GROUPS 

1.  Control  Group. — Ninety-nine  patients  were 
observed  in  the  first  control  group  in  which  noth- 
ing was  done  to  prevent  catheterization.  These 
patients  alternated  with  those  who  received  an 
instillation.  It  is  necessary  to  be  familiar  with 
the  routine  followed  on  the  gynecological  service 
of  the  Johns  Hopkins  Hospital  at  the  time  these 
patients  were  observed.  During  this  period  all 
patients  who  did  not  void  at  least  100  cubic  centi- 
meters of  urine  at  one  time  within  eight  hours 
after  they  were  returned  to  the  ward,  were  cathe- 
terized.  They  were  further  catheterized  every 
eight  hours  if  they  did  not  void  100  cubic  centi- 
meters at  one  time  within  a similar  period.  In 
other  words,  at  no  time  immediately  after  opera- 
tion, was  the  bladder  allowed  to  be  distended  with 


March,  1930 


POSTOPERATIVE  BLADDER  CARE — CRAIG 


163 


urine.  As  sutures  are  often  placed  near  and  the 
dissection  is  carried  close  to  the  bladder  in  gyn- 
ecological operations,  this  is  considered  a wise 
precaution. 

2.  Group  Tzvo  Received  One  Per  Cent  Mercu- 
rochrome  a~s  a Bladder  Instillation. — In  the  sec- 
ond group  of  seventy-eight  patients  who  received 
one  ounce  of  one  per  cent  aqueous  solution  of 
mercurochrome  immediately  after  operation,  it 
was  found  necessary  to  catheterize  eighteen  pa- 
tients, or  23  per  cent.  The  same  routine  was  ob- 
served as  in  the  control  group.  Some  of  these 
patients,  after  the  instillation  of  one  per  cent 
mercurochrome  complained  of  bladder  irritation 
and  a desire  to  void.  These  always  obtained 
immediate  relief  from  symptoms  by  a bladder  irri- 
gation of  50  per  cent  saturated  boric  acid  solu- 
tion, and  usually  continued  to  void  spontaneously. 
Hemorrhage  or  blood  in  the  urine  in  small 
amounts  occurred  in  about  two  per  cent  of  the 
patients  observed.  It  was  thought  that  this  was 
due  to  the  irritative  effect  of  the  mercurochrome 
on  the  bladder  mucosa.  For  this  reason  one-half 
per  cent  mercurochrome  was  substituted  for  the 
one  per  cent  mercurochrome.  No  blood  has  been 
found  in  the  urine  in  any  of  these  cases. 

3.  Group  Three  Received  One-Half  Per  Cent 
M ercurochrome  as  a Bladder  Instillation. — In  the 
third  group  of  ninety-three  patients,  mercuro- 
chrome (one-half  per  cent)  was  given  as  a blad- 
der instillation  and  it  was  found  necessary  to 
catheterize  only  eight  patients,  or  8.6  per  cent. 
It  is  necessary  to  state  that  the  routine  observed 
in  the  first  two  groups  was  not  followed  in  this 
group.  A slight  change  was  made  in  that  the 
initial  time  which  was  allowed  to  elapse  before 
catheterization  was  changed  from  eight  to  twelve 
hours. 

4.  Group  Four  Received  One-Half  Per  Cent 
Mercurochrome  and  Additional  Fluid  by  Rectum. 
In  the  fourth  group  of  thirty-nine  patients  who 
received  one  liter  of  two  per  cent  soda  bicarbo- 
nate solution  containing  sixty  cubic  centimeters 
of  mineral  oil,  per  rectum,  in  addition  to  a blad- 
der instillation  of  one  ounce  of  one-half  per  cent 
aqueous  solution  of  mercurochrome,  it  was  neces- 
sary to  catheterize  three,  or  7.7  per  cent.  The 
same  routine  was  observed  as  in  the  third  group. 

Table  1. — Showing  the  Results  Obtained  by  a Bladder 
Instillation  of  Mercurochrome 


Patients  Catheterizations  Necessary 


Group  Observed 

No.  Pts. 

Per  Cent 

1.  Control  group 

2.  Bladder  instillations  of 

99 

60 

60 

one  per  cent  mercu- 
rochrome   

78. 

IS 

23 

3.  Bladder  instillation  of 

one-half  per  cent 
mercurochrome  

93 

8 

8.6 

4.  Bladder  instillation  of 

one-half  per  cent 
mercurochrome  plus 
one  liter  of  rectal 
fluid  

39 

3 

7.7 

1 he  figures  given  above  represent  the  number 
of  patients  in  whom  one  or  more  catheteriza- 
tions were  necessary  and  does  not  represent  the 
proportionate  decrease  in  the  actual  number  of 


catheterizations,  as  patients  catheterized  once  not 
infrequently  had  to  be  catheterized  three  to  four 
times.  It  was  further  observed  that  an  instilla- 
tion of  mercurochrome  after  a catheterization 
decreased  the  necessity  for  subsequent  catheteri- 
zations. 

TECHNIQUE 

Th£  technique  in  all  of  these  cases  consisted 
in  the  instillation  into  the  bladder  on  the  operat- 
ing table  immediately  after  operation,  of  one 
ounce  of  the  mercurochrome  solution.  Since  then, 
in  many  cases  we  have  made  the  instillation  at 
the  time  of  catheterization  at  the  beginning  of 
the  operation  and  have  noticed  no  difference  in 
the  results. 

The  rectal  instillation  of  fluid  was  given  on  the 
operating  table  while  the  patient  was  still  under 
the  anesthesia.  If  the  flow  was  slow,  it  could  be 
easily  accelerated  by  a slight  Trendelenberg  posi- 
tion. It  is  absolutely  necessary  that  the  patient 
be  kept  under  anesthesia  while  the  fluid  is  being 
given.  In  less  than  one  per  cent  of  the  patients 
treated  was  any  of  the  fluid  expelled. 

COMMENT 

No  scientific  explanation  can  be  made  as  to 
why  an  instillation  of  mercurochrome  should 
cause  a patient  to  void  spontaneously.  It  is  as- 
sumed that  with  the  dissection  of  the  bladder 
causing  trauma,  with  disturbance  of  its  nerve 
supply,  with  the  anesthetic,  and  with  the  lowered 
resistance  at  the  time  of  operation,  there  is  a loss 
of  muscle  tone  in  the  bladder  wall  so  that  post- 
operative distention  occurs  quite  easily.  It  is  felt 
that  the  action  of  the  mercurochrome  is  an  irri- 
tative action  directly  on  the  bladder  musculature 
and  that  this  restores  the  muscular  tone  before 
there  is  sufficient  fluid  in  the  bladder  to  cause 
an  overdistention.  Further  observation  is  neces- 
sary before  this  point  can  be  determined  with 
accuracy. 

The  advantages  of  decreasing  the  necessary 
number  of  postoperative  catheterizations  is  obvi- 
ous, and  this  must  of  necessity  result  in  a decrease 
in  the  incidence  of  postoperative  cystitis.  Re- 
cently a number  of  articles  have  appeared  in  the 
literature  which  apparently  minimize  the  danger 
of  postoperative  catheterization,  some  even  stat- 
ing that  it  is  impossible  to  infect  a normal  bladder 
or  kidney,  even  if  pure  cultures  of  pyogenic  or- 
ganisms are  injected  into  the  bladder.  Such  state- 
ments cannot  be  accepted  until  more  conclusive 
experimental  work  has  been  done.  Furthermore, 
we  are  here  dealing  with  abnormal  bladders,  as 
is  indicated  by  the  difficulty  in  voiding.  It  is  also 
obvious  that  by  decreasing  the  number  of  post- 
operative catheterizations  the  postoperative  com- 
fort of  the  patient  is  increased  and  the  nursing 
care  is  proportionately  decreased. 

Undue  emphasis  cannot  be  placed  upon  the 
importance  of  sufficient  fluid  intake  on  the  day 
of  operation.  We  now  give  fluids  freely,  includ- 
ing coffee  and  orange  juice,  on  the  morning  of 
operation  up  to  within  one  hour  of  the  operation. 
I usually  insist  on  the  patient  taking  at  least  500 
cubic  centimeters  on  the  morning  of  operation. 


164 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


I have  not  seen  this  cause  vomiting  with  the  an- 
esthetic. About  1200  to  2000  cubic  centimeters 
of  fluid  can  be  easily  given  per  rectum  immedi- 
ately following  the  operation  and  this  usually  is 
a sufficient  quantity  for  the  day  of  operation,  so 
there  is  no  necessity  to  force  fluids  per  mouth 
or  to  disturb  the  patient  with  repeated  small  rectal 
instillations. 

SUMMARY 

1.  This  series  of  cases  demonstrates  that  a 
bladder  instillation  of  mercurochrome  decreases 
the  necessity  for  postoperative  catheterization, 
and  per  se  decreases  the  probability  of  postopera- 
tive cystitis.  It  prevents  the  occurrence  of  bladder 
distention,  rather  than  the  correction  of  a re- 
tention. 

2.  Four  groups  of  patients  were  studied  : 

(a)  A control  group  of  ninety-nine  patients 
was  observed  in  whom  it  was  necessary  to  cathe- 
terize  sixty,  or  approximately  60  per  cent. 

( b ) In  a group  of  seventy-eight  patients  who 
received  one  ounce  of  one  per  cent  mercuro- 
chrome into  the  bladder  at  the  time  of  operation, 
it  was  necessary  to  catheterize  eighteen,  or  23 
per  cent. 

(c)  In  a third  group  of  ninety-three  patients 
who  received  one  ounce  of  one  per  cent  mercuro- 
chrome as  a bladder  instillation,  it  was  necessary 
to  catheterize  eight,  or  8.6  per  cent. 

(d)  In  a group  of  thirty-nine  patients  who 
received  one  liter  of  fluid  per  rectum  in  addition 
to  the  one-half  per  cent  mercurochrome  in  the 
bladder,  three,  or  7.7  per  cent,  were  catheterized. 

3.  Fluids  per  rectum,  one  to  two  liters  given 
under  anesthesia,  further  increase  the  number  of 
patients  who  void  spontaneously. 

490  Post  Street. 

DISCUSSION 

Homer  C.  Seaver.  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles). — This  paper  offers  an  increase  in  com- 
fort to  the  woman  who  has  been  subjected  to  sur- 
gery. On  our  services  at  the  Los  Angeles  General 
Hospital,  Doctor  Shaw  and  I have  adopted  Doctor 
Craig’s  technique.  We  have  catheterized  preopera- 
tively  because  of  the  technical  advantages  in  operat- 
ing when  the  patient’s  bladder  is  empty.  Immediately 
following  catheterization,  one  ounce  of  one-half  per 
cent  mercurochrome  is  instilled  in  the  bladder. 

I am  able  to  report  on  three  hundred  cases  in  the 
majority  of  which  extensive  intrapelvic  surgery  was 
done  and  in  many  instances  a combination  of  lapar- 
otomy and  plastic  work.  In  the  first  one  hundred  it 
was  necessary  to  catheterize  postoperatively  but  three 
patients.  In  a second  group  of  forty  patients  none  had 
to  be  catheterized.  Of  the  last  cine  hundred  and  sixty 
patients  forty-three  were  catheterized.  The  average 
number  of  times  these  patients  had  to  be  catheterized 
was  slightly  under  three.  Considering  these  as  one 
group,  as  they  rightly  should  be  since  they  were 
consecutive  cases,  it  was  necessary  to  catheterize 
postoperatively  forty-six  out  of  three  hundred  pa- 
tients, or  15.3  per  cent,  which  is  a higher  incidence 
than  occurred  in  Doctor  Craig’s  third  group,  but  cer- 
tainly is  more  satisfactory  than  the  control  patients 
who  did  not  receive  the  instillations.  Of  the  three 
hundred  patients  there  were  eight,  or  2.6  per  cent, 
who  developed  a postoperative  cystitis.  The  only 
other  complication  was  a rather  serious  hematuria, 
which  occurred  on  the  second  postoperative  day  in 


two  patients.  This,  however,  disappeared  spontane- 
ously within  a few  days. 

In  view  of  the  facts,  I believe  that  Dr.  Glenn  Craig’s 
technique  should  be  adopted  as  a routine  measure  in 
all  cases  of  pelvic  surgery. 

* 

H.  K.  Bonn,  M.  D.  (520  West  Seventh  Street,  Los 
Angeles). — This  article  is  most  timely  and  of  con- 
siderable practical  importance.  As  stated  in  the  paper, 
the  report  is  concerned  with  the  prevention  of  a dis- 
tention of  the  bladder  rather  than  with  the  correction 
of  a retention.  I have  used  the  procedure  since  Doctor 
Shaw  made  a report  of  its  use  to  the  surgical  section 
of  the  Los  Angeles  General  Hospital  and  am  firmly 
convinced  of  its  value.  Personally,  I favor  the  use  of 
one-half  per  cent  mercurochrome  solution  for  the 
bladder  instillation  and  permit  the  patient  a leeway 
of  ten  to  twelve  hours  before  catheterization  is  done, 
the  majority  voiding  before  ten  hours  have  elapsed. 
But  I do  not  regard  eight  hours  as  a retention. 

Not  so  many  years  ago  it  was  not  an  uncommon 
practice  to  catheterize  patients  who  had  had  a peri- 
neorrhaphy or  other  plastic  vaginal  work  done  for 
a period  of  ten  days,  under  the  mistaken  impression 
that  only  in  this  manner  could  a good  result  be 
achieved.  A real  danger  was  present  in  these  cases 
of  repeated  catheterization,  namely,  that  of  acute  pyeli- 
tis, and  a pyelitis  can  appear  rather  quickly  after 
catheterization.  Such  a pyelitis  is  still  possible  in  this 
day,  but  the  use  of  mercurochrome  instillations  almost 
negatives  such  an  additional  complication.  Follow- 
ing the  removal  of  hemorrhoids,  it  is  not  uncommon, 
as  is  well  known,  for  the  majority  of  patients  to  fail 
to  void.  Here  the  mercurochrome  instillations  are 
of  very  definite  value,  as  I have  proved  to  my  own 
satisfaction. 

* 

William  H.  Gilbert,  M.  D.  (305  Medico-Dental 
Building,  Los  Angeles). — Postoperative  catheteriza- 
tion constitutes  a menace  to  the  patient  and  adds  con- 
siderably to  the  postoperative  discomfort.  Anything 
that  will  lessen  this  is  a most  desirable  procedure. 
I am  not  of  the  opinion  that  postoperative  catheteri- 
zation under  proper  precautions  causes  cystitis.  It 
does,  however,  add  to  the  liability  of  that  complica- 
tion. Without  doubt  overdistention  of  the  bladder  is 
the  greatest  menace  we  have  to  contend  with,  and  I 
believe  that  the  bladder  should  not  go  unemptied 
longer  than  eight  hours.  It  has  been  my  custom  for 
a number  of  years  to  administer,  preoperatively,  large 
quantities  of  water  and  orange  juice.  This,  coupled 
with  plenty  of  water  by  rectum  after  operation,  yields 
excellent  results  and  causes  the  patient  to  have  very 
little  annoyance  in  the  postoperative  use  of  the 
catheter. 

I am  satisfied  that  the  method  as  laid  down  by 
Dr.  Glenn  Craig  is  very  valuable  and  should  become 
a postoperative  procedure  with  all  of  us.  It  will  un- 
questionably lessen  the  frequency  of  catheterization 
and  the  prevalence  of  postoperative  bladder  infections. 

# 

H.  N.  Shaw,  M.  D.  (901  Pacific  Mutual  Building, 
Los  Angeles). — Two  years  ago  I visited  the  Johns 
Hopkins  Hospital  and  saw  Dr.  Glenn  Craig’s  work 
there.  I was  greatly  impressed  with  its  value  and 
Doctor  Seaver  and  I adopted  the  method,  both  on  our 
General  Hospital  service  and  in  private  practice.  In 
the  first  eighty-two  cases  we  had  no  catheterizations, 
with  only  three  in  the  first  hundred.  Two  of  these 
were  extensive  cystocele  operations,  which  usually 
have  to  be  catheterized  for  days,  and  in  these  cases  the 
period  of  catheterization  was  considerably  lessened. 

Unfortunately  they  copied  our  instructions  wrongly 
in  the  book  of  operating-room  directions  at  one  of 
the  hospitals,  and  our  patients  were  given  two  per 
cent  instead  of  one  per  cent  solution.  Two  of  the 
patients  had  severe  symptoms,  one  with  alarming 
hematuria  and  another  with  considerable  amounts  of 
pus  and  blood  in  the  urine.  These  symptoms  cleared 
up  very  quickly.  During  the  past  eighteen  months 
we  have  used  one-half  per  cent  instead  of  one  per 


March,  1930 


UROLOGY — PARKER 


165 


cent  solution,  and  while  not  quite  so  effective  as  the 
stronger  solution,  we  have  had  no  cases  of  hematuria. 

From  our  experience  in  over  one  hundred  patients, 
we  are  convinced  that  the  instillation  of  one-half  per 
cent  mercurochrome  into  the  bladder  before  or  at  the 
end  of  operation,  will  practically  eliminate  postopera- 
tive catheterization. 

Every  surgeon  knows  that  inability  to  void  after 
operation  is  a cause  of  great  discomfort  to  the  patient, 
and  that  the  catheterization  may  cause  a troublesome 
urinary  infection.  Cabot  has  found  that  a bladder 
which  has  been  overdistended  will  be  infected  by  a 
catheter,  regardless  of  aseptic  precautions,  while  it  is 
almost  impossible  to  infect  a partially  filled  bladder. 
For  this  reason  he  recommended  catheterization 
within  a few  hours  of  operation,  repeated  at  compara- 
tively short  intervals,  to  prevent  overdistention  and 
the  inevitable  infection.  The  less  disturbance  of  the 
patient  after  a serious  operation  the  better,  and  any 
procedure  which  can  eliminate  catheterization  is  bound 
to  be  valuable. 

* 

Doctor  Craig  (Closing).— It  is  gratifying  to  know 
that  the  procedure  recommended  in  this  paper  has 
proved  satisfactory  in  the  hands  of  others.  Doctor 
Shaw  had  told  me  of  his  good  results  and  I am  in- 
debted to  him  for  his  suggestion  that  I present  this 
paper. 

I am  in  complete  accord  with  Doctor  Bonn’s  state- 
ment that  an  acute  pyelitis  can  appear  very  quickly 
after  a bladder  catheterization  and  infection,  conse- 
quently to  prevent  it  is  of  major  importance.  There 
still  seems  to  be  a diversity  of  opinion  as  to  the 
potential  dangers  of  bladder  infection,  following  cathe- 
terization under  aseptic  conditions.  Doctor  Shaw  has 
called  attention  to  Cabot’s  work  with  distended  blad- 
ders, and  I feel  there  still  is  an  ever  present  danger 
of  infection  when  such  bladders  are  catheterized.  Any 
method  which  will  prevent  an  overdistention  will 
lessen  the  probability  of  infection  even  when  a cathe- 
terization is  necessary. 

While  the  instillation  of  mercurochrome  is  a simple 
thing  to  do,  it  does  definitely  decrease  the  necessity 
for  postoperative  catheterization  and  lessens  the 
danger  of  cystitis  and  pyelitis.  This  is  of  major 
importance. 


UROLOGY — SOME  GENERAL  OBSERVATIONS* 

By  Wilbur  B.  Parker,  M.  D. 

Los  Angeles 

T TROLOGY,  a branch  of  the  art  and  science 
^ of  medicine,  may  be  said  to  be  a number  of 
specialties  within  a specialty.  It  presents  a field 
so  broad  in  its  lines  of  development  that,  as  a 
collective  group,  no  man  can  hope  to  attain  per- 
fection. Urology  will  always  offer  opportunities 
for  advancement.  The  rapid  strides  in  scientific 
procedure  have  erased  forever  the  stigma  that 
our  specialty  was  once  the  favorite  choice  of  the 
charlatan.  In  our  own  country,  urology  owes  an 
everlasting  debt  of  gratitude  to  the  pioneers  in 
our  specialty,  several  of  whom  honor  us  today 
with  their  presence,  and  who  in  the  trying  days 
of  the  past  had  the  courage  to  train  and  announce 
themselves  as  specialists  in  urology.  The  honest 
and  efficient  labors  of  these  colleagues  had  much 
to  do  with  giving  urology  the  place  it  occupies 
among  present-day  specialties  in  medicine.  To- 
day the  standards  laid  down  by  these  men  make 

* Chairman’s  address,  Urology  Section,  California  Medi- 
cal Association,  at  the  fifty-eighth  annual  session,  May 
6-9,  1929. 


possible  entrance  into  the  specialty  only  after 
studious  application  and  practice. 

SOME  FUNDAMENTAL  NEEDS 

I cannot  conceive,  in  the  field  of  medicine,  a 
man  more  deserving  of  emulation  than  the  honest, 
properly  trained  urologist.  The  lack  of  this  quali- 
fication of  honesty  mars  the  records  of  a few 
men  of  recognized  ability  who  are  seemingly 
motivated  by  a desire  for  pecuniary  gain  and 
who  use  bizarre  methods  of  technique  designed 
for  self-aggrandizement.  Such  urologists  cast  the 
only  remaining  reflection  upon  our  specialty  as  it 
exists  today. 

We  may  well  consign  to  the  rank  of  charla- 
tan any  man  practicing  urology  who  is  dishonest, 
and  by  contrast  point  with  pride  to  the  man  of 
even  most  mediocre  ability  whose  training  and 
sincerity  cannot  be  questioned. 

It  is  regrettable  to  note  that  some  contributors 
to  recent  urological  literature  fail  to  give  rightful 
recognition  to  former  writers  through  mention  of 
proper  references.  In  many  journals,  during  the 
past  year,  apparently  original  articles  on  subjects 
especially  referable  to  diagnosis  and  methods  of 
technique  have  appeared  which  were  fully  covered 
and  adopted  years  before  by  men  much  more  able 
than  many  of  the  latter  day  writers.  Those  who 
are  guilty  show  either  an  inexcusable  lack  of 
review  of  past  literature  or  willful  plagiariasm. 

Certain  other  contributors,  who  seem  to  have 
psychologic  as  well  as  urologic  training,  by  omis- 
sion to  tabulate  untoward  results  and  through 
incomplete  quotations  of  the  opinions  of  other 
men,  have  helped  bring  about  with  some  of  our 
colleagues  the  adoption  of  methods  wholly  inade- 
quate and  obnoxious.  These  unfortunate  prac- 
tices will  naturally  eliminate  themselves  and  in 
the  end  act  to  the  disadvantage  of  those  who  thus 
offend. 

It  is  a well-known  truism  that  some  day  every 
successful  man  must  stand  upon  his  own  feet. 
Nevertheless,  we  still  observe  some  of  the  younger 
men  who  have  forgotten  the  time-honored  proverb 
that  “No  school  ever  made  a man,  but  many  a 
man  has  made  a school.”  The  failure  to  remem- 
ber this  proverb,  especially  when  such  lack  is 
combined  with  avidity  at  the  beginning  of  the 
practice  of  this  chosen  specialty,  has  brought 
upon  a few  of  the  graduates  of  our  greatest  clinics 
the  accusation  of  at  least  being  erratic,  a reflection 
unjust  to  their  able  preceptors. 

EXPLOITATION  OF  THE  PROFESSION 

The  entire  medical  profession  has  continued 
throughout  the  year  to  be  unmercifully  exploited 
by  manufacturers  of  various  modalities  and  spe- 
cifics, and  no  immediate  relief  for  this  exploita- 
tion can  be  seen.  Therefore  it  behooves  the 
members  of  this  urological  section  to  be  especi- 
ally discerning  in  the  choice  of  means  for  the 
prevention  and  treatment  of  venereal  diseases. 
The  Council  on  Pharmacy  and  Chemistry  of  the 
American  Medical  Association  is  to  be  highly 
commended  for  past  endeavors  and  deserves  ex- 


166 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


tended  means  for  more  thorough  investigation  in 
its  work  of  passing  on  new  preparations. 

Insurance  companies  of  all  types  tenaciously 
hold  to  their  viewpoint  that  medical  men  should 
furnish  them  complete  reports  of  patients  for- 
merly under  their  care.  They  extend  their  so- 
called  cooperation  by  obtaining  a legal  consent 
for  such  information  from  their  prospects,  but 
make  no  provision  for  remuneration  of  the  phy- 
sician. When  we  consider  that  the  index  of 
health,  interpreted  by  many  insurance  companies, 
depends  in  good  part  upon  a family  history  and 
urinalysis,  it  is  little  wonder  that  medical  men 
resent  this  almost  impertinent  practice.  This  pro- 
cedure has  had  no  small  part  in  nurturing  the 
establishment  of  innumerable  urinalysis  bureaus, 
commercial  to  the  nth  degree. 

Let  us  cite  an  instance  of  one  of  these  momen- 
tous opinions,  rendered  by  a urinalysis  bureau  to 
a patient  in  whom  the  urine  was  normal,  except 
for  the  presence  of  a few  leukocytes  and  an 
excess  of  indican.  Said  the  director  of  the  bureau 
in  question : 

“As  I go  over  your  reports,  I see  indican  continues 
unchanged.  This  indican  is  only  one  of  the  many 
intestinal  poisons  that  are  absorbed  from  the  intesti- 
nal tract.  Such  poisons  sooner  or  later  break  down 
the  defensive  forces  of  the  liver  and  enter  the  blood 
stream.  When  these  poisons  reach  a sufficient  degree 
of  concentration  we  experience  an  acute  illness.  This 
illness  is  commonly  called  a bilious  attack.  If  the 
poisons  are  not  in  quantity  sufficient  to  cause  an 
acute  illness,  degenerative  conditions  of  the  blood 
vessels  and  kidneys  may  occur  which  result  in  high 
blood  pressure.  There  is  a mass  of  accumulating  evi- 
dence to  show  that  these  intestinal  poisons  predispose 
to  or  possibly  cause  cancer. 

“With  these  thoughts  in  mind,  I hope  you  will  more 
seriously  consider  the  kind  and  character  of  food  you 
eat  and  the  amount  of  exercise  you  take.” 

The  patient’s  reaction  on  receiving  the  above 
was : “Am  I condemned  or  is  this  gentleman  mis- 
leading me?” 

This  patient  seven  years  previously  had  been 
salvaged  by  us  from  a threatened  renovesical  de- 
generation, due  to  filiform  urethral  strictures, 
prostatitis,  and  vesiculitis.  At  that  time  he  was 
experiencing  difficulty  in  holding  a twenty  dollar 
a week  position.  Today,  at  the  point  of  best 
possible  efficiency,  he  is  national  sales  manager 
for  a large  manufacturing  company. 

Such  bureaus,  which  exploit  the  “five  elements 
of  positive  health — inheritance,  nutrition,  sun  ex- 
posure, body  posture,  and  symmetrical  muscular 
power — that  contribute  to  the  development  of  a 
sixth  personality,”  are  referred  to  in  the  exem- 
plary article  of  Lovell  Langstroth,  San  Fran- 
cisco, published  in  the  September  1928  issue  of 
California  and  Western  Medicine. 

OTHER  ELEMENTS 

The  shopping  patient,  a constant  annoyance  to 
the  members  of  our  specialty,  should  be  vigor- 
ously discouraged,  even  to  the  point  of  nonaccept- 
ance of  his  case.  The  efforts  of  the  shopping 
patient,  when  added  to  the  unwise  or,  if  you 
choose,  unethical  references  of  physicians  to 
former  consultants,  have  resulted  in  irreconcil- 


able breaches  between  men  who  were  formerly 
at  least  tolerant  of  one  another. 

The  attendance  of  members  at  our  sectional 
meetings  has  been  governed  by  the  willingness 
of  contributors  to  produce  articles  of  real  value. 
The  percentage  of  absences  may  be  due  perhaps 
to  the  fact  that  possibly  a number  of  our  members 
are  suffering  from  one  of  two  ailments,  known 
as  superiority  and  inferiority  complexes. 

A fee  schedule  capable  of  proper  interpreta- 
tion between  contracting  parties  has  as  yet  not 
been  presented.  This  is  not  to  be  wondered  at, 
for  surgical  service  is  not  merchandise.  We  must 
admit  that  the  laity  have  important  rights  as  to 
the  amount  to  be  paid  for  services  rendered.  The 
subject  is  worthy  of  close  study. 

Our  comments  on  these  matters  should  not 
brand  us  as  overpessimistic  for,  as  a matter  of 
fact,  we  all  know  that  each  year  brings  forth  an 
increased  fraternalism  and  a realization  of  our 
great  responsibilities  toward  preventive  medicine. 

1107  Brack  Shops  Building. 

LONG  WAVE  X-RAYS  IN  DERMATOLOGY* * 

By  Laurence  R.  Taussig,  M.  D. 

San  Francisco 

Discussion  by  George  D.  Culver,  M.  D.,  San  Fran- 
cisco; William  E.  Costolovu,  M.D.,  Los  Angeles;  Moses 
Scholtz,  M.D.,  Los  Angeles. 

IIW  1925  Bucky,1  amplifying  the  work  done  by 

Schultz  and  others  in  Germany  and  by  Stern 
in  this  country,  published  the  first  report  of  his 
work  with  oversoft  x-rays.  These  rays  have  a 
wave  length  of  from  1.5  to  2.0  Angstrom  units, 
and  he  stated  that  they  differed  biologically  and 
physically  from  x-rays.  He  designated  them 
grenz  rays  to  convey  the  impression  that  they  lie 
between  the  ultra-violet  band  and  the  true  x-ray 
band  in  the  spectrum. 

APPARATUS  USED 

The  apparatus  used  in  the  production  of  grenz 
rays  consists  of  a special  interrupterless  trans- 
former, designed  to  supply  a maximum  of  twelve 
kilovolts.  The  principle  of  this  transformer  does 
not  differ  materially  from  that  of  the  usual  type 
by  which  the  modern  x-ray  tube  is  activated.  The 
tube  used  is  similar  in  principle  to  the  Coolidge 
tube,  but  differs  in  having  a window  of  Lindeman 
glass  through  which  the  rays  pass.  This  is  neces- 
sary because  the  very  soft  rays  would  be  absorbed 
to  a large  extent  by  ordinary  silicate  glass. 
Lindeman  glass  is  a lithium  borate  glass.  These 
tubes  are  water-cooled,  and,  on  account  of  the 
friability  of  the  Lindeman  glass  window,  are  usu- 
ally protected  by  a metal  sheath.  There  are  two 
tubes  available,  the  Muller  tube  and  the  Siemans 
tube.  The  first  has  an  anode  of  the  hollow  cone 
type  and  the  rays  are  projected  from  the  end  of 
the  tube,  while  the  second  has  an  anode  similar 

* From  the  Department  of  Dermatology,  University  of 
California  Medical  School,  San  Francisco. 

* Read  before  the  Dermatology  and  Syphilology  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


March,  1930 


LONG  WAVE  X-RAYS — TAUSSIG 


167 


in  design  to  that  of  the  conventional  x-ray  tube 
with  the  window  at  the  side.  An  erythema  ap- 
pears in  twenty-four  hours  if  a three-minute  ex- 
posure is  given,  using  8 kilovolts,  8 milliamperes, 
at  6 centimeter  target  skin  distance.  This  amount 
of  radiation  is  considered  empirically  as  one  unit, 
and  doses  of  from  one  to  two  units  are  given  as 
a rule  and  repeated  at  two  to  four-week  intervals 
for  a few  doses.  In  the  course  of  a few  weeks 
the  erythema  is  replaced  by  a varying  grade  of 
pigmentation,  which  remains  for  some  months. 

bucky’s  evaluations 

As  a result  of  his  laboratory  researches  Bucky 
reported  that  the  half  absorption  value  of  grenz 
rays  was  about  0.46  millimeters  in  water  and  that 
2 millimeters  absorbed  over  90  per  cent  of  the 
rays.  Assuming  the  thickness  of  the  skin  to  be 
about  1.5  millimeters,  he  concluded  that  only  very 
inconsiderable  amounts  of  radiation  could  reach 
the  papillary  and  subpapillary  layers.  He  stated 
that  these  rays  were  devoid  of  danger  even  when 
used  to  the  extent  of  a very  severe  reaction  on 
account  of  the  fact  that  complete  destruction  of 
the  basal  layer  of  the  epidermis  could  not  occur. 
He  is  quite  insistent,  however,  that  tensions  of 
ten  kilovolts  should  not  be  exceeded,  having  seen 
unpleasant  after-effects  following  the  use  of 
higher  voltages.  Bucky 2 also  found  that  with 
small  localized  exposures  to  grenz  rays  a con- 
siderable general  effect  occurred.  The  most  strik- 
ing feature  was  a rapid  and  marked  drop  in  the 
white  cell  count  which  as  rapidly  returned  to 
normal.  He  explained  this  as  being  due  to  the 
effect  of  the  rays  on  the  autonomic  nervous  sys- 
tem. The  erythema  caused  by  these  soft  rays 
develops  sooner  than  is  the  case  with  the  ordi- 
narily used  x-rays.  From  these  and  other  ob- 
servations Bucky  concluded  that  he  was  dealing 
with  a ray  physically  and  biologically  different 
from  the  x-ray  and  designated  it  the  grenz  ray 
to  indicate  that  it  lay  on  the  border  line  below 
x-rays. 

OTHER  VIEWPOINTS 

Most  of  the  subsequent  investigators  object  to 
considering  these  rays  as  other  than  unusually 
long  wave  x-rays,  maintaining  that  the  biological 
and  physical  features  were  quite  similar.  E.  Uhl- 
mann  3 and  others  were  able  to  show  actual  tissue 
destruction  in  animals  given  relatively  large  doses 
of  the  soft  rays.  He  concluded  that  these  rays 
are  not  devoid  of  danger  if  used  in  extreme  dos- 
age. Martenstein  and  Granzow-Irrgang 4 found 
that  intensities  of  approximately  one-third  of  the 
effective  skin  dose  penetrated  to  the  depth  of  the 
subpapillary  layer  of  the  skin.  Eller  5 objects  to 
the  term  “grenz  rays”  and  substitutes  for  it  that 
of  “supersoft  roentgen  rays  (2  A)”  as  being  more 
nearly  descriptive  of  the  true  nature  of  the  rays. 
He  produced  radiographs  of  metal  objects  on 
dental  films,  with  filters  as  thick  as  one  milli- 
meter of  aluminum.  He  used  exposures  approxi- 
mating those  used  in  producing  an  erythema  on 
human  skin.  His  results  were  confirmed  by  Dr. 
Charles  Lerner  of  New  York.  Hirsch,  quoted 
by  Eller,  published  a table  in  which  he  shows  that 


the  shortest  wave  length  produced  by  a peak  volt- 
age of  ten  kilovolts  is  1.24  A.  Gabriel 8 showed 
that  the  same  drop  in  the  white  cell  count  oc- 
curred with  short-wave  rays  as  with  the  grenz 
rays,  the  only  difference  being  that  it  was  some- 
what slower  in  developing  and  took  longer  to 
return  to  normal.  Attempts  to  standardize  dos- 
age on  the  basis  of  physical  measurements  have 
been  unsatisfactory  so  far. 

A wide  divergence  of  opinion  concerning  the 
usefulness  of  this  wave  length  is  found  in  the 
literature.  Bucky  is  by  far  the  most  enthusiastic 
advocate,  having  reported  good  results  in  a large 
number  of  dermatologic  and  general  medical  con- 
ditions, and  in  addition  maintained  that  the  method 
is  absolutely  devoid  of  danger  of  late  sequelae,  so 
much  feared  in  x-ray  therapy.  Though  a number 
of  writers  have  detailed  their  reasons  for  believ- 
ing that  there  is  a possibility  of  producing  late 
unfavorable  sequelae,  none  of  them  have  reported 
experiencing  any  of  these  late  results.  At  the 
1927  meeting  of  the  Deutschen  Dermatologischen 
Gesellschaft,  a number  of  members  who  had  had 
experience  with  this  method  of  treatment  ex- 
pressed their  opinions  as  to  its  field  of  usefulness. 
Artzt  and  Fuhs 7 reported  good  results  in  the 
treatment  of  tuberculosis  verrucosa,  erythema  in- 
duratum,  hidrosadenitis  axillaris,  lichen  chronicus 
of  Vidal,  mycosis  fungoides  and  basal  cell  carci- 
noma. Schreus8  reported  no  bad  effects  up  to  that 
time  other  than  a pigmentation,  which  lasted  a 
considerable  time.  Uhlmann  9 found  this  method 
striking  in  the  treatment  of  psoriasis,  including 
that  of  the  scalp,  but  concluded  that  these  soft 
rays  were  not  superior  to  the  x-ray  in  eczema 
and  neurodermite,  inferior  in  the  treatment  of 
tinea,  and  stressed  the  fact  that  they  were  not  to 
be  considered  as  entirely  harmless.  Rottmann  10 
found  changes  in  the  blood  vessels  which  con- 
vinced him  that  there  was  a possibility  of  late  ill 
effects.  Gabriel11  reported  finding  changes  in  the 
deep  layers  of  the  skin  of  animals  and  humans. 
Scholtz  12  considered  the  rays  similar  in  action 
to  x-rays  and  thought  that  ill  effects  were  unlikely 
with  careful  dosage.  He  considered  that  the  prac- 
tical use  was  limited  on  account  of  the  danger 
of  breaking  the  Lindeman  glass  window  and  by 
the  small  field  that  could  be  treated  at  one  time. 
Werther  13  stated  that  by  overdosage  it  was  possi- 
ble to  produce  epilation  and  long-standing  hyper- 
esthesia, but  reported  good  results  in  pruritus  and 
hyperkeratosis  of  the  senile  type.  He  had  not 
observed  a single  case  of  cancer  which  had  been 
cured.  He  felt  that  the  method  was  impractical 
for  eczema  and  psoriasis.  Bucky  14  reported  that 
he  had  treated  some  three  hundred  cases,  some 
as  long  as  four  years  previously,  and  stressed  his 
good  results  in  the  treatment  of  epithelioma.  In 
another  article  Bucky  2 reported  that  “many  skin 
diseases  react  wonderfully  to  this  treatment,  such 
as  eczema  of  all  kinds,  acne  rosacea,  lichen  planus, 
pruritus  ani ; psoriasis  came  back  after  a short 
time.”  He  had  equally  good  results  with  lupus, 
tinea,  sycosis,  warts,  mycosis  fungoides,  Kaposi’s 
disease,  and  epitheliomata.  Eller  5 reported  good 
results  in  dermatophytosis,  Duhring’s  disease, 


168 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


basal  cell  epitheliomata,  lichen  planus  hyper- 
trophicus,  perleche,  tinea  capitis,  small  early 
keloids  and  sycosis  barbae.  He  stresses  the  use- 
fulness of  the  grenz  rays  in  the  treatment  of  epi- 
theliomas of  the  lids,  having  found  no  damage 
to  the  eyeball,  with  large  doses  in  spite  of  the 
fact  that  no  special  precautions  were  taken.  In 
an  experience  of  over  two  years  he  has  seen  no 
sequelae  similar  to  those  produced  by  erythema 
doses  of  shorter  wave  x-rays,  but  warns  against 
overdosage.  The  only  case  showing  these  late 
sequelae  was  one  presented  at  the  New  York 
Dermatological  Society  by  MacKee 15  in  1928. 
Areas  of  slight  telangiectasia  and  depigmentation 
had  developed  in  areas  treated  six  months  previ- 
ously with  mild  doses  of  grenz  ray.  The  patient 
was  an  inveterate  psoriatic  who  had  received 
much  therapy,  including  x-ray,  ultra-violet  light, 
and  arsenic.  The  areas  exposed  to  the  soft  radi- 
ation, however,  had  presumably  not  been  previ- 
ously treated  with  x-ray.  It  is  reasonable  to 
believe  that  this  patient’s  skin  had  become  un- 
usually susceptible  to  external  influences  from  pre- 
vious therapy.  Several  writers  warn  that  the 
effects  of  the  soft  radiation  are  accentuated  when 
applied  to  areas  previously  treated  with  roentgen 
rays. 

PERSONAL  OBSERVATIONS 

In  the  past  nine  months  I have  used  the  ultra- 
soft  x-rays  on  a variety  of  dermatological  con- 
ditions. The  number  of  patients  treated  was 
intentionally  small  because  it  was  felt  that  con- 
servatism was  the  safest  policy  in  dealing  with 
a wave  length,  the  very  late  results  of  which 
might  possibly  be  unpleasant.  By  experiment  it 
was  found  that,  using  a Siemans  tube  activated 
by  a special  Wappler  transformer,  four  minutes 
exposure  with  8 kilovolts,  8 milliamperes,  at  8 
centimeter  target  skin  distance  produced  an  eryth- 
ema on  the  flexor  surface  of  the  forearm  which 
appeared  within  twenty-four  hours.  The  area  be- 
came pigmented  in  the  course  of  a few  weeks  and 
this  pigmentation  persisted  for  months.  This  dose 
was  considered  as  one  unit,  and  nonmalignant 
conditions  were  given  one  unit  or  less  at  a sitting 
while  the  malignancies  treated  were  given  two 
units  at  two-week  intervals.  Six  cases  of  basal 
cell  epithelioma  were  treated.  All  were  long- 
standing, extensive  lesions  with  bone  involvement 
and  all  had  received  a great  variety  of  treatment 
including  radium,  x-ray,  curette  and  cautery,  and 
even  arsenic  paste.  None  of  these  was  benefited 
though  treatment  was  persisted  in  for  a consider- 
able period  of  time  in  each  case.  Three  patients 
with  verrucae  vulgaris  were  treated  without  bene- 
fit. One  patient  with  an  extensive  and  resistant 
keratodermia  of  the  feet  (probably  tinea)  failed 
to  respond.  Two  cases  of  senile  keratoses  cleared 
rapidly.  Two  cases  of  lupus  vulgaris,  both  exten- 
sive and  resistant  to  other  forms  of  treatment, 
failed  to  improve  materially.  Of  the  patients  with 
palmar  eczema,  one  cleared  and  remained  well 
while  the  other  improved  but  showed  some  recur- 
rences, as  it  had  previously,  under  x-ray  and 
ultra-violet  light.  One  case  of  lichenification 
cleared  while  another  flared  up  and  became  ex- 


tensive and  acute.  I have  treated  no  patients  with 
basal  cell  epithelioma  that  I felt  were  curable  by 
other  better  known  means.  A number  of  these 
will  be  treated  in  the  near  future,  selecting  at  first 
those  which  present  some  measure  of  difficulty, 
such  as  lesions  close  to  the  eye. 

CONCLUSIONS 

1.  The  grenz  rays  described  by  Bucky  are  to 
be  considered  as  x-rays  of  very  long  wave  length, 
differing  from  the  rays  previously  employed  in 
dermatology  only  in  quality  and  quantity  rather 
than  in  kind. 

2.  These  supersoft  x-rays  offer  another  means 
for  combating  skin  disease,  but  will  probably  not 
supplant  the  shorter  wave  lengths  though  further 
experience  may  show  them  to  be  superior  in  some 
particular  instances. 

3.  The  unpleasant  late  sequelae  which  occur 
following  overradiation  with  short  wave  lengths 
do  not  occur  with  the  doses  so  far  employed.  The 
safety  of  repeated  exposures  is  questionable  and 
can  be  proved  only  by  extensive  experience. 

384  Post  Street. 

REFERENCES 

1.  Bucky,  G. : Reine  Oberflachentherapie  mit  iiber- 
weichen  Roentgenstrahlen,  Munchen.  med.  Wchnschr., 
1925,  lxxii,  802. 

2.  Bucky,  G.:  “Grenz”  (Infra-Roentgen)  Ray  Ther- 
apy, Am.  J.  Roentgenol.,  1927,  xvii,  645. 

3.  Uhlmann,  E. : Ueber  die  sogenannten  Grenz- 
strahlen,  Arch.  f.  Dermat.  u.  Syph.,  1928,  cliv,  509. 

4.  Martenstein,  H.,  and  Granzow-Irrgang,  D.:  Sind 
die  “Grenzstrahlentherapie”  nach  Bucky  volkommen 
ungefahrlich?  1.  Physikalische  Untersuchungen,  Strah- 
lentherapie,  1927,  xxvi,  162. 

5.  Eller,  J.  J.:  Supersoft  Roentgen  Rays  (2A)  in 
Dermatology,  Am.  J.  Roentgenol.,  1927,  xviii,  433. 

6.  Gabriel,  G. : Weitere  Untersuchungen  liber  die 
sogenannten  Grenzstrahlung,  Strahlentherapie,  1927, 
xxvi,  189. 

7.  Artzt  and  Fuhs:  Arch.  f.  Dermat.  u.  Syph.,  1928, 
civ,  79. 

8.  Schreus:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ,  73. 

9.  Uhlmann,  E.:  Arch.  f.  Dermat.  u.  Syph.,  1928, 
civ,  90 

10.  Rottmann:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ, 
104. 

11.  Gabriel:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ, 
104. 

12.  Scholtz:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ, 
106. 

13.  Werther:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ, 
108. 

14.  Bucky:  Arch.  f.  Dermat.  u.  Syph.,  1928,  civ,  109. 

15.  MacKee:  Society  Transactions,  Arch.  Dermat. 
and  Syph.,  1928,  xviii,  621. 

DISCUSSION 

George  D.  Culver,  M.  D.  (323  Geary  Street,  San 
Francisco).' — The  pleasing  feature  of  Doctor  Taussig’s 
paper  is  that  of  fairness  in  judgment  and  conserva- 
tism in  conclusions.  If  it  could  have  been  possible  in 
the  last  two  decades  to  have  had  conservatism  as  the 
watchword  in  the  use  of  radiant  energy  there  would 
be  fewer  heartaches  and  less  recrimination  now. 

I know  nothing  from  personal  experience  about  the 
so-called  grenz  rays,  and  am  perfectly  willing  to  be 


March,  1930 


LONG  WAVE  X-RAYS — TAUSSIG 


169 


criticized  for  offering  this  brief  discussion.  However, 
it  is  not  the  first  time  something  new  in  radiant 
energy  or  some  new  method  of  its  use  has  been 
offered  as  being  near  to  fool-proof.  There  are  few  of 
us  that  have  done  any  considerable  work  along  such 
lines  that  are  blameless.  I concede  that  I am  not  in 
the  ranks  of  those  who  can  look  back  without  regret. 

It  would  seem  that  overenthusiasm  with  the  over- 
soft  x-rays  may  also  leave  its  trail  of  disaster  unless 
the  check  of  clear  judgment  and  selective  usage  is  as 
closely  followed,  as  it  should  be  with  the  x-ray  and 
radium  as  we  know  those  agents  now.  Doctor 
Taussig’s  admonitions  are  worth  while. 

* 

William  E.  Costolow,  M.  D.  (1407  South  Hope 
Street,  Los  Angeles). — Doctor  Taussig  deserves  credit 
not  only  for  pioneering  this  new  form  of  radiation 
therapy  on  the  Pacific  Coast,  but  also  for  his  con- 
servative attitude  toward  a new  method  of  treatment. 
He  has  clearly  described  the  apparatus,  its  technique 
of  production,  and  the  physics  of  the  grenz  or  super- 
soft  x-rays. 

The  mechanical  simplicity  and  electrical  safety  to 
both  the  patient  and  physician,  together  with  the  fact 
that  physical  measurements  and  standardization  of 
dosage  are  not  necessary  as  with  the  ordinary  short- 
wave x-ray,  causes  the  grenz  ray  apparatus  to  be 
desirable  for  the  average  dermatologist  who  does  not 
have  available  the  services  of  a trained  physicist. 
Nevertheless,  this  apparatus  must  be  considered  as  a 
type  of  x-ray  apparatus,  and  care  should  be  taken  not 
to  produce  overdosage.  As  brought  out  by  Doctor 
Taussig,  radiographs  of  metal  objects  have  been  pro- 
duced through  filters  with  these  rays.  Hence,  the 
rays  cannot  be  considered  as  entirely  without  danger 
if  prolonged  and  repeated  exposures  are  given. 

At  the  Soiland  Clinic  in  Los  Angeles,  we  have  been 
using  the  grenz  or  supersoft  x-rays  since  December 
1928.  The  apparatus  which  we  have  employed  is  the 
“Dermix”  transformer,  manufactured  by  Koch  and 
Sterzel  of  Dresden,  with  the  Muller  tubes  from  Ham- 
burg. We  have  not  treated  any  cases  of  skin  malig- 
nancy with  the  supersoft  x-rays  and  do  not  intend 
to  for  the  present.  We  believe  that  if  radiation  is  to 
be  used  in  skin  malignancy  heavily  filtered  radium 
should  be  chosen.  It  does  not  seem  advisable  to  use 
a method  of  radiation  so  superficial  in  its  action  as 
the  supersoft  ray  method  for  the  destruction  of  malig- 
nant lesions  which,  although  often  appearing  super- 
ficial, really  have  deep  extension. 

In  our  experience  the  most  satisfactory  lesions  for 
the  grenz  ray  therapy  have  been  senile  keratoses.  In 
the  treatment  of  a considerable  number  of  these 
lesions  we  have  found  the  supersoft  rays  almost  spe- 
cific. Of  four  cases  of  lupus  vulgaris  treated,  one 
seems  entirely  well,  one  considerably  improved,  and 
two  unimproved.  Several  patients  with  localized  areas 
of  eczema  have  been  relieved.  It  is  only  possible  to 
treat  relatively  small  areas  with  the  grenz  apparatus, 
which  is  quite  a disadvantage  in  some  cases.  One 
case  of  pruritus  ani  was  completely  relieved,  and  one 
case  of  moderately  localized  tinea  capitis  was  entirely 
cured  with  two  treatments.  In  our  patients  who  were 
treated  with  the  supersoft  rays,  we  have  not  observed 
any  evidence  of  later  skin  atrophy  or  telangiectasia, 
such  as  may  follow  short-wave  x-ray  radiation.  How- 
ever, as  has  been  brought  out,  this  is  a later  possi- 
bility and  care  should  be  used  in  prescribing  repeated 
doses. 

The  supersoft  or  long  wave  x-rays  certainly  deserve 
a place  in  dermatological  treatment  and  should  be 
given  a thorough  trial,  especially  in  the  superficial 
nonmalignant  conditions,  where  they  may  partially 
supplant  the  present  type  of  x-ray  radiation. 

* 

Moses  Scholtz,  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles). — The  report  by  Doctor  Taussig  is  both 
timely  and  instructive.  I fully  appreciate  and  concur 
in  his  conservative  judgment. 


The  introduction  of  grenz  rays  in  therapeutics  was 
looked  forward  to  by  dermatologists  with  great  ex- 
pectations. It  was  hoped  for  that  a new  border-line 
modality  between  ultra-violet  light  and  x-rays  was 
discovered  and  that  it  would  combine  to  some  degree 
the  physical  and  clinical  properties  of  both. 

Had  this  proved  to  be  true,  a new  promising  vista 
of  therapeutic  possibilities  would  have  been  open  to 
dermatologists.  Unfortunately  subsequent  research  by 
physicists  and  clinicians  refuted  this  expectation  by 
establishing  that  grenz  rays  are  not  a border  line  for 
rays,  but  merely  a variety  of  x-ray  of  an  extremely 
low  voltage. 

My  personal  experience  with  grenz  rays  is  very 
limited  as  I have  used  the  apparatus  for  clinical  ob- 
servation ’only  during  the  last  few  months.  I was 
able  to  try  it  out  in  about  two  dozens  of  various  types 
of  superficial  dermatoses. 

It  is  apparent  that  the  field  of  clinical  application 
of  grenz  rays  in  dermatology  is  bound  to  be  very 
limited  for  a technical  reason:  the  small  size  of  the 
aperture  of  the  Muller  tube  and  the  short  distance 
used  in  the  exposure  allow  the  treatment  of  only  very 
small  patches. 

The  second  and  still  more  important  drawback 
revealed  in  my  experience,  and  observed  by  others, 
is  persistent  pigmentation  lasting  for  many  months. 
This  obviously  precludes  the  use  of  grenz  rays  on  the 
face  and  other  exposed  parts,  particularly  in  blond 
individuals  with  fair  skin. 

In  my  limited  series  I saw  patches  of  chronic 
squamous  eczema,  psoriasis,  senile  keratoses,  and  in- 
cipient superficial  epitheliomata  clear  up  after  one  or 
two  treatments.  The  dosage  used  was  in  accordance 
with  the  depth  of  the  lesions,  varying  from  one-half 
to  full  erythema  dose. 

It  seems  that  the  dosage  of  grenz  rays  is  not  stand- 
ardized as  yet  either  in  regard  to  individual  derma- 
toses or  to  individual  Muller  tubes.  Thus,  on  my 
machine  an  exposure  for  one  minute  of  the  flexor 
surface  of  the  forearm  with  eight  milliamperes,  eight 
kilovolts,  and  six  centimeter  skin  distance  produced  a 
mild  erythema,  but  an  exposure  for  two  minutes  pro- 
duced a distinct  erythema.  The  exposure  for  three 
or  four  minutes,  as  recommended  in  the  literature, 
produced  in  a few  cases  a sharp  reaction  with  acute 
exudative  dermatitis. 

In  spite  of  the  somewhat  disappointing  character 
of  the  early  reports,  it  seems  to  me  that  grenz  rays 
will  find  their  place  in  dermatologic  therapeutics,  at 
least,  in  a few  types  of  carefully  selected  dermatoses. 
I believe  that  the  maximum  of  clinical  usefulness  of 
grenz  rays  will  be  found  in  the  range  of  medium  and 
small  fractional  doses,  which  so  far  have  not  attracted 
sufficient  attention  on  the  part  of  the  early  observers. 

Bearing  in  mind  the  fact  that  grenz  rays  are  merely 
a variety  of  x-rays  of  extremely  low  voltage  provides 
a sufficient  safeguard  for  their  clinical  use  in  careful 
and  qualified  hands.  Grenz  rays  call  for  further  clini- 
cal observation  and  research  to  define  the  dosage  and 
clinical  indications,  and  are  not  ready  at  present  for 
a broadcast  in  the  general  practice. 

# 

Doctor  Taussig  (Closing).- — At  the  time  the  above 
paper  was  presented  no  instance  had  been  reported  of 
the  occurrence  of  telangiectasia  or  atrophy  following 
grenz  ray  therapy,  the  one  exception  being  doubtful. 
At  the  Portland  meeting  of  the  American  Medical 
Association,  Eller  showed  photographs  of  telangi- 
ectasia which  followed  a moderate  erythema  dose  and 
stated  that  he  had  seen  a few  of  these  late  changes, 
bearing  out  the  warnings  of  a number  of  the  more 
conservative  writers.  These  late  effects  are  apparently 
less  frequent  than  with  x-rays  of  shorter  wave  length 
and  perhaps  less  intense,  but  the  danger  is  there  and 
the  statements  of  some  of  the  enthusiasts  concerning 
the  safety  of  these  rays  must  be  disregarded. 


170 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


BRONCHOPNEUMONIA  IN  EARLY 
CHILDHOOD — ITS  TREATMENT* 

By  E.  P.  Cook,  M.  D. 

San  Jose 

Discussion  by  Edward  J.  Lamb,  M.D.,  Santa  Barbara; 
William  A.  Beattie,  M.D.,  Sacramento ; Adelaide  Brown, 
M.  D.,  San  Francisco. 

HP  HE  knowledge  which  has  been  gained  in 
^ recent  years  concerning  the  etiology  and  pa- 
thology of  bronchopneumonia  has  not  resulted  in 
any  striking  increase  in  our  ability  to  cope  with 
this  disease  successfully.  Possessing  no  specific 
remedy,  the  problem  is  at  once  a challenge  to  our 
therapeutic  ingenuity  and  resourcefulness.  Many 
dififerent  agents  of  undoubted  worth  are  used,  and 
it  is  my  present  purpose  to  attempt  to  assemble 
and  coordinate  these  procedures,  none  of  which 
are  original,  into  a systematic  plan  of  treatment. 
Such  a plan  places  in  the  foreground  the  carefully 
considered  management  of  the  case  as  a whole, 
rather  than  focusing  our  attention  too  minutely 
on  drug  therapy.  Pneumonia  is  simply  another 
instance  in  which  the  child,  as  a whole,  is  sick, 
even  though  the  major  pathological  processes  are 
limited  to  the  air  passages  and  lungs. 

PATHOLOGY 

The  upper  air  passages,  being  inhabited  by  a 
great  variety  of  microorganisms  and  extending 
directly  into  the  lungs,  make  possible  the  develop- 
ment of  bronchopneumonia  under  a variety  of 
conditions.  Infectious  diseases  are  by  far  the 
most  important  group  of  predisposing  causes. 
Measles,  whooping-cough,  and  influenza  are  fa- 
miliar examples.  Simple  infections  of  the  re- 
spiratory tract,  the  so-called  mixed  respiratory 
infections,  and  bronchitis  are  also  of  the  utmost 
importance.  We  may,  in  fact,  have  great  diffi- 
culty in  determining  whether  or  not  a bronchitis 
has  advanced  to  a point  where  it  should  be  called 
bronchopneumonia.  Fortunately  our  treatment 
does  not  depend  upon  the  answer  to  this  question, 
but  rather  we  must  be  guided  by  the  degree  of 
illness  as  evidenced  by  the  toxemia,  fever,  and 
general  prostration  of  the  patient. 

SYMPTOMS 

The  clinical  course  of  a primary  infection  is 
fairly  definite.  The  abrupt  onset  with  fever,  pros- 
tration, and  rapid  pulse  denotes  an  acute  infec- 
tion. The  appearance  of  cough  and  dyspnea  will 
direct  our  attention  to  the  lungs,  where  the  initial 
signs  are  faint  or  impure  breath  sounds  over  a 
localized  area,  followed  in  a day  or  two  by  rales. 
Bronchial  breathing  is  heard  only  where  large 
areas  of  consolidation  occur.  Physical  findings 
will  change  from  day  to  day  as  different  bronchial 
areas  become  involved  with  exudate.  The  dura- 
tion is  indefinite,  varying  from  a few  days  to 
several  weeks  or  months. 

In  the  secondary  type  of  infection  the  problem 
is  more  difficult.  A sudden  rise  in  temperature 
and  onset  of  cough  during  the  course  of  an  acute 

* From  the  Department  of  Pediatrics,  Santa  Clara 
County  Hospital,  San  Jose. 

* Read  before  the  Pediatrics  Section  of  the  California 
Medical  Association  at  the  fifty-eighth  annual  session, 
May  6-9,  1929. 


infectious  disease  should  never  fail  to  direct  one’s 
attention  to  the  lungs.  X-ray  examination  of  the 
chest  will  serve  to  confirm  the  diagnosis. 

PROPHYLAXIS 

Like  every  other  disease,  bronchopneumonia  is 
easier  to  treat  by  preventing  its  development ; and 
since  certain  things  can  be  accomplished  along 
this  line,  it  is  well  to  bear  them  in  mind.  It  is  not 
controllable  by  ordinary  public  health  methods 
of  isolation,  quarantine,  and  supervision  of  food 
and  water  supply.  Without  introducing  an  alarm- 
ing note,  it  is  quite  in  order  to  state  frankly  to 
parents  of  children  having  measles,  whooping- 
cough,  influenza,  and  the  other  acute  infectious 
diseases  that  the  mortality  in  these  conditions  is 
in  large  part  due  to  the  development  of  pneu- 
monia, and  therefore  their  utmost  care  and  co- 
operation is  urged  in  keeping  the  child  in  bed 
and  preventing  exposure.  Persons  with  acute  or 
chronic  upper  respiratory  infections  should  at  all 
times  be  kept  away  from  the  premature  and  con- 
genitally weak  infant,  but  where  this  is  not  possi- 
ble, a gauze  mask  worn  by  the  mother  is  effective. 

One  thing  which  is  of  the  utmost  importance, 
but  which  frequently  is  accomplished  with  diffi- 
culty, is  putting  children  to  bed  when  they  have 
a fever  and  keeping  them  there  until  they  are 
entirely  well.  Too  often  mothers  will  allow  the 
pleas  of  the  child  to  overrule  their  judgment  or 
their  discipline  and  a slight  cold  becomes  a more 
serious  matter  by  reason  of  exposure  and  fatigue. 
Furthermore,  it  is  a common  custom  for  parents 
to  allow  a child  to  get  up  as  soon  as  the  tempera- 
ture becomes  normal.  The  only  safe  rule  to  make 
is  that  an  afebrile  period  of  at  least  forty-eight 
hours  should  elapse  after  a respiratory  infection 
before  a child  is  allowed  to  be  out  of  bed.  Even 
then  it  should  be  a matter  of  one  or  two  hours 
the  first  day,  with  a convalescent  period  of  three 
days  before  he  is  allowed  to  go  to  school.  A child 
has  no  judgment  in  conserving  his  strength,  and 
the  minute  he  is  up  he  goes  at  top  speed  until 
exhausted. 

Ether  anesthesia  should  not  be  administered  to 
a child  suffering  from  even  the  mildest  form  of 
respiratory  tract  infection  except  in  case  of  a 
grave  emergency. 

NURSING  CARE 

The  first  requisite  in  successful  management  is 
a capable,  quiet  nurse  or  attendant  who  under- 
stands the  value  of  sickroom  serenity  and  effi- 
ciency. A patient  in  the  hospital  has  this  matter 
taken  care  of  automatically  and  the  physician  is 
relieved  of  a great  responsibility,  but  the  majority 
of  cases  are  treated  at  home  and  by  a mother  who 
is  perhaps  willing  and  cooperative  but  lacking  in 
nursing  sense.  Some  people  have  it  naturally,  but 
we  must  recognize  the  instances  where  special 
instructions  are  necessary  and  by  all  means  give 
them.  This  means  sitting  down  and  spending  time 
in  fundamental  nursing  instructions,  but  before 
we  can  do  that  we,  ourselves,  must  know  what 
constitutes  good  nursing  care. 

Temperature  Readings. — A mother  should  be 
taught  to  read  a thermometer,  take  the  pulse  and 
respiration  so  that  these  important  observations 


March,  1930 


BRONCHOPNEUMONIA  IN  CHILDHOOD — COOK. 


171 


can  be  entered  on  a chart  which  we  prepare  for 
that  purpose.  A graphic  chart  is  most  valuable  in 
following  the  course  of  a fever,  and  may  show 
the  first  indication  of  an  arising  complication. 

Ventilation. — Warmed  fresh  air  is  vital  to  the 
patient’s  well-being.  Adequate  ventilation  may  he 
secured  through  open  windows,  hut  during  cold 
or  stormy  weather  these  should  be  in  an  adjoin- 
ing room  rather  than  the  sickroom.  This  air 
should  be  warmed  to  a temperature  between  65 
and  68  degrees  as  actually  recorded  by  a ther- 
mometer. In  this  connection  I have  observed  a 
difference  in  temperature  of  six  degrees  between 
the  height  of  a standard  crib  and  the  height  to 
which  it  was  raised  by  putting  twenty-inch  blocks 
under  the  legs.  Hence  the  necessity  of  placing 
the  thermometer  near  the  child.  Such  a tempera- 
ture permits  the  child  to  be  clothed  lightly.  It  is 
exhausting  even  to  watch  a hot,  restless  child 
struggle  under  many  layers  of  clothing  and  bed- 
covers, with  the  necessity  of  lifting  the  added 
weight  with  every  inspiration. 

In  addition  to  warming,  the  air  may  also  be 
moistened  to  an  advantage.  Plain  unmedicated 
steam  is  very  effective,  or  compound  tincture  of 
benzoin,  oil  of  eucalyptus,  or  turpentine  may  be 
added  to  the  water.  Inhalations  may  be  given  for 
thirty  minutes  at  intervals  of  every  two  or  three 
hours  and  preferably  under  a canopy.  It  is  not 
advisable  to  use  a closed  tent  because  of  the 
extreme  heat  which  develops,  with  resulting  per- 
spiration and  possible  chill  afterward. 

Medicated  Air. — The  safest  apparatus  is  an 
electric  vaporizer,  or  an  electric  plate  on  which 
is  placed  an  open  vessel.  The  croup  kettle  with 
an  open  flame  is  more  commonly  employed  at 
home,  but  certain  precautions  must  always  attend 
its  use.  First  it  should  not  be  placed  so  close  to 
the  crib  that  the  child  can  reach  out  and  get  a 
steam  burn,  or  tip  it  over  and  start  a fire.  The 
kettle  should  never  be  allowed  to  boil  dry  if  ben- 
zoin is  used  in  the  water  because  such  fumes 
are  most  irritating.  All  of  these  mishaps  have 
occurred  in  my  experience  at  one  time  or  an- 
other, but  constant  warnings  have  reduced  their 
frequency. 

Inhalations  should  be  continued  as  long  as  there 
is  a distressing  cough  or  scanty  secretion.  The 
milder  cases  may  be  sufficiently  relieved  by  simply 
allowing  a kettle  to  boil  constantly  in  the  sick- 
room. 

Diet. — It  is  quite  possible  to  give  specific  in- 
structions to  the  nurse  regarding  diet,  but  these 
will  necessarily  vary  with  the  individual  child. 
Bearing  in  mind  the  possible  protracted  course  of 
the  disease,  it  is  necessary  to  encourage  the  intake 
of  as  much  nourishment  as  the  digestive  appa- 
ratus can  tolerate.  This  is  where  an  understand- 
ing nurse  can  be  of  great  assistance.  The  various 
foods  should  be  bland  and  easily  digestible.  These 
would  include  milk,  broths,  soft  eggs,  pureed 
vegetables,  or  creamed  vegetable  soups,  scraped 
beef,  jelly,  junket,  custard,  and  fruit  juices.  Milk 
is  sometimes  vomited,  but  this  may  be  avoided 
by  giving  it  hot  and  with  the  addition  of  bicarbo- 
nate of  soda.  In  general,  it  is  better  to  offer  small 


amounts  of  food  at  more  frequent  intervals  than 
three  large  meals  a day. 

Care  of  the  Bowels. — A daily  bowel  movement 
is  to  be  desired,  but  it  is  the  exception  to  have 
this  occur  spontaneously.  If  the  movements  are 
soft  there  is  no  objection  to  irregularity,  but  if 
constipation  occurs  the  use  of  mild  laxatives  is 
indicated.  Milk  of  magnesia,  cascara,  and  phenol- 
phthalein  are  usually  effective,  aided  when  neces- 
sary by  an  enema  to  empty  the  lower  bowel.  The 
problem  should  always  be  bandied  so  as  to  disturb 
the  patient  as  little  as  possible. 

Counterirritants. — The  use  of  some  form  of 
counterirritation  is  beneficial  when  pleural  pains 
and  cough  are  prominent  symptoms.  Mustard 
plasters  are  perhaps  most  effective.  Variations  in 
the  strength  of  mustard  and  the  sensitiveness  of 
the  skin  make  it  impossible  to  give  definite  in- 
structions regarding  the  proportions  until  a trial 
has  been  made.  Strengths  varying  from  one  of 
mustard  to  six  of  flour  to  as  strong  as  equal  parts 
may  be  used.  This  is  mixed  with  cold  water, 
spread  thinly  on  a cloth,  warmed,  and*  applied  to 
back,  sides,  and  chest  for  a period  ranging  from 
ten  to  thirty  minutes.  This  may  be  repeated  as 
often  as  every  four  hours. 

Counterirritation  is  otherwise  accomplished  by 
applying  flannel  cloths  wrung  out  of  hot  water 
and  mustard,  or  with  turpentine  stupes. 

Hydrotherapy. — A maxim  which  I have  always 
thought  particularly  apt  is  “plenty  of  water  inside 
and  out.”  A child  will  voluntarily  take  a certain 
amount,  but  rarely  is  it  sufficient  to  meet  the 
demands  of  his  toxemia.  Further  intake  may  be 
encouraged  by  offering  orangeade,  lemonade,  any 
of  the  canned  fruit  juices  or  bottled  soda  water, 
given  as  such  or  diluted  with  water. 

Sponging  should  be  carried  out  daily  at  least 
once.  A sponge  bath  at  a temperature  of  90  de- 
grees, given  under  the  covers  so  that  the  child 
will  not  be  exposed  to  the  air,  often  results  in  a 
refreshing  sleep  of  several  hours.  Hyperpyrexia 
in  itself  may  do  little  harm  unless  accompanied 
by  nervous  manifestations.  An  ice-bag  to  the 
head  and  a tepid  sponge  can  transform  a delirious 
patient  into  one  enjoying  a quiet  sleep. 

Just  a word  regarding  sponging:  Most  mothers 
fear  the  procedure  as  one  which  may  cause  the 
child  to  take  more  cold.  This  should  not  result 
if  the  patient  is  not  exposed  and  the  bath  is  begun 
at  a temperature  of  95  degrees,  gradually  being- 
reduced  to  90  degrees  and  even  85  degrees,  ac- 
cording to  the  degree  of  fever.  To  be  most  effec- 
tive the  cloth  should  be  wrung  fairly  dry,  the  bath 
continued  for  ten  to  fifteen  minutes,  and  the 
moisture  allowed  to  evaporate  on  the  skin. 

Abdominal  Distention. — This  unpleasant  occur- 
rence is  quite  frequent.  When  it  first  appears,  all 
food  should  be  withheld  for  twelve  hours  and  a 
cathartic  given. 

Turpentine  stupes,  and  enemas  of  soda,  turpen- 
tine, or  milk  and  molasses  will  relieve  the  milder 
cases.  If  these  are  ineffective,  one-half  cubic 
centimeter  of  obstetrical  pituifyin  should  be  given 
every  three  hours,  or  as  needed. 

A persistence  of  the  condition  after  these  meas- 
ures have  failed — and  they  unfortunately  will  fail 


172 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


sometimes — usually  means  the  development  of 
peritonitis  or  approaching  death  as  a result  of 
circulatory  failure. 

DRUG  TREATMENT 

The  parents’  importunate  demands  that  some- 
thing be  done  in  a critical  case  often  leads  us  into 
the  error  of  prescribing  medication  which  serves 
no  useful  purpose  in  our  scheme  of  treatment,  but 
does  irritate  and  exhaust  the  child  in  the  effort 
to  administer  it.  Furthermore,  it  is  apt  to  turn 
him  against  taking  nourishment  by  mouth  and 
make  it  difficult  to  give  that  which  is  most  needed. 

These  parental  demands  may  be  met  by  em- 
phasizing the  importance  of  rest,  less  disturbance, 
and  the  hour  by  hour  nursing  care.  I believe  we 
are  well  repaid  for  such  time  spent  in  education. 
A case  in  point  was  a mother  who  stated  to  me 
recently  that  she  had  succeeded  with  minor  colds 
of  the  past  winter  by  the  common-sense  care 
which  she  had  given  her  children,  as  learned  by 
experience  with  pneumonia  the  preceding  year, 
and  drugs  played  very  little  part  in  this  case. 

Cough. — Children  with  pneumonia  always  cough 
and  this  symptom  does  demand  our  consideration. 
The  warmed  fresh  air,  inhalations,  and  counter- 
irritation are  the  first  things.  Hot  drinks  are  very 
soothing.  One  ounce  of  hot  milk  with  a little 
baking  soda,  given  frequently,  will  often  allay  a 
distressing  spasm  of  coughing.  In  the  early  stage, 
when  secretions  are  scanty,  syrup  of  hydriodic 
acid  is  effective.  To  this  may  be  added  chloro- 
form water,  sodium  bromid  or  codein  as  a seda- 
tive and  the  whole  made  palatable  by  flavoring 
with  syrup  of  raspberry.  Codein  is  a drug  which 
can  be  given  with  sure  sedative  effect  and  no 
danger  of  habit  formation.  I have  never  heard 
of  a codein  addict. 

Rest  and  Sleep. — Rest  and  sleep  are  very 
necessary  in  the  conservation  of  strength,  but 
hyperpyrexia  may  result  in  a distressing  degree 
of  restlessness  or  insomnia.  At  such  a time  it  is 
desirable  to  insure  sleep  and  the  use  of  sodium 
bromid,  veronal,  or  other  soporific  is  definitely 
indicated. 

Cyanosis. — -Cyanosis  may  appear  as  a result  of 
improper  ventilation,  extensive  involvement  of 
the  lung  tissue  or  plugging  of  the  bronchi  with 
secretions.  The  inhalation  of  oxygen  has  been  of 
decided  benefit,  although  this  is  an  open  question 
with  many  clinicians  who  feel  it  to  be  inefficient. 

Circulatory  Failure. — Circulatory  failure  has 
always  been  one  of  the  most  feared  symptoms 
in  pneumonia.  As  a matter  of  fact  clinical  study 
has  shown  that  as  an  isolated  event  it  occurs  very 
seldom.  Rather  it  is  associated  with  a terminal 
collapse  in  which  there  is  respiratory  failure,  ab- 
dominal distention,  acute  sepsis,  and  rapid  death. 
Heart  stimulants,  such  as  strophanthin,  caffein, 
atropin,  or  adrenalin,  are  to  be  given.  Routine 
digitalization  has  given  rise  to  a great  deal  of 
discussion  and  may  be  a harmless  procedure  if 
not  carried  too  far.  It  has  not  been  my  practice 
to  give  it  as  a matter  of  routine. 

Respiratory  Failure. — Respiratory  failure  as 
evidenced  by  dyspnea,  cyanosis,  and  restlessness 
are  more  amenable  to  stimulation.  Nothing  is 
more  effective  than  the  mustard  pack.  It  is 


quickly  and  readily  prepared  from  materials 
which  are  instantly  available.  Further  than  this, 
atropin,  oxygen  inhalations,  and  whisky  or  brandy 
may  be  used. 

Specific  Therapy. — If  bacteriological  study  has 
shown  the  patient  to  have  a Type  I pneumococcus 
infection,  specific  serum  therapy  should  not  be 
forgotten. 

BLOOD  TRANSFUSION 


I have  recently  been  interested  in  the  effect  of 
blood  transfusion  in  cases  of  prolonged  acute  in- 
fections and  have  transfused  six  infants  who  were 
ill  with  bronchopneumonia. 

One  was  a protracted  case  which  had  been 
through  a stormy  two  weeks  and  was  showing 
definite  improvement  when  the  other  lung  became 
involved.  About  150  cubic  centimeters  of  whole 
blood  was  given,  and  although  the  child  did  not 
completely  recover  for  another  three  weeks  it  was 
the  impression  of  both  myself  and  the  parents 
that  the  child’s  vitality  was  definitely  greater  after 
the  transfusion.  A complicating  factor  was  a 
double  suppurative  otitis  media. 

The  second  case  was  one  which  was  sent  into 
the  hospital  with  a complicating  empyema.  A 
rib  resection  was  done,  and  125  cubic  centimeters 
of  whole  blood  given ; the  patient  died  twenty- 
four  hours  later. 

The  other  four  cases  were  infants  who  had 
been  sick  from  four  to  eight  days  with  profound 
toxemia  and  prostration.  Amounts  of  blood  vary- 
ing from  86  to  125  cubic  centimeters  were  given, 
and  each  one  showed  a prompt  decline  in  the 
temperature  and  improvement  in  the  general  con- 
dition. They  were  convalescing  within  a week. 
The  oldest  of  these  six  babies  was  sixteen  months. 
In  each  case  the  blood  was  given  into  the  longi- 
tudinal sinus. 


COMPLICATIONS 


Dehydration. — Some  of  the  sickest  children  I 
have  seen  have  been  those  who  were  allowed  to 
develop  a marked  degree  of  dehydration.  I have 
already  mentioned  the  necessity  of  forcing  fluids 
by  mouth.  If  a satisfactory  amount,  which  means 
from  one  to  two  quarts  a day,  cannot  be  given  in 
this  manner,  we  must  resort  to  infusions  or  intra- 
peritoneal  injections.  Large  amounts  of  normal 
salt  solution  can  be  given  by  hypodermoclysis. 
Glucose  solution  may  also  be  given  in  this  manner 
although  there  are  reports  of  cases  in  which 
sloughing  occurred  after  such  injections.  In  the 
peritoneal  cavity,  Ringer’s  solution  is  preferable. 
From  200  to  500  cubic  centimeters  may  be  given 
every  eight  to  twelve  or  twenty-four  hours  with 
complete  absorption  and  without  irritation.  This 
latter  advantage  makes  it  superior  to  normal 
saline  or  glucose.  The  giving  of  fluids  by  rectum 
is  very  unsatisfactory.  A few  ounces  may  be 
retained  at  first,  but  repetition  of  the  procedure 
results  in  such  irritation  of  the  rectum  that  fur- 
ther retention  is  impossible.  The  intraperitoneal 
route  is  the  one  of  choice  because  it  is  less  pain- 
ful and  can  be  repeated  frequently.  At  the  same 
time  absorption  is  not  so  rapid  as  to  thrust  a 
burden  on  the  cardiovascular  system. 

Otitis  Media. — Infection  of  the  middle  ear  is 
always  possible  when  there  is  an  infection  in  the 
upper  air  passages ; in  pneumonia  it  is  one  of 


March,  1930 


BRONCHOPNEUMONIA  IN  CHILDHOOD — COOK 


173 


the  most  frequent  complications.  The  infection 
may  be  through  the  blood  stream  or  through  the 
eustachian  tube,  the  latter  favored  by  the  ever 
present  cough.  The  only  certain  way  to  detect 
the  condition  early  is  by  frequent  examinations 
of  the  ear-drums.  Otitis  media  may,  and  fre- 
quently does,  occur  without  causing  pain.  The 
ears  are  objects  of  suspicion  also  when  there 
is  a sudden  rise  in  temperature,  increasing  rest- 
lessness, rolling  of  the  head  from  side  to  side, 
or  the  definite  complaint  of  earache. 

Pain  alone  is  relieved  by  the  application  of  dry 
heat  or  moist  compresses.  Carbolized  glycerin 
is  a favorite  remedy  and  causes  a local  anesthesia 
of  the  drum  membrane  which  is  useful  if  a para- 
centesis becomes  necessary. 

The  best  procedure  is  to  irrigate  with  hot  boric 
acid  solution.  One  teaspoon  of  boric  acid  crys- 
tals is  dissolved  in  a pint  of  water,  heated  to 
a temperature  of  100  degrees  Fahrenheit,  and 
placed  in  an  irrigating  can  which  is  held  above 
the  ear  about  one  foot.  This  avoids  excessive 
pressure  against  the  drum.  A pointed  glass  tip 
is  used  on  the  end  of  the  tubing  and  each  ear 
canal  douched  with  the  entire  amount.  This  is 
repeated  every  three  hours  and  serves  not  only 
to  allay  the  pain,  but  also  to  relieve  the  inflamma- 
tion. Once  the  mother  undersTands  the  pro- 
cedure, it  is  easier  than  the  rubber  syringe 
method,  and  more  effective  because  of  the  con- 
stant gentle  flow. 

An  ear-drum  which  shows  increasing  redness 
and  swelling  should  be  incised  early.  If  carefully 
performed  it  will  not  result  in  introducing  any 
outside  infection  and  does  allow  the  escape  of 
gas  and  serum.  Prompt  healing  and  relief  of  the 
symptoms  will  usually  follow. 

If  distinct  bulging  of  the  drum  membrane  has 
occurred,  the  paracentesis  will  be  followed  by 
drainage  of  pus  for  from  a few  days  to  three 
weeks  and  sometimes  even  much  longer.  During 
this  period,  douching  should  be  carried  out  care- 
fully and  continually,  and  the  external  ear  kept 
scrupulously  clean  to  avoid  the  development  of 
furunculosis. 

Pyelitis. — Urinary  tract  infections  will  fre- 
quently follow  a focus  in  the  respiratory  pas- 
sages, and  while  pyelitis  is  not  a common  sequel 
of  bronchopneumonia,  examinations  of  the  urine 
must  be  made  as  the  only  means  by  which  its 
presence  can  be  detected.  A moderate  albumin- 
uria is  to  be  expected,  but  persisting  pyuria  de- 
mands the  recognition  and  treatment  of  pyelitis. 

Empyema. — Empyema  is  a serious,  though  not 
very  frequent  complication  of  bronchopneumonia. 
In  the  daily  examination  of  the  chest  the  pres- 
ence of  fluid  may  be  detected.  An  exploratory 
thoracentesis  will  confirm  the  diagnosis.  If  the 
effusion  is  clear,  simple  drainage  may  relieve  the 
condition  without  recourse  to  surgical  drainage. 
Purulent  fluid  demands  rib  resection  and  ade- 
quate drainage.  Confidence  must  be  placed  in  a 
competent  surgeon  to  decide  the  correct  pro- 
cedure in  the  individual  case. 

Meningitis  and  Meningismus. — Symptoms  of 
meningeal  irritation  demand  early  spinal  punc- 
ture for  two  reasons.  First,  it  is  the  only  way 
by  which  we  can  differentiate  meningitis  from 


meningismus ; and,  second,  it  is  good  treatment 
in  either  case.  Repeated  spinal  drainage  offers 
the  best  hope  of  relief  in  meningitis,  and  will 
alleviate  the  marked  nervous  symptoms  of  menin- 
gismus. CONVALESCENCE 

All  children  with  bronchopneumonia  should  be 
kept  in  bed  at  least  one  week  with  a normal  tem- 
perature. This  time  should  be  extended  for  the 
severe  cases  and  those  with  persisting  cough,  but 
in  any  case  the  child  should  feel  perfectly  well 
before  he  is  allowed  to  get  up.  Recurrences 
would  thus  be  avoided  and  ultimate  complete 
recovery  hastened.  Exercise  at  first  should  be 
very  limited  and  the  patient’s  initial  period  out 
of  bed  should  be  no  longer  than  fifteen  to  thirty 
minutes.  This  is  gradually  increased  each  day, 
as  returning  strength  permits.  In  allowing  the 
patient  to  be  out  of  doors,  it  must  be  remembered 
that  the  child  has  become  accustomed  to  the  at- 
mosphere of  the  house  and  these  fresh-air  periods 
must  be  carefully  guarded  and  of  short  duration. 

The  diet  need  not  be  limited  and  the  appetite 
is  usually  such  that  it  is  not  necessary  to  force 
food.  Cod-liver  oil  is  one  of  the  best  reconstruc- 
tive tonics ; syrup  of  ferrous  iodid  or  saccharated 
carbonate  of  iron  may  be. added  if  the  infection 
has  been  prolonged  to  the  point  of  producing  a 
secondary  anemia. 

SUMMARY 

The  treatment  as  outlined  is  based  upon  clinical 
observation  and  experience  with  cases  in  the 
writer’s  practice.  It  necessitates  highly  intelli- 
gent care : care  which  safeguards  against  serious 
complications  by  treatment  of  simple  respiratory 
infections,  which  recognizes  all  possible  com- 
plications, and  which  is  painstaking  and  tireless 
in  surrounding  the  patient  with  all  possible  hy- 
gienic protection.  The  fundamental  principles  are 
proper  rest,  fresh  air,  proper  food,  hydrotherapy, 
and  symptomatic  medication. 

215  Sainte  Claire  Building. 

DISCUSSION 

Edward  J.  Lamb,  M.  D.  (1515  State  Street,  Santa 
Barbara). — Doctor  Cook’s  paper  brings  before  those 
present  at  this  Pediatric  Section  a conservative,  con- 
cise and  effective  means  of  treating  bronchopneumonia. 

I consider  the  nursing  care  of  these  patients  of  the 
utmost  importance.  Quietness,  rest,  fresh  air,  and 
proper  nourishment  are  the  chief  essentials. 

I am  glad  to  hear  Doctor  Cook  emphasize  the  im- 
portance of  fresh  air  being  warmed  to  a temperature 
of  60  to  65  degrees.  So  many  mothers  and  nurses  feel 
that  fresh  air  becomes  stale  when  warmed  to  this 
temperature,  and  consequently  our  little  patients 
suffer  a relapse  or  reinfection  when  a portion  of  the 
exposed  body  becomes  chilled  by  this  cold  air. 

■Concerning  medication,  great  relief  of  dyspnea  may 
be  afforded  by  inhalation.  Drugs  given  internally 
may  be  limited  to  atropin,  iodin,  opium  (alkaloids), 
and  ammonium  salts.  ^ 

William  A.  Beattie,  M.  D.  (Medico-Dental  Build- 
ing, Sacramento). — Bronchopneumonia  is  in  most  in- 
stances not  difficult  to  diagnose,  but  in  almost  every 
case  we  are  confronted  with  obstacles  and  difficul- 
ties in  its  treatment.  There  is  no  specific  to  use  in 
bronchopneumonia,  and  for  that  reason,  if  for  no 
other,  we  welcome  the  privilege  of  listening  to  this 
unusually  well-developed  system  of  its  general  treat- 
ment as  presented  by  Doctor  Cook. 

We  know  that  bronchopneumonia  is  largely  a pre- 
ventable disease,  and  too  much  emphasis  cannot  be 
placed  on  this  phase  of  its  treatment.  In  this  disease 


174 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


most  certainly  “an  ounce  of  prevention  is  worth  a 
pound  of  cure.’’  Advice  given  to  parents  as  to  the 
proper  method  of  treating  common  “colds,”  or  even 
better,  methods  of  preventing  the  spread  of  this 
common  infection,  will  help  in  no  small  measure  to 
prevent  the  development  of  bronchopneumonia.  In 
the  vast  majority  of  children  who  contract  this  dis- 
ease, we  find  them  either  subnormal  in  nutrition  or 
neglected  in  the  care  given  them  during  the  course 
of  a simple  infection  of  the  upper  respiratory  tract. 
The  consequences  are  the  development  of  the  danger- 
ous disease,  bronchopneumonia.  The  fact  of  lowered 
resistance  may  be  the  primary  condition  which  has 
made  them  a victim  to  infection.  In  other  words, 
bronchopneumonia  is  usually  a disease  secondary  to 
a mild  respiratory  infection  which  is  found  in  the 
majority  of  instances,  in  children  whose  care  or  de- 
velopment has  been  faulty.  It  is  therefore  of  par- 
ticular importance  that  in  any  outline  of  the  treatment 
of  bronchopneumonia,  special  emphasis  be  laid  upon 
prophylactic  measures. 

Adelaide  Brown,  M.  D.  (909  Hyde  Street,  San 
Francisco).- — Doctor  Cook’s  paper  emphasizes  the  im- 
portance of  nursing  in  bronchopneumonia.  Every 
mother  should  be  able  to  take  temperature,  record 
bowel  movements,  diet  (amount  taken),  and  count 
pulse  and  respiration  in  the  sleeping  child,  and  keep 
a log  of  the  day’s  happenings.  Written  instructions 
should  be  left,  whether  the  mother  or  a nurse  carries 
out  the  orders.  In  the  one  case  they  are  an  encour- 
agement and  save  uncertainty;  in  the  other,  they  save 
discussion  between  the  riiother  and  nurse. 

In  using  a croup  kettle  or  a steaming  apparatus,  I 
have  it  set  in  a metal  basin  as  a precaution  against 
fire.  For  the  restless  baby,  or  young  child  with  high 
temperature,  packs  changed  every  two  or  three  hours 
are  less  irritating  than  sponging  and  avoid  narcotics 
and  reduce  temperatures. 

For  enemata  to  reduce  gas,  milk  of  asafetida  with 
equal  parts  of  water  or  molasses  and  milk  do  not  irri- 
tate as  more  powerful  purgatives  do. 

Conservation  of  strength  is  the  sheet  anchor  of 
success  in  these  cases. 


SURGICAL  AND  NONSURGICAL  FACIAL 
NEURALGIAS* 


By  Mark  Albert  Glaser,  M.  D. 
Los  Angeles 


Discussion  by  Samuel  D.  Ingham,  M.D.,  Los  Angeles; 
II.  Douglas  Eaton,  M.  D.,  Los  Angeles;  Walter  F. 
Schaller,  M.  D.,  San  Francisco. 


Y TSUALLY  when  neuralgia  of  the  face  is  con- 
sidered,  attention  is  directed  to  the  trigeminal 
tract.  This  neuralgia  is  an  extremely  important 
disease  entity,  but  the  many  painful  affections 
involving  the  face  and  referable  to  other  cranial 
nerves  should  not  be  disregarded. 


TRIGEMINAL  NEURALGIA 

Trigeminal  neuralgia  was  recognized  by  Avi- 
cenna in  A.  D.  1000,  and  was  later  described  by 
Schlichtung  (1748),  Nicolous  Andre  (1756),  who 
first  named  it  “tic  douloureux,”  and  Fothergill 
(1773),  who  accurately  described  the  disease. 
Very  little  can  be  added  to  the  original  descrip- 
tion of  acute  attacks  of  sharp,  lancinating  pains, 
usually  with  freedom  from  pain  between  attacks, 
but  in  some  cases,  a sense  of  soreness  persists  in 
the  painful  zone.  The  attacks  of  pain  are  brought 

* Read  before  the  Neuropsychiatry  Section  of  the  Cali- 
fornia Medical  Association  at  the  fifty-eighth  annual 
session,  at  Coronado,  May  6-9,  1929. 


Fig.  1. — A semi-diagrammatic  sketch  demonstrating 
subtotal  section  of  the  sensory  root  of  the  trigeminal 
nerve.  1.  Hook  cutting  the  second  and  third  division 
fibers.  The  fibers  supplying  the  first  division  are  intact. 
2.  Hook  pulling  the  sensory  root  upward  so  as  to  expose 
the  motor  root.  3.  Third  division  of  the  trigeminal  nerve. 
4.  Motor  root.  5.  Ganglion.  6.  Dura.  7.  Middle  meningeal 
artery.  8.  Illuminated  retractor  elevating  the  brain. 
9.  Self-retaining  retractor. 


on  by  contact,  and  in  the  more  severe  cases  by 
even  a breath  of  air  or  spontaneously.  The  sever- 
ity of  the  pain  varies  greatly,  and  in  most  cases 
the  individuals  may  carry  on  their  daily  routine ; 
it  is  only  in  rare  cases  that  they  become  confined 
to  bed  fearing  the  extreme  consequences  of  the 
attacks.  The  pain  is  superficial  and  is  in  the 
zone  of  the  trigeminal  nerve.  Trigger  zones  are 
present  (Patrick),  and  there  are  never  any  areas 
of  anesthesia. 

Trigeminal  neuralgia  is  a disease  of  unknown 
etiology,  spontaneous  in  origin,  continuing  un- 
interrupted through  the  patient’s  life,  unless 
arrested  by  surgical  procedure.  No  single  in- 
stance of  spontaneous  cessation  has  been  re- 
corded. The  treatment  of  trigeminal  neuralgia 
is  either  alcohol  injection  of  the  nerve  trunks, 
or  surgery.  Recently  trichlorethylene  has  been 
introduced  and  the  results  have  been  satisfactory 
in  some  cases,  though  only  temporary. 

The  surgery  of  the  trigeminal  tract  is  one  of 
many  interesting  advances.  Rose  in  1892  resected 
the  ramus  of  the  mandible  and  curetted  away 
the  gasserian  ganglion.  Hartley  and  Krause  pub- 
lished their  contributions  a month  apart  which 
consisted  of  the  intracranial  section  of  the  periph- 
eral branches  of  the  gasserian  ganglion  through 
a middle  fossa  approach.  The  next  great  step 
was  made  by  Spiller  and  Frazier  when  they  di- 
vided the  sensory  root  (1901).  In  1915  Frazier 
advised  a subtotal  resection  so  as  to  prevent  a 


March,  1930 


FACIAL  NEURALGIAS— GLASER 


175 


keratitis  (Fig  1).  In  1919  Frazier  again  con- 
tributed the  preservation  of  the  motor  root.  More 
recently  Dandy  has  advised  the  section  of  the 
sensory  root  at  the  pons,  claiming  many  advan- 
tages for  this  new  procedure  over  the  previous 
operations. 

The  low  mortality,  which,  in  the  hands  of 
Frazier  has  been  0.37  per  cent,  the  relief  of  pain 
and  the  prevention  of  keratitis  does  not  as  yet 
warrant  a change  from  this  well  established  tech- 
nique. As  most  of  the  trigeminal  neuralgias  do 
not  involve  the  ophthalmic  division,  the  preserva- 
tion of  the  upper  third  of  the  sensory  root  so 
as  to  maintain  the  sensory  supply  to  the  cornea 
is  one  of  the  most  important  contributions. 

TUMORS  OF  THE  GASSERIAN  GANGLION 

Tumors  of  the  gasserian  ganglion  have  been  re- 
ported by  Russell,  Frazier,  Peet,  Sachs,  Shelden, 
etc.  Many  of  these  tumors  arise  from  the  dural 
sheath  of  the  ganglion ; others  are  nasal  pharyn- 
geal tumors ; while  still  others  are  metastatic. 
Tumors  may  readily  be  diagnosed  when  a patient 
presents  a clinical  picture  of  pain  in  the  trigemi- 
nal region  plus  anesthesia  with  paralysis  of  the 
muscles  of  mastication,  or  associated  with  other 
cranial  nerve  involvement. 

ATYPICAL  NEURALGIA 

From  the  group  of  trigeminal  neuralgias  have 
been  separated  a series  of  patients  complaining 
of  pain  in  the  face,  which  was  not  relieved  by 
section  of  the  sensory  root,  or  by  any  other  pro- 
cedures which  relieved  the  pain  of  trigeminal 
neuralgia.  For  want  of  a better  term  this  group 
has  been  designated  as  “atypical.”  A study  of  a 
series  consisting  of  one  hundred  and  forty-three 
patients  (Glaser)  demonstrated  that  whatever 
type  of  therapy  was  undertaken,  the  pain  usually 
became  worse.  Among  the  procedures  attempted 
for  the  relief  of  pain  were:  injection  of  alcohol 
in  branches  of  the  trigeminal  nerve ; cocainiza- 
tion  and  injection  of  the  sphenopalatine  ganglion; 
extraction,  of  teeth;  drainage  of  sinuses;  supra- 
orbital and  infra-orbital  nerve  avulsions;  nasal 
operations;  cervical  sympathectomy  (Frazier); 
stripping  of  the  peri-arterial  (carotid)  plexus 
(Frazier)  ; subtotal  section  of  sensory  root  of 
trigeminal  nerve;  mastoid  operations  and  pelvic 
operations.  This  disease  is  more  frequent  in 
females ; both  sides  of  the  face  are  equally  in- 
volved, and  is  more  common  in  the  first,  second 
and  third  decades.  Some  patients  present  a com- 
plete arc  of  pain,  as  in  Figure  2,  which  extends 
from  the  lower  jaw  to  the  upper  jaw,  malar  re- 
gion, nose,  over  the  eye,  in  the  eye,  under  the 
eye,  frontal  area,  temporal  area,  parietal  area, 
behind  ear,  front  of  ear,  through  ear,  to  occipital 
region,  suboccipital  region,  neck,  shoulder,  or 
arm.  In  the  series  of  cases  reviewed,  ten  areas 
of  pain  distribution  were  determined,  all  falling 
within  the  zone  herein  considered.  Various  com- 
binations of  these  areas  were  present,  as  was  also 
pain  in  single  zones. 

Analysis  of  the  type  of  pain  of  which  these 
patients  complained  demonstrated  an  extraordi- 
nary number  of  descriptive  adjectives.  A single 


adjective  was  not  always  used;  frequently  there 
were  several,  and  in  some  cases  the  patient  was 
wholly  at  a loss  to  describe  the  pain.  There  is 
one  outstanding  characteristic,  however,  in  which 
all  concurred — the  pain  was  not  superficial ; it 
was  not  referred  to  the  surface  like  that  of  tri- 
geminal neuralgia ; it  was  deep-seated  in  the  tis- 
sues, in  the  bone,  or  in  the  eyeball.  One  is  in 
the  habit  of  recognizing  various  types  of  sensa- 
tion as  thermal,  pain,  tactile  and  pressure.  Those 
of  tic  douloureux  invariably  imply  thermal  sen- 
sation and  a sense  of  sharp,  cutting  or  stabbing 
pain;  those  of  atypical  neuralgia  seem  frequently 
to  imply  pressure  sensations,  as.  throbbing,  grip- 
ping, pulling,  bursting,  and  the  like.  The  pain  of 
tic  douloureux  is  essentially  paroxysmal  with 
intervals  of  complete  relief.  The  pain  of  atypical 
neuralgia  is  essentially  persistent  and  continuous, 
with  periods  of  days  in  which  there  are  severe 
exacerbations.  During  the  first  two  or  three 
hours  of  these  aggravated  periods  the  pain  gradu- 
ally increases  until  the  height  is  reached,  after 
which  the  intensity  slowly  subsides,  until  at  the 
end  of  the  third  day  or  so  the  chronic  phase  is 
resumed. 

There  are  many  variations  from  this  rather 
typical  history.  There  may  be  an  interim  of  from 
three  to  nine  months.  A few  cases  showed  a re- 
mission as  long  as  from  two  to  three  years.  Dur- 
ing these  remissions  and  these  interims  some 
patients  were  entirely  free  from  pain  while  others 
had  a continuous  feeling  of  oppression  or  aching 
in  the  region  of  the  pain  zone,  though  not  of  such 
severity  and  intensity  as  during  the  exacerbation. 

None  of  the  patients  included  in  this  survey 
was  relieved  by  any  therapeutic  measures.  In  a 
few  the  pain  was  eased  by  the  administration  of 
coal-tar  products,  or  the  common  alkaloids  such 
as  codein  and  morphin.  Mention  may  be  made 
in  passing  of  the  common  use  of  opiates  in  the 
atypical  neuralgia,  while  those  of  true  tic  dou- 
loureux flatly  refuse  opium  or  its  derivatives. 

The  factors  aggravating  pain  may  be  divided 
into  general— such  as  changes  of  temperature, 
changes  of  climate,  and  menses.  These  factors 
were  much  more  frequent  than  the  local  con- 
ditions, such  as  washing  the  face,  brushing  the 
teeth,  or  eating,  the  latter  being  much  more  fre- 
quent in  trigeminal  neuralgia. 

In  conjunction  with  the  expression  of  pain, 
many  patients  had  associated  sympathetic  phe- 
nomena, such  as  lacrimation,  edema  of  the  eyes, 
unequal  pupils,  corneal  injection,  exophthalmos, 
salivation,  nasal  discharge,  flushing  of  face,  aural 
discharge,  nausea  and  vomiting,  perspiration. 

SPHENOPALATINE  NEURALGIA 

Sluder,  after  a careful  study  of  the  anatomical 
relations  of  the  sphenoid  and  posterior  ethmoids, 
demonstrated  that  in  many  cases  these  cells  were 
in  close  proximity  to  the  nasal  ganglion.  He  as- 
sumed that  if  inflammation  of  the  optic  nerve 
could  occur  from  infection  of  these  sinuses  there 


176 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


Fig.  2. — Atypical  neuralgia.  The  dots  indicate  the  com- 
plete pain  distribution.  The  dashes  indicate  the  sensory 
distribution  of  the  trigeminal  nerve.  Note  how  the  pain 
of  atypical  neuralgia  crosses  the  sensory  distribution  of 
the  trigeminal  tract. 

was  no  reason  why  the  nasal  ganglion  would  not 
suffer. 

A history  of  coryza  was  followed  by  pain  in 
the  root  of  the  nose,  in  and  about  the  eye,  the 
upper  jaw  and  teeth,  occasionally  the  lower  jaw 
and  teeth.  This  pain  also  extended  backward  to 
the  temple  and  above  the  zygoma  to  the  ear,  and 
was  always  severest  at  a point  five  centimeters 
back  of  the  mastoid.  It  could  also  extend  to  the 
occiput,  neck  and  shoulders,  or  even  the  arm,  fore- 
arm, hand  and  fingers.  Associated  with  this  pain 
was  a “stiff”  or  “aching”  throat,  or  itching  of  the 
hard  palate.  In  addition,  there  were  sympathetic 
symptoms  which  could  also  occur  without  even 
pain.  The  patient  was  seized  with  severe  sneez- 
ing and  a thin,  hot,  profuse  secretion  occurred; 
the  eyes  were  reddened ; there  was  increased 
lacrimation ; the  pupils  were  dilated  and  there  was 
dyspnea,  dry  rales,  asthenia,  and  photophobia.  If 
these  cases  do  not  get  better  by  cocainization,  he 
believed  the  pain  was  caused  by  a more  central 
lesion  of  the  maxillary  and  vidian  nerve,  second- 
ary to  sphenoidal  inflammation.  Intrasphenoidal 
application  of  cocain  was  then  indicated.  Injec- 
tion of  the  ganglion,  or  applications  of  formal- 
dehyd  and  silver  was  indicated  in  the  more  severe 
cases.  If  the  patient  is  not  relieved  by  these  treat- 
ments the  sphenoid  should  be  operated  upon, 
because  the  nerve  and  ganglion  would  then  be 
imbedded  in  a chronic,  inflammatory  tissue.  Many 
of  these  cases  have  only  a transitory  relief.  These 
cases  could  not  be  explained  clinically,  and  future 
study  would  necessarily  have  to  solve  the  problem. 

NEURALGIA  OF  THE  SEVENTH  CRANIAL  NERVE 

The  ear  sensory  supply  is  extremely  compli- 
cated and  there  are  many  areas  of  overlap.  The 
sensory  supply  of  the  ear  has  been  attributed  to 
the  seventh,  ninth,  and  tenth  nerves.  Anteriorly 
the  ear  is  bounded  by  the  trigeminal  tract,  pos- 
teriorly by  the  cervical  nerves.  Ramsay  Hunt 


was  the  first  to  call  attention  to  the  sensory  root 
of  the  seventh  nerve  and  its  sensory  supply  to 
the  ear.  A study  of  herpetic  inflammations  of 
the  geniculate  ganglion  demonstrated  that  this 
ganglion  supplied  the  tympanic  membrane,  the 
external  auditory  canal,  the  medius,  the  concha, 
tragus,  antitragus,  lobe  of  the  ear,  antihelix  and 
fossa  of  the  antihelix.  Taylor  and  Clark  reported 
a case  of  seventh  nerve  otalgia  wherein  the  pa- 
tient experienced  paroxysmal  pain  in  front  of 
the  left  ear.  The  pain  occurred  for  a half-hour 
almost  weekly.  It  was  stabbing,  not  only  in  front, 
but  also  deep  in  the  ear.  The  seventh  nerve,  the 
nerve  of  Wrisburg,  and  part  of  the  eighth  nerve 
were  divided.  Operation  resulted  in  relief  of 
pain,  complete  facial  palsy  and  deafness  on  the 
same  side  for  four  days.  After  six  months  the 
facial  palsy  improved ; the  patient  was  entirely 
pain  free. 

NEURALGIA  OF  THE  EIGHTH  CRANIAL  NERVE 

Frazier  in  1914  sectioned  the  eighth  nerve  of 
a patient  with  Meniere’s  disease  without  results. 
Recently,  Dandy  has  operated  on  a series  of  cases 
with  the  symptoms  of  Meniere’s  disease,  that  is, 
nausea  and  vomiting,  with  tinnitus  in  a deaf  ear. 
Absolute  cures  resulted. 

NEURALGIA  OF  THE  NINTH  CRANIAL  NERVE 

Weisenburg  was  the  first  to  call  attention  to 
pain  in  the  throat  due  to  involvement  of  the 
glossopharyngeal  nerve  in  a brain  tumor  (1910). 
In  1920  Sicard  and  Robineau  reported  three  cases 
of  glossopharyngeal  neuralgia.  Harris  described 
two  cases  in  1921.  Doyle  in  1923  reported  four 
more  cases.  Since  then  some  twenty-five  cases 
have  been  reported.  Glossopharyngeal  neuralgia 
consists  of  sharp,  shooting  pains  in  the  region  of 
the  tonsil,  base  of  the  tongue,  referred  to  the  ear, 
and  occasionally  down  the  neck.  There  is  a 
trigger  zone  in  the  tonsillar  region  and  the  base 
of  the  tongue.  The  attacks  may  also  be  brought 
on  by  swallowing  and  eating  or  may  occur  spon- 
taneously. The  operation  is  intracranial  section 
and  has  been  accomplished  by  Adson,  Stookey, 
Dandy,  with  the  entire  relief  of  pain. 

NEURALGIA  OF  THE  TENTH  CRANIAL  NERVE 

In  deep-seated  pain  in  the  ear  and  throat,  due 
to  carcinoma,  Fay  gained  relief  by  section  of  the 


Fig.  3. — X-ray  of  tooth  showing  pulp  stone  in  center. 


March, 1930 


FACIAL  NEURALGIAS — GLASER 


177 


tenth  nerve  when  the  ninth  nerve,  which  had  pre- 
viously been  sectioned,  did  not  relieve  pain.  Pain 
of  tuberculous  laryngitis  is  referred  to  the  su- 
perior laryngeal  nerve  of  the  vagus  and  can  be 
relieved  by  injection  of  alcohol,  or  by  section. 

NEURALGIAS  DUE  TO  MALIGNANT  INVASION  OF 
THE  VARIOUS  CRANIAL  NERVES 

Malignant  disease  about  the  face  and  neck  with 
the  terrific  pains  that  result  therefrom,  and  the  ex- 
treme discomfort  associated  with  sloughing  sur- 
faces, make  the  patient  extremely  miserable.  The 
cauterization  and  x-ray  treatment  that  is  carried 
out  causes  an  extreme  degree  of  pain.  It  is  in 
these  cases  that  injection  with  alcohol,  or  section 
of  the  various  nerve  roots,  will  greatly  ameliorate 
pain  and  lessen  the  patient’s  suffering,  and  will, 


Fig.  4. — Cross  section  of  the  same  tooth,  showing 
presence  of  pulp  stone  in  the  center.  (Tooth  extracted 
by  Dr.  J.  M.  Silverman.) 


in  addition,  allow  the  surgical  and  plastic  pro- 
cedures to  be  carried  out  painlessly.  Pain  deep 
in  the  ear  is  a symptom  difficult  to  relieve,  and 
it  is  for  this  reason  that  section  of  the  glosso- 
pharyngeal, or  the  tenth  nerve,  may  be  indicated. 
Upon  rendering  these  patients  pain  free,  the 
morale  is  greatly  increased,  morphin  is  unneces- 
sary, and  even  though  these  patients  realize  the 
procedure  has  nothing  to  do  with  a cure  of  their 
primary  disease  they  are  extremely  grateful  for 
the  relief  of  this  continuous,  terrific,  unbearable 
pain. 

DENTAL  PULP  STONE  NEURALGIA 

Severe  attacks  of  lancinating  pain,  referable  to 
one  tooth  or  several  teeth,  is  a disease  seen  more 
often  by  the  dentist.  It  is  caused  in  many  cases 
by  pulp  stones  which  are  calcareous  nodules  im- 
bedded in  the  pulp  and  which  press  upon  the 
nerves.  X-ray  will  demonstrate  these  nodules. 
Extraction  of  the  tooth  abolishes  the  pain  (Figs. 
3 and  4). 

CONCLUSIONS 

It  is  just  as  important  to  recognize  the  atypical 
form  so  as  to  desist  from  hopeless  surgery  as  to 
recognize  those  surgical  neuralgias  which  can  be 
cured  100  per  cent  by  operative  means.  Further- 
more, those  patients  who  suffer  from  neuralgias, 
due  to  invasion  or  irritation  of  the  cranial  nerves 
by  malignant  growth,  should  be  afforded  relief 
of  pain  either  by  alcohol  injections  or  surgical 
measures. 


In  this  paper  I have  only  attempted  to  briefly 
consider  the  more  salient  and  outstanding  diag- 
nostic features  of  the  facial  neuralgias. 

727  West  Seventh  Street. 

DISCUSSION 

Samuel  D.  Ingham,  M.  D.  (1252  Roosevelt  Build- 
ing, Los  Angeles). — The  survey  of  the  subject  of 
neuralgias,  as  presented  by  Doctor  Glaser,  leaves  little 
to  be  said  except  by  the  emphasis  or  discussion  of 
details.  The  typical  picture  of  tic  douloureux  is  easily 
recognized  and  the  most  effective  treatment  is,  of 
course,  resection  of  the  sensory  root.  The  method 
which  Doctor  Dandy  has  been  using  recently,  as 
mentioned  by  Doctor  Glaser,  is  an  approach  by  way 
of  the  posterior  fossa  under  the  cerebellum.  It  is 
interesting  to  note  that  Doctor  Dandy  states  that  he 
has  been  able  to  differentiate  the  pain  from  the  tactile 
fibers  in  the  sensory  root  of  the  fifth  nerve  at  the 
point  where  they  enter  the  pons.  By  cutting  only  the 
pain  fibers,  tactile  sensation  is  preserved  in  the  face 
and  trophic  ulcers  of  the  cornea  do  not  occur. 

The  injection  of  the  different  branches  of  the 
peripheral  nerve  with  alcohol  has  a definite  place  in 
the  treatment,  especially  with  those  patients  who  are 
poor  surgical  risks. 

Medical  treatment  is  generally  unsatisfactory,  al- 
though marked  relief  sometimes  occurs  from  daily 
doses  of  castor  oil  over  a prolonged  period. 

The  atypical  neuralgias  consist  of  a heterogeneous 
collection,  and  tax  the  diagnostic  ability  of  the 
physician. 

It  is  of  interest  to  note  that  important  contributions 
to  the  knowledge  of  anatomy  and  physiology  of  the 
sensory  cranial  nerves  have  been  made  by  the  neuro- 
surgeons. 

* 

H.  Douclas  Eaton,  M.  D.  (1136  West  Sixth  Street, 
Los  Angeles). — Doctor  Glaser,  in  his  discussion  of 
surgical  and  nonsurgical  neuralgias,  has  brought  to 
our  attention  a most  important  subject.  Though 
these  cases  are  not  so  frequent  as  some  other  less 
painful  neurological  conditions,  when  encountered 
they  are  most  intractable  to  treatment. 

Occasionally  one  sees  a case  of  trigeminal  neural- 
gia yield  at  least  for  a time  to  the  removal  of  foci 
of  infection  of  toxemia  but,  on  the  whole,  one  is 
quite  ready  to  agree  with  Doctor  Glaser  that  the 
treatment  of  this  disease  is  operative  either  by  alcohol 
injection  or  actual  surgery.  Successful  surgery  cer- 
tainly works  a miracle  for  these  patients. 

Frequently  cases  are  encountered  which  must  be 
classed  in  Doctor  Glaser’s  atypical  grouping.  Such 
cases  are  not  amenable  to  surgical  or  medical  treat- 
ment and  illustrate  again  the  present  limitations  of 
therapeutics  in  organic  neurology. 

The  objective  in  all  the  facial  neuralgias  we  are 
called  upon  to  treat  should  be  accurate  diagnosis,  for 
on  such  a study  is  dependent  any  possibility  of  suc- 
cessful therapy.  In  facial  malignancy,  nerve  surgery 
is  often  of  tremendous  value  in  relieving  the  extreme 
suffering. 

* 

Walter  F.  Schaller,  M.  D.  (909  Hyde  Street,  San 
Francisco).- — Neuralgia  has  many  points  in  common 
with  causalgia  in  the  character  of  the  pain,  superficial 
stimuli  causing  attacks,  and  radiation  of  pain.  For 
this  reason  and  because  of  the  preservation  of  sen- 
sation, contrasted  with  its  loss  in  neuritis,  I believe 
that  the  pathology  will  eventually  be  discovered  in 
the  sympathetic  nervous  system.  Doctor  Glaser 
points  out  associated  sympathetic  phenomena  in  his 
article.  Pain  in  the  domain  of  the  trigeminus,  affect- 
ing more  than  one  branch,  will  at  times  be  relieved 
by  the  injection  of  the  one  in  which  pain  originates 
or  shows  a well  marked  trigger  point. 

In  neuralgia  of  the  ophthalmic  division,  Vincent  of 
Paris  has  achieved  a result  by  decortication  of  the 


178 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


temporal  artery  when  other  surgical  means  had  failed. 
Sluder  has  pointed  to  the  sphenopalatine  ganglion  as 
a seat  of  atypical  neuralgia,  and  Sewall  of  Stanford 
has  devised  a new  surgical  approach  to  this  ganglion. 

The  treatment  of  severe  neuralgias  is  tending  to- 
ward surgery;  many  patients  who  have  had  tempo- 
rary relief  from  medical  measures  or  injections  finally 
request  permanent  relief  by  neurotomies.  The  re- 
moval of  focal  infections  in  established  cases  has 
been  far  from  satisfactory  in  my  experience:  a patient 
with  a facial  neuralgia  of  years’  standing  became 
edentulous  soon  after  the  onset.  The  diagnosis  of 
reflex  neuralgia,  due  to  tooth  impaction,  is  not  made 
so  frequently  as  in  the  past. 

Doctor  Glaser  has  given  us  a concise  and  compre- 
hensive account  of  the  present  status  of  neuralgia. 
The  profession  should  be  on  the  lookout  for  atypical 
neuralgias,  and  avail  themselves  of  the  suggestions 
for  treatment. 

(Xf 

Doctor  Glaser  (Closing). — I wish  to  thank  Doctors 
Schaller,  Eaton,  and  Ingham  for  their  very  interest- 
ing and  instructive  discussions. 


TUBERCULOSIS  IN  SCHOOL  CHILDREN* 

SOME  DIAGNOSTIC  POINTS 

By  E.  W.  Hayes,  M.  D. 

Monrovia 

Discussion  by  William  M.  Happ,  M.  D.,  Los  Angeles ; 
Lloyd  B.  Dickey,  M.D.,  San  Francisco. 

A CLEAR  conception  of  the  pathogenesis,  the 
physical  signs,  and  clinical  symptoms  of 
pulmonary  tuberculosis  in  children  has,  I think, 
been  the  most  perplexing  problem  that  those  of 
us  who  are  dealing  with  tuberculosis  have  had  to 
handle.  An  understanding  of  these  factors,  how- 
ever, is  of  vital  importance  in  our  campaign 
against  tuberculosis,  for,  as  has  been  repeatedly 
demonstrated,  if  the  disease  is  discovered  in  its 
early  stage  and  the  child  properly  handled,  it  can, 
for  the  most  part,  be  overcome.  On  the  other 
hand,  if  the  disease  is  allowed  to  progress  beyond 
the  early  stage,  during  both  the  period  of  child- 
hood and  that  of  adolescence,  the  mortality  rate 
is  high.  Again,  children  who  receive  a severe  in- 
fection and  who  do  not  succumb  in  early  life,  and 
who  do  not  receive  special  care  to  enable  them  to 
overcome  the  infection,  constitute  from  70  to  80 
per  cent  or  more  of  our  adult  cases  of  tubercu- 
losis. Dr.  Walter  Rathbun  recently  stated  that  he 
believes  that  we  will  find  the  missing  link  in  the 
tuberculosis  problem  through  the  study  of  the 
child. 

EARLIER  IDEAS  OF  PATHOGENESIS 

As  to  the  pathogenesis,  in  1876  Parrot  stated 
that  the  primary  focus  of  infection  in  children 
is  in  the  parenchyma  of  the  lung.  In  1912  Ghon, 
in  reporting  numerous  autopsies,  confirmed  Par- 
rot’s opinion.  Following  Parrot’s  and  Ghon’s 
work  we  were  left  with  the  impression  that  the 
tracheobronchial  glands  become  involved  by  ex- 
tension through  the  lymphatics  from  the  primary 
focus  in  the  parenchyma  of  the  lung;  that  this 
primary  focus,  for  the  most  part,  heals;  that  sub- 

*  Head  before  the  General  Medicine  Section  of  the  Cali- 
fornia Medical  Association  at  the  Fifty-Eighth  Annual 
Session,  at  Coronado,  May  6-9,  1929. 


sequent  involvement  of  the  lung  proper  is  the 
result  of  a reextension  of  the  disease  from  the 
tracheobronchial  glands. 

Some  five  or  six  years  ago  the  national  associa- 
tion appointed  a committee  of  six  men  to  formu- 
late an  outline  or  standard  which  would  serve  as 
a guide  in  our  study  and  classification  of  tubercu- 
losis in  children.  In  their  report  this  committee 
simply  added  to  the  classification  which  we  have 
for  adults,  that  of  hilum  tuberculosis.  Hilum 
tuberculosis,  as  described,  was  a separate  condi- 
tion occurring  as  the  characteristic  disease  of 
childhood,  wherein  the  glands  and  the  tissues 
around  the  root  of  the  lungs  w-ere  the  seat  of  the 
disease.  Here  again  the  inference  was  that  sub- 
sequent involvement  of  the  parenchyma  of  the 
lung  is,  for  the  most  part,  a direct  extension  from 
this  area. 

MORE  RECENT  REPORTS 

Since  this  report  was  submitted,  a number  of 
men,  both  clinicians  and  radiologists,  have  con- 
tinued to  carry  on  an  intensive  study  of  the  child. 
This  group  includes  such  of  the  present  workers 
as  Rathbun,  Myers  and  his  associates,  Dunham, 
Opie,  McPhedran,  Chadwick,  and  several  others. 
The  opinion  of  at  least  some  of  these  men  differs 
from  that  set  forth  by  this  committee,  not  only 
as  to  the  pathogenesis,  but  also  in  the  interpreta- 
tions of  physical  and  x-ray  signs  and  clinical 
symptoms.  The  work  of  these  later  investigators 
has  been  so  convincing  that,  at  the  present  time, 
at  least  some  of  the  original  committee  concur 
with  them  in  their  opinions.  The  result  is  that 
the  National  Sanatorium  Association  has  now 
appointed  a supplementary  committee  to  help 
work  out  a further  basis  for  the  standardiza- 
tion and  classification  of  pulmonary  tuberculosis 
in  children. 

REVIEW'  OF  THE  FINDINGS  OF  OPIE  AND 
MCPHEDRAN 

The  work  of  Opie  and  McPhedran,  who  for 
the  past  seven  years  have  been  carrying  on  this 
research  work  in  connection  with  the  University 
of  Pennsylvania,  has  been  particularly  enlighten- 
ing. Their  work  has  been  so  thorough  and  their 
conclusions  so  important  that  I feel  justified  in 
taking  a few  minutes  to  review  their  findings 
before  this  gathering.  During  this  seven  years 
they  have  studied  not  only  a large  number  of  chil- 
dren, but  they  have  also  studied,  by  x-ray  and 
tissue  examination,  four  hundred  pairs  of  chil- 
dren’s lungs  after  they  have  been  excised  at  post- 
mortem. According  to  their  findings,  subsequent 
involvement  of  the  lung  is  an  extension  from  the 
primary  focus  and  not  from  the  tracheobronchial 
glands.  They  grant  that  the  extension  of  the  dis- 
ease from  the  hilus  region  into  the  lung  paren- 
chyma may  occur  when  the  glands  break  down 
and  rupture  into  the  capsule.  Such  incidence  of 
spread,  however,  is  so  rare  as  to  be  almost  a 
curiosity. 

These  men  still  regard  tracheobronchial  lesions, 
or  the  so-called  juvenile  tuberculosis,  as  impor- 
tant because  they  indicate  severe  infection,  and 
the  children  in  whom  they  occur  are  likely  to  de- 
velop diffuse  pulmonary  lesions  from  the  primary 


March,  1930 


TUBERCULOSIS  IN  SCHOOL  CHILDREN — HAYES 


179 


focus,  but  not  as  a direct  extension  from  the 
tracheobronchial  area. 

The  primary  focus  of  infection  in  children  is 
characteristically  a basal  lesion  before  the  tenth 
year.  It  may  appear  as  a circumscribed  focal 
necrosis,  as  a diffuse  irregular  network,  or  as  a 
more  or  less  homogeneous  density  involving  a 
part  of  the  lobe.  In  general,  this  basal  infiltration 
in  childhood  tends  to  clear  up.  Often  the  only 
evidence  of  its  having  existed  is  the  finding  of 
small  deposits  of  calcium. 

The  apical  infiltrations  are  more  or  less  atypical 
in  childhood.  They  are  found,  however,  with 
comparative  frequency,  according  to  McPhedran, 
in  children  who  live  in  the  same  house  with  open 
cases  of  tuberculosis.  These  apical  lesions  appear 
as  soft  strands  proceeding  from  the  pleura  and 
diminishing  toward  the  hilum,  or  as  more  or  less 
blocked-out  wedges,  or  as  a mottling  which  is  less 
well  defined  than  in  adults.  The  primary  infiltra- 
tions in  the  upper  part  of  the  lungs  of  the  child 
do  not  have  so  great  a tendency  to  clear  up  as  do 
the  basal  infiltrations. 

Either  one  of  these  forms,  that  is,  the  basal 
or  the  apical  infiltration,  however,  may  advance 
rapidly  without  losing  its  original  type.  Again, 
it  has  been  found  that  extensive  and  spreading 
infiltrations,  particularly  in  the  apical  region,  may 
exist  for  years  without  signs  and  without  notice- 
able impairment  to  the  health.  Eventually,  how- 
ever, the  great  majority  of  such  lesions,  if 
unrecognized  and  untreated,  will  develop  into 
manifest  disease. 

Up  to  about  the  sixth  or  eighth  year  the  de- 
velopment of  manifest  disease  in  the  lung  of  the 
child  is  considered  the  result  of  the  direct  exten- 
sion of  the  primary  focus  of  infection.  Such  dis- 
ease tends  to  be  acute  and  widespread.  After  the 
sixth  or  eighth  year  the  manifest  disease  may  be 
the  result  of  a secondary  infection,  in  which  case 
it  tends  to  be  localized  and  chronic  in  type. 

These  infiltrations  as  a whole,  for  the  most 
part,  appear  to  rise  close  to  the  pleura  either  later- 
ally, anteriorly,  or  posteriorly,  and  extend  toward 
the  hilum,  often  in  wedge-shaped  areas  with  de- 
creasing density  in  contrast  to  the  arborization 
of  the  trunk  shadows,  which  diminish  from  the 
hilum  outward ; and  when  these  clear,  in  like 
manner,  they  tend  to  clear  from  the  periphery 
inward. 

Doctor  McPhedran  has  stated  that  if  we  com- 
pare the  roentgenograms  of  excised  lungs  with 
sectioned  specimens,  and  correlate  these  findings 
with  x-ray  exposures  of  the  living  where  the 
exposures  are  synchronized  to  the  heart  beat,  we 
can  demonstrate  that  very  slight  changes  in  the 
parenchyma  of  the  lung  can  be  recorded  in  the 
films  of  the  living. 

The  differential  diagnosis  of  some  of  these  lung 
infiltrations,  particularly  the  homogeneous  density 
of  a large  area  of  the  lower  lobe  in  nontubercu- 
lous  pneumonia,  rests  on  the  typical  onset  in  the 
child  living  in  contact  with  sputum-positive  tuber- 
culosis, by  the  slow  clearing  of  the  density  in  the 
favorable  cases  as  observed  by  the  x-ray,  by  the 


presence  of  an  active  tuberculin  reaction  and,  at 
times,  by  the  recognition  of  calcification  in  an 
associated  lymph  node. 

The  diagnosis  and  clinical  significance  of  tra- 
cheobronchial glandular  involvement  have,  in 
themselves,  been  subjects  of  much  difference  of 
opinion.  Opie  and  McPhedran  have  found  in 
their  work  that,  with  very  few  exceptions,  the 
only  definite  evidence  of  tuberculosis  of  the  tra- 
cheobronchial glands  is  the  presence  of  calcium 
deposits  as  revealed  by  the  x-ray.  The  exceptions 
to  this  dictum  occur  in  rare  fatal  infantile  cases 
where  the  gland  may  protrude  sufficiently  beyond 
the  hilus  shadow  to  be  recognizable.  Their  exten- 
sive researches  in  the  excised  lungs  and  the  lungs 
of  the  living  have  convinced  them  that  without 
calcium  deposits,  glands  involved  even  to  the  ex- 
tent of  caseation,  either  in  the  mediastinal  region 
or  in  the  hilus  region,  cannot  be  distinguished 
radiologically  from  the  surrounding  tissue.  They 
conclude,  likewise,  that  calcium  occurs  only  in 
glands  that  are  tuberculous. 

Again,  these  same  men  failed  to  find  any  direct 
relation  between  D’Espine’s  sign  and  extensive  in- 
volvement or  calcification  in  the  tracheobronchial 
glands.  The  enlarged  glands,  they  found,  do  not 
extend  to  the  spine  except  in  a few  rare  infantile 
cases  with  massive  caseation  of  the  lymph  nodes. 
The  usual  position  of  the  involved  glands  is  along 
the  posterior  or  posterolateral  aspect  of  the 
trachea. 

In  the  same  way  they  failed  to  find  any  defi- 
nite connection  between  interscapular  dulness  and 
muscle  spasm  and  enlarged  tracheobronchial 
glands.  The  apparent  widening  of  the  hilus 
shadow,  often  described  radiologically,  may  be 
found  to  be  due  to  movement  or  to  faulty  posi- 
tion. Their  conclusion  is  that  there  are  no  char- 
acteristic signs  other  than  calcium  deposits,  and 
no  symptoms  due  to  uncomplicated  tracheobron- 
chial tuberculosis  except  in  those  very  rare  cases 
where  it  has  extended  through  the  capsule  of  the 
node. 

They  also  found  that  D’Espine’s  sign,  as  well  as 
paravertebral  and  parasternal  dulness  and  bron- 
chovesicular  breathing  in*  the  interscapular  region, 
occur  in  children  that  are  normal. 

Further,  Opie  and  McPhedran  feel  from  their 
findings  that  the  so-called  peribronchial  thicken- 
ing of  the  trunks  and  the  apparent  beading,  which 
has  more  or  less  universally  been  given  a patho- 
logical significance  as  an  indication  of  the  exten- 
sion of  the  disease  from  the  hilus  region,  should 
not  be  considered  as  such  either  in  children  or  in 
adults.  In  a large  series  of  specimens  studied 
they  found  no  pathological  basis  for  the  inference 
that  this  thickening  is  due  either  to  a tuberculous 
or  to  a nonspecific  respiratory  infection.  By  the 
use  of  exposures  synchronized  to  the  heart  beat 
they  concluded  that  the  apparent  thickening  of 
the  trunks  was  due  to  movement  set  up  in  the 
accompanying  artery  by  systole,  and  that  the  ap- 
parent beading  was  caused  by  branches  coming 
off  from  the  arteries  at  angles.  We  are  not  justi- 
fied, then,  in  diagnosing  tuberculosis  by  x-ray 


180 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


findings  without  definite  signs  in  the  parenchyma 
or  calcium  in  the  glands. 

Again,  according  to  these  authorities,  another 
common  diagnostic  error  which  leads  to  false  con- 
clusions as  to  the  pathogenesis  of  tuberculosis  is 
the  finding  of  apparent  calcium  deposits  in  almost 
all  x-ray  films  of  chests,  particularly  along  the 
bronchi,  where  they  branch,  and  in  the  region  of 
the  hilus.  These  shadows  have  been  found  to  be 
due,  in  most  instances,  to  vessels  which  are  axial, 
or  nearly  so,  to  the  incident  or  primary  ray.  In 
such  cases  the  shadows  of  columns  of  blood  of 
various  lengths  are  cast  on  the  films.  They  appear 
as  dense  areas,  more  or  less  clear  and  regular  in 
outline.  Such  shadows  may  occur  anywhere  in 
the  lung  tissue  except  at  the  apex  and  in  the 
extreme  lateral  margin.  They  are  larger  and 
more  numerous  in  the  hilus  region,  where  the  ves- 
sels are  larger  and  more  numerous.  Shifting  the 
plane  of  the  x-ray  tube  will  cause  these  shadows 
to  disappear  or  reveal  their  true  nature. 

A calcified  lymph  node,  on  the  other  hand,  may 
change  its  contour  when  the  plane  of  the  tube  is 
shifted,  but  it  will  continue  to  be  recorded  as  a 
shadow  of  consistent  quality,  finely  and  irregu- 
larly granular,  or  made  up  of  softly  lamellated  or 
crenated  lines,  or  irregularly  stippled. 

SIGNIFICANCE  OF  THESE  OBSERVATIONS 

The  practical  significance  of  these  conclusions 
is,  on  the  one  hand,  first,  that  pulmonary  tubercu- 
losis in  the  child  is  an  involvement  of  the  lung 
parenchyma ; second,  that  this  involvement  may, 
and  not  infrequently  does,  progress  to  a consider- 
able extent,  where  it  exists  in  a latent  condition, 
without  giving  any  indication  of  its  presence 
through  physical  signs  or  clinical  symptoms ; and, 
finally,  that  these  latent  lesions,  unless  discovered 
and  treated  rigidly,  are  prone  later  to  develop  into 
serious  manifest  disease. 

The  practical  significance  of  these  conclusions 
is,  on  the  other  hand,  that  in  the  absence  of  char- 
acteristic physical  findings  or  clinical  symptoms 
of  tuberculosis  in  the  chests  of  children,  the  evi- 
dence of  a positive  diagnosis  rests  upon  a history 
of  household  exposure,  sensitiveness  to  the  tuber- 
culin test,  and  x-ray  evidence  of  parenchymatous 
involvement. 

In  conclusion,  I realize  that  the  last  word  re- 
garding tuberculosis  in  the  child’s  chest  has  not 
been  said.  The  work  of  these  men,  however, 
which  I have  used  as  a basis  for  this  paper,  has 
been  so  thorough  and  so  convincing  that  I feel 
it  deserves  our  most  thoughtful  consideration.  As 
Doctor  Rathbun,  whom  I have  already  quoted, 
says,  it  is  only  by  an  energetic  carrying  on  of  this 
work  by  a large  group  of  men  and  women  and 
by  a pooling  of  our  knowledge  as  we  go  along 
that  we  can  hope  to  arrive  at  anything  definite. 

129  North  Canyon  Drive. 

DISCUSSION 

William  M.  Happ,  M.  D.  (523  West  Sixth  Street, 
Los  Angeles). — Doctor  Hayes  has  brought  out  some 
interesting  points  for  discussion.  One  thing  which 
should  be  kept  in  mind  is  the  difference  between  the 
clinical  as  well  as  the  pathological  picture  of  pulmo- 
nary tuberculosis  in  infants  and  in  older  children.  In 
the  former  the  reaction  is  characteristically  glandular. 


The  enlargement  of  the  tracheobronchial  glands  is 
readily  demonstrable  by  x-ray  before  calcification  has 
taken  place,  even  in  young  infants.  It  is  important 
to  have  lateral  as  well  as  anteroposterior  pictures  to 
demonstrate  this.  Repeated  x-rays  are  of  more  value 
than  single  examinations. 

We  have  not  found  the  primary  focus  to  be  a basal 
lesion.  It  may  occur  in  any  part  of  the  lungs,  and 
usually  gives  no  localized  physical  signs.  The  re- 
action which  takes  place  in  the  chest  in  children 
usually  occurs  in  the  glands  draining  the  focus,  in 
the  hilum  of  the  lung,  or  as  an  extension  from  the 
focus  itself.  Such  types  of  tuberculosis  are  very  com- 
mon in  children.  The  apical  or  adult  type  of  reaction 
is  seldom  encountered  before  the  tenth  year. 

Physical  signs  are  usually  slight,  unless  caseation 
or  cavity  exist.  The  chief  diagnostic  points  are:  the 
symptoms,  fever,  tuberculin  test,  and  x-ray  findings. 
Contrary  to  former  belief,  the  prognosis  in  pulmo- 
nary tuberculosis  in  children,  even  in  infants  under 
one  year,  is  relatively  good. 

Comparative  clinical  studies  with  repeated  x-ray 
examinations,  checked  by  careful  pathological  studies, 
should  go  far  to  clarify  the  subject  of  tuberculosis  in 
children. 

* 

Lloyd  B.  Dickey,  M.  D.  (Stanford  University  Medi- 
cal School,  San  Francisco). — It  is  well  to  call  atten- 
tion to  the  fact,  as  Doctor  Hayes  has  done  in  this 
paper,  that  the  physical  signs  in  a child’s  chest  are 
seldom  in  proportion  to  the  amount  of  tuberculous 
disease  if  the  latter  is  present  in  a tuberculous  child. 
This  is  one  of  the  most  important  facts  to  be  remem- 
bered by  medical  men  who  are  trying  to  detect  early 
tuberculosis  in  childhood.  The  group  of  children 
classified  as  cases  of  “latent  tuberculosis”  by  Opie 
should  not  be  neglected,  even  though  they  show,  after 
careful  history  and  physical  examination,  no  manifest 
disease.  No  program  aiming  to  control  tuberculosis 
in  school  children  is  complete  without  means  for 
careful  observation  of  this  group.  It  is  possible  that 
these  are  the  children  that  are  building  up  the  resist- 
ance of  the  race  to  tuberculosis,  and  the  care  they 
receive  during  the  so-called  latency  of  their  disease 
probably  largely  determines  their  reaction  to  tuber- 
culous infection  and  reinfection  in  adult  life. 

Although  we  know  that  the  primary  disease  in 
children  is  usually  parenchymal,  we  still  feel  that 
when  symptoms  are  present  they  are  often  due  to  the 
extension  of  disease  to  the  lymphatic  system,  especi- 
ally to  the  hilar  lymph  nodes.  The  parenchymal  dis- 
ease, if  primary,  may  be  relatively  benign.  This  helps 
to  explain  the  large  number  of  positive  tuberculin 
reactors  that  never  show  symptoms  or  signs  of  dis- 
ease, and  these  children  make  up  a considerable  per- 
centage of  the  cases  of  “latent  tuberculosis.” 

Doctor  Hayes  (Closing).- — I am  particularly  pleased 
to  have  Doctor  Happ  and  Doctor  Dickey  discuss  my 
paper  because  of  the  work  they  have  done  in  this 
field.  They  have  emphasized  the  fact  that  the  clinical 
symptoms  and  physical  signs  are  often  wanting  or, 
at  best,  are  indefinite  and  misleading  in  the  case  of 
pulmonary  tuberculosis  in  children.  Consequently  we 
have  to  rely  largely  upon  our  history,  specific  tests, 
and  x-ray  study  in  this  work,  frequently  repeated  ob- 
servations being  important. 

In  considering  pulmonary  tuberculosis  in  children 
I think  we  should  keep  clearly  in  mind  the  fact  that 
there  are  two  distinct  types.  First,  there  is  the  type 
that  results  from  first  infection.  This  may  be  only  a 
small  area.  On  the  other  hand,  it  may  be  widespread 
and  diffuse.  This  is  the  type  that  is  accompanied  by 
involvement  of  the  hilus  glands.  This  type,  particu- 
larly if  the  source  of  infection  is  cut  off  and  the 
general  environment  of  the  child  improved,  is  rela- 
tively benign  and  tends  to  clear  up.  This  form  we 
ordinarily  regard  as  juvenile  tuberculosis. 

The  other  type  of  pulmonary  tuberculosis  in  chil- 
dren is  that  which  results  from  secondary  infection. 
It  tends  to  be  localized,  particularly  in  the  upper  part 


March,  1930 


HIPPOCRATIC  MEDICINE— PORTER 


181 


of  the  lung,  and  is  characterized  by  a tendency  to 
progress.  This  is  the  adult  type. 

The  juvenile  type  may  occur  in  adults,  but  I think 
is  less  frequent  than  the  adult  type  in  children. 

The  differentiation  between  these  two  types  can  be 
made,  for  the  most  part,  through  relatively  frequent 
x-ray  observation  of  the  course  they  pursue. 

THE  LURE  OF  MEDICAL  HISTORY 

HIPPOCRATIC  MEDICINE* 

PART  I 

By  Langley  Porter,  M.  D. 

San  Francisco 

T^/rODERN  medicine  prides  itself  on  its  effi- 
ciency  and  its  continuing  progress.  Those 
who  busy  themselves  in  its  activities  believe  that 
they  can  approach  it  only  through  the  method  of 
science.  This  method  of  science  is  a technique 
that  calls  for  accurate  observation ; it  calls  also  for 
precise  recording  of  observations  and  for  logical 
deductions  from  these  records — and  as  well  for 
the  dispassionate  application  of  these  deductions 
to  the  solution  of  problems  of  life,  death,  and  dis- 
ease. The  method  of  science  is  inevitably  based 
on  the  philosophic  conception  that  “order  rules 
nature,”  and  that  this  “order”  can  be  traced  by 
the  endeavors  of  man.  In  our  day  we  take  that 
ruling  order,  so  far  as  it  concerns  biology  and 
the  applications  of  biology  in  medicine,  to  be  ex- 
pressed in  the  theory  of  organic  evolution.  How- 
ever, we  must  realize  that  the  theory  enunciated 
by  Darwin  and  developed  by  his  successors  leaves 
much  unexplained,  and  itself  is  subject  to  evolu- 
tion’s dictates. 

Modern  medicine  has  gone  on  from  triumph  to 
new  triumph  because  it  has  been  able  to  accept 
this  hypothesis  and  to  deal  with  man  as  a biologi- 
cal, evolving  organism  adapted  to  an  environment. 
Today  we  think  of  the  perfection  of  that  adapta- 
tion as  health,  and  deviation  from  it  as  disease. 
Without  this  informing  idea,  all  the  help  of  optics, 
chemistry,  biochemistry  and  physics,  the  things 
which  have  continuously  helped  man  to  widen  and 
deepen  his  medical  knowledge,  would  have  been 
futile. 

MEDICINE  OF  ANCIENT  GREECE 

One  of  the  miracles  of  history  is  that  ancient 
Greece,  2500  years  ago,  should  have  been  able  to 
develop  a medicine  based  on  a study  of  nature ; of 
cause  and  effect — a medicine  that  originated  the 
method  of  science,  even  as  we  use  it  today;  one 
which  believed  thoroughly  in  the  healing  power 
of  nature — which  admitted  no  influence  of  a 
supernatural  kind,  and  eschewed  miraculous  cures, 
whether  these  were  produced  by  medicine  man,  or 
priest,  by  charm,  amulet  or  prayer. 

For  three  centuries  before  "Hippocrates — that 
is,  beginning  with  Thales  in  640  B.  C.,  Greek 
scientists  had  been  struggling  to  understand  the 
ordered  rule  of  nature  in  which  they  had  so  cer- 
tain a faith.  Thales  himself,  the  first  of  the  Greek 
thinkers  known  to  us  by  name,  and  following  him, 
Anaximander,  Alkmaeon,  Empedokles,  Demokri- 

*Read  before  the  San  Francisco  County  Medical  Society, 
January  14,  1930. 


tus,  Pythagoras  of  Croton,  and  a score  of  other 
Ionians,  had  been  arriving  at  the  conception  of 
a dynamic  universe,  a universe  in  flux ; an  infinity 
of  actions  and  reactions,  a cosmos  in  which  matter 
was  an  exponent  of  ceaseless  motion;  a concep- 
tion, in  fact,  not  very  different  from  that  which 
our  astronomers  and  physicists  offer  us  today, 
when  thej^  urge  on  us  the  modern  theories  of 
spiral  nebulae  and  of  atoms  made  up  of  constella- 
tions of  electrons,  swarming  about  a central  pro- 
ton. This  dynamic  conception  was  not  universally 
accepted,  not  even  in  Greece.  Philosophers,  among 
the  most  notable  of  them.  Socrates,  found  the 
cold  realities  of  observational  science  too  for- 
bidding, and  sought  solace  in  the  abstractions  and 
inspirations  of  metaphysics.  After  Socrates  came 
Plato  who,  while  a mathematician  and  philosopher 
of  the  highest  order,  developed  in  his  academy  a 
school  that,  in  spite  of  Aristotle,  proved  in  time 
to  be  detrimental  to  the  progress  of  the  biological 
sciences  and  of  medicine. 

THE  IONIAN  GREEKS 

The  mental,  intellectual  and  spiritual  qualities 
that  create  pioneers  are  just  the  qualities  needed 
to  develop  scientific  medical  thinkers,  and  so  it 
happened  in  Ionia.  The  arts,  especially  that  art 
most  essential  to  fighting,  seafaring,  adventuring 
people,  the  art  of  medicine,  developed,  becoming 
year  by  year  more  practical  and  more  scientific, 
more  based  on  a belief  in  the  “rule  of  order  in 
nature,”  more  divorced  from  magic,  astrology, 
and  things  supernatural. 

And  why  was  the  Ionian  Greek  so  dominantly 
an  individualist  and  a rationalist?  The  answer  is 
inherent  in  the  history  of  the  race.  He  had  the 
same  spirit  of  pioneering  that  animated  the  fore- 
fathers of  the  American  West.  He  was  a colonist, 
a sailor,  a trader,  a professional  soldier ; success 
in  all  of  those  walks  which  depend  on  daring, 
on  courage,  clear  thinking,  curiosity,  independ- 
ence of  character,  decision  and  skepticism  in  the 
face  of  conservatism.  Added  to  these  reasons  was 
the  paramount  influence  of  geographical  position. 
The  Ionian  colonies  lay  at  the  crossroad  of  the 
world’s  traffic : Egypt  to  the  south,  the  Hittite 
empires  to  the  east  and,  at  the  very  gates,  the 
islands  and  shores  that  were  saturated  with  the 
culture  of  the  Minoans  of  Crete,  that  island  people 
who  we  now  know  dominated  the  Mediterranean 
world  before  our  written  history  began.  It  was 
on  this  Minoan  culture  that  the  sure  foundation 
of  Greek  civilization  arose,  and  through  the 
Greeks  it  became  the  basis  of  the  European  and 
Western  culture  of  which  we,  today,  are  so  proud. 

IONIAN  GREEK  CONCEPT  OF  NATURE 

These  Greek  Ionian  philosophers  had  none  of 
our  modern  instruments  of  precision,  no  telescopes 
or  microscopes  or  stethoscopes ; no  physical  or 
chemical  methods,  no  x-rays,  no  photography. 
But  by  virtue  of  observation  and  comparison ; 
with  naked  logic  and  clearly  thought-out  infer- 
ence, they  evolved  a theory  of  the  nature  of  the 
world  and  of  man  that  was  satisfying  to  the  mind 
and  which  fitted  in  with  all  the  known  facts  that 
had  then  been  accumulated.  This  universe  that 


182 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vo  I.  XXXII,  No.  3 


they  visualized  was  thought  to  be  composed  of 
four  elements  : earth,  air,  fire,  and  water;  for  each 
of  these  there  was  a quality — dry,  moist,  hot,  and 
cold.  There  was  also  the  pneuma — a life-sustain- 
ing fluid,  a form  of  air,  permeating  the  universe, 
which  these  students  called  the  macrocosm.  The 
pneuma  entered  with  the  breath  into  the  body  of 
man  which  was,  in  contradistinction  to  the  uni- 
versal “macrocosm,”  the  “microcosm.”  From  the 
activities  of  the  pneuma  in  the  body  there  arose 
the  innate  heat — the  “fire  without  flame  or  spark,” 
as  Aristotle  put  it — truly  a marvelous  preview  of 
oxygen,  its  powers  and  activities. 

The  microcosm — man — was  made  up  of  the 
four  elements  and  the  four  qualities.  In  him  the 
elements  and  qualities  were  represented  by  the 
four  humours : phlegm,  blood,  yellow  bile,  and 
black  bile.  A man  was  healthy  when  the  four 
humours  were  in  perfect  balance : “perfect  krasis” 
the  Greek  would  say.  When  one  humour  was  in 
excess  there  was  a “dyskrasia,”  an  overbalance, 
and  disease  was  the  result ; a theory  not  so  unlike 
the  views  we  subscribe  to  today  in  our  theories  of 
acidosis  and  alkalosis. 

When  phlegm,  thought  to  be  a secretion  of  the 
pituitary  body,  appeared  in  excess  in  abscesses,  in 
colds  in  the  head,  in  tuberculosis,  and  in  the  dis- 
charge of  sputum,  it  was  taken  to  be  evidence  of 
nature’s  attempt  to  bring  about  a cure  by  getting 
rid  of  the  excess  humour.  In  the  case  of  abscess 
formation,  or  of  empyema,  a state  of  affairs  in 
which  nature  is  making  an  unsuccessful  attempt 
to  rid  the  body  of  an  oversupply  of  the  humour 
phlegm,  the  surgeon  must  intervene,  incise  the 
part  and  so  help  the  body  arrive  at  a rebalance. 

The  Hippocratic  physician  held  the  theory  of 
the  four  elements  and  the  four  humours  to  be 
valid.  Although  apparently  he  let  these  theories 
influence  his  practice  no  more  than  the  modern 
man  permits  the  quantum  theory  of  atomic  struc- 
ture to  interfere  with  his  treatment  of  tubercu- 
losis or  of  appendicitis. 

To  bring  the  humours  back  to  proper  propor- 
tion after  dyscrasia,  or  unbalance,  a process  of 
pepsis  was  thought  to  be  developed  in  the  body. 
This  was  conceived  as  a sort  of  ripening  or  cook- 
ing that  developed  under  the  influence  of  the 
innate  heat.  The  result  was  a restoration  of  krasis 
and  an  elimination  of  any  excess.  Brock  notes 
that  in  reality  the  process  was  thought  of  as  a 
kind  of  digestion  of  the  environment  by  the 
organism.  The  only  essential  difference  between 
health  and  ill  health  was  that  in  health  the  organ- 
ism mastered  its  environment  with  ease  ; while  in 
ill  health  the  mastery  was  difficult,  and  the  organ- 
ism became  conscious  of  disease. 

The  vast  majority  of  the  acute  diseases  seen  by 
Greek  physicians  were  malarial  and  tended  to 
terminate  suddenly  on  a certain  day  of  the  ill- 
ness ; this  termination  was  called  the  “krisis.”  Dis- 
eases of  long  duration  tended  to  end  by  slow  re- 
cession, lysis,  or  else  by  what  the  Greeks  called 
apostasis,  which  is  translated  by  W.  H.  S.  Jones 
as  abscession — a term  that  is  self-explanatory. 

The  Greeks  taught  that  no  hard-and  fast  line 
can  be  drawn  between  physiological  and  patho- 


logical processes.  The  process  of  coction  of  the 
humours  they  likened  to  the  digestion  of  food  and 
the  expression  of  excreta  after  meals. 

It  appears  that  the  daily  task  of  the  Greek  phy- 
sician at  the  periods  when  Greek  medicine  was 
at  its  best,  was  carried  on,  on  a basis  of  accurate 
clinical  observation,  accurate  recording,  logical 
deduction  and  reasonable  application  of  the  de- 
ductions to  the  solution  of  the  problems  of  daily 
practice.  It  is  for  this  reason  that  the  modern 
physician,  reading  the  works  of  Hippocrates  or 
Galen,  finds  himself  more  in  sympathy  with  the 
mental  processes  of  these  writers  than  he  does 
when  he  attempts  to  fathom  most  medical  writings 
that  originated  in  the  seventeenth  and  eighteenth 
centuries.  This  is  in  spite  of  the  fact  that  the 
doctrine  of  the  four  humours  and  the  practical 
teachings  of  the  Greeks  dominated  medical  ideas 
until  the  first  two  decades  of  the  nineteenth 
century. 

HOW  GREEK  MEDICAL  LORE  REACHED 
OTHER  LANDS 

The  story  of  the  transmission  of  Greek  medi- 
cine through  Alexandria,  Rome,  and  the  Greater 
Greece  that  flourished  in  Sicily  and  southern 
Italy — of  its  emasculation  at  the  hands  of  Syrian, 
Arab,  and  European ; Jew,  and  monk,  infidel  and 
Christian — is  fascinating  but  voluminous.  Equally 
so  is  the  record  of  its  renaissance  after  the  fall 
of  Constantinople  when,  through  the  gateway  of 
Venice,  good  Greek  medical  manuscripts  found 
their  way  into  Italy. 

The  sack  of  Mayence  in  1426  drove  artisans 
skilled  in  the  newly  developed  printers’  craft 
south  to  Italy ; and  books,  among  them  many 
Greek  medical  texts,  began  to  flow  from  Italian 
presses.  Students  and  readers  caught  the  infec- 
tion of  the  Greek  spirit.  Little  by  little  the  dis- 
torted, shadowy  interpretations,  codifications  and 
emendations  of  the  great  Greek  authors  which  the 
Arabs  and  the  medieval  schoolmen  had  passed 
down,  lost  their  authority. 

Not  only  in  science  did  the  Greeks  develop. 
All  the  world  knows  how  the  minds  of  their  gifted 
men  were  taken  up  with  the  interpretation  and 
revelation  of  the  secrets  of  nature;  how  number 
and  proportion  and  form  and  change  of  form  in- 
trigued them,  and  how  out  of  these  ponderings 
and  peerings  grew  the  understanding  of  the  laws 
of  proportion,  of  beauty  and  of  their  application 
to  architecture,  to  sculpture,  to  vase  painting,  to 
literature  and  philosophy  and  metaphysics.  Un- 
fortunately some  of  their  greatest  philosophers 
tried  to  solve  the  problems  by  applying  metaphysi- 
cal formulas  in  the  field  of  the  mundane,  and  in 
doing  so  they  began  the  rot  and  ruin  of  science 
and  of  the  art  of  medicine  that  was  to  prove 
almost  fatal  a thousand  years  later. 

•Not  all  Greeks  belonged  to  the  gifted  classes  ; 
the  man  in  the  street  and  in  the  tavern,  the  little 
householder  and  the  proletariat  existed  then  as 
they  exist  today,  and  perhaps  were  less  affected 
by  the  theories  of  the  Greek  intelligentsia  than  we 
are — and  much  less  influenced  by  the  better 
thought  of  their  own  time  than  the  people  of  like 
station  are  today.  For  there  were  no  widespread 


March,  1930 


CASE  REPORTS 


183 


school  systems,  none  of  the  modern  means  for 
the  diffusion  of  knowledge  that  exist  in  these 
times. 

So  it  need  not  surprise  us  that,  then  as  now, 
scientific  medicine  was  not  generally  accepted.  In 
the  parlance  of  the  present,  it  had  to  sell  itself 
to  those  it  would  serve,  and  that,  as  we  shall  see, 
was  reflected  in  its  great  anxiety  to  be  able  to 
prognose  well.  It  did  not  sell  itself  universally, 
perhaps  not  even  widely,  for  we  find  it  related 
that,  side  by  side  with  the  medicine  of  Hippocrates 
and  other  great  exponents,  priest-led  theurgic 
medicine  flourished  and  was  richly  supported  by 
invalids  who  flocked  to  the  temples  of  the  healing 
gods  for  cures.  Also,  just  as  there  is  today  a 
vast  trade  in  patent  medicine  and  proprietaries, 
a vast  support  for  cultists  and  traffickers  in  mirac- 
ulous and  supernatural  cures,  so  there  was  then  a 
dominating  folk  medicine  which  used  the  services 
of  astrologers,  of  magicians  and  sorcerers  that  put 
its  faith  in  amulets,  charms  and  incantations. 

University  of  California  Medical  School. 

(Part  II  of  this  paper  will  be  printed  in  the 
April  issue.) 


CLINICAL  NOTES  AND  CASE 
REPORTS 


A RARE  SEQUEL  TO  GASTRO- ENTEROSTOMY* 

REPORT  OF  CASE 

By  E.  Eric  Larson,  M.  D. 

Woodland 

HPHE  first  gastro-enteric  anastomosis  was  made 
by  Wolfler  and  Nicoladini  in  1881.  Since  then 
there  have  been  numerous  modifications  of  tech- 
nique designed  to  eliminate  complications.  At  the 
present  time  the  results  of  gastrojejunostomy  are 
very  satisfactory  when  the  operations  are  done 
by  surgeons  of  experience.  The  modern  gastro- 
enterostomy is  so  performed  that,  in  at  least  90 
per  cent  of  these  operations,  complications  do  not 
arise. 

We  wish  to  emphasize  an  unusual  complication 
which  has  been  infrequently  reported  by  both 
American  and  European  surgeons.1"14  Although 
rare,  it  always  must  be  borne  in  mind  when  a 
patient,  for  whom  a gastro-enterostomy  has  been 
done,  is  seen  with  evidence  of  an  acute  intra- 
abdominal catastrophe.  Prompt  operation  will 
give  complete  relief  ; delay  will  be  fatal. 

REPORT  OF  CASE 

Mr.  J.  E.  G.,  forty-one,  Portuguese,  entered  the 
Woodland  Clinic  on  January  25,  1925,  complaining  of 
periodic  abdominal  distress  of  fifteen  years  duration, 
which  was  typical  of  duodenal  ulcer. 

For  ten  days  before  entry  he  complained  of  a rather 
severe  recurrence  of  the  same  distress,  but  much  more 
knife-like  in  character  and  constant  after  food.  Alkalis 
had  not  been  tried  for  relief.  There  had  been  no 
weight  loss.  Morphin  had  been  given  by  his  home 
physician  for  two  or  three  days  prior  to  entering  the 
hospital. 

Physical  examination  was  negative  except  for: 
blood  pressure  108  systolic,  60  diastolic;  marked  ten- 

*  From  the  Department  of  Surgery,  Woodland  Clinic, 
Woodland. 


derness  in  the  left  epigastrium  with  no  spasticity  or 
rigidity,  but  with  a defense  tightening  of  the  abdomi- 
nal muscles  on  deep  palpation.  The  urinalysis  and 
blood  Wassermann  were  negative.  The  blood  count 
showed  leukocytosis  of  11,200,  with  74  per  cent  poly- 
morphonuclear leukocytes.  Gastro-intestinal  x-rays 
revealed  a rather  large  duodenal  ulcer. 

On  January  26,  1925,  at  operation,  the  stomach  was 
found  to  be  slightly  distended  and,  on  the  anterior 
wall  of  the  duodenum,  was  found  the  puckering  scar 
of  an  old  chronic  calloused  duodenal  ulcer.  On  the 
posterior  wall  was  found  the  crater  of  a rather  large 
acute  ulcer.  The  gall  bladder  was  moderately  dis- 
tended, grayish  white  in  appearance,  but  contained  no 
stones.  The  appendix,  showing  evidence  of  much 
trouble  in  the  past,  was  removed.  A posterior,  retro- 
colic,  retroperistaltic,  short-loop  gastro-enterostomy 
was  then  done.  The  proximal  jejunal  loop  was  four 
or  five  inches  in  length.  The  mesocolon  was  carefully 
sutured  by  interrupted  chromic  sutures  to  the  stomach 
wall  above  the  gastro-enterostomy  stoma.  The  ab- 
domen was  then  closed  in  layers.  The  patient  made 
an  uninterrupted  recovery  and  was  dismissed  from 
the  hospital  on  February  12,  1925.  On  several  visits 
to  the  clinic  within  the  next  three  weeks  he  stated 
that  he  was  perfectly  well. 

On  March  8,  1925,  forty-one  days  following  the 
gastro-enterostomy,  the  patient  returned  to  the  clinic 
stating  that  he  had  been  “poisoned”  by  his  breakfast. 
Soon  after  eating  he  was  seized  by  an  excruciating 
pain  in  the  epigastrium  followed  by  copious  vomiting 
which  contained  no  blood.  The  pain  and  vomiting 
continued  four  hours  when  we  saw  him.  At  this  time 
he  was  doubled  up  and  screaming  with  pain,  which 
recurred  at  short  regular  intervals. 

On  examination,  the  scar  from  the  former  incision 
seemed  normal.  There  was  noted  a fullness  in  the 
upper  left  abdominal  quadrant.  On  close  inspection, 
it  was  seen  that  this  fullness  was  getting  larger  rap- 
idly, with  the  patient  complaining  of  an  oncoming 
cramp  which  grew  progressively  worse  within  the 
next  minute  until  the  pain  became  almost  unbearable. 
With  a stethoscope  a gurgling  was  heard,  following 
which  the  tumor  mass  disappeared  and  the  pain 
ceased.  There  was  no  fever.  The  blood  count  re- 
vealed 8800  leukocytes,  with  86  per  cent  polymorpho- 
nuclear leukocytes,  and  13  per  cent  small  monocytes. 
The  urinalysis  was  negative. 

A diagnosis  of  intestinal  obstruction,  incident  to  the 
gastro-enterostomy,  was  made.  The  patient’s  symp- 
toms coincided  with  those  of  a similar  case  seen  else- 


Fig.  1. — Onset  of  migration  of  jejunum  through  opening 
left  after  gastro-entero-anastomosis. 


184 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


to  the  anastomosis.  Four  interrupted  chromic  catgut 
sutures  were  then  used  to  close  the  opening.  The 
patient  made  an  uneventful  recovery  and  has  remained 
well. 

COMMENT 

We  feel  that,  by  adding  to  the  literature  the 
record  of  this  unusual  complication,  emphasis  is 
placed  on  two  important  factors : first,  prevention 
of  such  an  occurrence;  second,  the  fact  that  this 
complication  should  be  constantly  in  mind  when 
an  acute  intestinal  obstruction  occurs  at  any  time 
following  a gastro-enterostomy.  In  such  a case 
delay  for  diagnostic  procedures  may  result  in 
alkalosis,  hemorrhage,  rupture  of  the  suture  line 
or  edema,  with  death  of  portions  of  the  intes- 
tines. Delay  in  reduction  of  the  strangulation  may 
entail  a prolonged  and  serious  operation  in  which 
the  anastomosis  must  be  torn  down,  the  loops 
disengaged,  and  the  anastomosis  rebuilt. 

1930  Wilshire  Boulevard. 

REFERENCES 

1.  Mayo:  Arch.  Surg.,  iv,  324-334,  1922. 

2.  Moschowitz  and  Wilansky:  Surg.,  Gynec.  and 
Obst.,  xxi,  390-393,  1915. 

3.  Bryan:  Surg.,  Gynec.  and  Obst.,  xxx,  82-83,  1920. 

4.  Warwick:  Brit.  J.  Surg.,  x,  577-579,  1922,  1923'. 

5.  Keene:  Brit.  J.  Surg.,  xii,  891-893,  1925. 

6.  Barker:  Lancet,  ii,  1277-1278,  1904. 

7.  Steinder:  Deutsche  Ztschr.  f.  Chir.,  clxxxi,  126- 
136,  Leip.  1923. 

8.  Peterson:  Arch.  f.  Klin.  Chir.,  lxxii,  94. 

9.  Peterson:  Ibid. 

10.  Gray:  Lancet,  ii,  526,  1904. 

11.  Gordon:  Lancet,  ii,  1477,  1905. 

12.  Steden:  Beitr.  Z.  Klin.  Chir.,  cxxxi,  486-488,  1924. 

13.  Wrede:  Munchen.  Med.  Wchnschr.,  lxii,  1727, 
1915. 

14.  Fromme:  Zentralbl.  f.  Chir.  xlvii,  1505-1512, 
1920. 

THE  SPECIFIC  GRAVITY  OF  THE  BLOOD 

By  John  Martin  Askey,  M.  D. 

Los  Angeles 

ALTHOUGH  the  specific  gravity  of  the  blood 
under  varying  conditions  in  the  past  has 
proved  of  little  clinical  value,  it  was  used  as  an 
index  to  the  hemoglobin  percentage  for  years 
before  the  advent  of  the  present  methods.  Tables 
were  devised  with  corresponding  values,  which 
were  inaccurate,  however,  due  to  failure  to  con- 
sider the  effect  of  the  color  index. 

Rogers  1 made  use  of  it  to  determine  the  de- 
gree of  blood  concentration  during  the  evacuation 
stage  of  cholera  in  the  London  epidemic  of  1908 
and  the  use  of  intravenous  saline  was  predicated 
upon  this  factor.  It  was  found  that  extreme 
dehydration  raised  the  specific  gravity  to  1066 
instead  of  a normal  1058  and  indicated  the  neces- 
sity of  intravenous  saline.  Recently  Barbour  and 
Hamilton  2 have  reported  a falling  drop  method 
for  determining  this  factor  and  believe  that  it 
should  be  investigated  again  in  various  conditions. 

Forty  years  ago,  when  venesection  was  com- 
mon, actual  weight  of  the  blood  was  possible. 
The  direct  method,  comparing  the  weight  of  the 
blood  with  an  equal  amount  of  distilled  water, 
using  the  pyknometer,  was  feasible.  This  still 


Fig.  2. — Internal  hernia  with  complete  intestinal  ob- 
struction caused  by  migration  of  jejunum  through  open- 
ing made  between  stomach,  ligament  of  Treitz  and 
jejunum. 

where  in  which  an  acute  intra-abdominal  attack  fol- 
lowed a Polya  resection.  In  the  latter  instance,  as 
proved  at  autopsy,  there  was  a strangulation  of  the 
jejunum  and  ileum  caused  by  the  migration  of  the 
small  intestine  through  the  artificial  aperture  between 
the  stomach,  ligament  of  Treitz,  and  mesocolon.  Be- 
cause of  the  great  similarity  of  the  two  cases,  we 
made  the  same  diagnosis  on  this  patient  and  recom- 
mended immediate  laparotomy. 

At  operation  it  was  found  that  no  adhesions  existed 
between  the  former  operative  scar  and  the  viscera. 
The  mass  in  the  left  upper  quadrant  consisted  of 
edematous  loops  of  jejunum  and  ileum  which  had 
become  strangulated  following  migration  through  the 
artificial  aperture,  always  resultant  upon  gastro-enter- 
ostomy, the  boundaries  being  the  ligament  of  Treitz, 
the  mesocolon,  the  stomach  and  the  anastomosis.  The 
loops  were  easily  pulled  back  through  the  stoma  and 
replaced  in  their  normal  position.  No  injury  was  done 


Fig  3. — Repair  of  opening  left  after  gastro-entero 
anastomosis. 


March,  1930 


CLINICAL  NOTES 


185 


remains  the  most  accurate,  though  obviously  im- 
practical. 

Anemia,  polycythemia,  either  true  or  relative, 
due  to  concentration  by  diarrhea,  prolonged  vom- 
iting or  sweating,  the  hydremic  plethora  follow- 
ing hemorrhage,  should  change  the  specific 
gravity. 

Qualitative  changes  in  plasma,  such  as  the 
azotemia  of  nephritis  and  the  hyperglycemia  of 
diabetes  presumably  should  alter  it. 

The  present  report  includes  the  results  of  fifty 
determinations  done  upon  whole  blood  by  the 
Hammerschlag  method. 

TECHNIQUE 

This  method  consists  of  suspending  a drop  of 
blood  in  a mixture  of  benzine  and  chloroform  and 
carefully  varying  the  concentration  of  each  until 
the  drop  remains  poised  midway  between  the  top 
and  bottom.  The  specific  gravity  of  that  mixture, 
determined  by  the  hydrometer,  is  then  equiva- 
lent to  that  of  the  blood.  Baumann 3 checked 
this  method  by  the  actual  weight  of  the  blood  by 
the  pyknometer  in  a number  of  experiments  on 
dogs  and  concluded  that  it  was  a method  “clin- 
ically easily  applied  and  yielded,  both  in  health 
and  disease,  results  that  were  uniform  and 
reliable,”  although  the  results  are  proportionately 
slightly  higher  than  pyknometer  determinations. 

BASIS  FOR  PRESENT  REPORT 

In  the  studies  reported  here,  determinations 
were  made  on  the  blood  of  fifty  people,  nine  of 
whom  were  apparently  in  good  health  and  the 
others  suffering  from  varying  conditions.  Par- 
ticularly the  effect  of  conditions  producing  con- 
centration of  the  blood  from  anhydremia,  such 
as  vomiting  and  diarrhea,  was  observed.  A 
number  of  severe  anemias  were  included  in  the 
study.  It  was  hoped  to  discover  some  relation 
whereby  the  blood  count  of  patients  truly  anemic, 
but  concentrated  by  dehydration,  might  be  deter- 
mined accurately. 

A blood  count  of  five  million  in  an  originally 
anemic  patient  who  has  been  vomiting  persist- 
ently is  of  no  value  as  an  accurate  count. 

Two  erythrocytic  counts  were  done  on  each 
patient  with  pipettes  certified  as  correct  by  the 


United  States  Bureau  of  Standards,  and  an 
average  taken.  The  hemoglobin  determinations 
were  done  with  a Sahli  hemoglobinometer.  The 
specific  gravity  readings  varied  from  1030  in  a 
patient  who  had  pernicious  anemia  to  1064  in  one 
with  a generalized  peritonitis  who  had  been  vom- 
iting for  twelve  hours.  The  latter  was  obviously 
dehydrated  with  dry,  wrinkled  skin,  the  former 
showed  the  well-preserved  physique  seen  often 
.in  pernicious  anemia.  Determinations  were  made 
on  several  normal  individuals  at  varying  times  of 
the  day  and  the  same  figure  obtained,  contrary  to 
the  idea  that  diurnal  variations  were  appreciable. 

In  the  group  of  individuals  that  were  consid- 
ered normal  the  results  ranged  from  1049  with  a 
red  count  of  4.49  millions  and  90  per  cent 
hemoglobin,  to  1058  with  a red  count  of  4.8 
millions  and  90  per  cent  hemoglobin.  In  seven 
instances  of  pernicious  anemia  the  results  ranged 
from  1030  in  a patient  with  1.1  million  red  cells 
to  1036  in  a patient  with  two  million  red  cells. 
The  remainder  of  the  patients  were  of  widely 
diverse  conditions,  including  heat  exhaustion, 
filariasis,  diabetes  with  high  blood  sugar  and 
nephritis  with  high  blood  urea. 

In  a patient  with  strangulated  umbilical  hernia 
who  vomited  for  three  days  there  was  a red  cell 
count  of  6.2  million,  104  per  cent  hemoglobin  and 
a specific  gravity  reading  of  1061.  Another  with 
peritonitis  after  twelve  hours  vomiting  had 
6.9  million  red  cells  and  a reading  of  1064  for 
specific  gravity. 

There  apparently  was  a very  definite  relation 
between  the  specific  gravity  of  the  blood  and  the 
quantity  of  hemoglobin  present.  With  the  color 
index,  one,  a reading  of  1030  corresponded 
approximately  with  a count  of  1,000,000  and  a 
rise  in  red  cells  of  500,000  was  accompanied  by 
a corresponding  rise  of  three  points  in  the  specific 
gravity.  It  was  possible  to  predict  very  closely 
the  red  cell  count  by  the  specific  gravity  reading 
save  in  severe  secondary  anemia  with  marked  dis- 
turbance of  the  color  index. 

Copeman  4 studied  one  patient  who  had  a red 
cell  count  of  500,000  and  a specific  gravity  read- 
ing of  1027.  Blood  serum  specific  gravity  is 
approximately  1027.  Those  patients  with  a red 


Table  1. — Ten  Cases  Showing  Relation  of  Specific  Gravity  to  Hemoglobin  and  Red  Cell  Count 


Specific  Gravity 

Hemoglobin 

Red  Blood  Ceils 

Color  Index 

Diagnosis 

1. 

1030 

22 

1,175,000 

1.14 

Pernicious  anemia 

2. 

1030 

24 

1,180,000 

1.1 

Pernicious  anemia 

3. 

1036 

42 

2,010,000 

1.1 

Pernicious  anemia 

4. 

1045 

71 

3,600,000 

.9 

Secondary  anemia 

5. 

1048.5 

70 

3,995,000 

.9 

Nephritis — blood  urea  76 

6. 

1051 

95 

4,490,000 

1.0 

Normal 

7. 

1055 

85 

5,225,000 

.8 

Diabetes — blood  sugar  190 

8. 

1057 

95 

5,650,000 

.9 

Arthritis  deformans 

9. 

1060 

104 

6,170,000 

.88 

Asthmatic  bronchitis 

10. 

1064 

104 

6,900,000 

.9 

Peritonitis — vomited  for  12  hours 

186 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


cell  count  higher  than  would  be  expected  from 
the  specific  gravity  reading  were  found  to  have 
a low  color  index.  Conversely,  those  showing 
red  cell  counts  lower  than  would  be  expected 
from  the  specific  gravity  reading  were  found  to 
have  a high  color  index.  Thus,  in  one  instance 
a specific  gravity  reading  of  1030  was  found  in  a 
patient  with  a red  cell  count  of  730,000  and 
a hemoglobin  of  25  per  cent  or  a color  index 
of  1.6.  With  a color  index  of  1 the  red  cell 
count  here  would  be  1,168,000,  which  corre- 
sponds to  the  specific  gravity  reading  of  1030. 

Despite  the  variety  of  conditions  studied,  rep- 
resenting diabetes  with  high  blood  sugar,  nephritis 
with  nitrogen  retention,  and  other  metabolic  dis- 
turbances, there  were  no  significant  variations  in 
the  specific  gravity  save  those  due  to  variation 
in  the  quantity  of  hemoglobin.  Apparently  the 
factor  overshadowing  all  others  in  changes  in 
specific  gravity  is  the  hemoglobin  content,  the 
constituents  of  the  plasma  exerting  little  influence. 

CONCLUSION 

The  determination  of  the  specific  gravity  of  the 
blood  is  apparently  of  little  practical  clinical  value 
and  its  addition  to  the  ever-increasing  list  of 
laboratory  procedures  seems  unnecessary. 

902  Wilshire  Medical  Building. 

REFERENCES 

1.  Cited  by  Whyte,  D.:  lilt.  Cong.  Med.,  17,  Sec- 
tion 6,  part  2. 

2.  Barbour,  H.  G.,  and  Hamilton,  W.  F. : The  Fall- 
ing Drop  Method  for  Determining  Specific  Gravity, 
J.  A.  M.  A.,  88,  91,  January  8,  1927. 

3.  Baumann,  E.  P. : The  Value  of  Hammerschlag’s 
Method  in  Clinical  Estimation  of  the  Specific  Gravity 
of  the  Blood,  Brit.  M.  J.,  1-,  473,  February  27,  1904. 

4.  Copeman,  S.  J.:  Report  on  the  Specific  Gravity 
of  the  Blood  in  Disease,  Brit.  M.  J.,  1,  161,  January  24, 
1891. 


SURGICAL  TREATMENT  OF  STAPHYLO- 
COCCUS MENINGITIS 

REPORT  OF  CASE 

By  George  H.  Sciaroni,  M.  D. 

Fresno 

LM.,  Los  Banos,  June  24,  1929.  White,  single, 
/o  schoolboy,  sixteen  years  of  age.  Referred  by 
Doctor  Mott. 

Family  History. — Grandfather  died  of  tuberculosis  at 
about  forty  years  of  age.  Otherwise,  family  history 
good. 

Past  History. — Patient  was  born  in  New  York. 
Came  to  California  at  the  age  of  eight  years.  Had 
whooping-cough  at  the  age  of  five  years;  measles  at 
the  age  of  seven  years.  Had  his  tonsils  removed  in 
1925.  Was  operated  on  for  appendicitis  in  1926  and 
at  the  same  time  had  a right  inguinal  hernia  repaired. 
In  1928  he  had  severe  attack  of  scarlet  fever  and  was 
sick  about  three  weeks,  but  fully  recovered,  appar- 
ently without  complications  or  sequela. 

Present  History. — About  June  10,  1929,  he  developed 
a small  carbuncle  on  the  back  of  the  neck  on  left  side 
near  hair  line.  After  a few  days  it  was  incised  and 
drained.  Six  days  later  he  developed  severe  pain  in 
hip  and  calf  of  left  leg  with  some  fever.  The  follow- 
ing day  he  was  brought  to  Fresno  and  had  x-rays 
taken  of  the  hip  and  leg,  with  apparent  negative  find- 


ings. However,  the  back  was  strapped  with  adhesive 
plaster  with  no  apparent  relief.  On  June  24  he  was 
admitted  to  the  LTnion  Hospital,  at  which  time  patient 
had  a temperature  of  104  degrees.  The  same  evening 
he  developed  definite  symptoms  of  spinal  meningitis, 
and  the  following  day  I was  called  to  perform  a spinal 
puncture. 

Physical  Examination. — On  inspection  I found  his 
general  appearance  very  characteristic.  He  was  a 
well-nourished  young  man,  about  five  feet  six  inches 
tall,  and  weighing  about  130  pounds.  Lying  straight 
in  bed  on  his  back  with  head  drawn  backward;  with 
flushed  cheeks  and  an  anxious  expression.  His  shoul- 
ders were  drawn  upward  and  his  neck  and  back 
muscles  were  rigid.  His  respiration  was  somewhat 
labored.  Pulse  was  106,  good  quality.  Temperature 
was  102.6  degrees.  His  abdomen  was  distended  with 
gas.  Upon  auscultation  his  heart  and  lungs  were 
negative.  His  lower  extremities  were  extended,  rigid, 
with  heels  drawn  upward  from  tonic  contraction  of 
gastrocnemius  and  soleus  muscles,  causing  his  toes 
to  point  almost  in  line  with  the  legs.  He  complained 
of  severe  pains  in  hips  and  legs,  especially  on  manipu- 
lation. 

Treatment. — The  spinal  needle  was  inserted  between 
the  first  and  second  lumbar  vertebra,  and  after  con- 
siderable difficulty  in  getting  the  fluid  through  the 
needle,  was  successful  in  removing  fifty  cubic  centi- 
meters of  thick,  yellowish  pus.  At  the  same  time 
injected  antimeningococcus  serum.  The  patient  was 
immediately  relieved  and  remained  so  for  about  two 
hours,  after  which  his  condition  returned  as  before. 
The  culture  and  microscopic  examination  of  pus  re- 
vealed Staphylococcus  aureus  in  pure  culture.  Six  hours 
later  another  puncture  was  made  and  about  twenty 
cubic  centimeters  of  pus  removed.  This  time  the  canal 
was  washed  with  antistreptococcus  serum.  Upon  get- 
ting the  laboratory  report  of  staphylococcus  infection, 
I suggested  operative  measures  in  hopes  of  establish- 
ing a permanent  drainage.  On  June  26  the  condition 
was  progressively  getting  worse.  Respiration  was 
labored  and  marked  cyanosis  present.  The  upper  and 
lower  extremities  were  completely  paralyzed  except 
his  hands  and  fingers,  in  which  he  had  slight  volun- 
tary movement.  Three  punctures  were  made  in  the 
twelve  hours.  The  last  puncture,  the  needle  was  left 
in  the  spine  with  hopes  of  draining  the  pus  and  keep- 
ing down  pressure,  but  very  little  drainage  was  ac- 
complished on  account  of  pus  drying  in  the  lumen  of 
the  needle  and  stopping  the  flow.  Three  hours  later 
the  needle  was  removed. 

Treatment  Continued. — On  June  27,  after  a series  of 
consultations,  an  operation  was  performed  under  ethy- 
lene anesthetic.  A laminectomy  of  the  second  lumbar 
vertebra  was  done.  Upon  opening  meninges,  a large 
amount  of  pus  drained  into  incision.  The  condition 
of  patient  was  very  bad,  so  a rapid  closing  was  neces- 
sary and  a small  rubber  drainage  tube,  surrounded 
by  gauze,  was  inserted.  Oxygen  and  stimulants  were 
given:  adrenalin,  strychnin,  etc.  His  temperature  at 
12  o’clock  noon  was  105  degrees.  At  1 p.  m.  he  was 
taken  to  surgery,  and  about  2 p.  m.  his  temperature 
was  107  degrees.  By  3 p.  m.  it  dropped  to  104  and 
by  12  o’clock  midnight  it  was  98.6  degrees.  At  4 a.  m. 
it  again  returned  to  104.6  and  thereafter  it  ranged 
from  99  to  103.  Nothing  of  much  interest  developed 
for  about  ten  days  except  that  his  breathing  steadily 
improved.  About  the  middle  of  the  second  week  he 
was  able  to  move  his  arms.  After  the  third  week  he 
could  use  his  legs  somewhat,  and  from  then  on  the 
paralytic  condition  improved  daily.  On  August  7 
(which  was  six  weeks  and  two  days  from  the  time 
he  entered  the  hospital)  he  was  discharged  from  the 
hospital  with  still  a slight  drainage  from  the  wound. 
312  Pacific  Southwest  Building. 

REFERENCE 

Emerson,  Kendal:  Boston  M.  and  S.  J.,  March  24, 
1927. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 


PELVIC  INFLAMMATORY  DISEASE 

H.  N.  Shaw,  Los  Angeles. — Pelvic  inflam- 
matory disease  is  due  to  the  following  causes : 
in  the  order  of  their  frequency,  gonorrhea, 
puerperal  infection  and  hematogenous  infec- 
tions, including  tuberculosis. 

Gonorrhea  probably  accounts  for  95  per  cent 
of  cases  of  salpingitis,  the  chief  damage  being 
originally  confined  to  the  tubes.  When  the  fim- 
briated extremity  becomes  closed  off,  and  also  the 
inner  end,  the  pressure  within  the  tube  may  cause 
if  to  rupture  into  and  infect  the  ovary.  This  is 
the  danger  in  this  type  of  infection,  and  it  is  the 
reason  that  a hard  and  fast  line  cannot  be  drawn 
in  regard  to  treatment.  The  infecting  organism 
varies  in  virulence  in  different  cases.  An  infec- 
tion due  to  an  organism  which  has  lain  hidden  in 
the  seminal  vesicle,  or  prostate,  for  many  years, 
will  be  very  different  from  one  which  has  come 
red  hot  from  an  organism  picked  from  a street 
walker.  In  the  latter  case  the  germ  has  been 
passed  from  one  contact  to  another  at  short  inter- 
vals, and  is  extremely  virulent. 

Diagnosis  from  smears  is  exceedingly  difficult. 
An  individual  may  have  germs  concealed  in  the 
deep  cervical  glands,  the  inflammatory  process 
may  have  closed  the  ducts  of  those  glands,  and 
smears  made  from  the  cervical  discharge  may  be 
negative.  This  is  the  most  dangerous  type,  as 
such  an  individual  may  squeeze  out  gonococci 
at  the  height  of  an  orgasm,  at  the  menstrual 
period  when  the  cervix  is  much  congested,  or  as 
the  child’s  head  passes  through  the  birth  canal 
in  childbirth.  The  only  smear  from  which  a 
definite  conclusion  can  be  drawn  is  a positive  one. 

In  acute  salpingitis  there  is  always  pain,  most 
often  bilateral.  Fever  seldom  goes  over  103  de- 
grees, and  leucocyte  count  tends  to  be  below 
18,000. 

Treatment  of  acute  salpingitis  should  always 
be  conservative.  Surgery  should  not  be  considered 
until  temperature  and  white  count  have  been  nor- 
mal at  least  two  weeks.  There  are  exceptions  to 
every  rule.  There  are  occasional  cases  where 
pus  is  present,  and  the  temperature  and  leucocyte 
count  remain  elevated  over  long  periods.  We 
had  a case  in  one  of  our  wards  for  over  five 
months  without  improvement  which  was  finally 
operated  upon.  We  found  a left  tubo-ovarian 
abscess  that  had  ruptured  into  the  lower  sigmoid. 
The  bowel  tore  across  at  the  upper  rectum  and 
we  had  to  make  a permanent  colostomy,  closing 
off  the  lower  end.  This  patient  would  have  been 
much  better  treated  had  we  operated  three  months 
before.  Remember  that  85  per  cent  of  acute  sal- 


pingitis cases  escape  operative  intervention.  But, 
when  you  are  convinced  that  a tube  has  been 
definitely  sealed  off  do  not  hesitate  to  advise  its 
removal,  otherwise,  it  is  like  a sword  hanging 
over  the  patient’s  head.  A flareup  of  the  process 
with  further  extension  may  damage  the  ovary. 
After  the  condition  has  become  chronic,  the  ques- 
tion arises  how  much  we  should  remove.  If  there 
is  question  of  tubal  patency,  a Rubin  test  should 
be  done,  and  a closed  tube  should  be  removed. 
The  uterus  should  be  removed  or  should  not, 
depending  on  how  smooth  a surface  can  be  left. 
If  the  uterus  can  be  used  to  cover  up  a raw  area, 
we  advise  leaving  it.  If,  on  the  other  hand,  the 
surface  of  the  uterus  is  raw,  difficult  to  peri- 
tonealize,  we  advise  its  removal.  If  an  ovary  is 
badly  infected,  removal  of  the  diseased  tissue  may 
seriously  interfere  with  the  veins  leading  from  it. 
This  means  cystic  ovary  and  another  major  opera- 
tion within  a few  months.  In  these  cases  we  have 
been  trying  ovarian  transplants  with  very  gratify- 
ing results  in  suitable  cases.  A piece  of  normal 
looking  ovary,  about  two  centimeters  in  diameter 
is  chopped  in  small  fragments  and  imbedded  in 
the  belly  of  the  rectus  muscle.  Care  is  taken  not 
to  cause  much  bleeding.  We  expect  to  report 
results  during  the  next  year. 

* * * 

Karl  L.  Schaupp,  San  Francisco. — By  pelvic 
inflammatory  disease  we  usually  mean  a gonor- 
rheal salpingitis  or  salpingo-oophoritis,  but  we 
must  also  include  other  infections  which  involve 
the  female  pelvic  organs. 

Puerperal  infection  and  infected  abortions  are 
the  most  dangerous  to  the  life  of  the  patient.  The 
onset  follows  shortly  after  delivery  or  after 
instrumentation  of  the  uterus.  It  is  sudden,  often 
beginning  with  a chill,  followed  by  high  tempera- 
ture, rapid  pulse  and  respirations.  Pain  in  the 
lower  abdomen  and  back  are  always  present.  The 
abdomen  becomes  spastic  early  and  later  may 
become  distended. 

This  type  of  infection  dififers  in  its  progress 
from  the  gonorrheal  in  that  it  follows  the  lym- 
phatics rather  than  the  mucous  membrane  of  the 
uterus  and  fallopian  tubes.  These  organs  become 
involved,  it  is  true,  but  by  extensions  through 
the  uterine  wall  and  broad  ligaments.  It  is  a 
metritis  and  parametritis  rather  than  endometritis 
and  salpingitis.  This  factor  is  important  in  the 
diagnosis  and  prognosis. 

Where  the  condition  primarily  involves  mucous 
membranes  one  usually  finds  rather  clearly 
defined  masses  in  the  region  of  tubes  and  ovaries. 
The  very  slightly  enlarged  uterus  can  be  felt  and 


187 


188 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


may  even  be  movable.  There  is  marked  tender- 
ness on  attempt  to  move  the  organs.  With  para- 
metritis, infiltration  of  the  lymphatics  of  the 
broad  and  sacro-uterine  ligaments  is  profound, 
and  causes  the  cervix,  uterus  and  adjacent  tissues 
to  become  so  thickened  and  fixed  that  all  that  can 
be  felt  is  often  one  large,  fixed  mass,  brawny  in 
consistency  and  giving  the  impression  of  having 
been  poured  'from  concrete.  Discharge  is  usually 
scant  and  of  a serosanguineous  nature.  The 
urethra  is  clean  and  cystitis  does  not  often  follow. 

The  blood  picture  is  that  of  a profound  infec- 
tion, especially  during  the  first  few  days.  As  the 
condition  progresses  a definite  secondary  anemia 
appears. 

When  the  typical  case  is  found  one  can  predict 
that  it  will  be  of  long  duration,  six  weeks  or 
longer,  and  the  patient  should  be  so  advised. 
Unless  there  is  diffuse  peritonitis  or  septicemia, 
one  of  two  things  will  probably  happen ; most 
often  a gradual  resolution  of  the  inflammatory 
masses,  with  simultaneous  improvement  in  the 
patient’s  general  condition  will  take  place,  or  at 
the  end  of  weeks,  localized  abscesses  may  form, 
probably  in  the  broad  ligaments.  Such  abscesses 
usually  contain  much  less  pus  than  one  would 
expect  from  the  size  of  the  mass  of  tissue 
involved. 

The  treatment  demands  patience  for  two  rea- 
sons, the  length  of  time  necessary  for  either  reso- 
lution or  abscess  formation  to  take  place,  and 
because  early  operative  procedures  merely  tend 
to  spread  the  process  and  endanger  life.  So 
much  pelvic  tissue  is  involved  that  it  cannot  all 
be  removed.  Bed  rest  is,  of  course,  most  im- 
portant and  should  be  rigidly  enforced  until  the 
temperature  has  been  normal  for  some  time.  Ice 
packs  to  the  abdomen  early  in  the  condition  are 
most  grateful.  Sedatives  must  be  given,  but  here 
opiates  are  dangerous  because  of  the  length  of 
time  through  which  relief  of  pain  is  sought  by 
means  of  drugs.  Hot,  prolonged  vaginal  douches 
seem  to  hasten  favorable  progress,  but  they  must 
be  very  hot  and  must  be  given  slowly  under  low 
pressure.  At  least  two  gallons  should  be  used 
twice  daily. 

When  abscess  formation  has  taken  place  the 
treatment  is  surgical  and  a posterior  colpotomy 
is  sufficient.  Laparotomy  rarely  becomes  neces- 
sary, but  when  it  does,  except  in  unusual  instances 
it  should  not  be  attempted  for  many  months. 

* * * 

Clarence  A.  DePuy,  Oakland. — In  a short 
discussion  of  pelvic  inflammatory  disease,  I would 
like  to  lay  stress  on  two  points  which  I think  are 
most  important : first,  diagnosis ; second,  treat- 
ment. 

In  a service  at  the  Alameda  County  Hospital 
which  has  extended  over  several  years,  I have 
been  most  impressed  with  the  large  number  of 
cases  of  this  disease  which  have  been  sent  in  by 
physicians  with  a diagnosis  of  “acute  appendici- 
tis,” and  a request  for  immediate  operation.  It  is 
my  belief  that  if  the  history,  symptoms,  physical 


findings  and  laboratory  findings  which  are  usually 
quite  distinctive,  are  carefully  investigated,  a 
correct  diagnosis  should  be  made  and  this,  of 
course,  influences  the  treatment. 

As  regards  treatment,  I believe  that  this  has 
been  well  standardized  by  the  men  doing  gynecol- 
ogy throughout  the  country.  It  is  palliative  until 
the  acute  symptoms  subside,  and  then  surgical  in 
certain  types  of  cases,  especially  where  there  are 
large  infected  tubes  and  ovaries.  It  may  be  neces- 
sary in  some  acute  cases  to  resort  to  culdesac 
drainage.  The  indications  for  this  are  well 
marked  by  the  symptoms  and  physical  findings, 
such  as  bulging  in  the  culdesac,  and  it  is  remark- 
able the  relief  obtained. 

It  is  still  the  practice  among  men  doing  general 
surgery  to  do  extensive  abdominal  operations  on 
patients  who  have  high  temperatures  and  all  the 
symptoms  of  acute  pelvic  peritonitis,  and,  I 
believe,  that  if  the  results  of  this  type  of  treat- 
ment are  investigated,  it  will  be  found  that  the 
mortality  is  high  and  the  postoperative  period 
quite  stormy. 

It  is  extremely  rare  that  a patient  treated  by 
palliative  measures  will  die  of  pelvic  inflamma- 
tory disease,  and  certainly  their  postoperative  con- 
valescence is  much  smoother  when  operated  on 
after  their  acute  symptoms  subside,  and  abdom- 
inal drainage  is  not  necessary. 

* * * 

Edward  N.  Ewer,  Oakland. — A patient  with 
tubal  infection  almost  always  gives  a history  of 
previous  attacks.  As  we  evidently  see  the  first 
attacks  infrequently,  it  is  probable  that  they  are 
light  in  character  and  tend  to  recover  with  the 
rest  made  necessary  by  the  pain  experienced. 
With  prolonged  rest  and  heat  applied  to  the  lower 
abdomen  by  electric  light  baths  most  of  these 
could  be  permanently  cured,  barring  reinfection. 
Subsequent  acute  activations  are  thought  by  some 
authors  to  be  reinfections  from  without  or  from 
gonococci  still  lurking  in  the  original  foci  below 
the  cervix.  I have  seen  a first  tubal  infection 
follow  at  once  upon  the  treatment  of  an  acute 
gonorrhea  with  tampons,  and  Curtis  believes  that 
douching  the  vagina  may  force  the  organisms  up 
through  the  cervix.  Extension  to  the  tubes  occurs 
by  way  of  the  mucosa. 

Pelvic  pain,  often  bilateral,  is  present,  tempera- 
ture reaches  102  to  103  and  the  leucocyte  count 
is  seldom  over  18,000.  If  there  is  much  vomiting 
peritoneal  reaction  is  suggested,  and  differentia- 
tion from  appendicitis  must  be  made.  This  is 
usually  easy,  for  bimanual  palpation  elicits  pain 
in  the  tube  regions  when  the  cervix  is  pressed 
upward,  and  if  there  have  been  previous  attacks, 
masses  may  be  felt  on  one  or  both  sides. 

In  appendicitis  the  pain  usually  begins  in  the 
upper  abdomen  and  finally  localizes  between  the 
umbilicus  and  the  anterior  superior  spine  and 
there  is  more  protective  muscle  tonus.  The  diag- 
nosis between  the  two  conditions  is  generally  so 


March,  1930 


BEDSIDE  MEDICINE 


189 


plain  that  there  is  seldom  excuse  for  opening  the 
abdomen  in  the  presence  of  pus  tubes. 

Tubal  pregnancy  and  ovarian  cysts  with  twisted 
pedicles  are  diagnosed  by  the  history  and  par- 
ticularly by  the  fact  that  the  blood  sedimentation 
time  is  slow  at  the  time  the  emergency  demands 
attention,  while  in  tubal  inflammation  it  is  around 
thirty-five  minutes,  or  twenty  or  under  if  pus  is 
present.  Unless  there  is  a large  amount  of  pus 
these  inflammations  will  recede  after  complete 
rest  in  bed,  and  tubes  should  rarely  be  removed 
till  the  sedimentation  time  has  increased  to  sixty 
minutes.  If  it  does  not  increase  it  is  likely  there 
is  pus  in  the  broad  ligament  cellular  tissue  or 
somewhere  else  and  not  in  the  tubes. 

Two  and  one-half  years’  use  of  this  test  at 
Highland  Hospital  convinces  us  of  its  reliability, 
and  the  test  is  most  easily  made  with  the  ordinary 
Linzenmeier  tubes. 

One  patient  with  all  the  physical  signs  of  acute 
pus  tubes  and  a leucocyte  count  of  18,700  was 
operated  upon  with  a tentative  diagnosis  of 
twisted  ovarian  cyst  solely  because  the  sedimen- 
tation time  was  eighty-five  minutes.  The  condi- 
tion found  was  hydrosalpinx  twisted  on  the  lax 
portion  of  the  tube  near  the  uterus.  Acute  tubal 
inflammation  would  have  given  a rapid  sedimen- 
tation time  and  we  would  not  have  felt  justified 
in  operating. 

When  pus  exudes  from  a tube  and  a pelvic 
peritonitis  occurs  a collection  of  pus  may  form  in 
the  culdesac.  Rest  then  may  not  afifect  the  rapid 
sedimentation  time  but  there  is  no  danger  in 
delaying  operation  till  the  bulging  vaginal  vault 
proclaims  the  abscess.  The  same  thing  is  true  of 
the  abscess  of  pelvic  cellulitis.  That  condition  is 
the  result  of  extension  of  inflammation  from  an 
infected  parturition  wound  in  the  cervix  or  upper 
vagina  or  from  the  wounds  caused  by  curetting 
an  infected  incomplete  abortion.  These  are  lym- 
phatic extensions  through  the  parametrial  tissues. 
If  resolution  goes  on  the  sedimentation  time  in- 
creases. If  it  does  not  and  pus  forms  the  physical 
signs  of  abscess  appear.  These  are  mass  forma- 
tion and  possibly  fluctuation,  felt  on  vaginal  or 
recto-vaginal  bimanual  palpation.  Incision  behind 
the  cervix  evacuates  the  pus  without  danger. 

The  importance  of  blood  sedimentation  tests  in 
pelvic  inflammatory  disease  should  be  stressed. 
There  are  many  articles  on  the  subject  in  the 
medical  literature  of  the  last  four  years,  and  there 
is  a particularly  good  one  by  Donald  G.  Tollefson 
giving  technique  and  other  information  in  the 
January  1930  number  of  California  and  West- 
ern Medicine. 


New  Ills  for  Old.- — One  by  one,  in  a world  which 
has  ostensibly  been  made  safe  for  democracy,  the 
textbook  pictures  of  medicine  are  stepping  out  of  their 
pages  and  coming  to  life.  Curiously  enough,  our 
furred  and  feathered  friends — and  to  some  extent  our 
scaly  ones — are  responsible  for  these  new  health  haz- 
ards. Bovine  tuberculosis  we  have  long  had  in  our 
midst,  until  now,  at  least  in  some  communities,  it  is 
practically  hailed  as  a friend.  The  tapeworms  of  fish 


and  beef  and  pork  have  long  delighted  us  with  their 
picturesque  infestations  and  we  have  shuddered  in 
amazement  at  our  own  recklessness  as  we  reveled 
in  our  raw  pork,  knowing  well  the  dangers  we  ran 
of  converting  ourselves  into  ant  hills  of  trichinae. 
Rabies,  once  practically  banished,  is  now  the  preroga- 
tive of  every  dog  owner,  and  he  does  not  hesitate  to 
expose  his  friends  and  neighbors  (a  subtle  distinction) 
to  the  pleasures  of  a fourteen  or  twenty-one  day  anti- 
rabic  course  of  treatment.  Tick  fever  does  not  yet 
concern  us  in  the  East;  if  it  did  every  Mary  would 
have  a little  lamb  to  follow  her  to  school. 

Malta  fever,  once  considered  the  exclusive  property 
of  the  goats  which  leap  from  precipice  to  precipice  on 
the  rocky  fastnesses  of  Gibraltar,  has  invaded  our 
Southwest,  and  very  recently  a wave  of  undulant 
(not  indolent  fever,  which  is  an  industrial  hazard) 
has  crossed  the  continent  like  a storm  cloud  and 
broken  upon  the  Atlantic  Coast.  The  rabbits  of 
Georgia  are  propagating  themselves  northward  with 
the  rapidity  which  is  a peculiarity  of  their  species, 
carefully  conserving  the  tularemia  which  is  their 
choicest  possession.  We  are  in  danger  of  becoming 
a tributary  to  the  animal  kingdom. 

Within  a week  of  this  writing  a new  shadow  has 
fallen  upon  the  land,  for  psittacosis  (see  Osier, 
William)  has  been  discovered  among  the  parrots  of 
New  England,  and  already  many  owners,  trainers, 
and  dealers  have  fallen  prey  to  human  psittacosis,  a 
disease  characterized,  according  to  the  dictionary,  by 
high  fever  and  pulmonary  disorders.  An  edict  has 
gone  out  from  headquarters  that  all  sick  parrots  (i.  e., 
those  with  high  fever  and  pulmonary  disorders)  are 
to  be  quarantined,  and  it  is  rumored  that  the  disease 
may  become  reportable.  Already,  it  is  said,  the  parrot 
market  is  being  raided  by  pet  lovers  and  the  supply 
is  in  danger  of  becoming  exhausted. 

If  shark  bite  became  communicable  it  is  doubtful 
if  the  makers  of  aquariums  could  keep  up  with  the 
demand.  — Editorial,  The  N e<w  England  Journal  of 
Medicine,  January  23,  1930. 


Thick  Films  for  Diagnosis  of  Malaria. — The  studies 
conducted  by  the  United  States  Public  Health  Ser- 
vice relating  to  the  prevention  and  eradication  of 
malaria  assume  many  interesting  phases.  A recent 
report  of  considerable  interest  issued  by  the  service 
is  that  relating  to  a method  of  preparing  and  examin- 
ing specimens  of  blood  from  a malaria  patient  on 
glass  slides  for  the  diagnosis  of  malaria. 

Laboratory  workers  and  others  interested  in  the 
diagnosis  of  malaria  have  recognized  the  advantages 
of  the  thick  film  method,  especially  for  malaria  sur- 
veys. An  assistant  may  be  easily  taught  to  collect 
good  specimens  and  the  method  has  been  used  widely 
and  is  successfully  used  in  field  work.  Much  time 
is  saved  in  the  examination  of  specimens.  When  the 
malaria  parasites  are  at  all  numerous  they  are  usually 
seen  in  the  first  thick  film;  when  they  are  rare  they 
are  often  detected  in  the  thick  film  when  they  might 
have  been  missed  in  a thin  film  or  found  only  after 
a long  search.  The  chief  purpose  of  the  thick  film 
is,  of  course,  the  diagnosis  of  malaria  rather  than  the 
study  of  the  characteristics  of  malaria  parasites,  a 
purpose  for  which  the  thin  film  is  more  suitable. 

It  is  commonly  recommended  that  fifteen  to  twenty 
minutes  be  devoted  to  a thin  film  before  it  is  declared 
negative  and  five  minutes  to  the  thick  film.  In  either 
case  the  time  spent  on  apparently  negative  specimens 
must  vary  with  the  circumstances.  When,  for  exam- 
ple, the  sole  purpose  is  to  find  a crescent  carrier  suit- 
able for  mosquito-infection  experiments,  a fraction  of 
a minute  will  suffice  for  the  thick  film.  In  a clinical 
case  it  may  be  necessary  to  spend  a good  deal  of  time 
on  a film;  but  here  it  is  usually  possible  to  get  a new 
specimen  taken  at  a time  when  parasites  may  appear 
in  larger  numbers. — United  States  Public  Health  Service, 
February  8,  1930. 


190 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Official  Organ  of  the  California,  Utah  and  Tfe-vada  £ Medical  oAssociations 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 

Telephone  Ttouglas  0062 


Editors 

Associate  Editor  for  Nevada 
Associate  Editor  for  Utah 

Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 
single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  Address. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned. 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects.  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 

Contributions — Exclusive  Publication.- — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


f GEORGE  H.  KRESS 
1 EMMA  W.  POPE 
HORACE  J.  BROWN 
. . . J.  U.  GIESY 


EDITORIALS 


TWO  RECENT  CALIFORNIA  RESEARCHES— 

THE  ASCHHEIM-ZONDEK  PREGNANCY 
TEST  AND  THE  COFFEY-HUMBER 
CANCER  EXPERIMENTS 

California  Doing  Its  Part  in  Medical  Research 
Work. — In  the  December  1929  issue  of  this 
journal,  page  428,  mention  was  made  in  this 
column  of  the  excellent  work  which  had  been 
brought  out  by  the  Hooper  Foundation  of  the 
University  of  California.  If  it  is  gratifying  to 
know  that  the  group  studies  of  that  Foundation 
are  a credit  to  California,  it  is  equally  pleasing 
to  know  that  here  and  there  throughout  our  state, 
individual  members  of  the  medical  profession  are 
not  lacking  in  capacity  for  keen  analysis  and 
constructive  thinking,  as  they  meet  their  day  to 
day  problems  in  medical  practice.  Two  of  such 
studies  seem  worthy  of  special  mention  at  this 
time.  Both  are  endocrine  researches,  and  each 
opens  up  vistas  of  new  fields  of  intriguing 
investigation,  combined  with  possibilities  of  much 
usefulness  in  general  practice  and  of  benefit  to 
humanity. 

* * * 

The  Evans-Simpson  Report  on  the  Aschheim- 
Zondek  Test  for  Pregnancy. — Among  the  special 
articles  in  this  issue  of  California  and  Western 
Medicine  is  an  article  on  the  “Aschheim-Zondek 
Test  for  Pregnancy — Its  Present  Status”  by 
Doctors  Evans  and  Simpson  of  the  Anatomical 
Laboratory  of  the  University  of  California.  Their 
corroborative  studies  of  the  original  work  of 


Zondek,  Smith  and  Aschheim  on  the  close  rela- 
tionship in  the  action  and  nature  of  the  anterior 
lobe  of  the  hypophysis  in  provoking  sexual 
maturity  in  sexually  undeveloped  animals,  and  of 
certain  substances  which  are  existent  in  the  blood 
and  urine  of  human  females  during  pregnancy 
are  most  interesting.  The  world  has  long  de- 
sired a test  which  would  give  more  accurate 
early  knowledge  of  pregnancy  than  do  the  symp- 
toms and  signs  listed  in  current  volumes  on 
obstetrics.  Doctors  Evans  and  Simpson  present 
the  technique  of  the  test  with  explanatory  com- 
ments on  the  reactions  that  are  quite  convincing ; 
and  summarize  their  viewpoints  by  stating  that 
it  is  a very  dependable  test,  that  it  may  be  looked 
upon  as  a positive  test  so  early  as  the  first  few 
days  after  the  first  missed  period,  and  that  it  is 
likewise  useful  in  differential  diagnosis  and  in  the 

diagnosis  of  certain  other  uterine  conditions. 

* * * 

University  of  California  Offers  Its  Facilities  to 
California  Physicians  Making  These  Tests. — 
Because  it  is  necessary  that  laboratories  which 
would  properly  do  this  test  should  have  an  ade- 
quate supply  of  sexually  immature  rats  or  mice 
constantly  on  hand,  and  have  experience  in  inter- 
preting the  histology  of  the  ovary,  and  until  such 
time  as  one  or  more  laboratories  throughout  the 
state  are  prepared  to  acquire  this  experience  and 
have  a supply  of  such  animals  at  their  disposal, 
the  Anatomical  Laboratory  of  the  University  of 
California  at  Berkeley  will  continue  to  extend  its 
facilities  for  doing  this  test,  to  physicians  in 
private  practice.  A charge  of  ten  dollars  is  made 
for  the  studies  and  report  in  each  case.  The 
University  authorities  hope  that  the  test  will  come 
into  such  general  use  that  it  will  be  possible  for 
one  or  more  private  laboratories  to  take  over  the 
work.  A perusal  of  the  Evans-Simpson  paper 
will  no  doubt  lead  many  physicians  in  California 
to  try  this  new  test  and  to  avail  themselves  of 
the  facilities  so  kindly  placed  at  the  disposal  of 
the  medical  profession  by  the  state  university. 

H:  sR 

The  C off  ey-H  umber  Report  to  the  San  Fran- 
cisco Pathological  Society. — When  a month  or  so 
ago  two  members  of  the  California  Medical 
Association,  Doctors  Walter  B.  Coffey  and  John 
D.  Humber  of  San  Francisco — at  the  request  of 
and  in  order  to  give  more  detailed  information 
to  colleagues  who  knew  of  and  who  were  inter- 
ested in  their  studies,  presented  to  the  San  Fran- 
cisco County  Pathological  Society*  a report  on 
some  cancer  investigations  which  they  had  been 
carrying  on  for  many  years,  they  probably  were  as 
much  surprised  as  were  many  other  members  of 
the  California  Medical  Association,  at  the  sensa- 
tional publicity  which  was  immediately  given  to 
their  observations  by  the  lay  press.  The  publicity 
did  not  confine  itself  to  local  newspapers,  but 
through  the  press  agencies  became  almost  over 
night  a subject  of  almost  national  comment  in 
the  public  press. 

* See  letter  in  this  issue  of  California  and  Western 
Medicine  in  correspondence  column  of  the  Miscellany 
Department,  in  which  a digest  of  this  report  by  Doctors 
Coffey  and  Humber  to  the  San  Francisco  County  Patho- 
logical Society  and  other  letters  are  printed,  page  210. 


March,  1930 


EDITORIALS 


191 


The  Embarrassing  Situation  Which  Arose. — 
It  was  an  embarrassing  and  difficult  situation 
which  confronted  these  two  colleagues.  They  had 
made  their  preliminary  report,  as  do  members 
of  onr  profession  here  and  everywhere,  at  the 
request  of  colleagues  who  were  interested.  They 
distinctly  stated  that  they  were  only  reporting 
some  experiments  and  observations  and  much 
additional  work  would  be  necessary  before  sound 
conclusions  could  be  drawn.  Because  of  the  public 
interest  which  at  once  became  so  manifest,  they 
were  called  upon  to  decide  whether  it  would  be 
wiser  to  permit  the  representatives  of  the  press 
to  have  access  to  the  information  which  was 
demanded,  or  to  assume  a semi-secretive  or  clam- 
like attitude  and  refuse  to  let  the  newspapers  have 
the  news  information  which  the  press  represent- 
atives insisted  on  having.  It  was  evidently  a 
situation  in  which  halfway  measures  would 
probably  lead  to  worse  results  than  would  a course 
of  frankness,  and  the  latter  course  was  therefore 
decided  up  only  after  consultation  with  California 
and  Eastern  colleagues. 

The  entire  experience  exemplified  how  mar- 
velously rapid  has  been  the  development  of  news 
dissemination  through  the  daily  press  in  the  last 
few  years,  and  what  a powerful  factor  the  news- 
papers can  be  in  spreading  information  on  public 
health  topics  in  which  the  people  at  large  have 

some  knowledge  and  more  or  less  interest. 

* * * 

Origin  of  the  Publicity  Campaign  to  Promote 
a Better  Understanding  of  Cancer. — The  recep- 
tivity of  the  lay  public  for  more  and  better 
knowledge  concerning  cancer  may  be  said  to  have 
had  its  foundation  in  the  action  in  1913,  taken  by 
the  Congress  of  Surgeons  of  North  America, 
when  that  body  appointed  a committee  on  publicity 
to  spread  a truer  understanding  of  cancer  among 
the  medical  profession  and  the  lay  public.  Out  of 
that  action  came  the  formation  of  the  American 
Society  for  the  Control  of  Cancer,  and  that  and 
other  organizations  since  that  time  have  rendered 
more  than  yeoman  service  in  a splendid  educa- 
tional campaign,  in  which  many  physicians  have 
taken  a prominent  part,  Dr.  Joseph  C.  Blood- 
good  of  Johns  Hopkins  University  being  particu- 
larly prominent.  * * 

Basic  Efforts  Against  Cancer. — In  the  1926 
Lake  Mohonk,  N.  Y.  Conference  of  the  American 
Society  for  the  Control  of  Cancer,  an  international 
symposium  was  held  on  cancer  control.  In  the 
volume  (Cancer  Control,  Surgical  Publishing 
Company,  Chicago,  1927)  which  contains  the 
reports  of  that  gathering,  it  is  stated  on  page  2 : 

“It  appears  that  the  direction  in  which  efforts  can 
most  hopefully  be  employed  to  cope  with  the  scourge 
of  cancer  is  through  education.  Apparently  there 
should  be: 

(1)  a widespread  campaign  to  teach  the  public 
what  everyone  should  know  about  cancer; 

(2)  a dissemination  among  the  practitioners  of 
medicine  of  information  that  would  help  them  in  diag- 
nosing and  treating  the  cases  which  come  to  them; 

(3)  adequate  hospital  provision  for  the  care  of 
curable  and  incurable  cancer  patients;  and 

(4)  continued  research  in  the  cause,  prevention  and 
cure  of  cancer.” 


Bloodgood’s  Outline  of  the  First  Publicity 
Efforts. — In  a paper  printed  by  Bloodgood  of 
Johns  Hopkins  in  Health  in  March,  1922,  entitled 
“Publicity  Necessary  for  the  Cure  of  Cancer,”  he 
made  mention  of  the  initial  action  of  the  Congress 
of  Surgeons  of  North  America  and  stated: 

“The  chairman  of  the  first  committee,  my  colleague 
Cullen  of  Baltimore,  with  great  foresight  conceived 
the  idea  that  a number  of  articles  be  published  in  lay 
magazines  and  that  these  articles  be  written  by  an 
experienced  and  able  lay  writer,  based  upon  facts 
obtained  from  the  surgeons  of  great  clinics  in  this 
country.  These  articles  were  written  by  Samuel 
Hopkins  Adams  and  published  in  the  Ladies’  Home 
Journal,  Collier’s  IVeekly,  and  McClure’s  Magazine. 
This  was  the  first  effort  for  publicity  on  cancer  in  the 
world,  and  although  it  is  but  nine  years  since  it  was 
launched,  the  evidence  is  conclusive  as  to  the  life- 
saving value  of  such  publicity.” 

* * * 

An  Excellent  Foreword  by  a Lay  Editor. — A 
foreword  by  the  editor  of  Health  to  the  above 
article  by  Doctor  Bloodgood  may  also  be  of  inter- 
est as  showing  the  viewpoint  of  a layman  : 

“Cancer  is  today  the  greatest  mystery  of  the  human 
body.  In  spite  of  the  wonderful  increase  in  our 
knowledge  of  human  diseases,  we  know  little  more 
about  it  than  our  forefathers  did.  Some  day,  this 
mystery  will  be  solved.  There  are  probably,  today, 
in  the  world,  one  thousand  trained  men  and  women 
who  are  giving  their  lives  to  study  and  experimenta- 
tion, trying  to  find  out  what  causes  cancer  and  how 
it  can  be  prevented.  When  these  questions  can  be 
answered,  it  will  be  a great  day  for  the  human  race. 
Until  they  are,  we  can  only  use  the  knowledge  we 
have.” 

The  excerpts  just  given  should  make  quite 
understandable  how  it  has  come  about  that  the 
lay  public  of  the  year  1930  has  almost  as  much 
interest  in  all  efforts  to  conquer  cancer  as  has 
the  medical  profession,  and  why  every  seeming 
advance  in  the  fight  against  cancer  is  read  with 
avidity. 

* * * 

The  Publicity  Given  to  the  Coffey-Humber 
Extract. — Of  course  it  may  be  said  that  the 
publicity  of  Bloodgood  and  his  colleagues  was  of 
a very  different  sort  than  the  publicity  which  has 
been  given  by  press  representatives  to  the  recent 
California  studies  which  already  are  popularly 
known  as  the  Coffey-Humber  cancer  experiments. 
So  it  has  been,  and  on  that  account  it  may  be 
worth  the  while  to  pause  for  a few  moments  to 
consider  a fewT  points  before  passing  judgment. 

Doctors  Coffey  and  Humber  made  no  claim  of 
having  discovered  a cancer  “cure.”  On  the  other 
hand,  they  invariably  emphasized,  in  their  several 
addresses  before  California  medical  organiza- 
tions, that  they  had  simply  been  carrying  on 
certain  experiments  for  many  years  in  connection 
with  their  theory  of  malignant  tissue  growths; 
that  they  had  succeeded  in  making  an  extract 
from  the  cortex  of  the  suprarenal  glands 
that  had  some  interesting  properties  in  rela- 
tion to  presumable  action  on  the  sympathetic 
nervous  system,  blood  circulation  and  on  ma- 
lignant tissue ; that  they  had  not  been  able 
as  yet  to  work  out  accurate  or  final  dosage  for 
their  preparation ; and  that  they  needed  a vastly 
greater  amount  of  clinical  material  and  observa- 


192 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


tion  before  anything  like  final  conclusions  could 
be  drawn  concerning  the  efficacy  of  the  extract 
or  principle  which  they  had  isolated  and  which 
they  were  trying  out  in  the  treatment  of  cancerous 
tissue.  Further,  that  they  would  refuse  to  accept 
patients  on  a fee  basis ; that  they  would  give  the 
treatment  only  to  such  patients  who  came  with 
letters  from  their  personal  physicians ; that  they 
desired  to  have  the  remedy  to  pass  through  the 
regular  course  of  scientific  tests  of  all  new  prep- 
arations ; that  they  did  wish  to  continue  their 
investigations,  because  the  remedy  did  seem  to 
have  real  merit  in  doing  away  with  pain  asso- 
ciated with  cancerous  new  growths ; and  that  they 
would  be  most  happy  if  further  experience  would 
prove  that  the  seeming  selective  action  which  the 
extract  apparently  had  in  dissolving  or  destroying 
cancerous  tissue  without  seeming  damage  to  nor- 
mal cells  should  pave  the  way  for  a better  method 
of  treating  cancer  than  at  present  existed. 

* * * 

Doctor  Coffey’s  Friends  Knew-  of  These 
Studies. — A year  or  more  ago.  Doctor  Coffey  told 
the  writer,  as  he  probably  told  others  of  his 
friends,  concerning  the  studies  being  made  by 
Doctor  Humber  and  himself.  It  seems  only  fair, 
therefore,  inasmuch  as  with  what  might  at  this 
time  be  called,  over-great  laudation  in  some  news- 
papers there  has  also  come  considerable  criticism 
to  Doctors  Coffey  and  Humber,  that  it  should  be 
generally  known  to  their  California  colleagues, 
that  Doctors  Coffey  and  Humber  did  not  rush  to 
the  lay  press  with  reports  of  their  studies. 

* * * 

As  the  Situation  Stands  at  Present. — All  must 
concede  that  it  would  be  a boon  to  humanity  if 
their  work  would  pave  the  way  to  new  and  better 
methods  of  treatment  of  cancer.  But  even  if  their 
studies  should  not  bear  such  great  fruit  they  will 
still  have  been  participants  in  doing  a real  service 
in  the  attempts  at  conquest  of  this  disease,  through 
the  great  publicity  which  has  been  and  will  be 
given  in  medical  and  lay  journals  and  in  news- 
papers to  a rediscussion  of  the  entire  cancer 
problem. 

For  be  it  remembered  that  publicity  is  what  the 
leaders  in  the  movement  against  cancer  have  felt 
was  absolutely  necessary.  Publicity  makes  for 
interest,  and  interest  makes  for  cooperation. 
When  we  become  cancer-minded  to  the  extent 
that  we  do  not  fear  cancer;  that  we  will  use  all 
present  efficient  methods  in  diagnosis  and  treat- 
ment ; that  we  will  carry  on  cancer  researches 
with  provision  of  ample  financial  backing  from 
public  funds  and  from  the  private  purses  of  inde- 
pendently wealthy  lay  citizens — then  we  will  also 
have  the  right  to  be  so  minded  that  we  can  feel 
assured  that  in  the  not  remote  future,  cancer  really 
will  be  conquered.  Speed  the  day,  and  may  these 
studies  by  our  two  California  colleagues  be  im- 
portant means  to  that  end. 


NARCOTIC  PRESCRIPTIONS  — CALIFORNIA 
NARCOTIC  LAWS  — FEDERAL  NAR- 
COTIC ACT— PROPOSED  PORTER 
NARCOTIC  ACT 

Violations  of  California  Narcotic  Laws  Subject 
Violators  to  Arrest  and  Notoriety. — By  order  of 
the  Council,  a letter  was  recently  mailed  to  every 
member  of  the  California  Medical  Association. 
In  that  letter  was  stressed  how  important  it  is 
that  all  physicians  should  obey  the  state  narcotic 
laws  which  were  enacted  in  1929  by  the  last 
California  Legislature. 

The  special  provisions  of  the  amended  Califor- 
nia law  (violation  of  which  carries  legal  penalties) 
and  which  should  be  scrupulously  observed  by 
every  physician  who  does  not  wish  to  jeopardize 
his  good  name  and  reputation  through  arrest  and 
resultant  newspaper  publicity  and  notoriety,  are 
those  clauses  which  demand  that  every  physician 
who  gives  a narcotic  prescription  must  in  his  own 
handwriting,  write  with  ink  or  with  indelible  pencil, 
the  patient’s  name  and  address,  the  date  of  the 
prescription  and  his  own  signature.  Other  pro- 
visions make  it  illegal  for  either  a physician  or 
pharmacist  to  be  parties  to  the  dispensing  on  tele- 
phone orders,  of  prescriptions  for  narcotics. 

The  above  are  in  the  present  provisions  of  the 
California  law,  and  every  physician  licensed  in 
California  who  fails  to  observe  these  statutes 
places  himself  in  danger  of  arrest.  If  the  statutes 
work  improper  hardships,  then  the  attention  of  the 
officers  and  members  of  the  California  Medical 
Association  should  be  called  thereto,  either 
through  letters  which  could  be  printed  in  the 
correspondence  column  of  California  and 
Western  Medicine,  or  which  could  be  sent  direct 
to  the  central  office  of  the  Association. 

s|e 

The  Federal  or  Harrison  Narcotic  Act. — Prac- 
tically all  members  of  the  medical  profession  have 
a personal  acquaintanceship  with  the  Harrison 
Narcotic  Act,  since  every  physician  who  wishes 
the  right  to  prescribe  narcotics  is  obliged  to  pay 
the  annual  federal  narcotic  tax  to  the  Commis- 
sioner of  Internal  Revenue,  and  to  comply  with 
the  other  regulations  in  that  law  provided.  When 
the  Harrison  act  came  into  existence  some  years 
ago,  it  excited  considerable  criticism  because  of 
some  of  its  provisions,  but  in  the  end  the  members 
of  the  medical  profession  throughout  the  country 
accepted  the  new  federal  law  because  its  capacity 
for  good  in  certain  directions  compensated  some- 
what for  other  inconveniences  which  were 
imposed.  * * * 

The  Proposed  Porter  Narcotic  Law — “H.  R. 
9054.” — But  now  a new  and  additional  federal 
regulation  is  proposed,  not  as  a part  and  parcel 
of  the  Harrison  act,  but  as  a something  else  and 
separate.  This  new  law  has  been  introduced  by 
Congressman  Porter  of  Pennsylvania  and  is 
known  under  the  title  of  “H.  R.  9054.”  Members 
of  all  committees  on  public  policy  and  legislation, 
representing  California,  Nevada  or  Utah  county 
medical  societies,  should  write  to  their  local  con- 
gressmen asking  for  copies  of  this  bill,  so  that  its 


March,  1930 


EDITORIALS 


193 


provisions  may  be  studied,  and  reports  thereon 
rendered  to  the  respective  county  societies  in 
order  that  appropriate  action  may  be  taken  by  the 
societies.  Individual  members  of  the  California, 
Nevada  and  Utah  Medical  Associations  who  are 
interested  should  also  feel  free  to  write  to  their 
congressional  representatives  for  copies  of  the 
proposed  bill. 

No  matter  how  well  meant  this  particular 
Porter  act  may  be,  it  carries  provisions  which 
seem  an  infringement  on  the  legitimate  practice 
of  medicine.  It  is  another  example  of  trying  to 
do  away  with  an  intemperance  evil  or  habit  among 
certain  classes  of  the  lay  population,  through  what 
seems  little  other  than  intemperate  legislation. 
Like  much  of  such  intemperate  legislation,  it 
would,  if  enacted,  probably  fail  to  accomplish  the 
perhaps  laudable  hopes  of  some  of  its  enthusiastic 
proponents.  It  would,  however,  create  a very 
considerable  and  unnecessary  hardship  to  prac- 
ticing physicians,  and  on  that  account  would  seem 
worthy  of  prompt  and  determined  opposition 
from  the  medical  profession. 

:}:  s|c 

Proposed  Porter  Narcotic  Law  Jeopardizes 
Fundamental  Professional  Rights. — This  proposed 
Porter  act  would  obligate  every  licensed  prac- 
titioner of  the  healing  art,  as  well  as  members  of 
the  professions  of  dentistry,  pharmacy  and  vet- 
erinary medicine,  to  secure  from  the  United  States 
Commissioner  of  Prohibition  a separate  license 
to  dispense  narcotics.  The  proposed  bill  has 
drastic  provisions  which  would  prevent  any  phy- 
sician who  had  ever  been  convicted  of  ever  so 
small  a technical  violation  of  a narcotic  law  of  the 
United  States  or  of  a commonwealth  from  ever 
again  receiving  a license  to  prescribe  narcotics ! 
Such  an  ironbound  provision,  with  other  regula- 
tions which  would  centralize  power  in  the  hands 
of  the  Commissioner  of  Prohibition,  indicate  that 
this  proposed  Porter  act,  in  addition  to  being 
obnoxious  through  duplication  of  narcotic  licen- 
sure, could  very  easily  jeopardize  the  professional 
reputations  and  livelihoods  of  a large  number  of 
physicians  in  the  United  States  who  unwittingly 
might  violate  some  of  the  superlatively  stringent 
provisions  of  the  proposed  law.  No  group  of 
citizens  desire  an  abatement  of  the  narcotic  evil 
more  than  do  members  of  the  medical  profession. 
Because  of  the  work  which  physicians  are  called 
upon  to  do  in  caring  for  seriously  sick  and  injured 
persons,  they  must  not  infrequently  prescribe 
narcotics.  This  regular  and  emergency  function 
of  members  of  the  medical  profession  should  not 
be  surrounded  by  excessive  red  tape  restrictions 
to  be  carried  out  under  an  autocratic  lay  commis- 
sioner or  a bureaucratic  board  or  subordinates. 

* * * 

Write  to  Your  United  States  Senators  and 
Congressman. — It  would  be  a very  salutary 
experience  to  the  United  States  senators  and 
congressmen  representing  the  states  of  Califor- 
nia, Nevada  and  Utah,  if  every  member,  or  at 
least  the  majority  of  members  of  the  state  medical 
associations  of  those  three  states  would  take  the 
brief  time  to  write  to  their  representatives 


requesting  copies  of  “Porter  House  Bill  H.  R. 
9054  and  H.  R.  9053,”  and  then,  after  perusal,  to 
send  in  a strong  letter  of  protest,  if  their  pro- 
visions are  as  obnoxious  as  are  here  most  briefly 
indicated. 

For  the  convenience  of  members  of  the  profes- 
sion in  the  three  states,  the  names  of  the  federal 
senators  and  congressmen  may  be  found  in  this 
issue,  in  the  “Public  Policy  and  Legislation” 
column  of  the  Miscellany  Department.  If  you 
wish  to  safeguard  yourself  against  future  trouble 
in  these  narcotic  matters,  take  the  trouble  to  write 
to  each  of  the  two  senators  from  your  state  who 
represent  you,  and  also  to  the  congressmen  from 
your  district.  Do  this  before  you  forget  it.  Then 
when  the  time  comes  to  later  on  more  vigorously 
oppose  the  Porter  bill,  the  officers  of  the  Califor- 
nia, Nevada  and  Utah  Medical  Associations  will 
be  in  position  to  render  more  effective  service, 
because  these  congressional  representatives  at 
Washington  will  have  been  previously  made  aware 
of  the  interest  of  the  entire  medical  profession 
in  these  matters,  and  will  have  had  time  to  study 
the  justice  of  the  contentions  of  the  medical  pro- 
fession and  to  act  accordingly. 


CONSTRUCTION  AND  MAINTENANCE 
COSTS  IN  THE  NEW  UNIT  OF  THE 
LOS  ANGELES  COUNTY  GEN- 
ERAL HOSPITAL— WHAT  OF 
ULTIMATE  RESULTS? 

Last  Month’s  Editorial  Comments  on  the  Los 
Angeles  County  Hospital. — In  last  month’s  issue 
of  California  and  Western  Medicine  the 
action  of  the  Council  of  the  California  Medical 
Association  in  calling  attention  to  certain  policies 
of  the  Los  Angeles  County  General  Hospital  was 
editorially  presented. 

Mention  was  made  of  the  massive  new  building 
now  in  course  of  erection.  It  was  stated  that  this 
new  building 

“ . . . will  cost  some  $10,000,000.  Perhaps  $12,000,000 
will  be  nearer  the  total  cost  of  this  new  unit.” 

* * * 

Board  of  Supervisors  Objecting  to  the  Costs. — 
About  one  week  after  the  above  issue  of  Califor- 
nia and  Western  Medicine  had  been  placed  in 
the  mails,  the  Los  Angeles  Times  printed  a lead- 
ing article  under  the  caption : 

“Hospital  Cost  Out  of  Bounds — Construction 
Total  Figures  50  Per  Cent  Overweight.”  Several 
sentences  from  that  article  are  here  quoted : 

“ . . . Two  members  of  the  Board  of  Supervisors 
emphatically  declared  they  will  insist  that  the  cost  of 
the  completed  building  be  held  down  to  the  original 
estimate  of  $11,000,000. 

“The  hospital  became  the  main  topic  of  discussion 
at  the  Hall  of  Records  yesterday  when  Supervisor 
Graves,  chairman  of  the  Building  Committee  of  the 
board,  issued  a statement  that  indications  are  that 
the  hospital  will  cost  approximately  $16,000,000.” 

* * * 

Views  of  American  Medical  Association  Pres- 
ident-Elect on  Hospital  Costs. — On  the  same  day, 
February  18,  the  Los  Angeles  Examiner  printed 
a news  dispatch  from  Chicago  bearing  on  hospital 
costs  throughout  the  United  States.  An  applica- 


194 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


tion  of  some  of  the  items  in  this  latter  news  item 
could  be  made  to  what  has  just  been  quoted  from 
the  Times.  The  Chicago  news  dispatch  included 
the  following : 

“Reduction  in  the  cost  of  hospital  treatment  was 
the  keynote  of  the  opening  address  at  the  Congress 
of  Medical  Education  of  the  American  Medical  Asso- 
ciation here  today.  . . . Dr.  William  Gerry  Morgan 
of  Washington,  president-elect  of  the  American  Medi- 
cal Association,  voiced  this  demand.  . . . He  criti- 
cized the  huge  sums  spent  in  building  magnificent 
edifices  for  hospitals,  and  luxurious  equipment.  Much 
of  this  money  should  be  diverted  to  maintenance,  he 
said.” 

* * * 

What  a Staff  Member  Writes. — On  the  same 
general  subject  is  a letter  received  by  the  editor, 
from  a fellow  staff  member  of  the  Los  Angeles 
County  General  Hospital,  who  wrote  in  commen- 
dation of  the  stand  taken  by  the  Council  of  the 
California  Medical  Association  concerning  the 
placing  of  county  hospital  patients  in  private  hos- 
pitals, and  who,  among  other  thoughts,  stated  as 
follows : 

“ . . . I have  always  thought  that  such  an  institu- 
tion as  is  being  built  (by  the  Los  Angeles  County 
Hospital)  is  going  to  be  in  great  competition  with 
private  hospitals  and  private  practice.  ...  I have 
been  on  the  staff  for  more  than  ten  years,  and  while 
I do  not  in  any  way  begrudge  the  ‘indigent,’  the 
‘pauper,’  or  the  ‘county  charge’  my  professional  ser- 
vices, I do  object  most  strenuously  to  the  county 
receiving  money  for  their  hospital  care.  ...” 

* * * 

An  Out-Patient  Service  Innovation — Protests 
Unavailing.- — The  writer  of  these  lines  in  Cal- 
ifornia and  Western  Medicine  happens  to  be 
a member  of  the  Advisory  Medical  Board  of  the 
staff  of  the  “Los  Angeles  General  Hospital, 
Unit  No.  One”  (Unit  No.  Two  is  the  Osteopathic 
Unit)  and  in  common  with  two  other  colleagues 
on  that  board,  two  years  or  so  ago  gave  expression 
to  his  belief  that  some  of  the  innovations  in  the 
proposed  new  building  were  of  such  nature  that 
the  county  of  Los  Angeles  would  be  put  to  much 
useless  annual  maintenance  expense,  and  that  the 
architects  should  not  prepare  plans  along  such 
lines. 

The  particular  provision  or  innovation  to  which 
he  and  his  two  colleagues  entered  vigorous  objec- 
tion was  that  which  provided  that  in  this  mas- 
sive, monolithic  steel-cement  structure,  out-pa- 
tients were  to  be  treated  not  on  the  ground  floor 
in  an  adequate  out-patient  dispensary,  but  on  all 
the  different  wings  and  floors,  in  almost  immediate 
conjunction  with  in-patient  services. 

* * * 

Such  an  Out-Patient  Innovation  Could  Add 
Greatly  to  Maintenance  Costs. — The  immense 
elevator  and  other  personnel  cost,  incident  to 
carrying  the  increasing  number  of  out-patients 
and  relatives  and  friends  to  these  different  floors 
can  be  better  understood  when  one  keeps  in  mind 
the  out-patient  figures  printed  in  last  month’s 
editorial,  namely,  223,475  out-patient  visits  at  the 
Los  Angeles  County  Hospital,  for  the  year  ending 
June  30,  1929. 

A large  number  of  such  ambulatory  or  such  out- 
patients are  accompanied  by  relatives  or  friends 


all  of  whom  would  be  obliged  to  go  to  the  out- 
patient rooms  in  the  different  wings  and  on  the 
different  floors.  Since  most  of  the  dispensary  or 
out-patient  clinics  are  held  in  the  8 to  10  a.  m. 
hours,  the  heavy  elevator  traffic  during  such  hours 
can  be  easily  imagined.  Furthermore,  if  the  out- 
patient services  increase  as  in  the  last  five  years 
it  will  become  a serious  question  whether  or  not 
sufficient  elevators  could  be  installed  to  handle  the 
enormous  traffic. 

The  Los  Angeles  County  Hospital  out-patient 
service  may  be  said  to  have  been  instituted  so 
recently  as  the  year  1925.  During  that  year  a total 
of  72,314  out-patient  visits  were  registered.  By 
contrast,  for  the  year  ending  June  30,  1929,  the 
total  of  223,475  out-patient  visits  were  registered. 
This  is  certainly  an  enormous  increase  for  a brief 
period  of  five  years.  The  question  naturally  arises 
as  to  whether  this  out-patient  or  dispensary  service 
will  continue  to  increase  in  such  rapid  manner  and 
if  so,  what  additional  accommodations  would  be 
necessary;  and  could  the  accommodations  which 
would  be  required  be  actually  furnished  under  the 
system  of  handling  these  out-patients,  which  it  is 
intended  to  put  into  operation. 

It  might  be  said  that  the  dispensary  hours  could 
be  made  to  cover  a larger  number  of  hours,  but 
inasmuch  as  these  out-patient  services  are  largely 
manned  by  attending  staff  members  who  give 
gratuitous  services  to  the  indigent  sick,  and  as 
these  staff  members  must  have  their  other  hours 
of  each  day  at  their  disposal  in  order  to  earn  their 
livings  in  private  practice,  it  would  be  evidently 
out  of  the  question  to  have  these  clinics  distributed 
through  different  hours,  in  order  to  take  the 
morning  peak  loads  off  of  the  elevators. 

Unfortunately  (as  the  writer  still  sees  it),  he 
and  his  two  colleagues  on  the  Advisory  Medical 
Board  were  outvoted,  and  provision  for  this  ex- 
periment of  so  handling  such  an  immense  num- 
ber of  out-patients  was  incorporated  into  the 
plans  which  were  drawn  up  by  the  architects  and 
which  were  adopted  by  the  Board  of  Supervisors. 
The  writer  and  his  two  colleagues  have  never  been 
able  to  make  themselves  believe  that  such  an  out- 
patient service  plan  as  is  above  indicated  would 
make  for  more  efficient  service  to  out-  or  to  in- 
patients and  are  equally  convinced  that  such  a 
plan  will  add  greatly  to  the  maintenance  and  over- 
head costs,  and  would  use  money  that  could  have 
been  put  to  far  better  purpose. 

Just  how  much  this  interesting  experiment  will 
amount  to  in  initial  construction  costs  and  how 
much  extra  annual  overhead  it  will  necessitate  is 
naturally  hard  to  estimate.  The  writer  has  been 
tempted  to  believe  that  such  a plan,  when  all  extra 
employees  and  time  lost  in  unnecessary  question- 
ing of  nurses  and  employees  by  visiting  relatives 
and  friends  are  included,  will  lead  to  an  increased 
annual  maintenance  charge  that  perhaps  may  be 
as  high  as  fifty  thousand  dollars  a year.  Fifty 
thousand  dollars  is  a high  interest  return  on  an 
endowment  fund  of  one  million  dollars,  and  one 
million  dollars  is  a very  considerable  amount  of 
money,  even  though  it  is  practically  set  aside  as 
an  endowment  from  the  pockets  of  taxpayers.  It 


March,  1930 


EDITORIALS 


195 


is  well  known  that  the  tax-paying  citizenship  do 
not  look  with  joy  and  approbation  on  annual  ex- 
penditures of  public  funds,  unless  such  funds  are 
utilized  in  harmony  with  the  best  standards  of 
economy  and  efficiency. 

* * * 

Should  a Public  Hospital  for  Indigents  Excel 
All  Private  Hospitals? — It  would  seem  that  a 
public  hospital  for  indigent  citizens  could  become 
a menace  or  pernicious  influence  to  private  hos- 
pitals and  to  private  medical  practice,  when  such 
a public  hospital  excelled  in  type  of  construction 
and  equipment,  the  great  majority  of  private  hos- 
pitals in  the  United  States.  The  writer  has  found 
that  a goodly  number  of  colleagues  who  know  the 
details  of  the  Los  Angeles  situation,  apparently 
concur  in  his  viewpoint.  The  same  thought  is 
brought  out  in  the  quotation  from  the  letter  re- 
ceived from  a staff  member,  as  indicated  in  the 
excerpt  already  made. 

It  is  to  these  private  hospitals  that  private  citi- 
zens who  are  pay  patients  must  go.  With  the 
present  hue  and  cry  concerning  excessive  hospital 
costs,  would  it  not  be  natural  for  such  private 
patients  who  do  not  belong  to  the  indigent  or 
pauper  class,  to  feel  that  they  should  not  be  taxed 
to  maintain  institutional  care  for  indigents,  not 
only  as  good  but  actually  superior  to  that  which 
they  themselves  could  have,  and  then  only  at  heavy 
financial  costs  and  stress? 

* * * 

What  Influence  Will  This  Hospital  Have  on 
Private  Hospitals  and  Private  Medical  Practice? 
If  in  the  Los  Angeles  County  Hospital,  the  state  of 
California  is  to  have  the  largest  hospital  in  the 
world — so  far  as  construction  dimensions  are 
concerned,  it  would  seem  fitting  that  a serious 
attempt  should  be  made  to  have  it  become  at  the 
same  time,  an  institution  where  maintenance 
charges  would  represent  a very  maximum  of 
efficient  end  results  for  the  funds  which  are  to  be 
provided  by  the  taxpayers. 

In  last  month’s  editorial  comments,  a quotation 
was  made  from  the  last  annual  report  of  the  Los 
Angeles  County  Hospital  in  which  it  was  stated : 

“During  the  present  year  its  per  capita  cost  per 
day  for  in-patients  was  $5,272  and  per  out-patient 
visit,  $1,235/’ 

The  question  naturally  arises  as  to  whether  the 
per  capita  cost  per  day  when  the  new  building  is 
completed,  will  be  materially  decreased  or  in- 
creased. 

Ten  million  dollars  for  a single  division  of  one 
public  county  hospital,  a few  years  ago,  would 
have  been  looked  upon  as  an  appalling  figure.  If 
the  totals  exceed  that  sum,  to  become  a possible 
twelve  to  sixteen  million  dollars  for  the  addition 
of  some  fifteen  hundred  additional  beds  to  the 
institution,  and  if  the  annual  maintenance  charges, 
because  of  peculiarities  of  construction  and  of 
arrangements  or  methods,  will  run  into  figures 
considerably  above  the  costs  of  private  hospitals, 
then  it  may  be  questioned,  perhaps,  whether  some- 
thing less  massive  and  grand  might  not  have 
served  the  indigent  sick  and  injured  of  Los  An- 
geles County  to  as  good  or  to  better  advantage. 

And  if  the  massive  building  should  become  a 
visual  invitation  to  lay  citizens  to  contemplate  the 


presumable  advantages  of  so-called  state  medi- 
cine, the  members  of  the  medical  profession,  not 
only  of  Los  Angeles  County,  but  of  California 
and  other  states  in  the  Union,  will  have  some- 
thing to  think  about. 

We  must  all  agree  that  it  will  be  most  inter- 
esting to  note  the  different  influences  and  effects 
which  this  large  public  hospital,  now  in  course  of 
construction  for  the  care  of  indigent  citizens  of 
Los  Angeles  County,  will  have  on  the  lay  pub- 
lic, and  on  private  medical  practice,  both  in  and 
beyond  the  geographical  domain  of  that  county. 


Bar  Association  Approves  Psychiatric  Study  of 
Criminals. — The  American  Bar  Association  went  on 
record  in  its  last  annual  meeting  at  Memphis,  Tenn., 
approving  the  scientific  treatment  of  criminals  as  a 
basis  for  law  enforcement,  the  employment  of  experts 
on  mental  disorders  by  criminal  and  juvenile  courts, 
penal  and  correctional  institutions,  and  the  filing  of 
psychiatric  reports  in  felony  cases. 

This  action  was  based  on  a report  of  the  Section 
on  Criminal  Law  and  Criminology  headed  by  Dean 
Justin  Miller  of  the  University  of  Southern  California 
Law  School,  which  the  association  adopted  by  a ma- 
jority vote.  The  section  has  been  cooperating  for  the 
past  two  years  with  committees  of  the  American 
Medical  Association,  the  American  Psychiatric  As- 
sociation, and  the  Social  Science  Research  Council  in 
a comprehensive  study  of  the  relationships  of  medi- 
cine and  law,  with  special  attention  to  the  psychiatric 
aspects  of  medico-legal  problems  arising  from  mental 
disorders. 

The  association’s  committee  on  psychiatric  juris- 
prudence, upon  whose  studies  Dean  Miller’s  report 
was  based,  fie  said,  was  not  prepared  to  report  upon 
its  study  of  criminal  law  procedures  involving  insanity 
problems  arising  in  the  actual  trial  of  the  criminal 
case.  These  problems  he  pointed  out  are  peculiarly 
difficult  and  will  require  further  intensive  study.  The 
present  report,  therefore,  confined  itself  to  those  prob- 
lems which  are  represented  after  the  verdict  or  plea 
of  guilty.  The  following  resolutions  were  adopted  by 
the  association : 

I.  Resolved:  That  the  American  Bar  Association  go 
on  record  as  stating  the  following  matters  to  be 
desirable: 

1.  That  there  be  available  to  every  criminal  and 
juvenile  court  a psychiatric  service  to  assist  the  court 
in  the  disposition  of  offenders. 

2.  That  no  criminal  be  sentenced  for  any  felony  in 
any  case  in  which  the  judge  has  any  discretion  as  to 
the  sentence  until  there  be  filed  as  a part  of  the  record 
a psychiatric  report. 

3.  That  there  be  a psychiatric  service  available  to 
every  penal  and  correctional  institution. 

4.  That  there  be  a psychiatric  report  on  every 
prisoner  convicted  of  a felony  before  he  is  released. 

5.  That  there  be  established  in  each  state  a com- 
plete system  of  administrative  transfer  and  parole,  and 
that  there  be  no  decision  for  or  against  any  parole  or 
any  transfer  from  one  institution  to  another,  without 
a psychiatric  report. 

II.  Resolved  by  the  American  Bar  Association  that 
the  various  state  and  local  associations  be  requested 
to  give  consideration  to  the  recommendations  in  Reso- 
lution “I,”  as  a part  of  their  programs  during  the 
coming  year,  and  for  this  purpose  to  secure  the  co- 
operation of  their  respective  state  and  local  medical 
associations. 

III.  Resolved  that  the  Committee  on  Psychiatric 
Jurisprudence  be  continued  for  further  study  of  this 
field,  in  cooperation  with  committees  for  the  Ameri- 
can Psychiatric  Association  and  the  American  Medi- 
cal Association  and  that  it  be  empowered  to  adopt 
such  means  as  in  its  judgment  are  best  suited  to 
effectuate  the  purpose  of  these  resolutions. — Mental 
Hygiene  Bulletin. 


MEDICINE  TODAY 

Current  comment  on  medical  progress,  discussion  of  selected  topics  from  recent  books  or  periodic  literature,  by 
contributing  members.  Every  member  of  the  California  Medical  Association  is  invited  to  submit  discussion 
suitable  for  publication  in  this  department.  No  discussion  should  be  over  five  hundred  words  in  length. 


Medicine 

Neurocirculatory  Asthenia. — With  the  pass- 
ing of  the  World  War,  there  passed  from 
the  literature  reference  to  a confusing  clinical 
syndrome,  neurocirculatory  asthenia.  First  re- 
ferred to  by  Da  Costa  during  the  Civil  War,  it 
was  later  recognized  by  others.  During  the  past 
war  it  was  also  much  spoken  of.  Lewis  stated 
that  of  about  seventy  thousand  soldiers  returned 
to  British  hospitals  for  cardiac  insufficiency,  ap- 
proximately 10  per  cent  had  structural  heart  dis- 
ease. Though  fashionable  in  the  war-time  litera- 
ture only,  this  condition  is  important  at  all  times, 
being  not  solely  a soldiers’  ailment.  Present  in 
the  civil  population  also,  male  and  female,  its 
great  importance  lies,  not  in  itself,  but  in  that  it 
gives  a peculiar  picture,  the  main  symptomatology 
of  which  is  cardiac,  and  so  leads  to  erroneous 
cardiac  diagnoses.  The  type  of  patient  concerned 
is  one,  usually,  to  which  such  a diagnosis  spells 
disaster — the  depressed,  blue,  melancholic,  intro- 
spective type. 

The  condition  is  variously  named  neurocircu- 
latory asthenia,  from  the  generally  apparent 
pathology;  irritable  heart,  from  the  most  pro- 
nounced symptoms;  and  effort  syndrome,  from 
the  immediate,  in  contradistinction  to  the  ultimate, 
etiology.  Present  in  the  second  and  third  decades, 
occasionally  in  the  fourth,  with  no  particular  pre- 
dominance in  male  or  female,  it  is  common  in 
the  tall,  thin,  visceroptotic  type,  those  who  have 
cold  hands  and  feet,  those  wTho  perspire  readily, 
flush  and  pale  noticeably,  have  attacks  of  dizzi- 
ness, palpitation,  and  even  apparent  dyspnea,  this 
latter  usually  taking  the  form  of  sighing.  They 
tire  easily,  complain  often  of  precordial  and  other 
vague  pains  of  variable  nature  and  shifting  dis- 
tribution, and  of  insomnia.  They  are  often  intro- 
spective and  depressed.  Gastro-intestinal  disturb- 
ances occur,  usually  constipation,  atonic  or  spastic, 
an  easily  upset  stomach  with  nausea,  and,  less 
commonly,  vomiting.  The  temperature  is  often 
erratic. 

Physical  examination  shows  little ; perhaps 
palpitation  and  a slightly  increased  temperature. 
The  general  impression  is  that  of  the  type  of 
constitutional  inferior.  Laboratory  work  may  be 
negative;  slight  anemia  is  not  infrequent.  The 
blood  pressure  may  be  low,  but  is  usually  normal. 
There  being  all  grades  of  severity  of  the  disturb- 
ance, the  symptoms  must  also  vary. 

Many  do  not  present  the  typical  physical  pic- 
ture or  symptomatology  because  of  a difference 
in  etiology.  In  the  .typical  case  the  etiology  is 
probably  endocrine.  Focal  infection  is,  however, 
not  an  uncommon  etiologic  factor.  In  such  cases, 
we  see,  not  the  typical  picture  presented  above, 


but  only  the  disturbances  which  brought  the  con- 
dition to  attention,  the  palpitation,  with  perhaps 
atypical  precordial  pains,  and  easy  fatigue.  There 
may  more  frequently  in  this  type  be  secondary 
anemia  and  pallor,  but  not  flushing.  Another  eti- 
ology becoming  more  frequent  daily  is  that  of 
industrial  poisoning,  perhaps  most  commonly  ben- 
zene, lead,  and  carbon  monoxid.  Lack  of  recrea- 
tion is  also  a factor. 

Many  consider  this  condition  to  be  the  incipient 
stage  of  exophthalmic  goiter,  and,  while  the  re- 
semblance is  striking,  the  proof  is  lacking.  Of 
course,  in  the  non-endocrine  cases  this  is  not  to 
be  considered.  However,  in  differential  diagnosis 
one  should  always  rule  out  exophthalmic  goiter 
and  tuberculosis. 

Therapeutically,  little  can  be  said  in  regard 
to  the  typical  case,  the  constitutional  inferior, 
although  the  following  may  be  tried,  often  with 
benefit:  the  judicious  use  of  sedatives  and  stimu- 
lants; the  care  of  anemia,  if  present;  cold  baths, 
salt  rubs,  the  cold  affusion,  physical  therapy, 
exercise,  the  use  of  abdominal  supports  where 
indicated,  proper  selection  of  occupation  and  avo- 
cation, general  hygiene,  endocrine  therapy,  and 
even  psychotherapy.  Focal  infections  should  be 
eliminated.  In  cases  due  to  industrial  poisoning, 
and  in  those  due  to  lack  of  recreation,  the  reme- 
dies are  obvious. 

But,  remembering  the  mental  condition  of  the 
patient,  the  avoidance  of  an  erroneous  diagnosis 
of  cardiac  disease  is  most  important.  This  may 
require  extensive  observation,  but  it  should  usu- 
ally be  possible  to  make  a decision  more  or  less 
immediately.  The  past  history  is  important.  The 
cardiac  examination  is  usually  negative  except  for 
palpitation;  and  during  the  time  of  life  that  the 
effort  syndrome  appears,  the  cardiac  disturbances 
such  as  angina  pectoris,  coronary  thrombosis,  etc., 
which  show  an  apparently  normal  heart  on  phy- 
sical examination,  are  quite  uncommon. 

In  any  case  presenting  cardiac  symptoms  the 
effort  syndrome  should  be  kept  in  mind. 

Louis  Baltimore,  Los  Angeles. 


Medicine 

Treatment  of  Anaerobic  Toxemia  in  Bowel 
Obstruction  and  Peritonitis. — In  the  dis- 
cussion of  toxemia  resulting  from  organic  bowel 
obstruction  or  peritonitis,  the  early  diagnosis 
and  early  surgical  intervention  must  always  be 
stressed.  As  long  as  the  patient  fails  to  call  a 
physician  early  or  is  treated  by  a physician  who 
does  not  recognize  the  early  symptoms  indicative 
of  the  above  conditions,  late  intervention  will  con- 
tinue to  result  in  a mortality  of  25  to  50  per  cent. 


March,  1930 


MEDICINE  TODAY 


197 


We  must  be  ever  searching  for  any  procedure 
or  therapeutic  agent  which  will  help  to  lower  this 
mortality. 

B.  welchii  and  many  other  anaerobes  are  present 
in  the  lower  ileum.  Dudgeon  cultivated  B.  welchii 
from  the  stools  of  35  per  cent  of  200  ward 
patients;  Williams  cultivated  B.  welchii  from  the 
vomitus  of  eleven  out  of  nineteen  cases  of  bowel 
obstruction ; nineteen  out  of  twenty  advanced 
cases,  and  no  cultures  from  three  cases  of  pyloric 
obstruction.  B.  welchii  toxemia  from  the  vomi- 
tus inoculated  into  thirty-two  mice  produced  lethal 
effects  in  twenty-one.  In  sixteen  controlled  mice 
protected  by  antitoxin,  no  deaths  occurred  from 
inoculation.  Davis  and  Stone  proved  that  succus 
entericus  did  not  produce  toxemic  symptoms  when 
injected  intravenously  into  animals,  but  when  the 
juice  was  permitted  to  stand  and  bacteria  pro- 
liferated, it  rapidly  became  toxic.  Bernheim  and 
Whipple,  Cannon,  Dragestedt  and  Dragestedt 
were  able  to  show  that  bacteria  in  the  lumen  is 
necessary  for  the  production  of  toxic  substances. 

A great  deal  of  experimental  evidence  by  many 
workers  has  associated  the  toxemia  with  the 
presence  of  B.  welchii  and  B.  vibrio  septique, 
B.  edematus,  and  other  pathogenic  anaerobes.  At 
present  I believe  that  the  practicing  surgeon  must 
accept  this  view. 

Bower  and  Clark  concluded  that  gas  gangrene 
antitoxin  must  be  given  favorable  consideration 
as  a therapeutic  agent  of  probable  value  in  the 
toxemia  of  acute  intestinal  obstructions  and  of 
peritonitis. 

Williams  reports  reduction  in  mortality  in  ap- 
pendicitis from  6.3  to  1.17  per  cent,  and  in  bowel 
obstruction  from  24.8  to  9.3  per  cent.  Michel 
treated  suppurative  appendicitis  with  peritonitis 
with  polyvalent  serum  with  similar  results.  Michel 
gives  Delbet  the  credit  for  first  using  serum. 

Under  no  condition  is  the  use  of  polyvalent 
anaerobic  antitoxin  to  be  substituted  for  the 
rational  surgical  treatment.  The  obstruction  must 
be  dealt  with  surgically,  enterostomies  performed, 
if,  in  the  opinion  of  the  surgeon,  they  are  neces- 
sary. Chlorid  deficiency  must  be  supplied  by 
normal  salt  solution  subcutaneously  and  two  per 
cent  salt  solution  intravenously.  Sedatives  are 
indicated  for  rest,  stomach  tube  for  drainage  of 
upper  intestinal  tract,  spinal  anesthesia  for  the 
relief  of  distention,  and  the  promotion  of  peris- 
talsis must  always  be  thought  of  particularly  in 
ileus.  Blood  transfusion  is  unmistakably  of  value. 
If  there  is  infection  of  the  operative  wound  with 
anaerobic  bacteria,  then  this  wound  must  be  de- 
brided,  drained,  wound  irrigated  with  Dakin’s 
solution  or  a mild  acid  solution.  Free  chlorin 
and  weak  acids  destroy  the  toxin  of  anaerobic 
bacteria. 

Patients  are  desensitized  by  use  of  a small  quan- 
tity of  tetanus  antitoxin  or  diphtheria  antitoxin. 
One  hundred  cubic  centimeters  of  polyvalent  an- 
aerobic antitoxin  with  100  cubic  centimeters  of 
five  per  cent  glucose  is  given  intravenously,  100 
cubic  centimeters  of  serum  is  injected  intramus- 
cularly, intrafascially  and  intracellularly  around 
the  wound.  At  the  end  of  twelve  hours,  100  cubic 
centimeters  is  again  given  intravenously. 


The  patient  receiving  the  antitoxin  becomes  less 
restless,  the  pulse  rate  diminishes,  temperature 
and  distention  are  reduced  and  the  jaundice,  if 
present,  is  lessened.  It  is  our  hope  that  patients 
suffering  from  toxemia,  due  to  bowel  obstruction 
or  peritonitis,  will  receive  anaerobic  antitoxin. 

Edmund  Butler, 
San  Francisco. 

Medicine 

Increasing  Weight  in  the  Nondiabetic  by 
Means  of  Insulin. — The  specific  effect  of 
insulin  upon  the  diabetic  individual  is  accom- 
panied by  a marked  nutritional  and  general 
improvement.  Stimulated  by  this  observation, 
investigations  followed  in  cases  of  a glycosuric 
nutritional  impairment,  and  beneficial  results  were 
obtained.  Cachexias,  malignancies,  tuberculosis, 
anemias,  vomiting  of  pregnancy,  Graves’  disease, 
etc.,  were,  consequently,  treated  with  insulin. 

The  response  to  the  administration  of  insulin 
is  an  expression  of  its  specific  influence  upon  the 
complicated  metabolic  mechanism  of  the  body. 
And  in  cases  of  impaired  nutrition,  when  the 
intermediary  metabolism — the  cellular  behavior — - 
is  undoubtedly  altered  but  gross  pathology  is 
strikingly  absent,  as  in  anemia  and  chlorosis,  the 
cellular  and  general  metabolism  is  affected  and 
happily  influenced. 

Our  modern  age,  characterized  by  its  haste  and 
nutritional  indiscretions,  tends  to  promote  meta- 
bolic disturbances  by  this  faulty  hygiene ; and  the 
anemic  and  chlorotic  patient  is  common,  more 
especially  in  the  large  industrial  centers.  In  these 
patients  insulin  administration  has  given  excellent 
results. 

Indications. — Anemic  or  chlorotic  younger 
patients,  mostly  women,  with  an  obvious  mal- 
nutrition sponsored  by  pernicious  food  habits, 
constitute  the  majority  I have  so  treated.  Occa- 
sionally are  seen  patients  with  constitutional 
asthenia,  with  a generalized,  perhaps  slight, 
enteroptosis ; or  with  latent  tuberculosis ; or  with 
mild  thyrotoxic  symptoms — even  in  cases  of  be- 
ginning Graves’  disease — and  not  too  far  pro- 
gressed active  tuberculosis,  with  greatly  reduced 
desire  for  food  intake  and  with  steady  loss  of 
weight.  Yet,  despite  the  varying  pathology,  the 
results  obtained  by  treatment  with  insulin  are 
equally  satisfying.  The  nutrition  of  these  patients 
improved,  anorexia  disappeared,  and  a sense  of 
well-being  naturally  followed. 

Method  of  Administration. — To  test  the  sensi- 
tiveness of  the  patient,  the  initial  dosage  should 
be  small,  approximately  five  units.  No  severe 
hypoglycemic  reactions  will  thus  occur.  Insulin 
is  given  twice  daily,  one-half  hour  before  meal- 
time. Every  three  to  five  days,  the  dosage  may 
be  increased  to  ten,  twenty,  thirty,  and  even  fifty 
units.  The  alert  individual  may  be  taught  self- 
administration. A special  diet  is  unnecessary.  It 
is  well,  however,  to  include  a minimum  of  fifty 
grams  of  carbohydrates  in  each  meal,  raising  it 
according  to  the  amount  of  units  administered, 
a task  easily  accomplished  in  the  ordinary  menu. 

Reactions. — Every  patient  should  be  taught  the 
possibility  of  hypoglycemic  reactions,  their  pre- 


198 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


vention,  and  treatment.  The  feeling  of  weakness 
that  first  occurs  is  soon  followed  by  nervousness, 
dizziness,  perspiration  of  the  forehead,  marked 
hunger,  and  the  sense  of  impending  collapse.  To 
guard  against  hypoglycemic  reactions,  patients  are 
advised  to  carry  sweets,  candy  or  sugar,  on  their 
person.  By  taking  sweets  fifteen  minutes  after 
injection,  and  upon  the  slightest  feeling  of  weak- 
ness, a reaction  will  be  avoided.  With  the  ad- 
ministration of  rather  large  doses,  reaction  may 
occur  repeatedly  after  several  hours. 

Effects. — During  the  first  few  days  of  treat- 
ment, no  great  alteration  in  appetite  may  be 
noted:  improvement  soon  occurs,  however,  and 
patients  with  habitual  anorexia  consume  an  in- 
creased quantity  of  food  with  avidity  and  pleasure. 
After  one  week,  several  meals  three  or  four  hours 
apart  are  taken  and  food  is  often  eaten  between 
meals.  The  increased  appetite  and  food  intake  is 
followed  by  a gain  in  weight  of  approximately 
two  to  three  pounds  weekly.  Eating  becomes  a 
pleasure  and  a sense  of  well-being  results.  And 
in  those  patients  previously  addicted  to  laxatives 
regular  defecation  replaces  a chronic  constipa- 
tion. The  increase  in  weight  does  not,  however, 
continue  ad  infinitum : for,  after  three  to  six 
weeks  of  treatment,  using  fairly  large  quantities 
of  insulin,  the  body  becomes  refractory,  and  even 
greater  quantities  of  insulin  have  no  further 
effect.  The  increased  weight  is  maintained  for 
six  to  twelve  months  after  completion  of  treat- 
ment, or  even  longer.  In  hyperthyroid  cases  the 
action  of  insulin,  derived  from  the  pancreas,  can 
readily  be  explained,  since  the  pancreas  is  an  an- 
tagonist in  action  to  the  thyroid  gland. 

Failures. — The  efficacy  of  insulin  therapy  is 
more  dependent  upon  the  susceptibility  and  re- 
sponse of  the  patient  than  upon  the  quantity  ad- 
ministered. From  the  vast  clinical  experience  of 
M.  Levai  about  20  per  cent  of  cases  treated  as 
described  failed  to  react  successfully.  With  pa- 
tience, rest  and  diet,  seemingly  refractory  cases 
can  be  influenced. 

Summary. — Insulin  therapy  is  of  distinct  value 
in  the  malnutrition  of  the  nondiabetic  individual, 
whatever  the  causative  factor  may  be.  If  the  pa- 
tient is  properly  instructed,  and  this  advice  is 
followed,  ill  effects  do  not  occur.  The  treatment 
must  certainly  be  individualized.  And  a gain  in 
weight  of  two  to  three  pounds  weekly  for  ap- 
proximately four  weeks  will  result. 

Frederic  Waitzfelder, 
Los  Angeles. 


Ear,  Nose  and  Throat 

New  Theories  About  Common  Colds. — All 

attempts  to  find  a specific  microorganism 
of  common  colds  have  met,  in  spite  of  many 
claims  to  the  contrary,  with  failure.  Newman, 
in  an  extensive  bacteriologic  study,  has  found  the 
total  number  of  bacterial  species  in  colds  equal 
to  nineteen,  with  none  of  them  as  a specific  cause. 
Krause  demonstrated  in  1914  that  not  only  bac- 
teria but  their  filtrable  virus  is  able  to  produce 
coryza.  Foster  repeated  and  confirmed  the  ex- 
periments of  Krause.  Dochez  demonstrated  the 


same  fact  on  apes.  These  observations  prove  that 
the  presence  of  bacteria  is  not  a necessary  factor 
in  exciting  nasal  colds. 

As  to  chilling  as  a cause  of  colds,  Schade  in 
1919  analyzed  extensive  statistical  material  of 
the  German  army  during  the  last  war,  and  found 
that  the  incidence  of  acute  respiratory  diseases 
was  four  times  as  great  among  troops  exposed 
to  unfavorable  weather  as  among  the  sheltered. 
Mudd  and  Grant  in  1921  published  their  experi- 
mental observations  on  students  with  chilling  of 
the  body  by  electric  fans,  as  a result  of  which 
colds  in  the  nose  and  throat  developed.  At  the 
same  time  the  authors  noticed  that,  as  a result  of 
vasoconstriction,  blanching  and  ischemia  occurred 
on  the  mucous  membranes  of  the  pharynx,  accom- 
panied by  a fall  of  temperature  thereon  equal  to 
1.42  degrees.  A few  other  authors  (Tschalussow, 
Cocks,  Galeotti  and  Jackson)  made  similar  obser- 
vations. 

These  experiments  compel  us  to  replace  the 
former  false  assumption  of  congestion  of  the 
mucous  membranes,  due  to  chilling  and  cold,  with 
a new  conception  of  a stage  of  blanching  and 
ischemia  of  same.  Mudd  and  Grant  advance  a 
hypothesis  that  ischemia  may  play  a part  in 
inducing  infection  by  decreasing  cell  respiration, 
by  retarding  removal  of  products  of  cell  meta- 
bolism, by  increasing  or  decreasing  the  local 
supply  of  specific  antibodies,  by  altering  the  state 
of  aggregation  of  the  colloids  of  the  protoplasm, 
or  a combination  of  the  above  factors,  so  as  to  dis- 
turb the  equilibrium  between  host  and  parasite 
and  to  excite  infection. 

The  new  fact  that  an  acute  nasal  cold  can  be 
produced  by  a filtrable  virus  of  Krause  and  Fos- 
ter, can  be  explained  best  by  the  anaphylactic 
theory  of  infection. 

Immunity  and  infection,  according  to  this 
theory,  rest  in  the  ability  of  tissue  cells  to  com- 
bat through  their  proteolytic  enzymes  the  invasion 
of  both  bacterial  and  nonspecific  proteins.  These 
enter  as  a result  of  parenteral  ingestion  through 
nonresisting  mucous  membranes.  The  degree  of 
immunity  depends  upon  the  affinity  which  the 
body  cells  have  for  protein  and  the  ability  of  the 
amboceptors  to  select  and  appropriate  from  the 
complex  protein  molecule,  throug'h  cleavage,  that 
stag'e  of  aminoacid  which  is  not  only  harmless, 
but  made  useful  by  the  tissue  cells  themselves. 
Incomplete  cleavage  or  digestion  of  the  protein 
molecule  sets  free  toxic  products  which  result  in 
tissue  irritation  and  disease. 

Among  factors  predisposing  to  colds,  presence 
of  nasal  or  pharyngeal  pathology  plays  an  im- 
portant part.  Persons  with  definite  pathological 
conditions  of  the  nose  and  pharynx  are  inclined 
to  infection  more  often  than  normal  individuals, 
because  their  tissue  cells  are  less  active  and  lack 
protective  arrangements  due  to  chronic  inflamma- 
tion. The  hypertrophic  condition  usually  asso- 
ciated with  chronic  inflammation,  exposes  a larger 
field  to  the  action  of  foreign  protein,  thus  making 
them  always  more  susceptible  to  anaphylactic 
shock  in  the  form  of  coryza  or  pharyngeal  cold. 

Benjamin  Katz,  Los  Angeles. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION  * 


MORTON  R.  GIBBONS President 

LYELL.  C.  KINNEY President-Elect 

EMMA  W.  POPE Secretary 


OFFICIAL  NOTICES 

Results  of  Nonpayment  of  Dues. — Membership  in 
the  California  Medical  Association,  by  reason  of  non- 
payment of  dues,  ceases  on  April  1 of  any  year  and 
all  privileges  of  membership,  including  receipt  of 
California  and  Western  Medicine,  also  cease.  The 
names  of  such  delinquent  members  are  removed  from 
the  April  mailing  list. 

This  notice  is  intended  to  remind  all  members  who 
have  not  yet  received  the  1930  card  of  membership  in 
the  California  Medical  Association  that  their  dues 
have  either  not  been  paid  to  the  county  secretary  or 
not  reported  to  the  state  office.  It  should  incite  such 
members  to  an  investigation  of  the  reason  why  no 
membership  card  has  been  received.  Otherwise  the 
April  and  subsequent  numbers  of  California  and 
Western  Medicine  will  be  missing.  As  this  office 
orders  only  a limited  excess  number  of  copies  each 
month,  missing  journals  can  seldom  be  replaced. 

Be  sure  you  hold  a 1930  card  of  membership.  If 
not,  telephone  your  county  secretary,  and  pay  your 
1930  dues  before  the  first  day  of  April. 


Concerning  Care  of  Out-Patients  in  Dispensaries. — - 

The  following  resolutions  were  passed  by  the  Council 
of  the  California  Medical  Association  at  its  meeting 
of  January  18,  1930  to  cover  certain  underlying  prin- 
ciples in  the  care  of  indigent  sick  and  injured  citizens 
of  California: 

Resolved,  By  the  Council  of  the  California  Medical 
Association  that,  in  its  opinion,  public  hospitals  of 
California  supported  by  taxation  should  not  maintain 
certain  institutional  activities  in  the  care  of  the  indi- 
gent sick  when  such  activities  might  ultimately  lead 
to  ill  results  to  the  public  health  and  to  medical 
science  standards;  and  be  it  further 

Resolved,  That  in  the  viewpoint  of  the  Council  of 
the  California  Medical  Association,  when  public  hos- 
pitals, such  as  county  hospitals,  maintain  out-patient 
or  dispensary  departments,  and  charge  admission  or 
treatment  fees  of  such  patients,  that  then  such  out- 
patient departments  of  public  hospitals  could,  and  in 
nearly  all  instances  should,  very  properly  refer  all 
outpatients,  with  the  exception  of  indigent  patients 
who  can  pay  nothing,  and  of  other  special  classes 
listed  below,  to  other  out-patient  dispensaries  or  in- 
stitutions of  good  reputation  in  the  same  communities, 
when  such  exist.  The  exceptions  are:  (1)  ambulant 
patients  who  have  been  in-patients,  on  whom  it  is 
desirable  to  have  a follow-up  supervision;  (2)  out- 
patients suffering  from  conditions  liable  to  shortly 
make  them  possible  in-patients. 

In  the  opinion  of  the  Council  of  the  California 
Medical  Association,  the  California  law  intends  county 


* For  a complete  list  of  general  officers,  of  standing 
committees,  of  section  officers,  and  of  executive  officers 
of  the  component  county  societies,  see  index  reference  on 
the  front  cover,  under  Miscellany. 


hospitals  to  supply  professional  services  and  hospi- 
talization only  to  the  indigent  sick  and  injured,  and 
county  hospitals  existing  under  the  general  California 
law  should  observe  this  fundamental  rule  and  law. 


COMPONENT  COUNTY  SOCIETIES 

ALAMEDA  COUNTY 

The  Alameda  County  Medical  Association  was 
fortunate  indeed  in  having  as  their  guest  speaker  on 
the  evening  of  January  8,  Dr.  Morris  Fishbein,  editor 
of  The  Journal  of  the  American  Medical  Association, 
who  spoke  on  “Fads  and  Quackery.” 

The  regular  meeting  of  the  month  was  held  in 
Hunter  Hall  on  January  20,  being  called  to  order  by 
President  Meads  at  8:20  p.  m.  The  program  of  the 
evening  was  presented  by  the  staff  of  Fabiola  Hospi- 
tal and  consisted  of  four  interesting  papers.  The  first 
was  by  Dr.  Don  D.  Weaver,  who  talked  on  the 
“Treatment  of  Surgical  Shock.”  Doctor  Weaver  had 
made  a survey  of  the  treatment  used  in  most  of  the 
large  institutions  in  the  United  States,  the  majority 
of  whom  agreed  that  the  treatment  should  be  directed 
against  such  outstanding  symptoms  as  loss  of  body 
heat,  relief  of  pain,  alterations  in  blood  pressure,  etc. 
Patients  should  be  kept  warm,  pain  and  restlessness 
should  be  relieved  by  morphin.  Drug  stimulants  are 
of.  very  little  value,  the  best  supporting  measures 
being  the  intravenous  administration  of  glucose  solu- 
tions or  of  solution  of  gum  acacia  or,  best  of  all, 
transfusions  with  whole  blood.  It  seemed  to  be  the 
consensus  of  opinion  of  all  authorities  on  this  subject 
that  there  is  no  substitute  for  whole  blood  in  the 
treatment  of  surgical  shock. 

The  second  paper  of  the  evening  was  by  Dr.  T.  C. 
Lawson  on  “Cancer  of  the  Cervical  Glands.”  The 
doctor  outlined  the  various  types  of  tumors  which 
may  be  found  in  this  region,  but  limited  his  discussion 
to  metastatic  growth  from  primary  tumors  of  epi- 
thelial origin.  He  reviewed  the  anatomy  of  the  lym- 
phatic system  and  discussed  the  glands  most  fre- 
quently involved,  pointing  out  the  common  sites  of 
primary  tumors  of  the  skin  and  mucous  membranes 
of  the  head.  In  the  treatment  of  the  condition,  Doctor 
Lawson  urged  early,  wide,  and  extensive  dissection 
of  the  lymphatics. 

Doctor  Holcomb  spoke  on  “Rotary  Lateral  Curva- 
ture of  the  Spine,”  showing  slides  of  patients  suffering 
with  the  condition,  together  with  various  methods  of 
mechanical  treatment. 

Dr.  O.  R.  Etter  was  the  last  speaker  of  the  eve- 
ning, taking  as  his  subject  the  “Diagnosis  of  Chronic 
Gall-Bladder  Disease.”  The  doctor  felt  that  the  two 
most  important  aids  in  determining  pathology  of  the 
gall  bladder  were  a proper  history  and  physical  exami- 
nation. Various  laboratory  procedures  were,  to  his 
mind,  secondary. 

Dr.  O.  D.  Hamlin  spoke  at  some  length  on  the  cost 
of  medical  care  and  outlined  some  of  the  work  of  the 
California  Medical  Association  in  an  attempt  to  offer 
solutions  of  the  question  “How  shall  the  doctor  be 
paid  in  these  cases?”  Doctor  Hamlin  called  attention 
to  the  Survey-Graphic  of  January  1930,  in  which  there 
are  a number  of  articles  by  both  lay  writers  and  phy- 
sicians on  this  subject. 

The  meeting  was  adjourned  out  of  respect  to  the 
memories  of  Doctors  Herbert  DeLoss,  Ward  M. 
Beckwith,  and  Frederick  W.  Browning. 

Gertrude  Moore,  Secretary. 


199 


200 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


CONTRA  COSTA  COUNTY 

The  Contra  Costa  County  Medical  Society  held  its 
regular  meeting  on  February  11  in  the  Chamber  of 
Commerce  rooms,  Richmond,  with  President  J.  W. 
Bumgarner  in  the  chair.  . 

The  minutes  of  the  previous  meeting  were  read  and 
adopted.  Dr.  J.  M.  McCullough  gave  a report  on  his 
attendance  at  the  Contra  Costa  County  Health  As- 
sociation meeting,  stating  that  Dr.  I.  O.  Church, 
county  health  physician,  was  investigating  the  inci- 
dence and  origin  of  tuberculous  cases  in  the  county 
during  the  past  year. 

The  scientific  program  was  presented  by  members 
of  the  society  from  Richmond.  It  consisted  in  a sym- 
posium on  respiratory  diseases,  and  was  as  follows: 

Dr.  E.  R.  Guinan  read  a paper  on  ‘‘Asthma  in  Chil- 
dren,” stressing  the  important  part  played  by  idiosyn- 
crasies of  food  in  these  cases. 

Dr.  W.  E.  Cunningham  presented  a paper  on  Com- 
mon Colds.”  It  was  pointed  out  that  treatment  of 
this  condition  had  changed  very  little  in  modern  times 
and  that  no  specific  therapy  was  found  efficient  except 
in  a very  limited  number  of  cases. 

Dr.  J.  F.  Feldman  spoke  on  the  “Pathology  of 
Pulmonary  Tuberculosis”  and  gave  practical  applica- 
tions showing  the  relationship  between  the  clinical 
findings  and  the  various  pathological  manifestations 
of  the  disease. 

Discussion  of  these  various  papers  was  further  par- 
ticipated in  by  the  various  members  present.  The 
meeting  was  followed  by  refreshments. 

Those  present  were  the  following:  J.  W.  Bum- 
garner, G.  M.  Bumgarner,  H.  Vestal,  E.  R.  Guinan, 
J.  F.  Feldman,  W.  E.  Cunningham,  M.  Deininger- 
Keser,  Rosa  Powell,  all  of  Richmond;  J.  M.  McCul- 
lough of  Crockett,  S.  N.  Weil  of  Selby.  Visitors 
attending  were  C.  O.  Bishop,  W.  H.  Young,  Mrs.  E. 
Redman,  R.  N.,  and  Mrs.  N.  Purvience,  R.  N.,  all  of 
Richmond. 

S.  N.  Weil,  Secretary  Pro  Tern. 

■» 

FRESNO  COUNTY 

The  regular  meeting  of  the  Fresno  County  Medical 
Society  was  held  February  4,  following  dinner  at  the 
Fresno  Hotel  at  7 p.  m.  Forty  members  were  present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted. 

The  application  for  membership  of  F.  J.  Callahan 
of  Madera  and  Ralph  F.  Blecker  of  701  T.  W.  Patter- 
son Building,  Fresno,  were  read. 

The  following  new  members  were  elected:  A.  A. 
Arehart  of  Riverdale;  Everett  Morris  of  Auberry; 
Carl  II.  Shuck,  Mattei  Building,  Fresno;  Henry  A. 
Randel,  Griffith  McKenzie  Building,  Fresno. 

The  board  of  governors  recommended  that  the 
society  authorize  them  to  have  the  Welfare  Commit- 
tee, Dr.  A.  B.  Cowan,  chairman,  confer  with  the 
Parent-Teacher’s  Association,  with  the  view  of  hav- 
ing examinations  for  preschool  children  throughout 
the  county.  It  was  moved  by  Doctor  Mitchell,  sec- 
onded by  Doctor  Madden,  that  the  recommendation 
of  the  board  of  governors  be  adopted. 

The  auditor’s  report  was  accepted. 

Doctor  Madden,  chairman  of  Nomination  Commit- 
tee, moved  that  Dr.  C.  B.  Collins  be  added  to  the  list 
of  delegates  elected  by  the  Fresno  County  Medical 
Society,  Dr.  C.  M.  Vanderburgh,  alternate. 

A letter  was  read  from  the  district  attorney  that 
all  the  accident  cases  coming  under  Chapter  417,  law 
in  effect  August  14,  1929,  be  reported  immediately 
both  by  telephone  and  writing,  to  the  police. 

It  was  moved  by  Doctor  Dau,  seconded  by  Doctor 
Stein,  that  a committee  be  appointed  to  meet  with 
the  druggists  to  request  that  they  do  not  refill  pre- 
scriptions. The  appointed  are  Doctor  Dau  (chairman), 
Doctor  Stein,  and  Doctor  Madden. 

It  was  moved  by  Doctor  Hare,  seconded  by  Doctor 
James,  that  a committee  be  appointed  by  the  chair 
to  study  hospitalization  of  people  of  moderate  means. 


Following  is  the  committee  appointed:  Doctors  Ander- 
son (chairman),  Dau,  and  James. 

Dr.  Robert  W.  Langley  of  Los  Angeles  presented 
the  scientific  paper  of  the  evening,  “Diagnosis  and 
Treatment  of  Cardiac  Pain.” 

J.  M.  Frawley,  Secretary. 

# 

KERN  COUNTY 

On  December  12  the  Kern  County  Medical  Society 
held  its  annual  dinner  dance  at  the  Bakersfield  Club. 
A large  percentage  of  the  members  and  wives  were 
in  attendance.  An  excellent  dinner,  fine  orchestra 
music  for  the  dance,  combined  with  the  usual  good 
fellowship  of  the  occasion,  resulted  in  a most  enjoy- 
able evening.  The  committees  responsible  for  the 
success  of  the  party  consisted  of  Doctors  Jones, 
McKee  and  Fox,  on  arrangements;  and  Mesdames 
Smith,  Gundry,  Moore,  Fox  and  Bahrenburg,  on 
decorations. 

The  regular  January  meeting  of  the  society  was 
held  at  Taft  on  the  evening  of  January  16,  with  the 
members  of  the  West  Side  Medical  Society  acting  as 
hosts.  This  annual  event  proved  a great  attraction,  as 
the  reputation  of  the  West  Side  members  is  famous 
for  the  dinners  they  serve  and  the  entertainment  they 
provide.  A sumptuous  repast  at  the  Petroleum  Club 
House,  to  the  strains  of  Hawaiian  music  from  an 
orchestra,  served  to  satisfy  the  gastronomic  desires 
of  the  twenty  members  present,  who  were  then  intro- 
duced to  Dr.  William  Duffield  of  Los  Angeles,  the 
speaker  of  the  evening. 

Doctor  Duffield,  in  his  usual  extemporaneous  and 
interesting  way,  spoke  on  the  subjects  of  organization; 
the  question  of  state  medicine;  hospital  taxation;  the 
recently  organized  Woman’s  Auxiliary;  and  many 
other  legislative  matters  that  are  at  present  of  vital 
interest  to  the  medical  fraternity  of  our  state. 

If  we  had  more  medical  missionaries  of  the  Duffield 
type  who  would  bring  subjects  such  as  he  gave  to  us 
before  our  meetings,  our  organizations,  and  each  of  us 
as  individuals,  would  profit  much  from  it. 

We  reluctantly  allowed  Doctor  Duffield  to  end  his 
talk  to  permit  him  to  catch  his  train,  but  not  until  a 
rousing  vote  of  thanks  and  appreciation  was  extended 
to  him,  and  an  invitation  to  come  back  again. 

G.  E.  Bahrenburg,  Secretary. 

NAPA  COUNTY 

The  regular  monthly  meeting  of  the  Napa  County 
Medical  Society  was  held  Wednesday,  February  5,  at 
the  Ramona  Gardens,  Napa.  A most  delicious  dinner 
preceded  the  business  meeting. 

The  meeting  was  opened  by  Dr.  George  Dawson, 
president. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

Communications  were  read  and  routine  business 
transacted. 

The  secretary  was  authorized  to  pay  for  the  printing 
of  the  regular  meeting  cards. 

The  committee  appointed  to  make  recommendations 
concerning  malpractice  suits  was  not  ready  to  report. 

A communication  from  Dr.  C.  E.  Sisson,  super- 
intendent at  Napa  State  Hospital,  was  read,  inviting 
the  Napa  County  Medical  Society  to  hold  its  next 
regular  meeting  at  the  Napa  State  Hospital.  The  invi- 
tation was  accepted. 

The  speaker  of  the  evening,  Dr.  John  Loutzenheiser 
of  San  Francisco,  gave  a most  interesting  discussion 
of  “Anatomic  Form  and  Its  Relation  to  General 
Practice.”  His  talk  was  illustrated  with  slides  show- 
ing many  typical  cases  of  postural  defect  and  the 
correction  by  properly  fitting  appliances.  He  stressed 
the  importance  of  low-back  pain  and  its  relief  by 
correct  posture.  An  informal  discussion  of  his  sub- 
ject followed. 

The  members  present  were:  W.  L.  Blodgett,  C.  H. 
Bulson,  H.  R.  Colman,  G.  I.  Dawson,  E.  F.  Donnolly, 


March,  1930 


STATE  MEDICAL  ASSOCIATIONS 


201 


C.  A.  Gregory,  C.  A.  Johnson,  D.  H.  Murray,  L.  Welti, 

G.  J.  Wood. 

Edmund  Butler  of  San  Francisco,  J.  W.  Green  of 
Vallejo,  C.  E.  Nixon  of  Napa  State  Hospital,  and 
Loving,  intern  Napa  State  Hospital,  were  guests. 

C.  A.  Johnson,  Secretary. 

■» 

ORANGE  COUNTY 

At  the  invitation  of  Dr.  H.  A.  Johnston,  the  regular 
meeting  of  the  Orange  County  Medical  Society  was 
held  at  Doctor  Johnston’s  residence,  1401  South  Los 
Angeles  Street,  Anaheim,  on  Tuesday,  February  4,  at 
8 p.  m. 

Doctor  Johnston  gave  us  an  interesting  talk  on 
“Surgical  Clinics  of  Europe,”  and  showed  several  reels 
of  moving  pictures.  An  exceptionally  large  attend- 
ance helped  to  make  this  meeting  a success. 

The  business  meeting  was  postponed  for  the  eve- 
ning with  the  exception  of  the  first  readings  of  three 
candidates:  Robert  S.  Wade,  E.  D.  Kilbourne,  and 

H.  MacVicker  Smith.  The  appointment  of  a com- 
mittee on  membership  and  organization,  in  accord- 
ance with  instructions  from  the  state  society,  was 
made  by  President  Robertson.  This  committee  con- 
sisted of:  J.  L.  Beebe,  Anaheim;  E.  J.  Steen,  Fuller- 
ton; H.  G.  Huffman,  Santa  Ana. 

Upon  completion  of  the  pictures,  a delicious  lunch 
was  served  by  Mrs.  Johnston. 

A unanimous  vote  of  thanks  and  appreciation  was 
extended  to  Dr.  and  Mrs.  Johnston  for  the  evening’s 
program  and  entertainment. 

Harry  G.  Huffman,  Secretary. 

* 

SAN  BERNARDINO  COUNTY 

The  regular  meeting  of  the  San  Bernardino  County 
Medical  Society  was  held  at  the  County  Hospital  in 
San  Bernardino  on  February  4. 

The  meeting  was  called  to  order  by  the  president  at 
8:10  o’clock,  and  the  minutes  of  the  previous  meeting 
were  read  and  approved. 

There  being  no  business  before  the  house,  the  pro- 
gram of  the  evening  was  begun,  an  audience  of  sixty 
being  present. 

The  following  program  was  well  received: 

Motion  picture  of  four  reels — “Surgical  Treatment 
of  Peptic  Ulcer,”  Davis  & Geek,  Inc.  The  discussion 
was  limited  to  the  time  taken  for  changing  the  reels, 
and  was  given  by  Dr.  Francis  E.  Clough  of  San 
Bernardino. 

“The  Medical  Treatment  of  Peptic  Ulcer”  by  Dr. 
F.  A.  Speik  of  Los  Angeles  followed.  Discussion  was 
opened  by  Dr.  G.  S.  Landon  of  San  Bernardino. 

Supper  was  served  following  the  scientific  program. 

E.  J.  Eytinge,  Secretary. 

* 

SAN  JOAQUIN  COUNTY 

The  stated  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  Thursday  evening  at  eight 
o’clock,  February  6,  in  the  Medico-Dental  Club,  242 
North  Sutter  Street,  Stockton. 

The  meeting  was  called  to  order  by  Dr.  Harry  E. 
Kaplan,  president.  The  minutes  of  the  previous  meet- 
ing and  of  a special  meeting  of  the  board  of  directors 
were  read  and  approved. 

A letter  from  Robert  Couchman  of  the  San  Jose 
Mercury-Herald , with  reference  to  the  forming  of  a 
local  health  district,  was  read.  An  answer,  written  by 
Doctors  Kaplan  and  Sippy,  was  read,  and  on  motion 
of  Dr.  Dewey  Powell,  seconded  and  carried,  the  presi- 
dent was  authorized  to  send  this  letter  as  expressing 
the  attitude  of  the  San  Joaquin  County  Medical  So- 
ciety toward  the  San  Joaquin  local  health  district. 

In  compliance  with  a letter  from  the  State  Com- 
mittee on  Membership  and  Organization,  the  presi- 
dent turned  the  matter  of  new  members  over  to  the 
local  Committee  on  Admissions,  Doctor  Conzelman, 
chairman. 

There  being  no  further  business,  Doctor  Kaplan 
introduced  Dr.  Walter  Coffey  of  San  Francisco,  who 


spoke  at  length  on  the  subject  of  “State  Medicine  and 
a Plan  to  Combat  It.” 

Doctor  Coffey  said  that  the  matter  was  brought  up 
at  the  state  convention  at  San  Diego.  In  Los  Angeles 
especially,  it  was  shown  that,  due  to  the  numerous 
free  clinics,  the  younger  physicians  were  finding  it 
hard  to  get  a start.  Attention  was  called  to  the 
numerous  articles  on  the  high  cost  of  sickness,  too 
often  written  by  people  who  knew  very  little  about 
the  subject.  It  is  high  time  that  the  medical  pro- 
fession should  step  in  to  protect  its  own  interests 
and  find  ways  and  means  to  deliver  medical  care  to 
the  middle  class  of  our  people  before  the  matter  is 
taken  out  of  our  hands  by  lay  organizations. 

The  slogan  should  be  changed  from  the  “High  Cost 
of  Sickness,”  to  the  “Low  Cost  of  Health.” 

In  an  attempt  to  solve  the  problem,  Doctor  Coffey 
has  submitted  a plan  which  is  at  present  being  studied 
by  the  Council  of  the  California  Medical  Association. 

In  closing,  the  doctor  stressed  the  fact  that  every 
effort  should  be  made  to  preserve  the  individuality  of 
the  physician  and  permit  the  patient  to  choose  his 
own  doctor.  In  addition  the  public  should  be  taught 
methods  for  the  conservation  of  health. 

The  discussion  was  opened  by  Dr.  John  H.  Graves 
of  San  Francisco,  who  said  that  while  the  method  of 
monthly  payments  for  medical  and  surgical  service 
was  very  old,  the  unique  thing  about  the  plan  pro- 
posed by  Doctor  Coffey,  is  for  the  organized  medical 
society  to  control  and  direct  the  service  and  preserve 
the  free  choice  to  the  beneficiaries  to  call  their  own 
physician,  provided  he  be  an  associate  member. 

The  doctor  quoted  numerous  interesting  statistics, 
all  of  which  went  to  show  that  in  the  high  cost  of 
sickness,  all  things  considered,  the  doctor’s  fee  repre- 
sents the  least  part  of  it  all.  He  admonished  those 
present  to  “Read  a little  and  don’t  believe  too  much. 
Talk  a little,  but  not  too  much.  Think  a great  deal.” 

Dr.  Langley  Porter,  dean  of  the  University  of  Cali- 
fornia Medical  School,  next  spoke  on  the  subject.  He 
said  that  if  someone  makes  a great  enough  cry  about 
something  it  is  soon  translated  into  a need  and  people 
seek  legislation  as  a remedy.  The  present  situation 
he  regarded  as  a crisis  in  morals.  The  sense  of  re- 
sponsibility of  individuals  for  their  own  medical  care 
is  disappearing.  The  plan  of  Doctor  Coffey  is  a tre- 
mendous advance  to  meet  the  situation. 

The  doctor  took  issue  on  only  one  point.  He  felt 
that  there  was  much  more  involved  than  medical  care 
when  a person  became  ill,  and  for  those  numerous 
items  he  felt  each  beneficiary  should  be  a member  of 
a benevolent  order  which  contracted  with  the  medical 
profession  for  care  of  its  members.  He  stated  that 
only  20  per  cent  of  the  cost  of  medical  care  goes  to 
the  doctor.  The  benevolent  order  should  administer 
the  other  80  per  cent. 

The  paper  was  further  discussed  by  Doctors  Eng- 
lish, O’Donnell,  Doughty,  Chapman,  De  Lappe, 
Barton  Powell,  Hammond,  Friedberger,  Dozier,  Mc- 
Gurk,  and  Dewey  Powell.  In  closing,  Doctor  Coffey 
stated  that  he  deeply  appreciated  the  large  amount  of 
general  discussion  on  the  subject  and  hoped  to  see 
every  county  society  develop  as  much  interest.  He 
felt  that  there  was  now  too  much  lay  organization 
drifting  into  the  conduct  of  the  doctor’s  business.  He 
felt  sure  that  there  are  enough  splendid  business  men 
among  the  physicians  to  make  an  assured  success  of 
such  an  organization.  He  stated  that  the  societies 
and  hospitals  controlled  by  medical  men  are  the  only 
ones  which  maintain  a system  of  graduated  charges 
to  meet  the  needs  of  patients  of  variable  ability  to 
pay.  He  urged  that  the  care  of  the  sick  be  kept  out 
of  both  politics  and  the  hands  of  laymen.  A patient 
is  not  property. 

The  meeting  was  well  attended,  there  being  eight 
visitors  and  thirty-eight  members  present  as  follows: 
Visitors — Doctors  Walter  Coffey,  John  H.  Graves  and 
daughter,  Langley  Porter  of  San  Francisco,  Fred  R. 
De  Lappe  of  Modesto,  Sutton,  Davenport,  Messrs. 
Curtis  and  Ladd  of  Stockton.  Members — Doctors 


202 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


S.  R.  Arthur,  Barnes,  Blackmun,  Blinn,  Broaddus, 
Buchanan,  Chapman,  Conzelmann,  Dameron,  Doughty, 
Dozier,  English,  Foard,  Friedberger,  Gallegos,  Good- 
man, Hammond,  Hanson,  Holliger,  Hull,  Kaplan, 
Krout,  La  Berge,  McCoskey,  McGurk,  Marnell, 
O’Donnell,  Owens,  Pinney,  B.  J.  Powell,  D.  R. 
Powell,  Powers,  Priestley,  Sanderson,  Sheldon,  Sippy, 
Smithers,  and  Williamson. 

On  motion  of  Dr.  Dewey  Powell  the  society  ad- 
journed with  a rising  vote  in  honor  of  the  distin- 
guished visitors  of  the  evening. 

* * * 

A special  meeting  of  the  San  Joaquin  County  Medi- 
cal Society  Thursday  evening,  February  13,  at  8:30 
o’clock,  in  the  Medico-Dental  Club  rooms,  was  called 
by  the  president  to  meet  Dr.  Edward  H.  Ochsner  of 
Chicago,  who  delivered  an  illustrated  paper  on  “Re- 
cent Fractures  of  the  Hip.” 

In  opening  his  paper  the  doctor  first  went  carefully 
into  the  history  of  the  methods  found  useful  up  to 
date,  of  which  the  two  outstanding  ones  were  that 
of  Whitman  and  of  Maxwell  and  Root.  The  earlier 
methods  had  proved  inefficient  in  so  many  cases  that 
as  late  as  1921  Galloway  admonished  the  profession 
to  treat  the  patient  and  let  the  fracture  alone. 

The  Whitman  method,  while  giving  excellent  re- 
sults in  most  cases,  required  a very  long  period  of 
treatment  with  the  patient  immobilized.  This  was  a 
serious  consideration  in  the  matter  of  aged  patients. 
The  Maxwell-Root  method  permits  the  patient  to  rest 
in  a semi-upright  position,  with  some  motion  at  the 
knee,  and  the  limb  can  be  used  in  two  to  three  months, 
as  compared  to  six  to  twelve  months  in  the  other. 

In  comparing  the  details,  the  doctor  stated  that 
x-ray  pictures  show  that  with  the  Maxwell-Root 
method  there  is  less  distortion  of  the  bone  trabeculae 
in  the  reunion  of  the  fragments,  and  that  is  the  reason 
there  is  an  early  function  of  the  limb. 

The  method  was  first  described  in  1870  by  F.  J. 
Maxwell  and  later  improved  by  Root  of  Iowa.  Doctor 
Ochsner  has  used  it  since  1900  with  much  satisfac- 
tion. The  procedure  is  described  as  follows:  The 
patient  is  anesthetized  either  with  ether  or  morphin; 
the  femur  is  brought  to  a vertical  position  followed 
by  outward  traction  and  the  limb  lowered  to  the 
horizontal.  Now  a Buck’s  extension  is  rigged  with 
weight  approximating  one-thirteenth  that  of  the  pa- 
tient. In  addition,  the  patient  lies  in  a semi-reclining 
position  and  a broad  strip  of  adhesive  seven  inches 
wide  passing  spirally  about  three-quarters  the  way 
around  the  thigh  from  below  upward  and  from  the 
outer  aspect  over  and  under,  the  end  attached  to  a 
cord  which  in  turn  passes  over  a pulley  and  supports 
a weight  sufficient  to  correct  the  tendency  to  ever- 
sion. The  foot  of  the  bed  is  supported  on  twelve-inch 
blocks.  The  leg  is  supported  on  a pillow,  leaving  the 
heel  free  and  the  sole  of  the  foot  vertical.  After  seven 
to  ten  days  it  is  safe  to  permit  gentle  flexion  of  the 
knee.  In  this  manner  the  patient  is  confined  to  bed 
for  two  to  three  months  and  then,  with  a light  cast 
from  the  umbilicus  to  the  knee  and  a high  sole  on  the 
normal  limb,  he  is  allowed  to  be  up  on  crutches. 

The  method  is  recommended  because  it  is  universal 
in  its  application  and  simple  to  apply.  It  is  attended 
with  reduced  morbidity  and  mortality  and  fewer  fail- 
ures. Here  the  doctor  cited  case  histories  and  sta- 
tistics to  prove  his  assertions. 

The  paper  provoked  considerable  discussion,  led 
by  Doctor  Sanderson  and  followed  by  Doctors  Chap- 
man, Hammond,  Hench,  Dameron,  and  Kaplan. 

In  answer  to  questions,  Doctor  Ochsner  closed  the 
discussion  by  saying  that  he  did  not  reduce  an  im- 
pacted fracture  if  the  angle  was  anywhere  near 
correct;  this  angle  is  determined  by  the  x-ray  pic- 
ture; and  the  blood  supply  as  a source  of  success  or 
failure  is  usually  of  little  concern  because  the  nutrient 
artery  of  the  femur  has  never  been  shown  to  be  in- 
volved in  arteriosclerosis.  Syphilis  is  a real  hindrance 
to  union. 

Mr.  J.  W.  Davidson,  special  agent  for  the  Board  of 
Medical  Examiners,  was  introduced  and  spent  some 


time  in  explaining  some  of  the  points  of  the  amended 
Medical  Practice  Act  of  1929. 

TRere  being  no  further  business  the  meeting  was 
adjourned.  . 

Those  present  were:  Drs.  Barnes,  Blackmun,  Blinn, 
Broaddus,  Chapman,  Conzelmann,  Dameron,  English, 
Frost,  Gallegos,  Hammond,  Hench,  Hull,  Kaplan, 
LaBerge,  Lynch,  McCoskey,  McGurk,  O’Connor, 
O’Donnell,  Peterson,  Pinney,  B.  J.  Powell,  Priestley, 
Sanderson,  Sheldon,  Sippy,  Van  Meter,  and  Vischi. 
The  following  visitors  attended:  Drs.  Sutton,  Sherrill, 
and  Vanderleek. 

C.  A.  Broaddus,  Secretary. 

SANTA  BARBARA  COUNTY 

The  annual  banquet  meeting  of  the  Santa  Barbara 
County  Medical  Society  was  held  at  the  University 
Club  on  Monday  evening,  January  13,  with  President 
N.  H.  Brush  presiding. 

The  minutes  of  the  previous  annual  meeting  were 
read  and  approved. 

At  the  commencement  of  the  dinner  Doctor  Wills 
introduced  Frank  Greenough’s  string  ensemble,  who 
entertained  with  wonderful  music  during  the  dinner 
hour.  Also,  during  that  time,  the  Revelettes — three 
girls  from  the  State  Teachers  College — gave  several 
songs,  which  were  enthusiastically  received. 

Doctor  Brush  then  called  upon  Doctor  Franklin,  a 
recent  member,  for  a few  remarks.  Doctor  Soper,  the 
honorary  member  of  the  society,  also  made  a few 
remarks. 

The  president  then  introduced  the  speaker  of  the 
evening,  Mr.  Max  Horwinski  of  Oakland,  who  was 
scheduled  on  the  program  as  a German  professor  from 
the  University  of  Wurtzburg,  and  who  gave  a most 
humorous  and  interesting  talk  on  the  origin  of  music. 

Doctors  Ussher,  Wilcox,  and  Shelton  were  then 
unanimously  elected  into  membership  in  the  society. 

Doctor  Brown  moved  that  balloting  for  officers  be 
made  by  acclamation,  and  after  some  discussion  this 
was  declared  unconstitutional. 

The  following  officers  were  then  elected  for  the 
ensuing  year: 

Hugh  Freidell,  president;  Henry  Ullmann,  vice- 
president;  W.  H.  Eaton,  secretary-treasurer;  O.  C. 
Jones  of  Santa  Maria  and  H.  G.  Hanze  of  Solvang, 
vice-presidents-at-large.  Delegates  for  two  years, 
Henry  Ullmann  and  Hugh  Freidell.  Alternates,  Drs. 
Mellinger  and  Eaton.  Board  of  censors,  Drs.  Johnson, 
Thorner,  and  Means. 

There  were  present  at  the  meeting  forty-six  mem- 
bers and  fourteen  visitors. 

There  being  no  further  business  the  meeting  ad- 
journed. 

* * * 

The  regular  meeting  of  the  Santa  Barbara  County 
Medical  Society  was  held  in  the  nurses’  home  at  the 
Cottage  Hospital  on  Monday  evening,  February  10, 
with  President  Freidell  in  the  chair. 

The  minutes  of  the  previous  meeting  were  read 
and  approved. 

A communication  from  the  State  Association  re- 
garding the  membership  drive  was  read.  The  State 
Association  is  very  desirous  of  getting  every  eligible 
practicing  physician  in  the  community  as  a member. 
The  secretary  reported  that  every  man,  to  his  knowl- 
edge, who  was  eligible  was  already  a member,  and  it 
was  moved,  seconded,  and  carried  that  he  report  same 
to  the  State  Association. 

A communication  from  Mrs.  Henry  Rogers  of  Peta- 
luma regarding  the  formation  of  a Woman’s  Auxili- 
ary to  the  County  Medical  Society  was  read,  and 
upon  motion  by  Doctor  Stevens,  duly  seconded  and 
carried,  the  president  appointed  a committee  to  form 
such  an  auxiliary  consisting  of  Doctors  Mellinger  and 
Bakewell. 

The  time  of  meeting  was  discussed,  and  it  was  the 
consensus  of  opinion  that  8:30  was  too  late,  and  also 
it  was  a violation  of  the  county  society  constitution. 


March,  1930 


STATE  MEDICAL  ASSOCIATIONS 


203 


Therefore  in  the  future  all  meetings  will  be  com- 
menced promptly  at  eight  o’clock. 

The  president  desired  that  either  a copy  or  an  ab- 
stract of  every  paper  presented  to  the  society  be  given 
to  the  secretary  for  filing  and  future  reference. 

The  secretary  again  announced  the  appointees  on 
the  board  of  censors,  consisting  of  Doctors  Johnson, 
Thorner,  and  Means;  and  Program  Committee,  con- 
sisting of  Doctors  Freidell,  Henderson,  and  Eaton. 

The  scientific  program  was  opened  by  Dr.  Ussher, 
who  gave  a paper  on  “Bronchial  Asthma  Without 
Evidence  of  Protein  Sensitivity.”  This  was  discussed 
by  Doctors  Henderson,  Stevens,  and  Atsatt. 

Doctor  Geyman  then  followed  with  a talk  on 
“Diverticulae  of  Duodenum  and  Stomach,”  illustrated 
by  lantern  slides.  This  was  discussed  by  Doctor 
Freidell. 

Both  of  these  papers  were  extremely  interesting  and 
were  enthusiastically  received. 

There  being  no  further  business  the  meeting  ad- 
journed. W.  H.  Eaton,  Secretary. 

* 

SANTA  CRUZ  COUNTY 


The  February  meeting  of  the  Santa  Cruz  County 
Aledical  Society  was  held  February  20,  at  Alexander’s, 
Boulder  Creek.  After  a most  enjoyable  dinner  the 
meeting  was  turned  over  to  Dr.  Leo  Eloesser  of  San 
Francisco,  speaker  of  the  evening.  The  paper  dealt 
with  pulmonary  diseases,  especially  abscess  and  bron- 
chiectasis, from  a surgical  standpoint.  Etiology, 
symptomatology,  diagnosis,  and  various  types  of 
therapy  were  discussed  and  illustrated  with  suitable 
lantern  slides.  A general  discussion  followed. 

Dr.  F.  P.  Shenk,  eye.  ear,  nose  and  throat  specialist, 
now  located  in  Santa  Cruz,  was  admitted  to  member- 
ship in  the  society.  The  resignation  of  Dr.  T.  F. 
Conroy,  who  has  retired  from  practice,  was  accepted. 

The  following  members  of  the  society  were  present: 
Doctors  Bettencourt,  Congdon,  Dowling,  Harrington, 
Eiskamp,  Fehliman,  Atwood,  Marshall,  A.  L.  Phillips, 
Piper,  Randall,  and  Shenk. 

S.  B.  Randall,  Secretary. 

STANISLAUS  COUNTY 


The  regular  monthly  meeting  of  the  Stanislaus 
County  Medical  Society  on  Friday,  February  14,  was 
called  to  order  by  President  Hiatt. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

A Committee  on  Membership  and  Organization  was 
appointed  by  Doctor  Hiatt,  including  Doctor  Hart- 
man, chairman,  and  Doctors  Allen  and  Pierson.  A 
discussion  of  doctors  who  did  not  belong  to  the 
county  society  revealed  that  only  two  eligible  doctors 
were  not  members.  It  was  decided  that  an  attempt 
be  made  to  get  these  two  to  join  the  society. 

Doctor  Hiatt  announced  that  on  April  11  the  society 
would  have  ladies’  night,  and  the  program  would  con- 
sist of  moving  pictures  and  interesting  case  reports 
by  members  of  the  societv. 


Dr.  Charles  A.  Lunsford  of  Oakland  gave  a very 
interesting  lecture  on  the  subject  “Epidermophytosis,” 
illustrated  with  slides. 

Donald  L.  Robertson,  Secretary. 

<3A, 


VENTURA  COUNTY 


The  February  meeting  of  the  Ventura  County  Medi- 
cal Society  was  held  in  the  new  offices  of  Dr.  D.  G. 
Clark  and  Dr.  William  Felberbaum  in  Santa  Paula, 
Tuesday  evening,  February  18.  President  D.  G.  Clark 
opened  the  meeting. 

Members  present  were:  Doctors  Wright,  Schultz, 
Bianchi,  W.  S.  Clark,  Tillim,  Armitstead,  Illick, 
Yoakum,  Felberbaum,  Hendricks,  Manning,  Osborn, 
Shore,  Smolt,  Achenbach,  Bardill,  AVelsh,  and  Johnson. 

The  minutes  were  read  and  approved. 

A letter  from  the  state  secretary  requesting  names 
of  delegate  and  alternate  elected  for  two  years  was 
read.  Moved  and  carried  that  Doctor  Achenbach, 
having  served  last  year  as  delegate,  be  elected  for  one 
year  more,  and  that  Doctor  Bardill  be  elected  alter- 
nate for  two  years. 


Moved  and  seconded  that  the  secretary  be  in- 
structed to  write  state  senator  and  representative 
protesting  against  proposed  change  in  prohibition 
regulations.  Carried. 

The  program  for  the  evening  consisted  of  an  in- 
formal lecture,  given  by  Dr.  Samuel  Robinson  of 
Santa  Barbara.  His  subject  was  “Malignant  Tumors 
of  the  Lower  Bowel.”  Points  in  diagnosis  were  briefly 
touched  upon,  and  then  a comprehensive  description 
of  the  surgical  technique  of  removal  of  these  tumors 
was  presented. 

At  the  close  of  Doctor  Robinson’s  paper  the  meet- 
ing was  adjourned.  Refreshments  were  served  by 
Doctors  Clark  and  Felberbaum. 

Charles  A.  Smolt,  Secretary. 


CHANGES  IN  MEMBERSHIP 
New  Members 


Alameda  County — Judith  Ahlem,  Edward  Purcell, 
Brooks  P.  Stephens. 

Fresno  County — Kenneth  D.  Luechauer. 
Lassen-Plumas  County — William  R.  Harder. 

Los  Angeles  County 


Clarence  E.  Bird 
LeRoy  Crummer 
Delmer  L.  Davis 
Edward  C.  Donohoe 
Albert  F.  Heimlich 
Herbert  A.  Judson 
Romeo  J.  Lajoie 
Verne  M.  Mantle 
Samuel  S.  Mathews 
Cyrus  W.  Poley 
John  H.  Rindlaub 
David  H.  Rosenblum 
Joseph  Sandie 
Benjamin  Harry  Sherman 
Edward  A.  Skaletar 


Lawrence  W.  Smith 
.John  M.  Spaulding 
Carl  I.  Sulzbacher 
Roy  N.  Taylor 
Elwyn  E.  Terrill 
M.  G.  Varian 
M.  Russell  Wilcox 
Leon  Wolff 
F.  LeGrand  Noyes 
James  M.  Odell 
Arthur  N.  Nelson 
Franklyn  Thorpe 
Elroy  F.  Sheldon 
J.  Dickson  Oyler 
Donald  G.  Bussey 


Monterey  County — Horace  L.  Dormody,  Hugh  F. 
Dormody. 

Orange  County — Richard  C.  Cochran,  Clarence  Anson 
Neighbors. 

San  Francisco  County — Roger  U.  Campbell,  Kaho 
Daily,  Francisco  L.  A.  Gonzales,  Keene  O.  Haldeman, 
J.  Laverne  Laughton,  Ruth  A.  Nethercut,  S.  D.  Patek, 
John  F.  Quinlan. 

Santa  Barbara  County — E.  K.  Shelton,  N.  T.  Ussher, 
A.  B.  Wilcox,  Albert  J.  Holzman,  Marthe  Cresson. 

Transferred  Members 


Ernest  Eric  Larson,  from  Yolo  to  Los  Angeles 
County. 

Charles  E.  Sisson,  from  Mendocino  to  Napa  County. 
Mast  Wolfsohn,  from  San  Francisco  to  San  Mateo 
County. 

Norbert  J.  Gottbrath,  from  San  Francisco  to  Santa 
Clara  County. 

Leonard  W.  Ely,  from  San  Francisco  to  Santa 
Clara  County. 

Resignations 

Warren  H.  Slabaugh,  Los  Angeles  County. 

Gilbert  Van  Vranken,  Los  Angeles  County. 

Louis  L.  Sherman,  Alameda  County. 

Jessie  B.  Farrior,  Alameda  County. 

Arthur  Wegeforth,  San  Diego  County. 

Joseph  Van  Becelaere,  San  Diego  County. 


Deaths 

Barsotti,  Camillo.  Died  at  San  Francisco,  Febru- 
ary 1,  1930,  age  67  years.  Graduate  of  Royal  Uni- 
versity of  Florence  Faculty  of  Medicine  and  Surgery, 
Florence,  Italy,  1887.  Licensed  in  California,  1892. 
Doctor  Barsotti  was  a member  of  the  San  Francisco 
County  Medical  Society,  the  California  Medical  As- 
sociation, and  a Fellow  of  the  American  Aledical 
Association. 

Scholl,  Marguerite  Julia.  Died  at  Los  Angeles, 
January  17,  1930,  age  36  years.  Graduate  of  Univer- 
sity of  Southern  California  School  of  Aledicine,  Los 
Angeles,  1921.  Licensed  in  California,  1921.  Doctor 
Scholl  was  a member  of  the  Los  Angeles  County 


204 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


Medical  Association,  the  California  Medical  Associa- 
tion, and  the  American  Medical  Association. 


OBITUARY 
Walter  Watkins  Davis 
1879-1930 

On  February  1,  1930,  at  7:30  p.  m.,  Walter  Watkins 
Davis  passed  away  at  his  residence  in  Brea,  Cali- 
fornia. Death  was  the  result  of  pneumonia. 

Doctor  Davis  was  born  in  Pittsburgh,  Pennsylvania, 
June  13,  1879;  son  of  William  P.  and  Deborah  Wat- 
kins Davis.  He  was  educated  at  Pittsburgh  high 
school;  Western  Pennsylvania  College  (now  Univer- 
sity of  Pittsburgh)  medical  department,  M.  D.  1903; 
interned  at  Reinemon  Maternity  Hospital,  Pittsburgh, 
1903.  Following  this,  Doctor  Davis  engaged  in  a 
general  practice  at  Pittsburgh,  Pennsylvania,  and  Im- 
perial, Pennsylvania,  until  1912,  when  he  removed  to 
Anaheim,  California.  In  Anaheim  he  was  associated 
with  the  Johnston-Beebe-Clark  Sanatorium  as  bac- 
teriologist for  two  years.  He  located  in  Brea  in  1914. 

During  the  war,  Doctor  Davis  served  as  a com- 
missioned first  lieutenant  at  Camp  Lewis,  Washing- 
ton, then  was  sent  overseas  with  Base  Hospital  93, 
serving  in  Mont  Dore,  France,  and  Coblenz  and 
Newied,  Germany.  He  was  discharged  at  Camp  Dix, 
New  Jersey,  July  9,  1919,  after  thirteen  months  of 
active  service.  Immediately  after  his  discharge  from 
the  service  he  returned  to  Brea  and  resumed  his 
extensive  practice. 

Doctor  Davis  married  Florence  Grewco  of  Pitts- 
burgh, June  6,  1906.  She  and  one  son,  David  William, 
survive  him. 

He-  was  an  Episcopalian,  member  of  the  American 
Legion,  a Pythian  Knight,  a Republican,  member  of 
the  Orange  County  Medical  Association,  the  Cali- 
fornia Medical  Association,  and  a Fellow  of  the 
American  Medical  Association. 

Doctor  Davis  was  only  fifty  years  old  at  the  time 
of  his  death,  but  as  a practitioner  he  had  a large  fol- 
lowing and  was  loved  and  respected  by  his  confreres. 

THE  WOMAN’S  AUXILIARY  OF  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION* 


OFFICIAL  NOTICE 

Secretaries  of  all  county  auxiliaries  are  requested 
to  furnish  a list  of  officers  and  members  to  the  State 
Auxiliary  secretary,  Mrs.  R.  A.  Cushman,  632  North 
Broadway,  Santa  Ana,  Orange  County,  at  least  thirty 
days  before  the  annual  session  at  Del  Monte  on  April 
28  to  May  1,  in  order  that  the  state  secretary  may 
send  in  her  report  to  the  national  secretary  at  the 
yearly  session  of  the  American  Medical  Association 
at  Detroit,  June  23  to  27. 

The  following  counties  are  in  the  honor  roll  of 
auxiliary  activities,  and  should  each  be  represented 
at  the  Del  Monte  session  by  properly  qualified  dele- 
gates and  alternates; 

Contra  Costa  County — Mrs.  J.  M.  McCullough, 
president. 

Kern  County- — Mrs.  F.  A.  Hamlin,  president. 

Los  Angeles  County — Mrs.  J.  F.  Percy,  president. 

Orange  County — Mrs.  F.  E.  Coulter,  president. 

San  Bernardino  County — Mrs.  H.  E.  Clough,  presi- 
dent. 

Sonoma  County — Mrs.  J.  Leslie  Spear,  president. 

Jean  F.  Rogers,  President. 


LOS  ANGELES  COUNTY 

Organization  Meeting  of  the  Los  Angeles  County 
Woman’s  Auxiliary. — Dr.  William  Duffield  called  to 
order  the  preliminary  meeting  of  the  Los  Angeles 

* As  county  auxiliaries  to  the  Woman’s  Auxiliary  of  the 
California  Medical  Association  are  formed,  the  names  of 
officers  should  be  forwarded  to  the  state  secretary-treas- 
urer, Mrs.  R.  A.  Cushman,  632  North  Broadway,  Santa 
Ana,  and  to  the  California  Medical  Association  office, 
Room  2004,  450  Sutter  Street,  San  Francisco.  Brief  re- 
ports of  county  auxiliary  meetings  will  be  welcomed  for 
publication  in  this  column.  See  advertising  page  6 of 
each  issue  for  state  and  county  officers. 


County  Woman’s  Auxiliary  at  2:15  p.  m.,  Friday, 
December  27,  1929,  in  Room  412,  Union  Insurance 
Building. 

After  presentation  of  a brief  history  of  the  Woman’s 
Auxiliary  movement,  Doctor  Duffield  retired  and  Mrs. 
James  F.  Percy  took  the  chair. 

Mrs.  Martin  G.  Carter  was  elected  chairman  pro 
tem.  The  secretary  then  read  the  official  call  for  this 
meeting  and  the  underlying  principles  that  govern  the 
formation  and  regulation  of  the  Woman’s  Auxiliary 
of  the  Los  Angeles  County  Medical  Association. 

On  motion  of  Mrs.  Piness,  duly  seconded  and  car- 
ried, it  was  ordered  that  a Woman’s  Auxiliary  of  the 
Los  Angeles  Medical  Association  be  formed. 

On  motion  of  Mrs.  Pierce,  duly  seconded  and  car- 
ried, it  was  resolved  that  the  by-laws,  as  read,  be 
adopted. 

Dues  of  the  following  charter  members  were  then 
received:  Mesdames  F.  S.  Balyeat,  Walter  Bliss,  J.  H. 
Breyer,  Martin  C.  Carter,  John  F.  Chapman,  Edgar  F. 
Craft,  Kenneth  L.  Davis,  William  Duffield,  George  G. 
Hunter,  W.  H.  Kiger,  E.  M.  Pallette,  William  B. 
Parker,  James  F.  Percy,  Clarence  W.  Pierce,  George 
Piness,  Rea  Smith,  H.  B.  Tebbetts,  W.  E.  Waddell, 
and  Chalmer  Hiram  Weaver. 

On  motion  of  Mrs.  Hunter,  duly  seconded  and  car- 
ried, the  chairman  appointed  Mesdames  William  Duf- 
field, chairman;  E.  M.  Pallette  and  H.  B.  Tebbetts  as 
a committee  on  nomination  of  permanent  officers. 

After  a ten-minute  recess,  the  chairman  of  the  Nomi- 
nating Committee  submitted  the  following  names: 

Mrs.  James  F.  Percy,  president;  Mrs.  P.  S.  Doane, 
first  vice-president;  Mrs.  B.  Von  Wedelstaedt,  second 
vice-president;  Mrs.  Martin  G.  Carter,  secretary- 
treasurer. 

On  motions  duly  made  and  seconded  and  carried, 
the  report  of  the  Nominating  Committee  was  accepted 
and  officers  as  named  were  declared  elected;  dues  of 
the  local  society  were  established  as  $1  a year;  the 
president  was  instructed  to  arrange  for  a joint  meet- 
ing of  the  auxiliary  and  the  Los  Angeles  County 
Medical  Society,  provided  that  Doctor  Fishbein  would 
talk  on  the  Woman’s  Auxiliary,  and  the  privilege  of 
enrollment  as  charter  members  was  extended  until 
after  the  February  meeting. 

There  being  no  further  business,  on  motion  duly 
made  and  seconded,  the  meeting  adjourned. 

* * * 

Executive  Board  Meeting  of  the  Woman’s  Auxiliary 
of  the  Los  Angeles  County  Medical  Society. — Mrs. 
James  F.  Percy  called  the  meeting  to  order  at  11:45 
a.  m.,  January  16  at  the  home  of  Mrs.  Martin  G. 
Carter,  3930  Ingraham  Street,  Los  Angeles. 

The  president  reported  that  Mrs.  Edgerton  Cripin 
had  been  appointed  membership  chairman.  After  the 
arrival  of  Mrs.  P.  Doane,  a recess  was  called  for 
luncheon. 

The  meeting  reconvened  at  1 :20  p.  m.  and  on 
motion  of  Mrs.  Doane,  seconded  by  Mrs.  Von  Wedel- 
staedt, the  following  standing  rules  were  adopted: 

1.  All  matters  of  business  which  members  desire 
to  bring  before  the  Association  shall  first  be  presented 
to  the  board  of  directors  for  action.  If  not  approved 
by  the  board,  upon  petition  presented  to  the  board, 
and  signed  by  one  hundred  members  of  the  Associa- 
tion in  good  standing,  such  business  must  be  brought 
before  the  Association  for  action. 

2.  There  shall  be  the  following  standing  commit- 
tees: Program,  Membership  Credentials,  Hospitality, 
Hostess,  and  Ways  and  Means. 

3.  The  Program  Committee  shall  consist  of  three 
members  together  with  the  president  of  the  Associa- 
tion who  shall  be  chairman  of  the  committee. 

4.  Admission  to  all  meetings  shall  be  by  card  of 
current  year  only. 

5.  A check  for  dues  must  accompany  all  applica- 
tion for  membership. 

6.  No  appeals  for  financial  aid  shall  be  made  from 
the  platform  or  in  the  Association  room  except  by 


March,  1930 


STATE  MEDICAL  ASSOCIATIONS 


205 


permission  of  the  Executive  Committee,  nor  shall 
there  be  any  personal  canvass  of  funds. 

7.  Members  may  bring  guests  to  all  regular  pro- 
grams by  paying  fifty  cents. 

On  motion  of  Mrs.  Carter,  seconded  by  Mrs.  Doane 
and  carried,  the  payment  of  bills  amounting  to  $1.95 
was  authorized. 

On  motion  of  Mrs.  Von  Wedelstaedt,  duly  seconded 
and  carried,  the  president  was  authorized  to  have 
membership  cards  and  notices  of  the  February  meet- 
ing printed. 

On  motion  of  Mrs.  Doane,  duly  seconded  and  car- 
ried, meetings  were  set  for  2:30  p.  m.  on  the  third 
Thursday  of  alternate  months. 

The  minutes  were  read  and  approved  and  the  meet- 
ing adjourned. 

(Mrs.)  Martin  G.  Carter, 

Secretary-Treasurer. 

NEWS 

The  Woman’s  Auxiliary  of  the  Los  Angeles  County 
Medical  Association  gave  a luncheon  at  the  Women’s 
Athletic  Club,  833  Flower  Street  at  one  o’clock,  Mon- 
day, January  6. 

The  president  introduced  Mrs.  Ruggles  Cushman, 
secretary  of  the  State  Auxiliary,  and  Mrs.  Morris 
Fishbein  of  Chicago. 

Dr.  Morris  Fishbein  gave  a talk  on  “The  Woman's 
Auxiliary  Movement.” 

The  following  signed  as  additional  charter  mem- 
bers: Mesdames  Eliot  Alden,  H.  D.  Barnard,  John 
Barrow,  C.  H.  Bishop,  H.  R.  Boyer,  Harry  V.  Brown, 
Arnold  Burkleman,  Arthur  Cecil,  Edgerton  Cripin, 
P.  Doan,  Roy  Hammack,  Samuel  Ingham,  Simon 
Jesberg,  D.  N.  Jones,  E.  D.  Kremers,  Edmund  L. 
Lazard,  E.  R.  Lewis,  T.  Lyster,  H.  A.  MacArthur, 
W.  H.  Mayne,  H.  F.  Markolf,  Harry  G.  Marxmiller, 
W.  T.  MacArthur,  E.  F.  Nippert,  John  Nuttall, 
H.  Olds,  Oscar  Reiss,  Henry  Rooney,  H.  E.  Schiff- 
bauer,  H.  Snure,  Philip  Stephens,  J.  E.  Walker, 
B.  Von  Wedelstaedt,  Ed  H.  Williams,  Neal  N.  Wood, 
W.  B.  Wright,  Jr.,  and  A.  H.  Zeiler. 


NEVADA  STATE  MEDICAL 
ASSOCIATION 

W.  A.  SHAW President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 

HORACE  J.  BROWN.. Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 


COMPONENT  COUNTY  SOCIETIES 

NEVADA  STATE  MEETING 

The  annual  meeting  at  Elko  was  a great  success 
and  all  those  who  did  not  attend  deprived  themselves 
of  lots  of  valuable  instruction,  as  the  program  was 
first  class  in  every  particular.  W.  A.  Shaw  of  Elko 
took  his  seat  as  president,  and  the  following  officers 
were  elected:  R.  P.  Roantree,  Elko,  president-elect; 
H.  W.  Sawyer,  Fallon,  first  vice-president;  E.  E. 
Hamer,  Carson  City,  second  vice-president;  D.  A. 
Turner,  Reno,  trustee  for  three  years;  Horace  J. 
Brown,  secretary-treasurer. 

The  president  has  made  the  following  committee 
appointments  for  the  year: 

Membership — A.  C.  Olmsted,  P.  De  McLeod,  W.  H. 
Frolich. 

Judicial — A.  J.  Hood,  Elko;  R.  A.  Bowdle,  R.  R. 
Ctaig,  W.  L.  Howell,  C.  W.  West,  V.  A.  Muller. 

Scientific  Work  and  Program — M.  A.  Robison,  E.  L. 
Creveling,  H.  A.  Paradis. 

Necrology — E.  E.  Hamer,  J.  E.  Worden,  G.  W. 
Green. 

Entertainment — S.  K.  Morrison,  D.  A.  Turner, 
W.  L.  Samuels. 


Public  Health  and  Education — M.  R.  Walker,  W.  A. 
Shaw,  Mary  H.  Fulstone. 

Military  Affairs — T.  W.  Bath,  C.  E.  Secor,  W.  A. 
Shaw,  and  Secretary. 

Council — H.  W.  Sawyer,  W.  L.  Howell,  J.  C. 
Cherry,  C.  E.  Swezy,  J.  H.  Hastings,  D.  A.  Smith, 
L.  P.  Monson,  Hal  L.  Hewetson,  A.  J.  Hood,  Elko; 
J.  T.  Rees,  F.  M.  West,  A.  B.  DeChene,  M.  J.  Rand. 

The  president  wishes  to  state  that  he  and  the  secre- 
tary are  willing  and  glad  at  all  times  to  cooperate  with 
any  of  the  committees  in  more  adequately  fulfilling 
their  duties  during  the  year. 

Do  not  forget  that  dues  are  now  due  and  that  you 
should  send  to  the  secretary  $10,  for  which  he  will 
send  you  a membership  card  and  twelve  issues  of 
California  and  Western  Medicine.  Members  should 
bear  in  mind  that  this  has  nothing  to  do  with  the 
county  society  dues,  which  should  be  paid  to  their 
local  secretary.  Several  of  the  Washoe  County  mem- 
bers were  confused  last  year  not  knowing  that  the 
dues  of  both  the  county  society  and  state  associa- 
tion were  raised,  and  only  paid  the  $5  dues  to  the 
county  society.  This  left  them  without  recognition,  so 
far  as  the  state  association  and  the  American  Medical 
Association  were  concerned.  We  hope  that  no  one 
will  be  confused  on  this  point  this  year. 

ELKO  COUNTY 

All  the  news  we  have  is  the  annual  meeting  of  the 
Elko  County  Medical  Society,  which  was  held  at 
Elko  January  14,  at  which  time  the  following  officers 
were  elected  for  1930:  R.  P.  Roantree,  president; 
W.  A.  Shaw,  vice-president;  John  E.  Worden,  secre- 
tary-treasurer; C.  W.  Eastman,  trustee. 

After  the  business  meeting,  all  present  enjoyed  a 
social  dinner  together  at  Sherell’s  Cafe. 

# 

WASHOE  COUNTY 

The  regular  monthly  meeting  of  the  Washoe  County 
Medical  Society  was  held  on  the  evening  of  Febru- 
ary 11  at  the  Reno  City  Hall.  President  E.  E.  Hamer, 
secretary  of  the  Nevada  State  Board  of  Medical  Ex- 
aminers and  president  of  the  society,  presided. 

The  program  feature  of  the  evening  varied  at  the 
beginning  by  having  a first-aid  feature  demonstration 
by  members  of  the  local  Bell  Telephone  Company, 
led  by  Mr.  A.  E.  Bodle  of  Bell  Telephone  employ. 
The  demonstration  was  treatment  of  a hypothetical 
case  of  fracture  of  the  skull  with  arterial  bleeding 
from  cut  over  the  eye,  electric  burn  of  the  right  hand, 
and  a compound  fracture  of  the  right  leg  at  ankle- 
joint  received  by  a lineman  in  a fall  from  a pole.  The 
first-aid  class  gave  artificial  respiration,  bandaged  the 
head,  sterilized  the  wounded  hand  and  leg,  bound  the 
hand,  and  immobilized  the  injured  leg  with  splints 
which  bound  the  injured  leg  to  the  well  one.  The 
operation  was  scientifically  completed  in  seventeen 
minutes. 

During  the  demonstration  the  physicians  looked  on 
and  enjoyed  the  systematic  methods  in  which  these 
young  men  worked  and  their  apparent  ease  which  was 
the  result  of  experience  and  practice.  They  were 
heartily  cheered  and  commended  for  the  excellency  of 
their  demonstration.  Men  like  these  and  like  the  Boy 
Scouts,  available  for  emergencies,  are  a public  benefit 
in  any  community. 

The  medical  papers  for  the  evening  were  in  the 
nature  of  presentation  of  cases  of  skull  and  brain  in- 
juries, led  by  Dr.  Donald  Maclean  and  followed  by 
Dr.  Horace  J.  Brown.  Doctor  Maclean  gave  a his- 
tory of  six  private  cases.  The  synopses  of  four  are 
here  given. 

Case  1.  Japanese  laborer.  Injury  produced  by  dyna- 
mite blast,  piece  of  rock  the  size  of  a head  striking 
victim  on  top  of  head,  splitting  skull  in  two  and  lay- 
ing wide  open  both  hemispheres.  No  rock  or  bone 
found  in  brain.  Very  little  hemorrhage.  Patient  per- 
fectly conscious,  but  could  not  see.  Pupils  equal  but 
dilated.  Pulse  60,  but  shortly  dropped  to  40  or  less. 
Wound  was  one  and  one-half  inches  wide  by  four 


206 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.XXXII,  No.  3 


inches  long.  Skull  completely  gone  from  wound  area. 
Membranes  torn,  hemispheres  widely  separated,  heart 
beat  seen  registering  in  the  brain.  No  pain,  but  totally 
blind,  with  ringing  of  the  ears.  No  operative  pro- 
cedure done.  Ate  normally,  secretions  normal  for 
two  days.  Night  of  second  day,  temperature  was  105 
degrees  F.,  moribund,  died  at  five  o’clock. 

Case  2.  Prizefighter,  who  became  “punch  drunk” 
in  encounter.  Then  became  quartz  miner.  Consid- 
ered “not  there”  mentally  by  friends.  Was  shot  by 
forty-five  caliber  Colt  for  petty  theft.  Bullet  struck 
top  of  head,  tearing  skull  off  completely  to  frontal 
eminence.  Ran  250  yards  and  hid  for  two  hours  after 
shot.  Was  semiconscious  when  found.  Examination 
showed  no  apparent  brain  injury,  although  mem- 
branes were  torn.  Pulse  was  about  100.  Developed 
acute  meningitis,  with  temperature  of  106  degrees  F. 
Died  on  third  day. 

Case  3.  November  30,  1915,  21-year-old  boy  was 
kicked  by  horse.  Both  feet  of  the  animal  struck  boy 
over  left  parietal.  He  was  seen  almost  immediately 
by  doctor.  Boy  was  unconscious,  pulse  30,  respira- 
tion slow  and  stertorous,  parietal  bone  fractured  in 
many  places.  Fracture  extended  over  vault  down  to 
parieto-occipital  junction,  right  side.  Decompression 
done.  Restoration  of  fragments  of  bone  to  as  nearly 
normal  contour  as  possible.  In  operation,  dura  found 
intact  and  was  left  so.  Unconscious  eleven  days. 
After  that  there  was  a gradual  return  to  conscious- 
ness. Began  to  work  on  April  1,  1916.  May,  1920, 
attacks  of  dizziness  and  could  not  maintain  his  bal- 
ance. He  was  taken  to  Stanford  Hospital.  There 
spinal  puncture  was  done  with  no  result.  Then  brain 
was  needled  through  area  of  fracture.  Several  ounces 
of  fluid  were  drained  off.  Dizziness  relieved  for  sev- 
eral days,  but  July  29  became  paralyzed  and  com- 
pletely deaf  in  right  ear.  August  9,  occipital  decom- 
pression was  done,  with  relief  of  all  symptoms,  but 
leaving  patient  with  paralysis  of  pharynx.  August  17, 
operation  was  done  for  removal  of  tumor  of  cere- 
bellum. Died  on  August  19.  Diagnosis  was  sarcoma 
of  cerebellum. 

Case  4.  Auto  accident  on  night  of  August  16,  1929. 
Five  boys  in  a Ford  coupe  smashed  into  pine  tree 
with  sufficient  force  to  snap  tree  off  thirty  feet  above 
ground.  One  boy  was  killed  instantly,  one  died  shortly 
after.  Two  others  escaped  with  practically  no  injuries. 
Patient  here  described  had  a terrific  concussion,  scalp 
wound  over  left  parietal,  tear  over  left  ear,  and  excori- 
ation of  left  side  of  neck.  Unconscious  when  brought 
to  hospital  few  hours  after  injury.  Eyes  reacted  nor- 
mally. Apparent  paralysis  of  left  arm  and  leg,  with 
Babinski  of  left  leg  and  ankle  clonus  of  same.  Right 
side  normal.  X-ray  negative  for  fracture  of  skull. 
Diagnosis  was  concussion,  with  paralysis  of  right  arm 
and  right  leg  due  to  contrecoup.  Pulse  dropped  to  50. 
Temperature  was  102  degrees  F.  Antitetanic  serum 
given,  with  result  that  temperature  rose  to  105  de- 
grees and  107  degrees.  Eighteen  days  after  accident, 
subtemporal  decompression  was  done.  Bulging  of 
dura  was  opened  and  considerable  yellow  fluid  evacu- 
ated. Wound  closed  with  drain  in  dura  which  was 
removed  in  forty-eight  hours.  Unconscious  twenty-six 
days.  Consciousness  returned  slowly.  Urine  voided 
involuntarily;  bowels  by  enema.  After  recovering 
consciousness,  paralysis  of  arm  and  leg  gradually  sub- 
sided. Home  on  October  6.  Recovery  practically  com- 
plete except  for  slight  limp  in  left  leg. 

Doctor  Brown  followed  Doctor  Maclean  with  ex- 
temporaneous citing  of  instances  of  brain  injuries 
which  brought  out  the  value  of  blood  pressure  read- 
ings to  determine  the  progress  of  the  brain  hemor- 
rhage. There  were  running  comments  on  brain  cases 
seen  in  the  World  War  by  those  who  had  served 
overseas  in  the  great  conflict. 

The  meeting  concluded  with  a satisfied  feeling  by 
all  present  that  if  was  an  hour  well  spent  in  the  dis- 


cussion of  a type  of  case  which  calls  for  experienced 
judgment  of  highest  type. 

Thomas  W.  Bath,  Secretary. 


NEVADA  NEWS 

On  December  10,  at  the  Elko  General  Hospital, 
the  following  members  of  the  staff  were  elected  as 
officers  for  1930:  John  E.  Worden,  chief  of  staff; 
W.  A.  Shaw,  vice;  W.  A.  Haas,  secretary. 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY,  701  Medical  Arts  Building', 

Salt  Lake  City Associate  Editor  for  Utah 


COMPONENT  COUNTY  SOCIETIES 

SALT  LAKE  COUNTY 

The  regular  meeting  date  of  January  13  was  changed 
to  January  10  in  order  that  a banquet  could  be  held 
for  Dr.  Morris  Fishbein  of  Chicago,  editor  of  The 
Journal  of  the  American  Medical  Association. 

The  meeting  was  called  to  order  at  8:30  p.  m.  by 
President  M.  M.  Nielson,  who  introduced  the  speaker 
of  the  evening.  Seventy-eight  members  and  ten  visi- 
tors were  present. 

Doctor  Fishbein  gave  a very  interesting  talk  upon 
the  “Cost  of  Medical  Care.” 

President  Nielson  announced  at  the  close  of  the 
talk  that  Doctor  Fishbein  would  give  a public  lecture, 
under  the  auspices  of  the  B’Nai  Brith  Forum,  at  the 
Assembly  Hall  on  January  11,  at  8:15  p.  m.  The  sub- 
ject of  the  talk  was  “Fads  and  Quackery.” 

The  meeting  was  adjourned  at  9:40  o’clock. 

* * * 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society,  held  at  the  Holy  Cross  Hospital  Monday 
evening,  January  27,  was  called  to  order  by  President 
M.  M.  Nielson  at  8:05  o’clock.  Forty-eight  members 
and  eight  visitors  were  present. 

The  minutes  of  the  meeting  of  December  9 were 
read  and,  after  correction  by  Doctor  Pace,  accepted. 
The  minutes  of  the  meeting  of  January  10  were  read 
and  accepted  without  correction. 

The  clinical  meeting  was  then  turned  over  to  L.  N. 
Ossman.  The  program  was  as  follows: 

The  Diagnosis  of  Antrum  Disease — T.  F.  Welsh. 

Case  of  Duodenal  Ulcer  and  a Case  of  Appendi- 
citis— A.  J.  Hosmer. 

The  Use  of  Horse  Serum  in  the  Treatment  of 
Burns,  Case  Report — S.  G.  Kahn. 

A Case  of  Patent  Urachus — G.  N.  Curtis. 

Hypernephroma — W.  G.  Schulte. 

Empyema — T.  W.  Stevenson. 

Cholecystography — J.  P.  Kerby. 

These  papers  were  discussed  by  C.  L.  Sandberg, 
J.  A.  Phipps,  F.  Leaver  Stauffer,  and  B.  Coray. 

J.  Z.  Brown  reported  for  the  Committee  on  Selec- 
tion of  a Meeting  Place.  J.  P.  Kerby  moved  that  the 
society  continue  to  meet  at  the  Newhouse  Hotel. 
Motion  seconded  and  carried. 

The  meeting  adjourned  at  9:45  o’clock. 

Barnet  E.  Bonar,  Secretary. 


UTAH  NEWS 

The  regular  weekly  meetings  of  the  Academy  of 
Medicine,  held  Thursdays,  have  continued  since  last 
report.  On  the  several  dates  specified  below  the  fol- 
lowing programs  were  presented: 

January  16 — Recent  Findings  in  Etiology  of  In- 
fluenza, L.  L.  Daynes.  Polyposis  Gastrica,  George 
Middleton. 


March,  1930 


STATE  MEDICAL  ASSOCIATIONS 


207 


January  23 — Thrombo-Angiitis  Obliterans,  H.  T. 
Anderson.  Medical  Notes  from  San  Francisco,  E.  L. 
Viko.  Subphrenic  Abscess,  L.  A.  Stevenson. 

January  30 — Schilling  Index,  T.  A.  Flood.  Talk  on 
Pneumothorax,  Doctor  Van  Scoyoc. 

February  6—  Addison’s  Disease,  Doctor  Skofield. 
Surgical  Treatment  of  General  Peritonitis,  Doctor 
Young.  Prevention  of  Postoperative  Emboli,  Dr.  F. 
Hatch. 

* * * 

One  of  the  outstanding  events  of  the  professional 
world  during  the  past  month  was  the  joint  banquet 
of  the  Salt  Lake  Dental  and  Salt  Lake  County  Medi- 
cal Societies.  The  Salt  Lake  County  Dental  Society 
as  hosts  entertained  the  doctors  at  the  Elks’  Club  on 
the  night  of  Friday,  February  7. 

Some  two  hundred  members  of  both  societies  at- 
tended. During  and  following  the  dinner,  entertain- 
ment was  staged  in  the  form  of  vocal  numbers,  adagio 
dancing,  and  a one-act  playlet  of  comedy  type.  Ad- 
dresses were  made  by  Doctor  Irvine  and  Doctor 
Wherry,  and  a response  by  Dr.  M.  M.  Nielson  rounded 
out  the  evening,  which  came  to  an  enthusiastic  close 
about  nine  o’clock. 

The  Salt  Lake  County  Medical  Society  desires  to 
express  its  sincere  appreciation  of  the  feeling  of  good 
fellowship  and  cooperation  which  lies  back  of  this 
very  pleasant  occasion.  Similar  functions  have  oc- 
curred in  the  past,  and  have  contributed  much  to  the 
spirit  of  good  fellowship  between  the  two  professional 
groups. 

* * * 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society  was  held  at  the  Salt  Lake  County  Hospital 
on  Monday,  February  10. 

The  meeting  was  called  to  order  at  8:10  p.  m.  by 
President  M.  M.  Nielson.  Thirty-two  members  and 
fourteen  visitors  were  present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted  without  correction. 

The  clinical  program  was  then  turned  over  to  Clark 
Young.  The  following  papers  were  presented: 

Arthroplasty  of  Knee- — Interesting  Fractures,  R.  J. 
Alexander;  Differential  Diagnosis  of  Heart  Murmurs, 
Ralph  Tandowsky;  Spinal  Fusion  (Hibbs’)  Operation 
for  Pott’s  Disease,  L.  C.  Snow;  Gastric  Carcinoma, 
Richard  Baylor;  Rhinorrhea — Spinal  Fluid,  W.  H. 
Rothwell;  Clinical  Report  of  Forty-Five  Cases  of 
Spinal  Anesthesia,  R.  D.  Smith  (by  invitation) ; Con- 
servative Treatment  of  Abortion,  Ray  T.  Woolsey; 
Duodenal  Ulcer,  Frank  H.  Low  (by  invitation); 
Musculospiral  Paralysis — Unknown  Origin,  R.  O. 
Johnson. 

* * * 

The  following  report  of  the  Necrology  Committee 
was  made : 

In  Memorium — E.  G.  Gowans 

Whereas,  Our  comrade,  Dr.  E.  G.  Gowans,  who 
has  for  so  long  been  an  admired  and  respected  mem- 
ber of  our  profession,  our  society,  and  an  honored 
citizen  of  the  state,  has  been  taken  from  us  by  the 
summons  of  a Power  greater  than  ours;  and 

Whereas,  We  feel  his  loss  and  a deep  sympathy  for 
the  loss  of  those  who  loved  him  in  a more  intimate 
way;  therefore  be  it 

Resolved:  That  the  Salt  Lake  Medical  Society  offi- 
cially recognize  the  death  of  Doctor  Gowans  by 
spreading  a copy  of  this  resolution  upon  the  minutes 
of  the  society  as  a permanent  record,  and  by  forward- 
ing a copy  of  the  same  to  the  family  of  the  deceased 
as  an  attest  of  that  regret  which  is  ours  as  well  as 
theirs. 

J.  Z.  Brown  moved  that  the  report  of  the  Necrology 
Committee  be  accepted  and  filed.  Motion  seconded 
and  carried. 

* * * 

A report  of  the  committee  regarding  a communica- 
tion from  the  Salt  Lake  General  Hospital  asking  for 
the  sentiment  of  this  society  in  respect  to  professional 
cards  being  allowed  in  the  year-book  of  this  institu- 
tion was  made.  It  was  the  sense  of  the  committee 


that  names  of  the  doctors  who  would  contribute  to 
the  magazine  fund  be  printed  in  one  page  of  the  ad- 
vertising section  of  that  magazine.  J.  P.  Kerby 
moved  that  the  report  be  accepted.  Seconded  and 
carried. 

The  report  of  the  board  of  censors  on  the  applica- 
tion of  J.  M.  Schaffer  was  to  the  effect  that  the  appli- 
cant be  notified  to  apply  to  the  nearest  component 
society  of  the  Utah  State  Medical  Association. 

The  applications  of  Maurice  Gordon  and  J.  R. 
Wherritt  were  read  and  given  to  the  board  of  censors 
for  investigation. 

The  applications  of  Mildred  Nelson  and  Orin  Ogil- 
vie  were  favorably  reported  upon  by  the  board  of 
censors,  and  both  were  unanimously  elected  members 
of  the  society. 

F.  M.  McHugh  took  the  chair  and  announced  that 
on  February  24  there  would  be  a dinner  meeting  at 
the  Newhouse  Hotel  at  7 p.  m. 

The  meeting  was  adjourned  at  10  p.  m. 

Barnet  E.  Bonar,  Secretary. 

OBITUARY 
Ephraim  G.  Gowans 
1868-1930 

Dr.  Ephraim  G.  Gowans  had  for  many  years  been 
prominently  known  as  an  educator,  jurist,  and  phy- 
sician. He  was  born  in  Tooele,  Utah,  February  1,  1868, 
the  son  of  Hugh  S.,  and  Betsy  Gowans,  who  came 
to  Utah  from  Scotland  in  1855.  He  received  his  early 
education  in  the  county  schools  and  later  studied  at 
the  Brigham  Young  Normal  School  in  Provo,  gradu- 
ating in  1891.  Doctor  Gowans  married  Mary  Lyman 
shortly  afterward  and  then  took  a bachelor  of  science 
degree  from  Brigham  Young  College  at  Logan.  He 
graduated  in  medicine  from  the  Baltimore  Medical 
College  and  later  took  a postgraduate  course  at  Johns 
Hopkins.  For  a time  he  practiced  his  profession  in 
Springville,  but  later  removed  to  Salt  Lake.  In  1907 
Doctor  Gowans  was  appointed  judge  of  the  Juvenile 
Court,  holding  the  post  until  1909.  In  1909  he  was 
appointed  superintendent  of  the  State  Industrial 
School  in  which  office  he  continued  until  1915.  At 
the  close  of  his  term  as  industrial  school  superin- 
tendent he  served  four  years  as  superintendent  of 
public  instruction  and  then  for  two  years  as  director 
of  health,  retiring  from  the  latter  position  in  1921. 

As  an  educator  he  was  at  different  times  instructor 
at  Brigham  Young  College,  Brigham  Young  Univer- 
sity, and  the  University  of  Utah  from  which  latter 
position  ill  health  compelled  his  retirement  in  1929. 
He  was  a former  member  of  the  Bonneville  and  Ex- 
change Clubs,  the  Deseret  Sunday  school  general 
board,  and  the  Ensign  Club.  Doctor  Gowans  died 
Wednesday,  February  5,  1930.  He  is  survived  by.  his 
widow,  a son,  three  daughters,  a sister,  and  three 
brothers. 


Eulogy  of  the  Doctor. — There  are  men  and  classes 
of  men  that  stand  above  the  common  herd — the  sol- 
dier, the  sailor,  the  shepherd  not  infrequently,  the 
artist  rarely,  rarer  still  the  clergyman,  the  physician 
almost  as  a rule.  He  is  the  flower  of  our  civilization 
and  when  that  stage  of  man  is  done  with,  only  to  be 
marveled  at  in  history,  he  will  be  thought  to  have 
shared  but  little  in  the  defects  of  the  period  and  to 
have  most  notably  exhibited  the  virtues  of  the  race. 
Generosity  he  has,  such  as  is  possible  only  to  those 
who  practice  an  art  and  never  to  those  who  drive  a 
trade:  discretion,  tested  by  a hundred  secrets;  tact, 
tried  in  a thousand  embarrassments;  and  what  are 
more  important,  Herculean  cheerfulness  and  courage. 
So  it  is  that  he  brings  air  and  cheer  into  the  sickroom 
and  often  enough,  though  not  so  often  as  he  desires, 
brings  healing. — Robert  Louis  Stevenson. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  department  are 
grouped:  News;  Medical  Economics;  Correspondence;  Department  of  Public  Health;  California  Board  of  Medical 
Examiners;  and  Twenty-Five  Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 

NEWS 


California  Tuberculosis  Association  Meeting. — -The 
annual  meeting  of  the  California  Tuberculosis  Asso- 
ciation will  be  held  in  Merced  on  April  7 and  8,  with 
headquarters  at  the  Tioga  Hotel.  Those  interested 
are  cordially  invited  to  attend. 

The  regular  annual  business  meeting  will  be  held 
on  April  7,  and  on  the  evening  of  that  day  there  will 
be  a dinner  at  the  hotel,  followed  by  an  address  by 
Dr.  J.  W.  Mountin  of  the  United  States  Public  Health 
Service  on  “Tendencies  in  Public  Health  Organiza- 
tion and  Their  Relation  to  the  Tuberculosis  Program.’’ 

On  Tuesday,  April  8,  the  clinical  section  will  meet 
both  morning  and  afternoon.  The  program  is  as 
follows: 

Adorning — Dr.  F.  M.  Pottenger,  chairman: 

Report  of  heart  work. 

Parenchymatous  Lesions  in  Childhood — Dr.  Chesley 
Bush. 

Demonstration  of  interesting  x-ray  films. 

Afternoon — Dr.  William  C.  Voorsanger,  chairman: 

Blood  Sedimentation  Tests  in  Tuberculosis — Dr. 
Robert  A.  Peers. 

Healing  in  Tuberculosis — Dr.  Philip  H.  Pierson  and 
Dr.  W.  R.  P.  Clark. 

The  Results  of  Chest  Surgery — A round-table  dis- 
cussion of  statistics  conducted  by  Dr.  Leo  Eloesser. 

Attention  is  directed  to  the  final  items  on  the  pro- 
gram of  both  morning  and  afternoon.  It  is  hoped  that 
all  those  who  possess  unusually  interesting  x-ray  films 
illustrating  phases  of  chest  pathology  will  bring  these 
films  for  demonstration.  In  this  manner  many  un- 
usual conditions  will  be  brought  before  the  meeting. 

The  discussion  of  the  results  of  chest  surgery,  to 
be  led  by  Doctor  Eloesser,  will  be  open  to  all  those 
having  available  statistics.  It  is  felt  that  the  time  has 
passed  when  the  report  of  a few  cases  of  thoraco- 
plasty, phrenicotomy  and  the  like  is  interesting,  but 
a composite  picture  of  the  experience  of  many  men 
along  this  line  should  be  of  the  utmost  value. 

Reservations  should  be  made  as  soon  as  possible  at 
the  Tioga  Hotel,  Alerced,  and  should  include  dinner 
reservations  for  the  evening  of  April  7. 


The  Pacific  Coast  Surgical  Association  held  its  first 
annual  meeting  last  Friday  and  Saturday,  February  7 
and  8 at  Del  Monte. 

The  officers  elected  for  the  ensuing  year  are:  J.  Tate 
Alason  of  Seattle,  Washington,  president;  Rexwald 
Brown  of  Santa  Barbara,  first  vice-president;  E.  W. 
Rockey  of  Portland,  Oregon,  second  vice-president; 
E.  L.  Gilcreest  of  San  Francisco,  secretary-treasurer. 

The  council  consists  of  the  following:  Thomas  O. 
Burger  of  San  Diego,  Philip  K.  Gilman  of  San  Fran- 
cisco, A.  Aldridge  Matthews  of  Spokane,  Washing- 
ton; George  W.  Swift  of  Seattle,  Washington. 

The  association  will  meet  next  year  in  Victoria  the 
last  week-end  in  February.  Clinics  will  be  held  in 
Seattle  the  two  previous  days  of  the  meeting. 


Northern  California  Neuropsychiatric  Society. — On 

December  9,  1929,  the  Northern  California  Neuro- 
psychiatric Society  was  formed.  At  a preliminary 

208 


meeting  held  at  the  University  of  California  Hospital 
on  the  above  date,  the  following  officers  of  the  newly 
formed  society  were  elected:  Dr.  Julian  Wolfsohn, 
president;  Dr.  Edward  Twitchell,  vice-president;  and 
Dr.  Mark  Gerstle,  Jr.,  secretary-treasurer.  It  was 
agreed  that  meetings  should  be  held  on  the  second 
Alonday  evening  of  alternate  months  at  either  Stan- 
ford, University  of  California,  or  the  San  Francisco 
hospitals. 

The  membership  of  the  society  comprises  the  neuro- 
psychiatric staffs  of  both  the  University  of  California 
and  Stanford  medical  schools  as  well  as  neuropsychi- 
atrists in  the  San  Francisco  region  and  other  cities 
in  the  northern  portion  of  the  state.  Twenty-four 
members  have  joined. 

The  second  meeting  of  the  society  was  held  on 
February  10  at  Lane  Hall  at  which  meeting  a paper 
was  read  by  Dr.  F.  L.  Reichert  on  some  experimental 
work  which  he  has  done  on  hypophysectomized 
puppies. 

The  second  paper  was  by  Dr.  Helen  Detrick  (by 
invitation),  and  with  the  third  paper  by  Doctor  Proe- 
scher  (by  invitation)  constituted  a symposium  on 
recent  advances  in  the  treatment  of  epilepsy. 


Medical  Library  for  University  of  Southern  Cali- 
fornia.— Gift  of  the  professional  library  of  the  late 
Dr.  C.  F,  S.  Tate  to  the  School  of  Medicine  of  the 
University  of  Southern  California  and  the  recent  ac- 
quisition of  the  large  book  collection  of  Dr.  Charles 
W.  Bryson  have  made  possible  the  establishment  of 
a separate  medical  library  by  the  university  medical 
school.  According  to  an  announcement  by  Dean 
William  D.  Cutter,  the  library  will  be  housed  for  the 
present  in  two  rooms  in  the  basement  of  Bridge  Hall, 
which  are  now  being  outfitted.  The  appointment  of 
Aliss  Marguerite  Campbell,  formerly  librarian  of  the 
Peking  Union  Medical  School,  Peking,  China,  and 
of  the  Boston  Medical  Library,  as  custodian  was  also 
announced. 

The  library  will  be  opened  for  use  in  a few  weeks, 
with  between  four  and  five  thousand  volumes  avail- 
able for  reference. 

Doctor  Tate  whose  name  will  be  associated  with 
the  founding  of  this  new  library  was  a graduate  of 
the  University  of  Southern  California  in  1895.  He  was 
a descendant  of  the  Fee  and  Tate  families  of  South 
Carolina,  was  born  in  Oakdale,  Illinois,  August  1, 
1873,  and  moving  to  California  in  1882,  was  educated 
in  the  schools  of  Santa  Ana  and  Los  Angeles.  His 
medical  training  was  received  at  the  University  of 
Southern  California  and  the  University  of  Pennsyl- 
vania, and  his  practice  was  carried  on  entirely  in  Los 
Angeles. 


California  Conference  of  Social  Work. — The  twenty- 

second  annual  meeting  of  the  California  Conference 
of  Social  Work  will  be  held  at  Santa  Barbara  this 
year,  from  Alay  13  to  17.  A cordial  invitation  to  at- 
tend the  conference  and  affiliated  kindred  groups  is 
extended  to  members  of  social  and  health  agencies 
throughout  California,  and  to  all  persons  interested 
in  problems  of  social  welfare. 

Under  the  leadership  of  Justin  Miller,  dean  of  the 
law  school  of  the  University  of  Southern  California, 


March,  1930 


MISCELLANY 


209 


elected  president  of  the  conference  for  1930,  and  Erie 
Fisk  Young,  Ph.  D.,  chairman  of  the  Program  Com- 
mittee, plans  for  the  Santa  Barbara  meeting  are  well 
under  way.  “Social  Progress  and  the  Law”  has  been 
selected  as  the  conference  theme,  but  the  program 
will  range  over  the  whole  field  of  interests  covered 
by  the  standing  sections  on  health,  family  and  child 
welfare,  delinquency,  organization  and  administration, 
education,  recreation,  industry,  and  racial  and  citizen- 
ship problems. 

Recreation  Center  will  be  headquarters — an  ideally 
central  location  with  meeting  places  and  hotels  in 
close  proximity. 

Advance  information  regarding  conference  plans 
will  appear  in  the  February  issue  of  the  conference 
quarterly  bulletin,  or  may  be  obtained  from  the  execu- 
tive secretary.  Miss  Anita  Eldridge,  Exposition  Audi- 
torium, San  Francisco. 


Medical  Summer  Courses,  University  of  California. 

The  University  of  California  Medical  School  will  offer 
summer  courses  for  graduates  in  medicine  from  June 
2 to  21,  1930. 

The  first  week  will  be  devoted  to  a review  of  recent 
advances  in  fundamental  sciences  and  in  clinical  medi- 
cine and  surgery. 

During  the  second  and  third  weeks,  courses  of  two 
weeks’  duration,  similar  to  those  of  the  past  five  years, 
will  be  offered  in  general  medicine,  surgery,  the  spe- 
cialties, and  laboratory  subjects. 


CORRESPONDENCE 


President’s  Letter  to  the  Members 

To  the  Members: 

The  present  unfortunate  confusion  regarding  the 
Coffey-Humber  cancer  treatment  appears  to  call  for 
some  statement  in  California  and  Western  Medicine. 
The  following  is  a personal  statement  made  in  an 
effort  to  clarify  this  subject: 

There  is  grave  danger  that  contemplation  of  the 
glorious  results  of  a true  cancer  cure  may  so  stimu- 
late the  imagination  of  some  of  us  that  the  necessity 
for  sober  proof  will  be  overlooked. 

Doctors  Coffey  and  Humber  have  at  no  time 
claimed  that  their  treatment  is  a cure.  They  have  at 
all  times  in  their  statements  indicated  that  much  and 
prolonged  critical  research  must  intervene  before  a 
positive  statement  can  be  made. 

The  press,  on  the  other  hand,  has,  while  generally 
quoting  the  authors  of  the  treatment  fairly,  so  magni- 
fied certain  phases,  and  permitted  its  own  obvious 
enthusiasm  to  dominate  the  stories,  that  the  un- 
scientific public  has  quite  generally  accepted  the  treat- 
ment as  a cure. 

The  result  of  such  publicity  is  most  regrettable. 
The  judgment  of  the  value  of  the  treatment  has  been 
removed  entirely  from  scientific  environment  and 
vested  in  the  public,  which  can  have  no  scientific 
basis  for  opinion.  A painful  result  of  publicity,  and 
one  regretted  by  Doctors  Coffey  and  Humber,  is  that 
many  cancer  sufferers  who  cannot  avail  themselves  of 
the  treatment  will,  in  hope,  delay  timely  operations. 

Another  result  is  the  insurmountable  impediment  to 
scientific  work,  which  the  vast  amount  of  unsolicited 
material  constitutes. 

The  present  status  of  the  treatment,  according  to 
its  authors,  is  that  in  certain  cases  its  exhibition 
softens  tumor  masses  and  reduces  pain.  In  a very  few 
cases,  there  has  been  an  apparent  cure.  Sufficient  time 
has  not  elapsed  to  announce  a cure  in  any  case.  Too 
few  cases  have  been  followed  through  to  justify 
opinion. 

Doctors  Coffey  and  Humber  do  not  claim  a cure. 
They  have  confidence  that  their  treatment  has  great 
promise,  and  they  wish  time  for  research. 


No  final  scientific  opinion  can  be  formed  short  of 
some  few  years  from  this  date.  Preliminary  opinions 
can  be  of  no  immediate  value.  Unfavorable  opinions 
must  be  unscientific  unless  based  on  evidence  of  value 
comparable  to  that  required  to  demonstrate  success. 
It  is  devoutly  hoped  that  California  and  Western 
Medicine  may  at  some  time  be  permitted  to  publish 
fulfillment  of  all  hopes  for  the  Coffey  and  Humber 
treatment. 

Meanwhile  let  us  avoid  judgment,  whether  favor- 
able or  unfavorable. 

Morton  R.  Gibbons, 
President,  California  Medical  Association. 


Subject  of  Following  Letter:  Postponement 
of  Presentation  of  Paper  by  Doctors 
Coffey  and  Humber 

To  the  Editors: 

Because  of  the  fact  that  it  has  been  announced  that 
we  are  to  present  a paper,  “A  Preliminary  Report  of 
a Potent  Extract  from  the  Cortical  Substance  of  the 
Suprarenal,”  before  the  San  Francisco  County  Medi- 
cal Society  on  March  11,  1930,  we  are  sending  you  a 
copy  of  a letter  sent  by  us  to  the  president  of  that 
society.  The  letter  is  as  follows: 

February  27,  1930. 

Dr.  Harold  K.  Faber, 

President,  San  Francisco  County  Medical  Society, 

San  Francisco,  California. 

Dear  Doctor  Faber: 

Knowing  that  the  San  Francisco  County  Medical  So- 
ciety is  desirous  of  having  a complete  report  of  the  work 
on  the  extract  of  the  cortical  substance  of  the  supra- 
renals,  and  that  a committee  from  the  society  can  aid 
materially  in  determining  the  results  obtained  in  the 
series  of  cases  now  being  studied,  we  would  be  very  glad 
to  have  such  a committee  appointed  by  you  from  among 
the  members  of  the  San  Francisco  County  Medical  Society. 

We  would  also  welcome  the  postponement  of  our  ap- 
pearance before  the  society  from  March  11,  1930,  until  the 
general  meeting  in  April,  or  at  such  later  time  as  the 
above  committee  is  ready  to  report  its  findings  also. 

Very  truly  yours, 

W.  B.  COFFEY, 

JOHN  D.  HUMBER. 

The  meeting  has  been  postponed  to  some  date  to 
be  announced  later  and,  in  order  that  members  may 
have  a basis  for  discussion  when  the  material  is  pre- 
sented, we  are  setting  out  in  this  letter  the  premises 
which  we  believe  to  be  true  and  upon  which  we  have 
based  our  investigations  and  in  support  of  which  we 
believe  we  can  produce  experimental  evidence.  The 
premises  are: 

1.  Nature  has  provided  certain  controls  or  “gov- 
ernors” in  our  physiological  make-up,  among  which 
is  a control  or  stabilizer  of  tissue  growth. 

2.  This  control  or  stabilizer  of  the  development 
and  multiplication  of  tissue  cells  is  of  the  nature  of 
an  active  principle  or  hormone. 

3.  This  hormone  is  produced  by  certain  cellular 
elements  of  the  body  which  are  found  to  exist  in  con- 
siderable amounts  in  the  cortex  of  the  suprarenal 
glands. 

4.  This  hormone  or  active  principle  may  be  pro- 
duced in  other  parts  of  the  body  yet  to  be  determined. 
We  have  found  that  extracts  made  from  other  tissues 
have  what  we  think  is  probably  an  inhibitory  effect 
on  cellular  growth  where  normal  cellular  growth  has 
been  disturbed. 

5.  This  hormone  or  active  principle  is  found  in  a 
highly  potent  form  with  unmistakable  effect  upon 
malignant  cellular  growTth  in  extracts  made  from  por- 
tions of  the  cortex  of  the  suprarenal  glands. 

6.  This  extract  containing  the  active  principles  has 
a destructive  effect  upon  malignant  tissue,  causing  its 
necrosis  and  death,  without  destruction  of  normal 
tissues. 

Very  truly  yours, 

W.  B.  Coffey 
John  D.  Humber. 


210 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


Subject  of  Following  Letter:  Coffey-Humber 
Studies  Concerning  Cancer 

Editors’  Note:  Doctors  Walter  B.  Coffey  and  John 
D.  Humber  of  San  Francisco  on  January  6 last,  pre- 
sented to  the  San  Francisco  County  Pathological  So- 
ciety a preliminary  report  concerning  some  cancer 
studies.  Reference  is  made  thereto  in  an  editorial  in 
this  issue  of  California  and  Western  Medicine.  For 
the  convenience  of  readers  of  this  journal  who  are 
interested  in  this  subject,  the  letter  printed  below, 
which  was  sent  upon  request  to  The  Journal  of  the 
American  Medical  Association  and  which  appeared  in 
the  February  1 issue  of  that  publication,  is  here  re- 
printed. It  is  hoped  to  have  a full  report  of  the  studies 
of  Doctors  Coffey  and  Humber  in  a later  issue  of 
California  and  Western  Medicine. 

The  letter  was  printed  under  the  caption: 

The  Effect  of  a Suprarenal  Extract  for  Malignant 
Growth. — To  the  Editor:  In  a report  made  to  the 
San  Francisco  County  Pathological  Society,  Janu- 
ary 6,  we  pointed  out  that  our  experimental  work  on 
endocrine  extracts  began  in  1925,  attempting  to  find  a 
vasodilator  and  a stabilizer  of  tissue  growth.  After 
many  failures,  an  extract  of  suprarenal  cortex  from 
sheep  was  made  which  reduced  blood  pressure  when 
injected  subcutaneously.  Further  development  of  the 
work  demonstrated  that  this  extract  was  a stabilizer 
of  growih.  A few  patients  with  high  blood  pressure 
together  with  a malignant  condition  had,  under  treat- 
ment, a lowering  of  blood  pressure  from  240  to  150, 
together  with  a sloughing  of  the  malignant  tissue  and 
subsequently  disappearance  of  the  growth.  Later,  we 
injected  the  extract  only  in  patients  in  whom  the 
malignant  growth  was  inoperable,  with  the  possibility 
of  obtaining  autopsies.  One  patient,  who  had  an  em- 
bryonal carcinoma  of  the  testes  which  could  not  be 
completely  removed,  was  given  the  first  injection, 
August  22,  1927,  and  is  now  without  any  evidences 
of  tumors.  Another  patient  with  inoperable  carcinoma 
of  the  rectum  and  complete  obstruction  was  referred 
for  colostomy,  and  was  given  a first  injection  Sep- 
tember 1,  1929.  At  present  this  patient  is  without 
any  evidence  of  tumor  and  so  far  has  had  no  ill  effects 
from  the  injections  and  has  apparently  recovered. 
Within  from  twenty-four  to  forty-eight  hours  after 
the  first  dose,  the  tumor  masses  begin  to  soften,  then 
liquefy,  and  within  ten  days  begin  to  slough.  If  the 
masses  are  favorably  located,  many  have  even  begun 
to  slough  within  forty-eight  hours.  Although  our 
series  to  date  is  small,  we  have  had  an  opportunity  to 
study  the  changes  in  the  tissues  of  patients  who  died. 
(Others  we  observed  clinically  and  were  successful  in 
obtaining  autopsy.) 

All  tissues  were  studied  by  Dr.  A.  M.  Moody.  The 
essential  changes  are  necrosis  of  tumor  cells  which 
cannot  at  present  be  differentiated  from  that  occur- 
ring naturally  in  malignant  tumors.  They  were  pres- 
ent in  one  patient  with  primary  carcinoma  of  the 
kidney;  in  the  tissues  of  the  lungs,  about  the  secon- 
dary tumor  nodules,  which  were  all  necrotic,  marked 
vascularization  surrounded  each  nodule.  One  patient 
who  had  received  injections  for  two  and  a half  months 
prior  to  death,  and  who  died  from  kidney  insufficiency 
as  a result  of  bilateral  ureteral  obstruction,  had  atro- 
phic suprarenals,  measuring  only  three  millimeters 
in  thickness.  This  was  a primary  carcinoma  of  the 
cervix  which,  during  the  course  of  injections,  had 
sloughed  away.  No  secondary  growths  beyond  the 
uterus  and  bladder  were  found,  although  microscopic 
scattered  mitosing  cells  were  present  in  the  bladder 
wall. 

This  work  to  date  has  been  purely  of  an  experi- 
mental nature  to  determine  the  effect  on  malignant 
tumors.  Softening,  with  liquefaction,  has  occurred  in 
all  tumors  thus  far  studied.  These  tumors,  except  one, 
were  carcinoma  of  different  types;  the  exception  is  a 
recurrent  spindle  cell  sarcoma,  with  extensive  metas- 
tases.  Because  of  these  results,  a broad  plan  of 
study  has  been  outlined  with  a determination  to  dis- 
cover as  soon  as  possible  the  value,  if  any,  of  this 


extract  in  cancer.  Until  such  time  as  additional  data 
become  available,  we  wish  to  impress  on  the  medical 
profession  the  fact  that  the  work  to  date,  although 
quite  promising,  is  still  in  the  experimental  stage 
and  therefore  decidedly  inconclusive.  The  pathologic 
studies  have  been  made  by  Dr.  A.  M.  Moody,  patholo- 
gist of  the  St.  Francis  Hospital. 


February  1,  1930. 


Walter  B.  Coffey,  M.  D., 
John  D.  Humber,  M.  D., 

San  Francisco. 


DESCARTES  WAS  RIGHT* 

By  Harry  M.  Hall,  M.  D. 

IV heeling,  IV.  Va. 

PART  II 

Notwithstanding  deflections  from  the  ranks  of  those 
who  hold  to  the  old  ethics,  there  are  still  many  left. 
It  represents  something  akin  to  the  silent  vote  in 
politics.  This  great  body  of  medical  men  is  held  to- 
gether with  a rather  indescribable,  invisible  tie  that, 
for  want  of  a better  term,  I shall  refer  to  as  a “gentle- 
man’s agreement.”  It  still  is  very  -much  in  existence 
and  will  probably  be  the  saving  grace  of  the  pro- 
fession in  the  time  of  extreme  stress  and  trouble. 
This  rather  remarkable  yet  intangible  force  acts  auto- 
matically, so  to  speak,  in  the  last  analysis,  to  defend 
the  members  of  the  medical  profession  against  dan- 
gers from  without.  Some  day  or  other,  rather  soon 
I think,  this  element  rather  reluctant  to  engage  itself 
in  conflict  will  descend  in  full  force  on  our  notorious 
detractors  and  suggest  they  forget  the  high  cost  of 
medical  care  until  they  mitigate  some  of  the  preced- 
ing causes  that  lead  up  to  it.  Let  some  of  them  make 
instruments  cheaper,  x-ray  outfits  less  expensive,  and 
other  paraphernalia  within  the  bounds  of  moderation. 
We  must  teach  the  laity  it  is  a dangerous  occupa- 
tion to  heckle  and  disturb  the  medical  profession  and 
that  it  is  a tragic  thing  to  clip  our  wings.  Surely  we 
must  have  had  an  efficient  and  wonderfully  capable 
line  of  medical  men  in  the  past  to  bring  so  complex, 
baffling  and  obscure  a thing  as  disease  up  to  where 
it  is  today.  Considering  the  tremendous  amount  of 
work  required  to  establish  every  shred  of  information 
about  illness  and  disease  and  make  it  conform  to  the 
major  pattern  of  modern  medicine,  the  medical  men 
of  the  past  must  have  been  marvelously  endowed. 
The  future  should  be  measured  by  the  past.  To  make 
us  into  a mechanized  group  of  robots  would  be  dis- 
astrous. People  may  be  standardized  when  well,  they 
are  all  individualists  when  ill.  A machine  cannot 
attend  them. 

IMPORTANCE  OF  LEADERSHIP  AND  LOYALTY 

The  time  has  come  for  the  medical  profession  to 
pick  their  leaders  with  great  care.  This  will  involve 
the  rejection  of  great  names  as  executive  officers. 
Perhaps  a way  around  it  would  be  to  create  two  presi- 
dents, one  the  chairman  of  a board,  the  other  the 
regular  president.  One  or  the  other  could  be  made 
honorary.  The  head  of  a large  medical  organization 
should  be  a militant  and  aggressive  leader,  partaking 
of  the  qualities  of  a Roosevelt  or  a Mussolini  with- 
out their  despotic,  autocratic  qualities,  although  to  an 
extent  he  should  have  a little  of  these.  Great  sur- 
geons and  internists,  including  the  specialists,  are  not 
necessarily  men  of  such  stamp.  In  fact,  they  are  often 
the  very  opposite.  Usually  they  have  a distaste  for 
conflict,  are  given  to  conservatism  and  can  be  found 
clinging  to  the  thought  that  to  yield  is  better  and 
more  peaceful.  Having  acquired  wealth,  fame  and 
almost  everything  else,  they  find  the  world  smiling 
and  agreeable.  It  is  next  to  impossible  to  ask  them 
to  recall  their  earlier  days  of  privation.  It  is  difficult 
for  them  to  sense  the  problems  of  the  modern  rank 
and  file.  They  are  old  warriors  whose  eyes  have 
grown  dim  to  the  peculiar  insults  of  the  hour.  They 
cannot  sense  the  struggles  of  the  minor  men  of  the 

* Part  I of  this  paper  was  printed  in  the  February  issue. 


March,  1930 


MISCELLANY 


211 


profession.  Contract  practice  and  state  medicine  do 
not  seem  to  them  as  anything  but  passing  fictions  of 
the  day.  Great  industrialists,  often  among  their  pa- 
tients, are  good  fellows  and  cannot  have  any  designs 
on  medicine.  They  move  in  an  atmosphere  of  pleas- 
ant relations,  quiet  regularity  and  very  little  competi- 
tion. Other  medical  men  refer  work  to  them;  they 
are  called  on  to  address  great  assemblages;  their 
words  are  considered  the  last  thing  in  wisdom;  men 
surrounding  them  look  up  to  them;  they  travel,  have 
their  social  conquests;  statesmen,  ambassadors,  the 
great  and  near  great  consult  them;  life  is  surely  very 
pleasant.  It  would  be  next  to  impossible  to  have  them 
believe  that  out  in  the  open  doctors  are  being  de- 
prived of  work,  forced  to  accept  reduced  wages,  are 
barely  making  a competence,  are  being  crowded  into 
narrower  spheres,  are  ridiculed  in  the  press  and  maga- 
zines, beset  by  trivial  malpractice  suits,  having  a 
struggle  to  preserve  their  traditions  and  wondering 
whither  they  drift.  The  problems  of  the  young  man 
just  entering  medicine  stand  no  more  chance  of  being 
really  understood  in  their  stark  and  naked  truth  by 
these  great  men  than  did  the  fortunes  of  that  other 
young  man  seem  to  have  any  advantage  over  the 
camels  passing  through  the  needle’s  eye.  For  us  to 
venerate;  for  us  to  regard  as  still  great  teachers 
through  experience;  for  us  to  love;  for  us  to  picture 
as  making  us  scientifically  what  we  are,  they  are  still 
the  old  idols.  But  as  to  making  them  active  presi- 
dents, executives,  officers  or  directors,  we  believe  that 
is  neither  wise  nor  practical.  We  have  some  of  them 
now  bursting  into  print  with  strictures  on  us  which 
are  at  times  more  embarrassing  than  the  laymen  give 
out.  Carrying  enormous  weight,  the  public  counts  on 
their  statements  as  actually  the  gospel  truth,  whereas 
they  are  really  only  opinions  of  single  men. 

Great  names  in  medicine  often  perform,  heedlessly, 
great  and  small  infractions  of  the  principles  of  ethics 
which  we  are  quite  sure  appear  trivial  to  them,  and 
so  set  a bad  example  to  lesser  men.  St.  Paul  prob- 
ably made  this  clear  in  his  dissertation  on  not  eating 
what  may  be  poison  for  the  other  fellow.  When 
great  medical  men  are  solicited  to  testify  to  the  great 
health  qualities  of  a cake  of  yeast  or  a baking  powder 
they  should  recall  this.  The  lesser  man  would  not 
be  led  to  do  a lot  he  does  if  he  did  not  look  on  at 
the  great  and  near  great  doing  it  before  he  does.  I 
believe  vanity  has  a lot  to  do  with  it.  A great  medical 
man  sometimes  reflects  on  history  and  the  dictum, 
“The  king  can  do  no  wrong,’’  and  he  forthwith  appro- 
priates the  idea.  This  establishes  a precedent  and 
down  the  line  it  goes  to  others  who  promptly  feel  if 
he  can  do  it  then  it  must  be  all  right.  If  enough  do 
it  that  particular  part  of  the  ethical  code  goes  the 
way  of  the  Eighteenth  Amendment.  Christ  was  led 
up  into  the  mountain  and  offered  the  whole  world  to 
succumb.  History  records  that  he  promptly  rejected 
the  offer. 

A house  divided  cannot  stand.  With  our  usual  lack 
of  foresight,  we  are  dividing.  The  College  of  Sur- 
geons, the  College  of  Physicians,  the  Southern  Medical 
Association,  the  interstate  Postgraduate  Assembly, 
and  numerous  other  bodies  give  ample  proof  of  this. 
Organized,  I believe,  for  scientific  purposes  alone, 
they  have  not  adhered  solely  to  this  idea.  As  an  ex- 
ample, the  American  College  of  Surgeons  exercises 
a control  over  hospitals.  This  implies  that  hospitals 
are  solely  surgical.  We  know  this  is  not  the  case. 
It  is  a function  that  the  American  Medical  Associa- 
tion alone  should  carry  out.  This  is  no  criticism  of 
the  College  of  Surgeons  as  being  officious.  It  may 
be  they  saw  the  need  of  it  first,  and  they  have  handled 
it  admirably.  Nevertheless,  it  is  not  their  duty.  I am 
quite  well  aware  that  the  argument  is  advanced  that 
not  all  of  the  medical  men  of  the  country  can  gather 
in  one  place  at  one  time;  that  specialists  cannot  expect 
the  American  Medical  Association  to  lend  too  much 
attention  to  their  wants  and  they,  therefore,  must 
have  their  own  societies;  and,  since  even  the  Ameri- 
can Medical  Association  publishes  separate  archives 
to  meet  their  requirements,  it  is  just  as  logical  to 
arrange  separate  meetings.  The  surgeons  say  they 


cannot  hope  to  discuss  all  their  problems  even  when 
by  themselves  for  the  better  part  of  a week.  The  in- 
ternists give  the  same  reason.  The  Southern  Medical 
Association  doubtless  has  its  reasons  while  the  Inter- 
state Postgraduate  Assembly  has  a feeling  it  is  fast 
becoming  the  largest  single  gathering  of  medical  men 
that  meets  at  one  time.  All  these  reasons  are  doubt- 
less correct,  and  the  profession  of  medicine  requires 
all  these  associations.  However,  they  are  getting  to 
have  an  uncomfortable  habit  of  flourishing  their 
power,  extolling  their  size  and  referring  to  their  ac- 
complishments outside  of  their  scientific  realms.  This 
is  quite  human  and  altogether  natural.  To  those  who 
are  responsible  for  the  brilliant  performances  of  these 
strong  and  notable  organizations,  nothing  but  praise 
is  perhaps  due,  and  I am  here  referring  to  these 
courses  solely  as  to  what  might  happen.  A great 
many  medical  men  who  fail  to  stop  and  consider  re- 
alities actually  gain  the  idea  that  these  associations 
are  somewhat  competitive  to  the  American  Medical 
Association  and  not  corollaries  thereto.  Capable  of 
but  a single  allegiance,  they  pour  out  all  their  loyalty 
in  one  direction.  It  is  impossible  for  them  to  brook 
any  suggestion  that  there  must  after  all  be  but  one 
big  single  organization  to  which  we  must  look  to 
settle  our  several  perplexities.  None  of  the  members 
of  these  organizations  can  see  any  harm  in  too  much 
division.  To  the  most,  they  are  stated  as  mere  side 
shows  to  the  main  tent.  1 rather  gather  that  this  is 
not  so.  It  occurs  to  me  that  a separation  into  so 
many  groups  is  dividing  our  forces — crystallizing  our 
ready  solubility  from  one  clear  and  potent  fluid.  We 
shall  dillydally  around  with  them  until  we  become 
like  a lot  of  Balkan  states  that  never  know  just  who 
is  governing  them  and  are  destitute  of  a cohesive 
army  and  innocent  of  a navy,  and  are  on  the  whole 
the  very  quintessence  of  impotency.  And  all  of  us 
should  carry  around  with  us  constantly  this  thought 
that  if  anything  ever  causes  the  fall  of  the  American 
Medical  Association  the  demise  of  all  of  the  others 
will  quickly  follow.  Probably  the  American  Medical 
Association  should  have  a banner  or  a flag  and  when- 
ever any  other  medical  organization  meets  it  should 
be  unfurled  across  the  stage  to  remind  the  audience 
that  united  we  stand;  divided  we  fall. 

INCREASING  COMPLEXITY  OF  MEDICINE 

The  increasing  complexity  of  medicine  is  the  last 
subject  with  which  we  shall  concern  ourselves.  It  is 
in  some  ways  the  most  important  one  of  all.  Ameri- 
can life  today  insists  on  pursuing  any  subject  until 
it  is  lost  in  its  ramifications.  The  law  makes  the 
simplest  case  a maze  of  technicalities.  An  involved 
one  runs  into  years  with  volumes  of  testimony.  Re- 
ligion, divided  into  many  sects,  has  become  such  a 
labyrinthal  matter  that  no  one  cares  to  approach  it 
for  simple  comfort.  Government,  especially  at  Wash- 
ington, has  come  near  to  defeating  itself  by  the  excess 
of  its  excursions.  A tariff  bill  is  an  affair  of  months, 
an  income  tax  blank  too  much  for  any  ordinary  man. 
Not  so  in  the  powerful  and  ever  increasing  industrial 
scene,  where  simplicity  is  the  outstanding  feature. 
Thousands  are  spent  to  reduce  the  parts  in  a machine. 
Consider  your  telephone.  Lose  yourself  in  wonder 
over  the  arc  light.  Grow  eloquent  over  your  micro- 
scope. 

Medicine  is  perhaps  the  most  complex  of  all  things. 
As  is  time  and  eternity,  so  is  medicine;  as  is  the 
geologist  and  his  rock,  so  is  medicine;  as  is  the  evolu- 
tionist and  his  story,  so  is  medicine.  It  embraces  all 
things,  considers  all  things,  encompasses  all  things. 
It  is  beyond  one  mind  to  fathom.  It  transcends  all 
efforts  to  visualize  it.  To  try  and  place  into  language 
the  confines  of  its  portentous  schemes,  its  boun- 
daries, its  limitations  are  quite  beyond  our  efforts. 
To  attempt  to  assemble  some  simple  words  that 
would  correlate  disease,  its  etiology,  diagnosis,  treat- 
ment and  termination  can  scarcely  be  done,  nor  could 
a dozen  men  each  taking  a division  contribute  greatly 
to  the  elucidation.  Medicine  is  a vast  enterprise,  a 
prodigious  science,  a very  involved  art.  As  a single 
physician  gazes  at  a single  patient  before  him,  some- 


212 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


thing  of  the  stupendous  phantasmagoria  of  medicine 
rushes  before  him.  It  can  be  well-nigh  appalling,  and 
it  is  well  that  disease  is  inclined  to  appear  in  a more 
simple  form  as  commonly  seen.  But  in  that  single 
patient  before  him,  what  dreams  may  come,  what 
possibilities  there  are  for  all  those  other  thousand 
maladies  to  bear  down.  No  wonder  the  individual 
doctor  lifts  his  eyes  to  “that  inverted  bowl”  for  coun- 
sel, to  find  it  not.  No  wonder  he  seeks  consultation. 
No  wonder  he  gathers  in  groups.  No  wonder  he  as- 
sembles clinics.  No  wonder  he  rushes  to  foundations. 
Rebecca  in  Ibsen’s  “Rosmersholm”  killed  Mrs.  Ros- 
mers  by  constantly  suggesting  to  her  the  nature  of 
her  defects  in  meeting  her  duties.  The  wife  jumped 
into  the  mill  race.  The  enormity  of  medicine  is  killing 
off  the  single  practitioner  in  the  same  manner. 

I believe  that  it  is  generally  conceded  that  one  can 
absorb  so  much  of  a subject,  -after  which  the  brain 
palls.  In  making  out  programs  for  medical  gatherings 
this  is  lost  sight  of  entirely.  So  we  have  the  spectacle 
of  almost  a week  of  addresses  from  eight  until  nine 
with  intermissions  for  meals.  Again  we  have  the 
circus  idea,  three  rings  and  look  at  what  you  like. 
Few  minds  can  retain  what  they  receive  in  such  a 
scientific  festival.  The  span  of  life  to  most  active 
men,  as  far  as  medicine  is  concerned,  is  doing  well 
if  it  is  forty  years.  As  one  stands  almost  like  a child 
on  the  shores  of  medical  life  and  gazes  on  the  mighty 
seas  of  medical  literature,  medical  knowledge  and 
medical  practice,  no  wonder  one  feels  like  a lone  atom 
or  a mere  pigmy,  a tiny  unit  in  the  cosmos.  With 
medical  societies  multiplying;  medical  meetings  in  the 
city,  state,  country,  and  even  abroad,  on  the  increase; 
medical  requirements  born  as  were  the  leading  char- 
acters in  “Pigs  Is  Pigs”;  rules,  penalties,  laws,  stand- 
dards,  codes,  tables,  statistics,  calories,  calculations, 
tests  of  function,  laboratory  schemes,  blood  chemis- 
try, biochemistry — is  it  any  wonder  one  human  mind, 
convoluted  as  it  is,  reacts  in  rebellion  at  the  tremen- 
dous load?  The  logical  result  of  all  this  is  to  give 
some  doctors  an  inferiority  complex.  Many  doctors 
die  of  cardiovascular  disease,  but  the  etiologic  factor 
in  the  form  of  incessant  worry  that  caused  their 
malady  was  none  other  than  the  sense  of  inadequacy 
they  gave  up  to,  after  realizing  the  utter  vastness  of 
their  calling.  Because  we  have  all  come  to  sense  the 
unlimited  confines  of  our  vocation,  many  medical  men 
are  unwilling  to  trust  to  their  individual  judgment 
any  more.  This  naturally  leads  to  many  consultations 
in  which  there  are  specialists  on  many  subjects.  To 
obviate  the  spread,  the  group  was  created.  The  group 
likewise  must  fall  back  on  men  from  greater  groups.' 
Naturally,  too,  this  contributes  to  the  high  cost  of 
medical  care.  However,  it  results  in  no  higher  fee 
to  the  original  physician.  It  is  very  evident  that  we 
can  have  too  much  discussion  of  a case,  carrying  it 
to  where  the  perplexity  is  greater  than  ever  and  the 
patient  may  die  in  the  process.  Doctor  Butt,  a West 
Virginian,  once  wrote  a paper  on  gastrotomy  in  rela- 
tion to  a young  man  who  had  eaten  frozen  apples  and 
cabbage  and  then  drank  water.  In  this,  he  remarked 
that  had  he  held  consultation  instead  of  making  up 
his  mind  individually  to  operate,  the  patient  would 
have  died.  In  numbers  there  is  safety  is  undoubtedly 
true,  but  it  has  its  limitations. 

So  medicine  will  have  to  be  simplified.  Its  litera- 
ture, its  nomenclature,  its  activities  will  have  to 
undergo  revision  sooner  or  later.  Physiologists  and 
pathologists  must  bear  a heavy  load  of  responsibility 
in  the  next  decade.  It  has  been  said  the  test  of  the 
medical  profession  in  the  future  will  be,  “Is  surgery 
still  existent  after  fifty  years?”  If  by  that  time  we 
have  not  found  the  means  to  kill  the  pyogenic  bac- 
teria— streptococcus  and  staphylococcus — as  well  as 
the  cause  and  the  elimination  of  cancer,  we  will  have 
suffered  a grievous  failure.  If  we  cannot  reduce  me- 
tabolism and  biochemistry  to  more  simple  terms,  then, 

I would  say,  something  is  radically  wrong  with  us. 

Hospitals  with  a thousand  beds,  medical  centers 
that  look  like  medieval  cities,  diagnostic  clinics  the 
size  of  hotels,  laboratories  that  resemble  railroad 


terminals  make  us  look  like  a vast  enterprise.  Some 
day  simplicity  will  come  like  a tornado  and  level 
them  all. 

CONCLUSION 

In  conclusion,  I feel  that  this  narrative  must  have 
sounded  its  share  of  discordant  notes  and  revealed  a 
melancholy  outlook.  I feel  as  I end  it,  like  the  ghost 
at  a feast.  To  arraign  even  lovingly  the  faults  and 
failings  of  the  profession  we  venerate  breathes  the 
air  of  ungratefulness.  There  is  something  unpleasant 
about  the  actor  that  plays  the  character  of  filmy  noth- 
ingness. The  part  calls  for  a stalking  grimness,  a 
seeming  lack  of  substance,  a cold  clamminess,  and 
always  one  must  be  pointing — always  pointing — at  the 
foibles  of  the  other  guests,  with  a sort  of  bony  finger 
from  a hand  that  none  can  grasp.  But  ghosts  have 
slain  their  Macbeths — although  not  directly.  To  have 
given  some  of  the  views  of  this  recital  has  cost  -me 
some  grief  and  sorrow,  and  not  a little  perturbation. 
Had  I not  had  affection  for  over  thirty  years  for  the 
medical  profession  and  am  ever  jealous  of  its  honor,  I 
could  never  have  tried  to  mirror  some  of  my  own  in- 
consistencies. We  must  always  to  our  own  selves  be 
true  and  be  courageous  enough  to  examine  ourselves, 
as  we  are  frank  about  confessing  our  errors  in  the 
performance  of  our  duties.  So  I believe  the  several 
things  I have  related  to  have  some  part  in  our  unrest. 
My  judgment  is  anything  but  infallible,  but  there  the 
matter  rests.  To  us,  the  man  to  be  feared  is  the  one 
who  says,  “Always  with  a smile”  and  that  all  our 
ills  will  eventually  right  themselves.  To  us,  he  is  an 
incubus. 

We  may  be  in  for  a period  of  partial  eclipse,  but 
be  that  as  it  may  we  can  always  count  on  enough 
hardy  souls  to  affect  a renaissance.  We  may  be  too 
deeply  involved  in  some  of  our  obsessions  to  extri- 
cate ourselves  at  once.  We  may  see  state  medicine, 
although  I strongly  doubt  it.  We  may  see  our  hospi- 
tals, our  work  and  our  followings  taken  from  us  and 
controlled  by  large  units.  I doubt  that,  too. 

Notwithstanding  the  character  of  what  has  gone 
before,  our  great  passion  is  that  the  medical  pro- 
fession, taking  it  by  and  large,  is  the  greatest  intelli- 
gent unit  in  civilization  today.  The  purport  of  this 
whole  paper  is  a deep  chagrin  at  our  not  being  the 
chief  controlling  factor  in  the  world’s  affairs.  It  ap- 
pears to  me  that  we  alone  seem  to  understand  the 
meaning  of  humanity.  In  modern  dramas  and  in 
present-day  literature  it  seems  to  me  that  it  is  the 
medical  man  when  he  appears  who  alone  has  a great 
compassion  and  understanding  for  all  the  other  char- 
acters. 

Picture  a world  if  you  can  where  all  the  doctors 
of  today,  ministering,  as  they  are  at  this  very  hour, 
were  suddenly  eliminated,  and  in  their  place  were 
machine-like  personages  that  sought  from  files  and 
indexes  the  precise  methods  of  approach,  with  per- 
sonality eliminated.  It  is  unthinkable.  When  the 
crucial  time  comes,  if  it  ever  does,  I feel  that  the  great 
medical  solidarity  will  be  found  with  capable  leader- 
ship in  the  perfected  organization  of  a greater  and 
more  unified  American  Medical  Association;  that  in- 
dustrial interference  will  come  and  go;  contract  prac- 
tice appear  and  disappear,  and  state  medicine  attain  a 
growth  only  to  sicken  like  a weed.  Medicine  is  too 
old  a custom  for  anything  to  long  stop  its  progress, 
arise  what  may,  for  nature  and  evolution,  progress 
and  civilization  have  embraced  medicine  as  a brother 
of  their  blood.  You  can  no  more  block  it  now  nor 
change  its  destiny  than  you  can  that  of  existence. 
Medicine  has  become  a very  member  of  the  integral 
body  of  life  itself.  The  martyrdom  of  all  the  great 
figures  of  its  past  has  seen  to  that.  Concentrate  on 
it  as  you  may  it  will  ultimately  appear  unscathed,  for 
there  is  something  indestructibly  valid  about  it.  Un- 
faithful as  some  few  of  its  followers  may  be  to  the 
meaning  of  its  finer  truths,  all  will  subscribe  to  its 
authenticity.  To  those  who  have  embraced  it,  some 
sense  of  immortality  surrounds  it.  Hardened  as  any 
doctor  may  become  to  its  altruistic  prophecies,  he 
never  seems  to  lose  a clinging  sense  of  its  subtle 
proofs  of  somewhere  having  a great  destiny.  What 


March,  1930 


MISCELLANY 


213 


else  can  so  subscribe?  I know  of  nothing.  So  on  this 
rock  we  found  our  hopes  and  yearnings.  Whatever 
happens,  back  we  will  come,  stronger,  more  vibrant, 
more  invincible,  more  powerful  than  ever,  led,  it  may 
be,  by  some  great  voice  from  among  us  filled  with 
the  intense  clairvoyancy  of  Descartes,  and  proving 
that  he  was  right  when  he  said: 

“If  ever  the  human  race  is  lifted  to  its  highest 
practicable  level  intellectually,  morally  and  physically, 
the  medical  profession  will  perform  that  service.” 

DISCUSSION  OF  PAPERS  OF  DOCTORS  HALL  AND  MCBRAYER 
(IN  PART  only) 

Dr.  George  H.  Kress,  Los  Angeles:  Doctor  Hall  has 
given  us  a very  keen  analysis  of  certain  conditions  which 
are  of  vital  importance  to  the  future  of  medical  practice 
in  America.  I wish  to  thank  him  for  this  splendid  analy- 
sis and  also  for  the  suggestions  of  future  action  which 
are  indicated  both  in  and  between  the  lines  of  his  paper. 

He  tells  us  of  conditions  as  he  has  observed  them  in 
the  industrial  State  of  West  Virginia.  His  picture  fits 
in  very  well  with  some  of  the  experiences  we  have  had  in 
California.  We  have  been  much  distressed  with  certain 
drifts  in  medical  practice  in  our  state,  and  the  officers 
of  the  California  Medical  Association  have  given  con- 
siderable study  to  ways  and  means  whereby  undesirable 
features  of  modern-day  medical  practice  might  be  over- 
come. 

One  of  our  officers,  Dr.  Walter  Coffey  of  San  Francisco, 
recently  brought  to  our  attention  a plan  that  seemed  to 
us  to  have  many  commendable  features. 

As  we  see  this  problem,  the  well-to-do  citizens  and 
very  poor  citizens  are  almost  always  assured  of  good 
medical  care.  The  rich  can  choose  whom  they  desire  for 
medical  advisers,  and  the  poor  receive  a very  high  grade 
of  medical  care  from  members  of  the  attending  staffs 
of  public  hospitals.  The  in-between  class  of  citizens,  the 
so-called  white-collar  brigade,  seem  to  be  the  greatest 
sufferers,  because  with  the  present  high  cost  of  living, 
with  all  its  modern-day  comforts  and  luxuries,  there  is 
usually  very  little  money  left  to  pay  hospital  expenses  or 
doctors’  fees.  If  a plan  could  be  put  into  operation  to 
give  proper  care  to  this  class  of  citizens,  much  of  the  cry 
about  the  high  cost  of  medical  care  would  not  be  heard. 

The  opening  editorial  of  the  November  issue  of  our  offi- 
cial journal,  California  and  Western  Medicine,  is  a state- 
ment which  I was  instructed  to  write  by  the  Council  of 
the  California  Medical  Association,  and  which  is  entitled 
“A  California  Plan  to  Combat  State  Medicine — Important 
Notice.” 

That  was  a somewhat  high-sounding  caption,  but  it  was 
used  to  call  the  attention  of  members  of  the  California 
Medical  Association  to  certain  drifts  in  medical  practice 
and  to  caution  individual  members  to  make  no  contracts, 
because  the  Association’s  officers  were  considering  ways 
and  means  of  safeguarding  the,  rights  of  all  members. 

In  the  plan  proposed  by  Doctor  Coffey,  who  is  the  chief 
surgeon  of  the  Southern  Pacific  Railroad,  and  which  he 
submitted  as  a basis  for  discussion,  it  is  proposed  to  bring 
into  being  an  organization  that  will  act  as  the  trustee  or 
business  agent  of  its  members.  These  members  will  send 
their  bills  for  professional  services  to  the  trustee  organi- 
zation, which  organization  will  collect  from  employers  the 
money  which  will  guarantee  skilled  medical  care  to  em- 
ployees and  the  families  of  employees.  The  employees  are 
to  be  permitted  to  make  their  own  choice  of  physicians 
as  at  present.  In  other  words,  every  effort  will  be  made 
to  continue  private  practice  along  the  same  lines  as  at 
present,  except  that  the  central  or  trustee  organization 
will  collect  the  moneys  and  then  reimburse  the  phy- 
sicians. 

Our  legal  advisers  are  making  a study  on  different  plans 
whereby  such  a central  or  trustee  organization  may  be 
brought  into  being.  There  are,  of  course,  many  obstacles 
facing  us,  but  our  Association  is  prepared  to  spend  money 
to  find  out  ways  and  means  whereby  the  interests  and 
standards  of  medical  practice  may  be  maintained  in  Cali- 
fornia. There  seems  to  be  a general  impression  among 
the  officers  of  the  California  Medical  Association  that  if 
the  medical  profession  does  not  find  a solution  of  some 
of  these  problems  that  some  kind  of  a plan  will  be  thrust 
on  it  under  lay  influence  and  domination,  and  which  could 
be  so  harmful  that  medical  practice,  as  we  now  under- 
stand it,  would  receive  a serious  blow. 

We  are  not  prepared  to  give  out  details  concerning  the 
plans  we  have  in  mind  because  they  are  still  in  what 
might  be  called  a preparatory  stage.  We  are  hopeful, 
however,  that  we  may  be  able  to  devise  ways  and  means 
that  will  place  scientific  medicine  in  its  proper  place 
before  the  citizens  of  California.  We  believe  it  will  be 
possible  to  give  the  highest  type  of  medical  and  surgical 
service  to  citizens  of  less  than  $2500  yearly  income,  at 
the  same  time  protecting  in  fullest  measure  the  rights 
of  the  individual  practitioner,  and  permitting  also  the 
development  of  a stronger  and  larger  California  Medical 
Association.  We  have  no  desire  to  engage  in  reckless 
experiments,  but  we  are  convinced  that  something  must 
be  done,  and  that  talking  in  the  abstract  or  in  platitudes 
will  not  solve  our  problems.  We  intend  to  carry  on  our 
investigations.  If  we  can  find  a legal  and  ethical  plan 
of  organization  that  will  permit  us  to  maintain  medical 
standards,  and  also  protect  the  economic  interests  of 


physicians,  while  at  the  same  time  we  can  give  as  good 
and,  we  hope,  a better  service  to  the  patients  under  dis- 
cussion, then  it  is  our  intention  to  use  our  best  endeavors 
to  put  such  a plan  into  operation.  If  that  should  come  to 
pass,  our  state  journal  will  give  ample  publicity  to  the 
matter. 

* 

Dr  H O.  Reik,  Atlantic  City,  N.  J.:  In  my  humble 
opinion  as  an  editor,  these  are  the  two  most  remarkable 
contributions  that  have  been  made  to  this  conference  of 
secretaries  and  editors  during  the  past  several  years. 

I have  no  intention  of  trying  to  discuss  the  various 
problems  introduced  in  those  papers.  I think  that  the  two 
papers  give  us  food  for  thought  for  a long  time  to  come, 
because  they  express  so  clearly  and  so  succinctly  the 
great  problem  that  confronts  the  medical  profession  to- 
day; a problem  which  is  not  duly  appreciated  by  the  vast 
majority  of  the  members  of  the  profession.  I wish  it  were 
possible  to  compel  every  practicing  physician  to  read 
both  these  papers.  ..  _ T 

While  I cannot,  because  time  does  not  permit  and  I 
haven’t  the  ability  to,  discuss  the  technical  details  of 
these  papers,  I do  want  to  take  advantage  of  the  oppor- 
tunity to  pay  a tribute  of  respect  to  the  two  authors. 
I appreciate  Doctor  McBrayer’s  temerity  in  offering  a 
solution,  which  is  apparently  a good  one;  it  may  be  the 
correct  one,  the  best  one.  That  remains  to  be  seen.  His 
reference  to  President  Harris’  several  papers  on  this  sub- 
ject is  timely,  and  we  should  pay  attention  to  them. 

I want  to  pay  even  a higher  tribute  of  respect,  if 
Doctor  McBrayer  will  permit,  to  Doctor  Hall  for  the  pres- 
entation of  his  paper.  He  is  the  first  man,  I think,  among 
us  who  has  had  the  courage  to  stand  here  and  tell  us  not 
only  the  truth,  but  the  whole  truth.  He  must  have  an- 
ticipated when  preparing  the  paper  that  he  would  give 
us  entertainment  and  amusement  in  his  criticisms  of  big 
business,  but  he  must  also  have_  anticipated  that  he 
would  make  us  squirm  when  he  criticized  members  of  the 
profession  and  their  acts,  and  it  is  for  that  particular 
part  of  his  paper  that  I want  particularly  to  express 
thanks.  This  morning,  at  the  breakfast  table,  I confessed 
to  my  chief  that  I have  in  my  desk  several  papers  and 
editorials,  some  of  which  represented  my  best  thought, 
that  I had  not  had  the  courage  to  print.  Doctor  Hall  has 
given  me  some  moral  support  today.  I think  he  is  the 
‘‘noblest  Roman  among  us  all.” 


PUBLIC  POLICY  AND 
LEGISLATION 


In  the  current  issue  of  California  and  Western 
Medicine  is  printed  an  editorial  dealing  with  nar- 
cotic laws,  and  therein  the  suggestion  is  made  that 
members  of  the  California,  Nevada,  and  Utah  medical 
associations  write  to  their  respective  Senators  and 
Congressmen  to  secure  copies  of  the  proposed  Porter 
Narcotic  Law,  which  is  known  as  “H.  R.  9054.”  For 
the  convenience  of  members  who  wish  to  cooperate 
along  this  line,  the  names  of  the  Senators  and  Con- 
gressmen from  these  three  states  are  here  printed. 
An  easy  method  of  address  for  United  States  Senators 
or  Congressmen  would  be  as  follows: 

Hon.  Hiram  IV.  Johnson 

U.  S.  Senator  from  California 

IV ashington,  D.  C. 

Hon.  Clarence  F.  Lea 

Congressman  from  California 

IV ashington,  D.  C. 

* * * 

California 

Senators 

Hon.  Hiram  W.  Johnson  of  San  Francisco. 

Hon.  Samuel  M.  Shortridge  of  Menlo  Park. 

Congressmen 

Hon.  Clarence  F.  Lea  of  Santa  Rosa. 

Hon.  Harry  L.  Englebright  of  Nevada  City. 

Hon.  C.  F.  Curry  of  Sacramento. 

Hon.  Florence  P.  Kahn  of  San  Francisco. 

Hon.  Richard  J.  Welch  of  San  Francisco. 

Hon.  Albert  E.  Carter  of  Oakland. 

Hon.  Henry  E.  Barbour  of  Fresno. 

Hon.  Arthur  Monroe  Free  of  San  Jose. 

Hon.  W.  E.  Evans  of  Glendale. 

Hon.  Joe  Crail  of  Los  Angeles. 

Hon.  Phil  D.  Swing  of  El  Centro. 


214 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.XXXIl,  No.  3 


Nevada 

Senators 

Hon.  Key  Pittman  of  Tonopah. 

Hon.  Tasker  L.  Oddie  of  Reno. 

Congressman 

Hon.  Samuel  S.  Arentz  of  Simpson. 

Utah 

Senators 

Hon.  William  H.  King  of  Salt  Lake. 

Hon.  Reed  Smoot  of  Provo. 

Congressmen 
Hon.  Don  B.  Colton  of  Vernal. 

Hon.  Elmer  O.  Leatherwood  of  Salt  Lake  City. 


TWENTY-FIVE  YEARS  AGO* 

EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  3,  March  1905 

From  some  editorial  notes: 

. . . Our  State  Legislators. — It  is  rumored  that  the 
legislators  at  Sacramento  have  gone  crazy,  and  there 
seems  to  be  some  ground  for  the  rumor.  The  anti- 
vaccination bill  passed  the  Senate  and  we  learn  that 
it  is  very  liable  to  pass  the  Assembly  though,  at  the 
time  of  writing,  the  final  result  is  not  known.  . . . 

. . . Bind  Your  Journals. — Do  you  not  wish  to  have 
your  volumes  of  the  journal  bound  and  preserve  them 
for  future  reference?  Remember,  these  volumes  are 
the  full  transactions  of  the  state  society  and  also  the 
transactions  of  most  of  the  county  societies. 

. . . Danger  in  X-Ray  Exposure. — A warning  against 
the  haphazard  and  indiscriminate  use  of  the  x-ray  by 
inexperienced  operators  seems  particularly  opportune 
at  this  time,  as  the  lay  press  of  San  Francisco  has 
so  recently  published  the  case  of  the  unfortunate  Mrs. 
Fleishman-Aschheim,  whose  arm  was  amputated,  a 
few  weeks  ago,  for  an  epitheliomatous  degeneration 
caused  by  repeated  exposure  to  these  rays.  Dr.  Philip 
Mills  Jones,  the  pioneer  of  this  work  on  the  Pacific 
Coast,  suffered  from  x-ray  burn  of  the  hand  as  early 
as  1896;  and  though  in  1900  he  gave  up  this  work 
entirely,  even  at  the  present  writing  trophic  and  de- 
generative changes  are  going  on  in  that  important 
member  of  his  anatomy.  . . . 

. . . The  Relation  of  the  American  Medical  Associa- 
tion to  Medical  Advertising — (A  Statement  by  the  Publi- 
cation Committee). — Probably  only  a few  of  the  mem- 
bers' of  our  society  know  that  the  advertising  pages 
of  the  Journal  A.  M.  A.  have  been  the  subject  of  criti- 
cism almost  continuously  for  more  than  ten  years 
past.  That  our  members  may  know  that  we  have  not 
acted  alone  nor  without  sufficient  consideration  in  the 
criticisms  which  have  been  made  in  the  state  journal, 
it  has  been  thought  wise  to  place  before  you  a brief 
summary  of  the  facts  as  they  are  to  be  found  recorded 
in  the  pages  of  the  Journal  A.  M.  A.  . . . 


From  an  article  on  “Neurasthenia  in  Childhood’’  by 
Hubert  N.  Rowell,  M.  D.,  Berkeley: 

We  are  indebted  to  the  late  Dr.  George  M.  Beard 
for  the  first  comprehensive  description  of  this  dis- 
ease, which  he  presented  some  twenty-five  years  ago. 
In  so  doing  he  adduced  nothing  original,  and  nothing 
which  had  not  been  observed  by  others,  decades 
before;  but,  grouping  an  array  of  nervous  phenomena 
into  one  composite  photograph,  he  introduced  into 
our  nosology  the  term  “neurasthenia”  in  lieu  of  what 
had  formerly  been  known  as  nervous  prostration  or 
nervous  exhaustion.  . . . 

* This  column  aims  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


From  an  article  on  “The  Surgical  Treatment  of  Chronic 
Tonsillitis’’  by  J.  A.  Black,  M.D.,  San  Francisco: 

For  many  years  this  subject  would  cover  but  a 
small  space  on  paper,  as  it  was  considered  that  the 
surgeon  had  done  all  that  was  required  of  him  when, 
by  means  of  a tonsillotome,  he  had  removed  what 
showed  of  an  hypertrophied  tonsil,  and  probably  with 
it  a good  portion  of  the  anterior  or  posterior  pillars, 
creating  so  much  of  an  after-disturbance  in  the  throat 
that  no  singer  or  public  speaker  would  submit  to 
removal  of  the  tonsils  for  fear  of  a total  or  partial 
loss  of  the  speaking  or  singing  voice.  . . . 

From  an  article  on  “The  Effects  of  Tonsillotomy’’  by 
IV.  B.  Stevens,  M.D.,  San  Francisco: 

The  effects  of  tonsillotomy  naturally  fall  into  two 
groups: 

First — The  immediate  or  those  closely  succeeding 
the  operation,  and  which  are  for  the  most  part  tran- 
sient; and 

Second — The  ultimate,  which  are  more  or  less  per- 
manent. . . . 


From  an  article  on  “Some  Remarks  on  G onorrhea  in 
IV omen”  by  Beverly  MacMonagle,  M.D.,  San  Francisco: 

The  fact  that  gonorrhea  produces  the  most  serious 
and  profound  changes  in  the  pelvic  organs  cannot  be 
too  strongly  insisted  upon. 

Its  frequency  is  difficult  to  state;  it  varies,  both  in 
localities  and  in  great  cities,  within  wide  limits,  so 
that  it  is  impossible  to  formulate  any  statement  that 
can  have  any  general  application.  . . . 


From  an  article  on  “Flies  as  Carriers  of  Contagion" 
by  George  H.  Aiken,  M.D.,  Fresno: 

For  a physician  to  have  presented  this  subject  to 
the  medical  profession  twenty  years  ago  would  have 
been  to  invite  ridicule  with  criticism,  but  thank  God 
we  have  made  advancement  since  that  time.  . . . 


From  an  article  on  “ Aseptic  Catheterization  of  the  Uri- 
nary Passages”  by  M.  K rotoszyner,  M.  D.,  and  PV.  P. 
IVillard,  M.  D.,  San  Francisco: 

In  treating  the  subject  of  aseptic  catheterization, 
we  must  consider  the  sterilization  of  catheters,  the 
preparation  of  the  urinary  channel,  and  the  introduc- 
tion of  the  instruments  in  an  aseptic  manner.  . . . 


From  an  article  on  “The  Sanitary  Needs  of  the  State” 
by  N.  K.  Foster,  M.D.,  Sacramento : 

That  government  best  serves  its  subjects  which  gives 
to  them  the  largest  measure  of  protection  in  all  their 
rights  and  privileges.  If  “life,  liberty  and  the  pur- 
suit of  happiness”  are  inalienable  rights,  the  means  of 
acquiring  and  preserving  them  are  also.  . . . 


From  miscellaneous  items: 

“ Mother  Mary.”  Now,  who  is  this  Mrs.  Eddy?  She 
is  Mrs.  Mary  Moss  Baker  Glover  Patterson  Eddy. 
Mrs.  Eddy  has  had  three  husbands,  and  the  last  one, 
she  says,  “died  of  arsenical  poisoning  mentally  admin- 
istered.” . . . — Dr.  O.  T.  Osborne.  . . . 


An  Opinion  From  Virginia. — “We  are  very  much  in 
sympathy  with  that  excellent  and  high-class  publica- 
tion, The  California  State  Journal  of  Medicine,  in  its 
severe  arraignment  of  the  Journal  of  the  American 
Medical  A ssociation  for  ethical  laxity,  if  not  for  its 
gross  violation  of  ethics.  . . . 

. . . — The  Southern  Clinic  (February,  1905).  . . . 


From  Medical  Society  Reports: 

Pasadena  Branch,  Los  Angeles  County — At  a meeting 
of  the  Pasadena  branch  of  the  Los  Angeles  County 
Medical  Association  at  which  there  were  thirty  mem- 
bers present  out  of  an  enrollment  of  forty-two,  the 


March,  1930 


MISCELLANY 


215 


following  resolution  was  presented  by  Doctor  Bridge 
and  unanimously  adopted  by  the  section: 

Resolved,  That  it  is  the  sense  of  this  section  of  the 
Los  Angeles  County  Medical  Association  that  the 
existing  medical  law  should  be  left  on  the  statute 
books  as  it  is  and  that  no  further  medical  legislation 
should  be  enacted  at  this  session.  . . . 

. . . The  exaugural  of  Dr.  F.  C.  E.  Mattison  was 
on  the  “Relation  of  the  Physician  to  the  General 
Public.”  Doctor  Gaspar  Miller  of  the  William  Pepper 
Laboratory,  Philadelphia,  was  present  and  spoke  in- 
structively of  the  effort  of  Philadelphia  to  get  a better 
milk  supply.  . . . 

Placer  County — . . . By  the  resignation  of  Dr.  R.  F. 
Rooney  from  the  secretaryship  of  the  society,  which 
position  he  has  held  since* the  organization  was  first 
started  in  1889,  its  members  lose  an  officer  whose 
untiring  energy,  straightforwardness  and  high  ethical 
principles  have  been  the  means  of  bringing  this 
society  to  the  successful  position  it  now  occupies.  . . . 

San  Francisco  County — . . . The  committee  appointed 
to  consider  the  advisability  of  establishing  a milk 
commission  reported  as  follows:  . . . 

...  1.  There  shall  be  a milk  commission  of  the 
San  Francisco  County  Medical  Society,  whose  duty 
it  shall  be  to  examine  milk  submitted  to  them  by 
dairymen  and  certify  as  to  the  result  of  such  exami- 
nation, with  the  object  of  obtaining  pure  milk  for 
infants  and  invalids.  . . . 

Shasta  County — . . . Resolved,  That  the  Shasta 
County  Medical  Society  hereby  reaffirms  and  empha- 
sizes its  belief  in  proper  vaccination  as  a protection 
against  smallpox,  and  that  it  is  further  of  the  decided 
opinion  that  inoculation  with  pure  vaccine  virus,  fol- 
lowed by  cleanliness  of  the  wound  with  good  sanitary 
surroundings,  is  an  entirely  harmless  and  innocent 
measure.  . . . 


DEPARTMENT  OF  PUBLIC 
HEALTH 


By  W.  M.  Dickie,  Director 

Rocky  Mountain  Spotted  Fever  Vaccine  Available. 

Dr.  R.  R.  Parker,  special  expert,  in  charge  of  the 
United  States  Public  Health  Service  Rocky  Moun- 
tain Spotted  Fever  Laboratory  at  Hamilton,  Mon- 
tana, advises  that  Rocky  Mountain  sp'otted  fever 
vaccine  for  1930  will  be  available  for  distribution 
from  that  laboratory  shortly  after  February  1.  The 
same  plan  of  distribution  will  be  followed  as  during 
previous  years,  namely,  the  vaccine  will  be  forwarded 
directly  to  physicians  upon  application.  The  amount 
available  will  likely  be  considerably  greater  than 
heretofore. 

1.  The  vaccine  is  furnished  to  physicians  without 
charge,  and  it  is  hoped  that  any  charge  for  adminis- 
tration will  be  nominal. 

2.  Requests  for  vaccine  should  be  addressed  to  the 
Officer  in  Charge,  United  States  Public  Health  Ser- 
vice, Hamilton,  Montana,  and.  should  specify  the  num- 
ber of  persons  for  whom  vaccine  is  required. 

3.  It  is  desired  to  make  the  vaccine  available  to  all 
who  wish  to  take  it.  However,  it  is  expensive  to 
manufacture,  and  although  it  is  expected  that  vaccine 
can  be  supplied  in  any  amount  likely  to  be  required, 
at  the  same  time  it  is  desired  to  avoid  wastage.  Phy- 
sicians are  likely  to  base  requests  on  the  amount  used 
in  the  year  just  past.  This  is  not  a reliable  index  since 
experience  has  shown  that  local  demand  in  most  in- 
stances is  in  direct  proportion  to  the  local  prevalence 
of  cases,  which  is  a variable  factor.  Therefore,  in 
order  that  the  most  advantageous  distribution  of  the 
vaccine  may  be  made  it  is  suggested  that  requests  be 
conservative,  and  repeated  several  times  if  necessary, 
in  order  that  physicians  may  not  find  themselves  with 
considerable  amounts  of  unused  vaccine  at  the  end  of 
the  season  as  has  sometimes  happened,  especially  in 


1929.  Requests  can  usually  be  filled  the  same  day  as 
received  and,  if  wired  in,  there  will  be  but  a short 
delay  in  receiving  the  vaccine. 

4.  Full  directions  for  administering  the  vaccine  ac- 
company each  lot  forwarded. 

5.  It  is  earnestly  requested  that  the  Hamilton  Labora- 
tory be  informed  of  any  case  of  spotted  fever  occurring 
in  a vaccinated  person  and  that  the  attending  physician 
keep  as  detailed  records  of  the  case  as  circumstances 
permit.  Information  by  wire  is  desired  if  possible,  so 
that,  if  feasible,  a representative  of  the  Hamilton 
station  may  visit  the  case  concerned. 


Pork,  Insufficiently  Cooked,  Causes  Trichinosis.— 

Since  Christmas,  twenty-five  cases  of  trichinosis,  due 
to  eating  pork  which  was  not  thoroughly  cooked,  have 
been  reported  in  California.  The  State  Department 
of  Public  Health  has  issued  a warning  urging  that 
all  pork  used  for  human  consumption  be  cooked  until 
it  is  thoroughly  white  with  no  sign  of  red  meat.  At 
this  season  of  the  year,  when  pork  is  used  in  large 
quantities,  cases  of  this  severe  and  painful  disease 
occur  with  considerable  frequency.  Some  cases  occur 
among  certain  foreign-born  residents  who  are  in.  the 
habit  of  eating  raw  ham  and  raw  sausage.  The  trichi- 
nosis death  rate  is  very  high  among  such  individuals. 
Very  often  roast  pork  is  served  teeming  with  red 
juices  in  the  center  of  the  piece,  while  the  surface  por- 
tion is  well  done.  Care  should  be  taken  in  cooking 
pork  sufficiently  long  to  insure  that  it  is  thoroughly 
cooked  throughout.  A temperature  of  160  degrees  F. 
will  readily  destroy  the  parasites  that  cause  trichinosis. 

Symptoms  of  the  disease  generally  occur  between 
the  seventh  and  tenth  day  after  eating  the  infested 
meat.  Symptoms  of  trichinosis  generally  begin  with 
fever,  diarrhea,  and  other  intestinal  symptoms,  fol- 
lowed by  pains  in  the  muscles  and  joints.  The  onset 
of  these  pains  is  coincidental  with  the  enlargement  of 
the  embryos  of  the  parasites  in  the  muscles.  The 
ankles  and  eyelids  become  swollen.  The  fever  may  be 
continuous  and  it  may  last  for  several  weeks.  .Public 
health  authorities  recognize  that  the  inspection  of 
pork  meat  is  of  no  advantage  in  the  prevention  of 
trichinosis.  The  only  feasible  method  of  prevention 
lies  in  thoroughly  cooking  all  pork  products  before 
eating  them.  Cases  of  this  disease  reported  during 
the  past  week  have  occurred  in  San  Francisco,  Ala- 
meda, Oakland,  and  Petaluma. 

During  the  four  weeks  ending  January  11,  1930, 
seventy-two  cases  of  trichinosis  were  reported  to  the 
State  Department  of  Public  Health.  All  of  these  cases 
were  due  to  the  eating  of  undercooked  sausage. 


Control  of  Venereal  Diseases  Is  Important. — The 

Public  Health  Service  has  continued  its  efforts,  to 
reduce  the  prevalence  of  venereal  diseases,  through 
cooperation  with  state  and  local  health  authorities, 
by  the  carrying  on  of  educational  work  and  the  con- 
ducting of  research  in  problems  related  to  the  treat- 
ment and  control  of  syphilis  and  gonorrhea.  New 
activities  recently  undertaken  included  an  investiga- 
tion of  the  syphilis  problem  among  rural  negroes  in 
the  southern  states  and  a campaign  for  prevention  of 
venereal  diseases  among  seamen  in  the  American  mer- 
chant marine  and  other  beneficiaries  entitled  to  treat- 
ment in  the  hospitals  of  the  service. 

State  health  authorities  reported  a total  of  195,559 
cases  of  syphilis  and  156,544  cases  of  gonorrhea  for 
the  fiscal  year  1929.  Clinics  operated  under  state 
supervision  reported  120,315  new  patients  and  2,128,417 
treatments. 


Births,  Deaths,  and  Marriages  Increase. — The  in- 
crease in  the  number  of  births,  deaths,  and  marriages 
in  California  is  commensurate  with  the  increasing 
population  of  the  state  and  each  year  the  activities 
of  the  Bureau  of  Vital  Statistics  of  the  State  Depart- 
ment of  Public  Health  thus  become  more  extensive. 
Four  hundred  thousand  birth,  death,  and  marriage 
certificates  have  been  filed  with  the  State  Department 
of  Public  Health  during  the  past  two  years.  The 


216 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  3 


state  index  of  births,  deaths,  and  marriages  which 
occurred  since  1906  now  contains  more  than  five  and 
one-half  million  names.  The  name  of  the  child  is  in- 
dexed, as  well  as  that  of  the  father;  the  name  of  the 
bride  and  also  the  name  of  the  groom;  the  name  of 
each  decedent  is  also  indexed. 

The  demand  for  certified  copies  of  records  comes 
from  a wide  variety  of  sources.  The  bulk  of  them, 
however,  are  received  from  attorneys,  veterans’  wel- 
fare organizations,  organized  charities,  police  depart- 
ments, insurance  companies,  interested  relatives  and 
individuals.  Detailed  tabulations  of  births,  deaths,  and 
marriages  are  available  at  all  times.  A careful  study 
of  the  vital  statistics  of  the  state  reveals  the  social 
trend  of  the  population  and  provides  a reliable  index 
for  the  direction  of  activities  in  the  prevention  and 
control  of  disease,  as  well  as  activities  that  may  lead 
to  the  betterment  of  faulty  social  conditions. 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 


By  C.  B.  Pinkham,  M.  D. 

Secretary  of  the  Board 

News  Items,  March  1930 

Of  interest  to  every  practicing  physician  in  the  state 
is  the  case  against  Dr.  S.  S.  Kalman,  Roseville  phy- 
sician, which  was  disposed  of  yesterday  in  the  court 
of  Don  L.  Bass,  Justice  of  the  Peace  for  Roseville. 
Doctor  Kalman  was  charged  on  December  25  with 
illegal  possession  and  sale  of  narcotics,  the  alleged 
evidence  being  based  upon  a statement  by  a certain 
narcotic  addict,  who  was  apparently  being  employed 
to  trap  physicians  by  well  simulated  physical  anguish, 
while  successfully  concealing  the  fact  that  he  is  an 
addict.  Doctor  Kalman  was  at  first  held  for  trial 
before  the  Superior  Court,  but  investigation  developed 
that  his  possession  of  narcotics  was  wholly  legal  and 
rather  less  than  the  average  for  practicing  physicians. 
It  further  appeared  that  his  administration  of  a mini- 
mum dose  of  pantopan  to  the  patient  in  question  was 
neither  illegal  nor  improper,  but  he  was  held  to  have 
committed  a misdemeanor  in  the  fact  that  he  did  not 
report  the  treatment  to  the  enforcement  board  and 
the  case  was  remanded  to  the  Justice  Court  for  hear- 
ing on  that  basis.  Doctor  Kalman  readily  admitted 
that  he  was  at  fault  in  failing  to  make  the  report  and 
paid  the  fine  assessed  by  Judge  Bass.  The  case  in- 
volves rather  a close  point  of  law  as  to  what  consti- 
tutes a reportable  and  a nonreportable  treatment.  As 
the  amended  law  was  enacted  by  the  last  legislature, 
there  is  as  yet  no  court  decision  to  define  this  point. 
Until  the  courts  have  cleared  up  this  point,  physicians 
will  only  find  safety  in  refusing  to  alleviate  the  suffer- 
ings of  transient  patients,  or  if  it  be  done,  the  phy- 
sician must  declare  the  patient  to  be  an  addict  . . . 
(Roseville  Tribune,  January  15,  1930).  The  records 
show  Dr.  S.  S.  Kalman  was  fined  $100. 


Following  a hearing  before  the  board  on  a charge 
of  alleged  illegal  operation,  the  license  of  William  A. 
Lang,  M.  D.,  Long  Beach,  California,  was  revoked 
by  the  Board  of  Medical  Examiners,  February  4,  1930. 


The  license  heretofore  held  by  George  E.  Darrow 
(Azusa,  California),  to  practice  as  a physician  and 
surgeon  in  the  State  of  California  was  revoked  at  the 
regular  meeting  of  the  Board  of  Medical  Examiners 
held  in  Los  Angeles  February  4,  1930,  after  a hear- 
ing based  upon  charges  of  illegal  operation.  (Previous 
entries,  September,  October,  and  December  1929.) 


The  license  of  Wilson  McKenery  Moore,  M.  D., 
Los  Angeles,  called  before  the  Board  of  Medical  Ex- 
aminers for  violation  of  the  terms  of  his  probation, 
was  revoked  February  5,  1930,  after  a formal  hearing 
before  the  board.  (Previous  entry,  September  1929.) 


The  license  of  James  A.  Hadley,  M.  D.,  revoked 
March  1,  1928,  was  restored  by  the  Board  of  Medical 


Examiners  February  5,  1930,  and  Doctor  Hadley  was 
placed  on  probation  for  a period  of  five  years,  during 
which  time  he  is  not  to  have  or  apply  for  either  an 
alcohol  or  narcotic  permit. 


Superior  Judge  Johnson,  in  a recent  decision,  sus- 
tained the  action  of  the  Board  of  Medical  Examiners 
in  revoking  the  license  of  Fred  B.  Tapley,  Marysville 
physician,  July  17,  1929.  (Previous  entries,  September 
and  November  1929.) 


The  Federal  Grand  Jury  today  returned  an  indict- 
ment naming  Dr.  I.  Jesse  Citron,  Beverly  Hills  phy- 
sician, in  thirty-one  counts,  charging  sale  of  narcotics 
to  Alma  Rubens,  film  player.  . . . According  to  As- 
sistant United  States  Attorney  William  Gallagher,  the. 
new  indictment  naming  Citron  places  emphasis  on  the 
asserted  bartering  in  morphin  with,  the  stricken  movie 
actress.  The  indictment  charges  that  on  thirty-one 
occasions  the  physician  sold  morphin  and  cocain  to 
Miss  Rubens  illegally  (Hollywood  News,  January  24, 
1930).  (Previous  entry,  September  1929.) 


After  partially  hearing  the  charges  against  Dr.  Fay 
E.  Cramer,  Inglewood  physician,  the  Board  of  Medi- 
cal Examiners  continued  the  hearing  to  the  July  meet- 
ing to  be  held  in  San  Francisco. 


Charged  with  practicing  medicine  without  a license, 
Dr.  John  P.  Shepherd,  operator  of  the  Hillside  Sani- 
tarium in  Rincon  Valley,  was  arrested  today  by  J.  W. 
Davidson,  special  agent  of  the  State  Board  of  Medical 
Examiners.  Shepherd  was  released  on  $250  cash  bail 
posted  with  Justice  of  the  Peace  Marvin  T.  Vaughan 
here.  . . . According  to  Davidson,  Shepherd  produced 
no  records  to  show  that  he  is  a licensed  practitioner. 
The  method  of  treatment  used  at  the  sanitarium, 
which  specializes  in  tubercular  cases,  is  known  as  the 
“Vapor”  method,  Davidson  said.  Doctor  Shepherd 
established  the  sanitarium  here  last  August,  coming 
here  from  Arizona  where  he  had  been  associated  with 
another  physician,  according  to  Davidson.  Shepherd 
told  Davidson  that  he  was  licensed  in  eastern  states 
and  that  he  was  graduated  from  a Philadelphia  medi- 
cal college  (Santa  Rosa  Republican,  January  27  1930). 
Failing  to  find  that  anyone  by  the  name  of  John  P. 
Shepherd  had  filed  an  application,  on  October  18,  1929 
and  January  25,  1930,  the  secretary  of  the  Board  of 
Medical  Examiners  wrote  John  Shepherd,  asking  for 
his  medical  credentials,  but  as  yet  has  not  been 
informed. 


Dr.  Arthur  C.  R.  McCown,  arrested  in  Oakland  last 
Friday,  charged  with  violating  the  State  Medical  Prac- 
tice Act,  was  accused  today  of  masquerading  under 
false  credentials  as  a physician.  The  accusation  was 
made  by  Dr.  Arthur  C.  McCown  of  St.  Helens, 
Oregon,  who  was  robbed  in  January  1928  of  his  Uni- 
versity of  Oregon  Medical  School  diploma,  a first 
lieutenant’s  commission  in  the  Army,  and  narcotic 
requisition  blanks.  Doctor  McCown  believes  the  per- 
son apprehended  here  may  be  an  impostor  using 
his  name,  it  was  reported.  Theft  of  the  credentials 
from  Doctor  McCown  was  traced  at  the  time  to  a 
man  named  Webb,  who  used  the  physician’s  office  as 
a study.  The  arrest  of  Doctor  McCown  was  made  in 
Oakland  last  Friday  night  at  9200  A Street.  He  was 
taken  immediately  to  San  Francisco  and  obtained  his 
freedom  on  $500  bail.  Complaint  against  Doctor  Mc- 
Cown was  made  by  Dr.  William  Agnew  of  San  Fran- 
cisco, who  declared  he  had  turned  over  his  practice 
to  the  physician  on  representation  that  he  was  licensed 
in  Oregon.  Doctor  Agnew,  who  was  planning  a trip 
to  Europe,  instructed  Doctor  McCown  to  obtain  a 
reciprocity  license  from  the  State  Medical  Board  en- 
titling him  to  practice  in  this  state,  but  discovered 
that  he  never  made  application,  according  to  the  com- 
plaint (Oakland  Tribune,  January  27,  1930).  This  in- 
dividual is  reported  to  have  served  as  ship  surgeon 
with  the  Alaska  Packers’  Fleet  and  made  one  trip  as 
ship  surgeon  for  a prominent  steamship  line  running 
from  New  York  to  San  Francisco. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


THE  NEW  VOGUE  IN  DOCTORS’  EQUIPMENT 


By  ALLISON 


We  are  distributors  of  the  distinctive  ALLISON  line  of  treatment  room,  consultation  office 
and  reception  room  furniture.  Let  us  help  you  in  planning  your  new  office,  or  in  refurnishing 
your  old  suite.  May  we  send  catalog?  Free  on  request. 


TRAVERS  SURGICAL  CO. 

Physicians’  and  Hospital  Supplies 

FRESNO  SAN  FRANCISCO 

933  Van  Ness  429  Sutter  Street 

CALIFORNIA’S  LEADING  SURGICAL  SUPPLY  HOUSE 


unuisa 


A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER. 


N 

■ ^^^Hg  Looks  like  a dress  silk  stocking.  A new  German 

g^^V  ^^Hg  invention.  Gives  compression  when  drawn  up  at 

- the  top.  Tightness  regulated  in  direct  relation  to 

■■•■■■■■■■■■■■■a  vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treatment  of  varicose  veins 
and  swollen  limbs.  Neat  and  comfortable. 

Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 


PRICES 

Length  as  illustrated # 7.00 

Half  thigh  length 9.00 

Full  length  10.00 


In  ordering  give  patient’s 
calf  measurement. 


SOLD  AND  FITTED  BY 


323  W.  6TH  STREET 


LOS  ANGELES,  CALIF. 


Phone  MUtual  8081 


34 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


• • • quick  relief  and 
comfort  in  pyelitis,  cystitis 
and  urethritis 


because  • • • 


it  exerts  a decided  analgesic  action  upon  the  mucosa, 
producing  marked  symptomatic  relief. 

Adequate  Caprokol  treatment  also  insures  a continuous 
flow  of  germicidal  urine  over  the  infected  areas,  result- 
ing, finally,  in  complete  sterilization  of  the  urinary  tract. 

SHARP  & DOHME 

BALTIMORE 

NEW  YORK  CHICAGO  NEW  ORLEANS  ST.  LOUIS  PHILADELPHIA  ATLANTA 

KANSAS  CITY  SAN  FRANCISCO  BOSTON  DALLAS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


Dairy  Delivery  Company 

Successors  in  San  Francisco  to 

Millbrae  Dairy 

The  Milk  With  More  Cream 


We  deliver  daily  from 
San  Francisco 
to 

Menlo  Park 


PHONE  VALENCIA  TEN  THOUSAND 
and  BURLINGAME  3076 


Johnston- Wickett 
Clinic 

ANAHEIM,  CALIFORNIA 

Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 

Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 

Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


I 


Easily 
( Digested 

More  than  18% 
Invert  Sugar 


HU’s  a pure, 
healthful  grape  juice 
with  all  the  fresh 
goodness  of  sun- 
ripened  California 
grapes.  Nothing — not  even  sugar — is  added 
to  the  pure  juice.  An  exclusively  controlled 
process  insures  fresh,  lasting  purity. 

Because  of  its  food  value,  natural  purity 
and  delicious  flavor  ’49  Brand  is  excellent 
to  build  strength  and  increase  vitality.  Be- 
cause of  its  high  percentage  of  natural  invert 
sugar  and  absolute  purity  ’49  Brand  is  highly 
valuable  for  general  diet  and  hospital  use. 

Physicians,  dietitians  or  hospitals  inter- 
ested in  learning  more  about  ’49  Brand 
Grape  Juice  (Red  or  White)  and  its  uses 
may  write  to 

VITA-FRUIT  PRODUCTS  INC 

Russ  Bldg.,  San  Francisco 
Grape  Juice  Plant  at  Lodi 

PARROTT  & CO.,  Sales  Representatives 
San  Francisco  Los  Angeles  Seattle  Portland  Tacoma  Spokane 


3<> 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Rainier  Pure  Grain  Alcohol 

USP 

The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRA  IN  ONL  Y 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 

RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calif. 


FOR  RENT  OR  SALE 


20  Room  Residence.  14  Acres.  Ideal  location  for  Rest  Home  and  Sun 
Bath  Sanitarium. 

Magnificent  ocean,  mountain  and  mission  view,  \y2  miles  from  town. 

For  particulars  address 

HENRY  S.  GANE,  19  E.  Canon  Perdido  Street,  Santa  Barbara 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


\ 


The  Tycos  Recording  Sphygmomanometer 
furnishes  automatically  a graphic  record  of 
diastolic  and  systolic  pressure  together  with 
rhythm  and  amplitude.  No  stethoscope  required. 
Almost  indispensable  in  determining  surgical 
risk  and  eliminating  the  personal  equation. 
Opens  an  entirely  new  field  of  information. 
Permanent  records,  free  from  error. 

Write  for  new  1930  edition  of  Tycos  Bul- 
letin #6  “Blood  Pressure-Selected  Abstracts.”  A 
great  aid  to  the  doctor  who  wishes  to  keep 
abreast  of  blood  pressure  treatment,  diagnosis 
and  technique. 


Taylor  Instrument  Companies 

ROCHESTER,  N.  Y.,  U.  S.  A. 

CANADIAN  PLANT,  TYCOS  BUILDING,  TORONTO 
MANUFACTURING  DISTRIBUTORS  IN  GREAT  BRITAIN,  SHORT  & MASON,  LTD.,  LONDON 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  31) 

sodium  salicylate  or  of  sodium  iodid  has  been  brought 
forward,  and  the  objections  to  the  fixed  proportion 
mixtures  apply  to  the  mixtures  listed  in  this  report. 
Ampoule  No.  50  Iron  and  Arsenic  (Iron  Cacodylate) 
is  unacceptable  because  the  name  is  nondescriptive; 
because  recommendations  for  the  routine  intravenous 
use  of  iron  are  not  warranted,  and  because  iron  caco- 
dylate presents  an  irrational  and  useless  method  of 
the  administration  of  iron  and  arsenic.  The  Council 
declared  Ampoule  No.  61  Sodium  Salicylate  15(4 
grains,  Ampoule  No.  59  Sodium  Iodid  15(4  grains, 
Ampoule  No.  66X  Sodium  Salicylate,  Sodium  Iodid 
15(4  grains  each,  Ampoule  No.  66  Sodium  Salicylate, 
Sodium  Iodid  and  Colchicin,  and  Ampoule  No.  50 
Iron  and  Arsenic  (Iron  Cacodylate)  one  grain,  un- 
acceptable for  New  and  Nonofficial  Remedies  because 
recommendations  for  the  routine  intravenous  admin- 
istration of  sodium  salicylate  and  sodium  iodid  are 
not  warranted  and  because  the  administration  of 
sodium  salicylate  and  sodium  iodid,  of  sodium  sali- 
cylate, sodium  iodid  and  colchicin  in  fixed  proportion 
and  of  iron  and  arsenic  in  the  form  of  ferric  caco- 
dylate whether  intravenously  or  otherwise  is  irra- 
tional.— Jour.  A.  M.  A.,  January  4,  1930,  p.  31. 

Excretion  of  Barbital. — Sir  Maurice  Craig  holds 
that  barbital  preparations  may  be  taken  for  years 
without  producing  deleterious  effects.  This  view  has 
received  some  experimental  verification.  On  the  other 
hand,  it  has  been  held  that  in  certain  conditions — - 
manic-depressive  insanity,  constitutional  psychopathic 
inferiority  and  psychoneuroses — its  use  may  lead  to 
habit  formation  and  that  to  such  patients  these  drugs 
should  never  be  administered. — Jour.  A.  M.  A.,  Janu- 
ary 4,  1930.  p.  35. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the  Food, 

(Continued  on  Next  Page) 


One  of 
America’s 
Leading  Hos- 
pital Supply 
Houses— 

Manufacturers  of  "Porcello” 
Aseptic  Steel  Furniture 


Reid 

Bros. 

Factory  at 
Irvington, 
California 


OFFICES 

91  Drumm  Street  San  Francisco,  Calif. 

Phone  DOuglas  1381 

1417  Fourth  Avenue,  Seattle,  Washington 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Analyzed  and  Certified  Products 

NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 
INTRAMUSCULAR  MEDICATIONS 
PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


STATE  BOARD  REVIEW 

Preparation  for  State  Board 
Examination 

WRITTEN  OR  ORAL 

DR.  MORRIS  STARK 

4405  So.  Broadway 
LOS  ANGELES,  CALIFORNIA 


Creating  Joy 

Qreate  joy  for  yourself  and  others 
by  sending  flowers 


Telephone:  Sutter  6200 
SAN  FRANCISCO 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Previous  Page) 

Drug,  and  Insecticide  Administration  of  the  United 
States  Department  of  Agriculture  which  enforces  the 
Federal  Food  and  Drugs  Act:  Yumco  Tablets  (The 
Yum  Products  Corporation)  containing  sodium  sali- 
cylate, acetphenetidin  (phenacetin),  baking  soda,  phe- 
nolphthalein,  a trace  of  alkaloids  and  a laxative  plant 
drug  extractive.  Kelp-O-Lite  (Pacific  Kelp  Products 
Company,  Inc.),  consisting  essentially  ol  aluminum 
sulphate  and  water,  with  traces  of  calcium,  iron, 
potassium  and  sodium  compounds,  benzoic  acid,  and 
chlorids.  Dakol  Nasal  Cream  (New  Haven  Labora- 
tories, Inc.),  consisting  essentially  of  petrolatum,  with 
one-fourth  of  one  per  cent  of  chloramin  T,  volatile- 
oils  including  menthol  and  a small  amount  of  saponifi- 
able fat.  Sun  and  Moon  Sacred  Ointment  and  Sacred 
Herb  Oil  (A.  W.  Lowrie,  Inc.),  consisting  essentially 
of  a petrolatum  and  fatty  acid  base,  with  oils  of  sassa- 
fras, spearmint  and  wintergreen,  while  the  herb  oil 
consisted  essentially  of  olive  oil  with  oils  of  sassa- 
fras, spearmint,  and  wintergreen.  Flumonia  (Fuming) 
Salve  (Van  Vleet-Mansfield  Drug  Company)  consist- 
ing of  a petroleum  jelly  containing  small  amounts  of 
menthol,  camphor,  and  oil  of  eucalyptus.  Mentho- 
Squillo  (Mansfield  Drug  Company)  consisting  es- 
sentially of  acetic  acid,  spirits  of  niter,  menthol,  a 
trace  of  red  pepper,  sugar,  alcohol  (6.8  per  cent)  and 
water.  Chek-a-Cold  Tablets  (The  Continental  Drug 
Corporation)  consisting  essentially  of  acetanilid,  red 
pepper,  and  aloes.  U-Rub-It  (U-Rub-It  Chemical 
Company)  consisting  essentially  of  petrolatum  and 
beeswax,  with  oils  of  eucalyptus,  peppermint  and 
sassafras,  with  menthol,  oil  of  wintergreen  and  capsi- 
cum.— Jour.  A.  M.  A.,  January  4,  1930,  p.  SO. 

Viosterol  Versus  Cod-Liver  Oil. — Cod-liver  oil  and 
viosterol  solutions  are  by  no  means  to  be  regarded 
as  therapeutically  equivalent.  Cod-liver  oil  cannot  be 
replaced  by  the  newer  irradiated  products  except  so 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


39 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 
NEW  YORK,  NEW  YORK 
FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  haring  an  addict  problem  is 
invited  to  write  for  " Hospital  Treatment  for 
Alcohol  and  Drug  Addiction  ** 


FRANK  F.  WEDEKIND  CO. 

SURGICAL  SUPPLY  CENTER 
First  Floor,  Medical  Building 

Opposite  St.  Francis  Hospital 
BUSH  AND  HYDE  STREETS 

Telephone  GRaystone  9210 

Main  Store  and  Fitting  Rooms 
2004-06  SUTTER  STREET  WEST  6322 

Corsets  . . Surgical  Appliances  . . Storm  Binders 
Orthopedic  Appliances  . . Elastic  Hosiery  . . Trusses 
California  Manufacturing  Agents  for 

The  "Storm  Binder”  and  Abdominal  Supporter 
( Patented ) 


far  as  the  antirachitic  factor  vitamin  D is  concerned. 
Cod-liver  oil  is  also  a carrier  of  the  indispensable 
vitamin  A.  Furthermore  cod-liver  oil  contains  digesti- 
ble and  assimilable  fats. — Jour.  A.  M.  A.,  January  4, 
1930,  p.  S3. 

Pituitary  Solution  (Squibb)  One  Cubic  Centimeter, 
Five  Units,  and  Pituitary  Solution  (Squibb)  One 
Cubic  Centimeter,  Twenty  Units,  Not  Acceptable  for 
New  and  Nonofficial  Remedies. — E.  R.  Squibb  & Sons 
market  Pituitary  Solution  (Squibb)  one  cubic  centi- 
meter, five  units,  and  Pituitary  Solution  (Squibb) 
one  cubic  centimeter,  twenty  units.  The  first  product 
is  one-half  the  strength  of  solution  of  pituitarium 
(United  States  Pharmacopeia),  while  the  second  is 
twice  the  strength.  The  Council  holds  that  it  is  not 
in  the  interest  of  rational  therapy  to  market  strengths 
different  from  that  of  the  standard  pharmacopeial 
product  and  therefore  cannot  give  recognition  to  such 
preparations.  Accordingly,  the  Council  declared  these 
Squibb  preparations  unacceptable  for  New  and  Non- 
official Remedies. — Jour.  A.  M.  A.,  January  11,  1930, 
p.  105. 

Resuscitations  and  Intracardiac  Injections. — The 

power  to  revive  the  dead  is  one  that  the  physician  is 
often,  but  vainly,  expected  to  exhibit.  The  alleged  mira- 
cles of  such  revivals  by  injecting  epinephrin  into  the 
heart  are  always  widely  reported  in  the  newspapers. 
Physicians  who  have  heard  of  these  alleged  resusci- 
tations are  tempted  to  employ  the  same  means.  If 
the  death  was  real,  no  harm  and  no  benefit  results. 
Revival  follows  sometimes,  perhaps  not  because  of 
the  treatment  but  in  spite  of  it.  In  such  cases  there 
is  indeed  grave  danger  that  serious  injury  may  follow 
from  the  treatment  that  the  patient  has  received.  The 
evidence  seems  conclusive  that,  if  the  patient  revives 
after  such  an  intracardiac  injection,  he  would  have 
revived  without  it.  Intracardiac  injection  is  not  a 
justifiable  measure  for  resuscitation. — Jour.  A.  M.  A., 
January  11,  1930,  p.  107. 

(Continued  on  Page  41) 


_ SAVE  MONEY  ON  — 

YOUR  X-RAY  SUPPLIES 


We  Sane  You  from  10%  to  25% 

GET  OUR  PRICE  LIST  AND  DISCOUNTS 


Insures  finest  radiographs  on  heavy  parts,  such  as 
kidney,  spine,  gall-bladder  or  heads. 

Curved  top  style — up  to  17  x 17  size  cassettes 

Flat  top  style  for  11  x 14  size Ufi.OO 

Flat  top  style  for  14  x 17  size 260.00 

X-RAY  FILM — Buck  Silver  Brand  or  Eastman  Super- 
speed Duplitized  Film.  Heavy  discounts  on  carton 
quantities.  Buck,  Eastman  and  Justrite  Dental  Films. 
BARIUM  SULPHATE— for  stomach  work,  purest 
grade.  Also  BARI-SUSP  MEAL.  Low  Prices. 
DEVELOPING  TANKS  — 4,  5 & 6 compartment 
soapstone,  EBONITE  2 5 & 10  gallon  sizes. 
Enamel  Steel  and  Hard  Rubber  Tanks. 
COOLIDGE  X-RAY  TUBES— 7 styles.  Gas  Tubes. 
INTENSIFYING  SCREENS  & CASSETTES  for 
reducing  exposures.  Special  low  prices. 

JONES  BASAL  METABOLISM  UNITS, 
Most  accurate,  reliable,  portable — $235.00. 

If  you  have  a machine  Geo.  W.  Brady  & Co. 

have  us  put  your  name  781  S-  Westcr„  Ave. 

on  our  mailing  list.  Chicago  - - Illinois 


4° 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Medico  - Dental 

Professional  Service 


<t/fs 

FINANCED  BY  OUR  ORGANIZATION  OFFER  MANY 
ADVANTAGES  TO  BOTH  DOCTOR  AND  PATIENT 

Organized  for  the  purpose  of  financing  the  installment  purchase  of 

Medical  and  Dental  services 

EXCLUSIVELY 

Our  service  takes  care  of  your  installment-paying  patient  in  a 
scientific  and  dignified  manner — whereby  the  doctor  is  paid  cash 
for  his  services , allowing  the  patient  to  pay  over  a period  of  months 
without  additional  cost. 

NO  INVESTMENT  REQUIRED  TO  USE  OUR  SERVICE 
For  Further  Information  Address 

Medico- Dental  Finance  Co. 

450  Sutter  Street  KEarny  6250  San  Francisco 

OAKLAND  SACRAMENTO 

Thu  Business  Formerly  Conducted  Under  the  Name  United  Commercial  Securities  Corporation 


Constipation  in  Infancy 

'T'HE  fact  that  Mellin’s  Food  makes  the  curd  of  milk  soft  and  flaky  when  used  as  the 
modifier  is  a matter  always  to  have  in  mind  when  it  becomes  necessary  to  relieve  consti- 
pation in  the  bottle-fed  baby;  for  tough,  tenacious  masses  of  casein  resulting  from  the 
coagulation  of  ingested  milk,  not  properly  modified,  are  a frequent  cause  of  constipation  in 

T^HE  fact  that  Mellin’s  Food  is  free  from  starch  and  relatively  low  in  dextrins,  is  another 
matter  for  early  consideration  in  attempting  to  overcome  constipation  caused  from  the 
use  of  modifiers  containing  starch  or  carbohydrate  compounds  having  a high  dextrins  content. 

T^HE  fact  that  Mellin’s  Food  modifications  have  a practically  unlimited  range  of  adjustment 
is  also  worthy  of  attention  when  constipation  is  caused  by  fat  intolerance,  or  an  excess 
of  all  food  elements,  or  a daily  intake  of  food  far  below  normal  requirements,  for  all 
such  errors  of  diet  are  easily  corrected  by  following  the  system  of  infant  feeding  that  employs 
Mellin’s  Food  as  the  milk  modifier. 

Infants  fed  on  milk  properly  modified  with 

Mellin’s  Food 

are  not  troubled  with  constipation 

A pamphlet  entitled  “Constipation  in  Infancy ” and  a liberal  supply 
of  samples  of  Mellin’s  Food  will  be  sent  to  physicians  upon  request. 


MELLIN’S  FOOD  COMPANY 


BOSTON,  MASS. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


CAL SO  WATER 


PALATABLE  ALKALINE  SPARKLING 


Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Galso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Galso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Los  Angeles 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  39) 

Pancretone,  Another  Nostrum  for  Diabetes. — The 

Wabash  Chemical  Company  of  Chicago  exploits  an 
alleged  cure  for  diabetes  called  Pancretone.  It  also 
has  as  a side  line  a number  of  other  nostrums,  such 
as  Digestoids,  Laxalets,  Intesoids,  Pilene,  Virillo, 
Asthmatol,  and  Myrol.  Pancretone  is  advertised  on 
the  free  trial  treatment  plan,  common  to  diabetes  cure 
quackery.  According  to  the  advertising  for  Pancre- 
tone, the  diabetic  who  will  take  the  preparation  “re- 
quires no  rigid  diet  regulation.”  He  is  told,  however, 
that  he  must  “not  use  Potatoes,  White  Bread,  Sugar, 
Candy,  Pie  and  Cake,  Macaroni,  Rice,  Spaghetti  and 
Beans,  Dates,  Figs,  Bananas,  Preserves  and  Jellies.” 
The  American  Medical  Association  Chemical  Labora- 
tory examined  a package  of  Pancretone  consisting  of 
tablets,  and  also  a specimen  of  Laxalets  and  of  Diges- 
toids. From  its  examination,  the  laboratory  concluded 
that  “Pancretone”  is  essentially  a “digestive  tablet” 
containing  an  amyloplastic  enzyme,  to  which  has  been 
added  considerable  calcium  carbonate  and  cornstarch; 
that  Laxalets  are  essentially  a laxative  combination, 
suggestive  of  aloin,  belladonna,  cascara,  and  strych- 
nin; and  that  Digestoids  are  essentially  a digestive 
combination  suggestive  of  charcoal,  baking  soda,  sac- 
charated  pepsin,  pancreatin,  and  aromatics.  It  is  obvi- 
ous from  the  report  of  the  analysis  that  any  beneficial 
results  that  may  follow  the  Pancretone  “treatment” 
will  be  due  to  the  rigid  diet  restrictions  that  are  part 
of  it.  Any  preparation  that  is  so  advertised  as  to 
induce  diabetics  to  treat  themselves  without  the  advice 
of  a physician  is  a menace.  Pancretone  belongs  to 
this  class! — Jour.  A.  M.  A.,  January  11,  1930,  p.  124. 

Ergotamin  Tartrate. — The  value  of  ergotamin  tar- 
trate in  the  treatment  of  migraine  has  not  as  yet  been 
fully  established.  Recently  good  results  have  been 
reported  from  its  use.  A knowledge  of  the  action  of 
(Continued  on  Page  46) 


^W...  A World  Mart 
of  Surgical  Supplies 

Brought  to  You  . . . 
...IN  LOS  ANGELES 

For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 

Send  (or  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 

KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


KLIM 

for  the  Relief  Bottle 

HPHE  practice  of  giving  one  or  two  bottle  feedings  a day  to  breast 
fed  infants  is  fast  growing  in  favor.  The  rest  afforded  the 
mother  better  enables  her  to  nurse  the  baby  during  the  interim 
and  so  relieves  the  strain  that  she  is  encouraged  to  continue 
breast  feeding.  This  method  also  produces  a gradual  weaning 
which  is  helpful  upon  the  cessation  of  breast  milk. 

When  Klim  is  used  for  complemental  feeding,  there  is  no  danger 

of  engendering  digestive  disturbances  due  to  sudden  changes  in 

curd  formation.  The  friable  and  finely  divided  curd  of  this  pure, 

specially  powdered  milk,  together  with  the  absolute  uniformity  of 

the  product,  assures  adequate  nutrition  and  the  preservation  of 

normal  metabolic  balance. 

Literature  and  samples  including  spe- 
cialfeeding calculator  sent  on  request. 

Merrell-Soule  Co.,  Inc.,  350  Madison  Avenue,  New  York 


(Recognizing 
the  importance 
of  scientific 
control,  all  con- 
tact with  the 
laity  is  predi- 
cated on  the 
policy  that 
KLIM  and  its 
allied  products 
be  used  in  in- 
fant feeding 
only  according 
to  a physician’s 
formula.) 


Merrell-Soule  Powdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 


B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 

M 

Training  School  for 
N urses 

n 

For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


DOCTOR:* 

On  your  way  to  or  from  the  Del  Monte  Convention  pay  us  a visit  at  our  San 
Francisco  store.  We  are  always  pleased  to  welcome  old  or  new  friends,  and 
can  assure  you  the  best  of  attention  and  courtesy. 

Agents  A I ■ ■—  BA  £ Agents 

BARD-PARKER  BLADES  ▼▼  Am  ■—  ■ ■_  ■<  >3  BAUMANOMETER 

I UCeiCAL  CCHPANr 

WE  AIM  TO  SERVE 

521  Sutter  Street  Phone  DOuglas  4017  San  Francisco 


44 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Banning  Sanatorium  Foarna  A^mlT 


Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
Treatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


LIVERMORE  SANITARIUM 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
and  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 


GENERAL  FEATURES 


1.  Climatic  advantages  not  excelled  in  United  States. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge 
Department. 

3.  A resident  medical  staff.  A large  and  well  trained 
individual  attention. 

Information  and  circulars  upon  request 
Address:  CLIFFORD  W.  MACK,  M.  D. 

Medical  Director 
Livermore,  California 
Telephone  7-J 


Beautiful  grounds  and  attractive  surrounding  country, 
of  an  athletic  director.  An  excellent  Occupational 

nursing  staff  so  that  each  patient  is  given  careful 

CITY  OFFICES: 

San  Francisco  Oakland 

450  Sutter  Street  1624  Franklin  Street 

KEarny  6434  GLencourt  5989 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


An  Effective 

in  the  Treatment  of  Pneumonia 


Anything  short  of  major  cali- 
bre in  a diathermy  machine  for 
the  treatment  of  pneumonia 
will  prove  disappointing.  The 
Victor  Vario-Frequency  Dia- 
thermy Apparatus  is  designed 
and  built  specifically  to  the 
requirements.  It  has,  first,  the 
necessary  capacity  to  create 
the  desired  physiological  ef- 
fects within  the  heaviest  part 
of  the  body;  secondly,  a re- 
finement of  control  and  selec- 
tivity unprecedented  in  high 
frequency  apparatus. 

In  the  above  illustration 
the  apparatus  proper  is  shown 
mounted  on  a floor  cabinet, 
from  which  it  may  be  lifted 
and  conveniently  taken  in 
your  auto  to  the  patient’s 
home. 


A REPORT  from  the  Department 
ii  of  Physiotherapy  of  a well' 
known  New  York  hospital,  dealing 
with  diathermy  in  pneumonia  and 
its  sequelae,  states  as  follows : 

“As  a rule  diathermy  is  indicated  in 
acute  pneumonia,  especially  so  when 
the  symptoms  are  becoming  or  already 
are  alarming:  the  temperature  is  high, 
the  patient  is  delirious,  the  pulse  is 
extremely  rapid,  cyanosis  is  deep,  the 
respiration  rate  is  high,  the  breathing 
is  very  shallow,  and  the  cough  remains 
unproductive.  Not  infrequently  in  a 
pneumonia  case  with  such  alarming 
symptoms,  after  a few  diathermy  treat- 
ments an  entire  change  of  the  picture 
takes  place:  cyanosis  lessens,  respira- 
tion becomes  deeper,  the  quality  of 
pulse  improves,  the  rate  decreases,  the 


temperature  is  lowered,  and  the  cough 
becomes  productive.  Auricular  fibril- 
lation that  develops  occasionally  in 
similar  pneumonias  or  other  types  of 
pneumonia  where  the  toxemia  is  great, 
has  been  changed  to  a perfect  normal 
rhythm  after  a few  diathermy  treat- 
ments.’’ 

You  will  value  diathermy  as  an 
ally  in  your  battles  with  pneu' 
monia  at  this  season,  aside  from 
the  satisfaction  derived  from  hav' 
ing  utilised  every  proved  thera' 
peutic  measure  that  present  day 
medical  science  offers. 

A reprint  in  full  of  the  article 
above  quoted,  also  reprints  of  other 
articles  on  this  subject,  will  be 
sent  on  request. 


San  Francisco:  Four-Fifty  Sutter 


Los  Angeles:  Medico-Dental  Bldg- 


GENERAL 


X'RAY  CORPORATION 


Manufacturers  of  the  Coolidge  Tube  and  complete  line  of  X-Ray  Apparatus 
Physical  Therapy  Apparatus,  Electrocardiographs,  and  other  Specialties 

2012  Jackson  Boulevard  Branches  in  all  Principal  Cities  Chicago,  111.,  U.  S.  A. 


FORMERLY  VICTOR 


,t@§l  X-RAY  CORPORATION 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


4(> 


DIATHERMY 


GALVANIC 


SINE  WAVE 


X-RAY 


Dewar  & Hare  Electric  Co. 


386  Seventeenth  Street 


Oakland,  California 


99 


THE  "THERMOTAX 

A high  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 


THE  "ELECTROTAX” 

A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 

Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


San  Francisco  Home  for 
Incurables,  Aged  and  Sick 

2750  Geary  Street,  N.  E.  corner  Wood  Street 
Telephone  WEst  5700 

A non-profit  institution  for  the  service  of  persons  of 
limited  means.  Two  large  courts  with  gardens; 
solariums,  roof  garden  and  sun  room. 

Day  and  night  nursing  care— -Staff  Physician  in  at- 
tendance— Private  Physician  if  desired. 

Convalescent  patients  received. 

No  mental,  alcoholic  or  contagious  cases  accepted. 
Formal  application  required  before  admission. 

DR.  GEO.  W.  COX 
(Johns  Hopkins)  Attending  Physician 
MISS  MARY  A.  TAUTPHAUS,  R.N.,  Superintendent 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  41) 

the  drug  makes  it  easy  to  understand  why  the  drug 
may  help  in  some  cases  and  more  frequently  fail  to 
relieve.  The  drug  is  unfit  for  prolonged  use  be- 
cause it  may  lead  to  gangrene  and  other  symptoms 
of  ergotism.  According  to  New  and  Nonofficial  Reme- 
dies, ergotamin  tartrate  is  marketed  under  the  name 
“Gynergen”  by  the  Sandoz  Chemical  Works. — Jour. 
A.  M.  A.,  January  11,  1930,  p.  126. 

Phyllamin. — According  to  the  advertising  of  Menley 
& James,  Ltd.,  Phyllamin  is  “A  Delectable  Concen- 
trated Tonic  Nutriment”  and  “Presents  Fresh  Sum- 
mer Spinach  Juice  Cold  Expressed.”  The  prepara- 
tion is  claimed  to  contain  “Chlorophyll  and  all  the 
known  five  vitamin  factors”  and  to  represent  “all  the 
mineral  salts  of  vegetables  and  fruits  conserved  in 
pure  honey.”  As  is  the  case  with  many  proprietary 
preparations  claimed  to  owe  their  value  to  the  pres- 


ence of  vitamins,  the  advertising  makes  extreme 
claims  for  therapeutic  qualities  but  contains  nothing 
to  indicate  that  determinations  of  the  vitamin  potency 
have  actually  been  made.  The  preparation  has  not 
been  accepted  for  New  and  Nonofficial  Remedies. — 
Jour.  A.  M.  A.,  January  11,  1930,  p.  127. 

“Common  Cold”  Vaccines. — The  nearest  approach 
to  a final  proof  that  infections  of  the  upper  respira- 
tory tract,  usually  grouped  under  the  term  “common 
cold”  are  due  to  an  unknown  filtrable  virus  has  been 
made  by  Dochez  and  his  coworkers.  This  unknown 
filter  passer  is  not  contained  in  any  currently  ex- 
ploited “common  cold  vaccine.” — Jour.  A.  M.  A., 
January  18,  1930,  p.  189. 

Another  Maurice  Lundin  Fraud. — Maurice  Lundin 
has  been  conducting  a concern  that  he  called  the 
Bono  Drug  Company  (and  also  Bono  Company)  in 
New  York  City  and  Jersey  City,  New  Jersey.  The 
postal  authorities  have  just  debarred  the  Bono  Drug 
(Continued  on  Page  48) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


DISORDERED  NUTRITION 

Before  it  develops  into 

A NUTRITIONAL  DISORDER 

Resulting  in 


MALNUTRITION! 


Avoid  digestive  troubles  in  infancy  and  childhood  and 
. insure  a better  health  foundation  for  the  later 
years.  Milk  must  be  free  from  pathogenic  bacteria  and 
be  digestible  to  be  beneficial ! 

In  cases  where  even  the  weakest  milk  mixtures,  such  as 
whey  and  buttermilk  whey  are  not  tolerated,  Dryco  is 
retained  and  well  assimilated! 

Thousands  of  physicians  rely  upon  Dryco  as  the  best 
milk  for  bottle-fed  babies.  Its  protein  is  97  per  cent 
assimilable.  It  is  stable  in  its  constituents  and  reliable 
in  results! 


PRESCRIBE  DRYCO  . . THE  SAFE  MILK 


Easily  prepared,  modified  and  digested;  contains  the 
vitamins  unimpaired;  requires  no  refrigeration  and 
is  free  from  pathogens!  No  danger  of  frozen  milk 
disturbances! 


Vs, 


Let  Us  Send  Clinical  Data  and  Samples  of  This  Milk 

Pin  This  to  Your  Rx  Blank  or  Letterhead  and  Mail 


THE  DRY  MILK  COMPANY,  INC. 


15  PARK  ROW,  NEW  YORK,  N.  Y. 


48 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 

FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  i Excellent  Cuisine 


DR.  MAX  ROTHSCHILD 
Medical  Director 


DR.  HARRY  C.  WARREN 
Asst.  Medical  Director 


Rates  and  Prospectus  on  Request 


San  Francisco  Office 
384  Post  Street 
Phone  DAVENPORT  4466 


Address:  BELMONT,  CALIF. 
Phone  BELMONT  100 
(3  Trunk  Lines) 


No.  611 — 16"  Physician’s  Bag,  in  Black  or 
Brown,  Price  $13.00 


Bischoff’s  Surgical  House 

THE  HOUSE  OF  SERVICE 

427  20th  Street,  Elks  Bldg.,  Oakland,  Calif. 

Branch,  68  So.  1st,  San  Jose,  Calif. 

A COMPLETE  LINE  OF  PHYSICIANS’, 
HOSPITAL  AND  SICKROOM  SUPPLIES 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  46) 

Company  and  the  Bono  Company  from  the  use  of  the 
mails  because  of  the  fraudulence  of  the  business. 
Under  another  name  Lundin,  according  to  the  federal 
authorities,  is  also  engaged  in  marketing  a small  pneu- 
matic ring  called  the  “Potentor”  supposed  to  be  worn 
around  the  scrotum  and  penis  for  the  cure  of  impo- 
tence. The  sale  of  this  device  by  one  Julius  Saur, 
with  whom  Lundin  was  formerly  associated,  was  the 
basis  of  a fraud  order  in  1928.  Under  still  another 
name  Lundin  sells  through  the  mails  a device  called 
the  “Saddle,”  also  sold  as  a cure  for  impotence;  this 
was  recently  held  obscene  by  the  postal  authorities. 
A few  years  ago  a fraud  order  was  issued  against 
the  Strong  Chemical  Company  (another  Lundin  en- 
terprise), which  was  selling  a glass  vacuum  pump 
called  the  “Emperor  Male  Developer.”  Lundin’s  Bono 
Drug  Company  sold  three  products:  (1)  “French  Pep 
Tablets,”  said  to  be  a cure  for  impotence,  sexual  de- 
bility, inflammation  and  enlargement  of  the  prostate, 
“kidney  trouble,”  “bladder  trouble,”  etc;  (2)  “French 
Pomade,”  which  was  a supplementary  treatment  to 
be  used  with  the  French  Pep  Tablets;  and  (3)  “Bonol 
Balsam,”  which  was  supposed  to  grow  hair  on  bald 
heads! — Jour.  A.  M.  A.,  January  18,  1930,  p.  205. 

Mother  Nature’s  Marvelous  Powder. — -Mother  Na- 
ture’s Marvelous  Powder,  sometimes  called  Mother 
Nature’s  Marvelous  Remedy  and  sometimes  P.  G. 
Powder,  is  put  on  the  market  by  Nature’s  Mineral 
Remedy  Company,  which  does  business  from  a post- 
office  box  in  Durango,  Colorado.  Nature’s  Mineral 
Remedy  Company  seems  to  be  a trade  name  used  by 
one  W.  C.  Picking.  More  recently  it  appears  that 
Picking  has  organized  another  concern  known  as  the 
Colorado  Natural  Remedy  Association  of  Denver. 
This  also  sells  powdered  rock  (under  the  name 
“Kolorok”)  and  it,  too,  is  described  as  “Mother 
Nature’s  Powder.”  From  the  advertising  it  appears 
that  the  “Marvelous  Powder”  is  good  for  whatever 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


Announcing 

The  new 

AUDIPHONE 

This  hearing  device  is  equipped  with  a small 
inconspicuous  earpiece  and  a powerful  light- 
weight battery  which  can  be  easily  concealed. 

The  Audiphone  was  developed  in  the  Bell 
Telephone  Laboratories,  and  is  manufactured 
by  the  Western  Electric  Company — a strong 
guarantee  of  its  reliability. 

Full  details  or  demonstration  upon  request 

W.  D.  FENNIMORE  , A.  R.  FENNIMORE 


177-181  Post  Street  San  Francisco 


ails  you.  From  the  analysis  made  in  the  American 
Medical  Association  Chemical  Laboratory  it  appears 
that  this  product  consists  essentially  of  approximately 
88  per  cent  of  calcium  sulphate  (gypsum)  and  10  per 
cent  of  calcium  carbonate  (chalk),  containing  prob- 
ably a trace  of  calcium  oxid  (lime).- — Jour.  A.  M.  A., 
January  18,  1930,  p.  205. 

Armstrong’s  Oxycatalyst. — No  scientific  evidence 
worthy  of  the  name  appeared  to  sustain  the  claims 
made  for  the  Oxycatalyst,  whil  there  is  increasing 
evidence  that  the  exploitation  of  the  product  is  much 
more  concerned  with  economics  than  medicine.  Two 
original  ampoules  of  Armstrong’s  Oxycatalyst  were 
examined  in  the  American  Medical  Association  Chemi- 
cal Laboratory.  The  contents  of  the  ampoules  were 
found  not  to  hasten  the  discharge  of  a charged  electro- 
scope, indicating  that  the  product  was  not  radioactive. 
The  laboratory  concluded  that  the  specimens  were  non- 
radioactive preparations  probably  containing  sodium 
chlorate,  ferric  chlorid,  and  sodium  phosphate. — Jour. 
A.  M.  A.,  January  18,  1930,  p.  206. 

Multiple  Nebulizer — Improved  Acceptable. — The 
Council  on  Physical  Therapy  reports  that  this  appa- 
ratus has  been  found  acceptable  for  inclusion  in  its 
list  of  accepted  physical  therapy  apparatus.  “The 
Multiple  Nebulizer — Improved’’  (American  Technical 
Laboratories,  Glendale,  California),  is  stated  to  be  an 
apparatus  that  atomizes  or  nebulizes  oils  or  other 
liquids.  It  is  so  constructed  that  any  such  medica- 
ment can  be  administered  alone  or  in  combination 
with  other  medicaments  without  interruption  of  treat- 
ment.— Jour.  A.  M.  A.,  January  25,  1930,  p.  265. 

Lukutate. — This  is  another  rejuvenating  nostrum 
from  the  Orient  via  Germany.  It  seems  to  have  run 
a somewhat  hectic  course  in  Germany.  In  due  time 
its  value  was  correctly  appraised,  and  the  Germans 
appear  to  have  relegated  it  to  the  limbo  of  futile  fakes. 
Today  the  Lukutate  Corporation  of  America  is  try- 
ing to  convince  the  people  of  these  United  States  that 
(Continued  on  Page  53) 


R 

For  the  Doctor: — 

Our  Professional  Liability  Policy 

For  the  Hospital:— 

Our  Hospital  Liability  and  Our 
General  Liability  Policies 

For  Both: — 

A Prognosis  of 

Complete  Protection 
Unsurpassed  Service 
Permanent  Satisfaction 

Over  $68,000,000  in  Resources 

WE  INSURE  ONLY  ETHICAL 
PRACTITIONERS  AND  HOSPITALS 

❖ 

UNITED  STATES  FIDELITY 
AND  GUARANTY  COMPANY 

BALTIMORE,  MARYLAND 
BRANCH  OFFICES 

340  Pine  Street,  San  Francisco,  Calif. 

1404  Franklin  Street,  Oakland,  Calif. 

724  South  Spring  Street,  Los  Angeles,  Calif. 

602  San  Diego  Trust  & Savings  Building 
San  Diego,  Calif. 

Continental  Nat’I  Bank  Bldg.,  Salt  Lake  City,  Utah 


50 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Doctor!  Have  You  a 
Collection  Problem? 


Our  bookkeeper  fails 
to  find,  your  account 
settled  on  our  books. 
Please  help  him  out. 


pAST  DUE! 

I)#"  This  Account  has  no  doubt  escaped 
your  notice.  Will  you  please  favor  us  with 
a remittance  by  return  mail  and  oblige? 


THIS  ACCOUNT 
IS  PAST  DUE. 
PLEASE  REMIT. 


Regarding  Your  Past-Due  Account 

Our  records  show  that  several  statements  and  re- 
minders have  been  sent  you  regarding  the  enclosed 
statement. 

If  your  circumstances  have  made  it  impossible  for 
you  to  pay  the  amount  due,  kindly  write  us  promptly 
to  that  effect.  Our  office  will  then  endeavor  to  extend 
all  possible  courtesies. 

You  appreciate,  we  are  sure,  that  physicians,  like 
other  citizens,  must  pay  their  bills  promptly.  They 
can  only  do  so,  however,  when  their  own  clients  in 
turn  pay  them  promptly  for  such  professional  services 
as  may  have  been  rendered. 

A check  to  cover  your  account,  which  is  now  con- 
siderably overdue,  will  be  appreciated. 


Final  Notice 

In  practically  all  businesses  the  custom  which  is 
generally  followed  with  overdue  accounts  is  to  send 
such  to  a collecting  agency. 

Our  bookkeeper  has  nothing  in  the  records  of  the 
office  to  show  when  you  intend  to  pay  the  enclosed 
account.  Perhaps  the  previous  statements  and  remind- 
ers may  have  been  overlooked  or  ignored. 

Following  the  rule  of  this  office,  this  overdue  account 
will  be  sent  to  the  collecting  agency  within  ten  days 
if  arrangements  for  its  settlement  are  not  made  prior 
to  that  time. 

This  collection  bureau  method  is  disagreeable  to  us ; 
and  we  believe,  also  to  you.  By  promptly  sending  your 
check  all  this  can  be  avoided. 

When  an  account  is  sent  to  the  collecting  agency 
that  organization  takes  full  charge  of  it  thereafter. 


'The  doctor  who  does  not  collect  a goodly 
proportion  of  the  fees  he  has  earned , is  more 
than  apt  to  be  faced  with  a column  in  the 
red;  and  no  man  can  do  justice  to  himself 
in  his  profession  and  give  expression  to  his 
best  work,  and  capacity  under  such  a handi- 
cap. . . . This  system  creates  a minimum  of 
antagonism  among  delinquent  patients  in  its 
results.” 

Reprinted  from  “California  and  Western 
Medicine,”  September,  1927. 


These  collection  stickers  and  notices  are 
now  stocked  by  us  and  the  numerous  repeat 
orders  speak  well  for  the  effective  manner 
in  which  they  have  stimulated  the  collection 
of  dormant  accounts. 

The  prices  quoted  below  are  for  the  com- 
plete series  — three  gum  stickers  and  two 
notices,  as  reproduced  in  this  ad.  The  price 
includes  postage: 

250 £ 6.75 

500 9.00 

1000  13.50 

We  shall  be  pleased  to  quote  you  on  any 
other  piece  of  printed  matter  for  which  you 
may  be  in  the  market. 


The  JAMES  H.  BARRY  COMPANY 


1 1 2 2 -24  MISSION  STREET 
SAN  FRANCISCO,  CALIFORNIA 
[Telephone  MArket  7900  ] 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5' 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  275  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newly  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Will  supply  constant  and  ample  expo- 
sure when  operating  on  rectum  or  anus, 
without  additional  assistant.  PRICE  $10. 
Full  description  on  request. 


Keeping  Step- 

Over  a period  of  86  years,  Sharp  & Smith 
has  been  keeping  step  with  the  steady  advance 
of  medical  and  surgical  science. 

Moreover,  Sharp  & Smith  has  furthered 
this  advance  by  designing  special  instruments 
and  introducing  new  supplies. 

You  order  from  the  S and  S catalog,  there- 
fore, with  a confidence  that  is  based  on  more 
than  three-quarters  of  a century  of  progres- 
sive service  to  your  profession. 


General  Surgical  Supplies 
65  East  Lake  Street  Chicago,  Illinois 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5<? 


The 

Santa  Barbara  Clinic 

1421  State  Street 

SANTA  BARBARA,  CALIFORNIA 

General  Surgery 

Rexwald  Brown,  M.  D. 

Irving  Wills,  M.  D. 

Internal  Medicine 

Hilmar  O.  Koefod,  M.  D. 

H.  E.  Henderson,  M.  D. 

Wm.  M.  Moffat,  M.  D. 

Neville  T.  Ussher,  M.  D. 
Obstetrics  and  Gynecology 

Benjamin  Bakewell,  M.  D. 
Lawrence  F.  Eder,  M.  D. 
Diseases  of  Children 

Howard  L.  Eder,  M.  D. 

Ear,  Nose  and  Throat 

H.  J.  Profant,  M.  D. 

Wm.  R.  Hunt,  M.  D. 

U rology 

Irving  Wills,  M.  D. 

Orthopedics 

Rodney  F.  Atsatt,  M.  D. 

Eye 

F.  J.  Hombach,  M.  D. 
Roentgenology 

M.  J.  Geyman,  M.  D.,  Consultant 


Experienced  Technicians  in  Clinical  Laboratory 
and  Physiotherapy  Departments.  Electrocardio- 
graphic and  Basal  Metabolic  determinations  made. 


ST.  JOSEPH’S  HOSPITAL  san  francisco, 

J CALIFORNIA 

Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


Health  First 

1 1 

■ 1 ■ 1 

SPRING  WATER 

Delivered 

HHn 

to  Offices  and  Homes 

Entire  Bay  District 

j t \ 

Purity  Spring  Water  Co. 

2050  Kearny  Street 

San  Francisco 

i 

\ Phone  DAvenport  2197 

Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 


Los  Angeles  Office 
WILSHIRE  MEDICAL  BLDG. 
1930  Wilshire  Blvd. 


For  particulars  address: 

POTTENGER  SANATORIUM 

Monrovia,  California 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  49) 

in  Lukutate  we  have  a rejuvenating  substance  of 
marvelous  potentialities,  but  no  definite  information 
in  regard  to  its  composition  is  offered.  It  is  stated 
that  “The  history  of  Lukutate  is  one  of  ancient  lore 
and  modern  science,  Oriental  jungle  and  European 
laboratory’’  and  that  “The  basic  ingredients  are  cer- 
tain Indian  fruits.  ...”  It  is  claimed  that  for  hun- 
dreds of  years  these  extraordinary  fruits  have  been 
known  to  the  natives  and  have  been  eagerly  sought 
by  tribes  and  even  animals  of  all  sorts.  An  aphro- 
disiac slant  pervades  the  advertising.  An  imposing 
array  of  German  and  Austrian  testimonials  forms  part 
of  the  “come  on”  advertising  of  Lukutate.  However, 
articles  in  German  medical  and  pharmaceutical  jour- 
nals indicate  that  physicians  in  that  country  are  far 
from  being  as  enthusiastic  over  Lukutate  as  the 
American  public  is  led  to  believe.  The  results  of  offi- 
cial investigation  of  Lukutate  in  Austria  were  to  the 
effect  that  the  main  ingredients  were  frangula  (buck- 
thorn) and  cascara  sagrada  and  that,  therefore,  the 
Lukutate  products  were  to  be  regarded  as  medicinal 
preparations,  and  their  sale  seems  to  have  been  pro- 
hibited in  Austria.  In  the  United  States  testimonials 
for  Lukutate  seem,  at  present,  to  be  much  less  impos- 
ing. The  American  Medical  Association  Chemical 
Laboratory  examined  specimens  of  Lukutate  Tincture 
purchased  from  the  Lukutate  Corporation  and  found 
it  to  be  essentially  an  aqueous-alcoho'.ic  solution  of 
plant  extractives,  one  of  which  is  indicative  of  an 
emodin-bearing  drug,  such  as  cascara,  senna,  or  buck- 
thorn, and  containing  a small  amount  of  fruit  sugars 
(fructose). — Jour.  A.  M.  A.,  January  25,  1930,  p.  281. 

Medical  Publicity  Bureau — A Correction. — An  arti- 
cle on  the  Medical  Publicity  Bureau  was  published 
in  the  Journal  American  Medical  Association,  Decem- 
ber 7,  1929.  The  information  given  relative  to  the 
(Continued  on  Next  Page) 


A Thoroughly  Equipped 

PHYSICAL  THERAPY 
LABORATORY 

Available  to  patients  under  prescription  of 
licensed  physicians. 


DELMER  J.  FRAZIER 

426-427  Dalziel  Building 
OAKLAND 
PHONE  LAKESIDE  5659 


We  solicit  correspondence  from  physicians 
regarding  pharmaceutical  and  proprietary 
preparations. 

LENGFELD’S  PHARMACY 

216  Stockton  Street  San  Francisco,  Calif. 

Telephone  SUtter  0080 


54 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


STL  MARY9S  HOSPITAL  San  Francisco 

Conducted  by  Sisters  of  Mercy 

Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.  A.  C.  S. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Burns,  M.  D. 


Obstetrics 

Philip  H.  Arnot,  M.  D. 
Medicine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 

Stephen  Cleary,  M.  D. 

T.  T.  Shea,  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M.  D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M.  D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Chas.  C.  Mohun,  M.  D. 

Randolph  G.  Flood,  M.  D. 

Heart 
Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 
Dentistry 

Thos.  Morris,  D.  D.  S. 
Francis  L.  Meagher,  D.  D.  S. 


Trademark  1V/I»  Trademark 

Registered  1 vIKlVl  Registered 

Binder  and  Abdominal  .Supporter 


"Type  A”  "Type  N” 


The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-Iliac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 

Katherine  L.  Storm,  M.  D. 

Originator,  Owner  and  Maker 
1701  Diamond  St.,  Philadelphia,  Pa.,  U.  S.  A. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Previous  Page) 
personnel  of  the  bureau  was  based  on  two  reports — 
one  furnished  by  the  National  Better  Business  Bureau 
and  the  other  by  the  Department  of  Health  of  the 
City  of  New  York.  In  the  course  of  the  article  these 
statements  appeared:  “National  Better  Business  Bu- 
reau reported  . . . that  Dr.  James  Macbeth  and  Dr. 
William  J.  Robinson  were  the  principals.  . . .”  “The 
report  further  said  that  Dr.  William  J.  Robinson  of 
the  Critic  and  Guide  was  the  principal  stockholder.  . . .” 
Doctor  Robinson  has  notified  the  Journal  American 
Medical  Association  that  “at  no  time  has  he  been  in 
any  way  whatever,  directly  or  indirectly,  closely  or 
remotely,  actively  or  passively,  connected  with  the 
Medical  Publicity  Bureau”  and  that  “at  no  time  has 
he  held  any  stock  in  said  Medical  Publicity  Bureau.” — 
Jour.  A.  M.  A.,  January  25,  1930,  p.  282. 

Effects  of  Cinchophen.  — Purpuric,  urticarial,  or 
scarlatiniform  eruptions  have  been  reported  by  many 
observers  following  the  administration  of  cinchophen. 
They  may  occur  with  or  without  edema.  Gastro- 
intestinal disturbances,  from  epigastric  discomfort  to 
acid  eructations  and  heartburn,  are  the  commonest 
expression  of  intolerance  to  cinchophen.  These  may 
be  avoided  by  the  giving  of  an  abundance  of  water  with 
the  drug,  and  one  gram  of  sodium  bicarbonate,  though 
the  latter  should  be  given  separately  and  not  mixed 
with  the  drug.  By  using  neocinchophen,  one  may 
avoid  usually  the  symptoms  of  gastric  irritation. 
Sometimes  cardiovascular  disturbances  have  been 
noted.  By  far  the  most  serious  results  of  cinchophen 
intoxication  result  from  injury  to  the  liver,  which  may 
even  go  on  to  a fatal  acute  yellow  atrophy. — Jour. 
A.  M.  A.,  January  25,  1930,  p.  283. 

Cod-Liver  Oil,  Viosterol  or  Sunlight  for  Rickets. — 
Cod-liver  oil,  viosterol,  and  ultra-violet  rays  are  gen- 
erally accepted  as  specific  agents  in  the  prevention 
and  cure  of  active  rickets  in  infants.  Their  relative 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

•f 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Year  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


merits  are  still  under  investigation.  Cod-liver  oil  con- 
tains the  valuable  vitamin  A in  addition  to  vitamin  D. 
Viosterol  is  of  advantage  because  of  the  ease  of  ad- 
ministration and  its  concentration.  Ultra-violet  rays 
are  undoubtedly  a valuable  therapeutic  agent  when 
under  controlled  supervision.  Their  effect  on  general 
nutrition  and  resistance  as  well  as  on  the  calcium  re- 
tention is  good.  Their  use,  to  the  exclusion  of  vita- 
min D or  viosterol,  seems  unwise.  A combination 
seems  most  desirable  when  sunshine  is  not  available. — 
Jour.  A.  M.  A.,  January  25,  1930,  p.  283. 


Psittacosis  in  Upstate  New  York. — Up  to  the  date 
on  which  this  issue  went  to  press  (January  22),  ten 
cases  of  psittacosis  or  “parrot  fever,”  definitely  so  con- 
sidered on  clinical  and  epidemiological  evidence  has 
been  reported  to  the  State  Department  of  Health.  Of 
this  number  two  cases  and  one  death  occurred  in 
Johnstown,  two  cases  and  one  death  in  Yonkers,  one 
case  in  Irvington,  two  cases  in  Hastings-on-Hudson, 
and  three  cases  in  Spring  Valley.  Information  has 
been  received  regarding  a number  of  other  suspected 
cases,  but  the  diagnoses  have  not  been  confirmed. 

That  the  association  of  parrots  with  human  cases 
is  something  more  than  mere  coincidence  seems  borne 
out  by  the  following  considerations: 

1.  In  each  instance  a parrot  had  recently  been  pur- 
chased, usually  within  two  weeks  of  the  onset  of  the 
first  case  in  the  household. 

2.  In  each  case  the  parrot  was  sick  on  arrival  or 
became  so  within  a few  days. 

3.  In  each  of  the  recent  instances,  with  one  excep- 
tion, the  sick  person  had  actually  handled  the  sick 
parrot.  In  the  one  excepted  case  the  patient  denied 
actually  handling  the  bird  though  she  had  been  near 
it.  Moreover  this  is  the  only  one  of  the  recent  cases 
wherein  infection  through  contact  with  a human  case 
seems  at  all  plausible. 

4.  In  each  case  the  human  disease,  though  closely 

(Continued  on  Next  Page) 


DOCTOR: 

NOW  is  the  time  to 
purchase  good  used 
Equipment! 

Values  were  never  so  great 
Terms  are  easy 

See  us  first  for  real  bargains  in 

Electro  Therapy  Apparatus  and 
Treatment  Room  Furniture 

"Everything  for  the  Doctor” 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Bldg. 

391  Sutter  Street  San  Francisco 

Telephone  SUTTER  5314 


5<5 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . . and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


NEW! 


KOMPAK  MODEL 


STANDARD  FOR  BLOODPRESSURE 


Demonstration,  or  Sent  for  Inspection  Upon  Request 


RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


Look  at  your  ledger — WHAT  A MESS 

"WE  GET  THE  COIN ” "WE  PAY ” 

BITTLESTON  COLLECTION  AGENCY,  Inc. 

1211  Citizens  National  Bank  Bldg.  LOS  ANGELES  TRinity  6861 


SUGARMAN  CLINICAL  LABORATORY 


450  Sutter  Street 


SUITE  1439 


San  Francisco,  Calif. 


Telephone:  DAvenport  0342 


Emergency:  WEst  1400 


(Continued  from  Previous  Page) 
resembling  pneumonia,  and  especially  influenza  pneu- 
monia, has  differed  from  it  in  certain  definite  particu- 
lars. Briefly,  these  differences  are  a low  respiratory 
rate  (thirty  or  less)  during  the  first  week  or  more, 
despite  a high  fever  and  definite  signs  of  pneumonia 
in  the  chest;  an  almost  total  absence  of  sputum;  a 
low  or  normal  number  of  white  cells  in  the  blood; 
a slow  pulse  relative  to  the  temperature;  and  an  ab- 
sence of  cyanosis  or  blueness  of  the  lips,  finger  tips, 
face,  etc. 

No  one  of  these  peculiarities,  nor  all  of  them,  would 
necessarily  rule  out  a diagnosis  of  pneumonia  or  war- 
rant a diagnosis  of  parrot  fever.  However,  their 
occurrence  in  each  of  these  cases  thus  far  reported, 


leads  to  the  belief  that  they  may  be  characteristic. 

The  disease  in  parrots  is  characterized  by  drooping, 
ruffling  of  the  feathers,  loss  of  appetite,  more  or  less 
diarrhea,  and  a high  mortality.  Of  the  six  parrots 
associated  with  the  ten  cases  in  upstate  New  York, 
four  have  died,  one  was  killed  while  sick,  and  one 
still  survives — in  a laboratory. 

Unless  a parrot  has  been  acquired  recently  or  per- 
haps has  been  associated  with  a recently  purchased 
parrot  that  has  been  sick,  it  is  in  no  danger  of  acquir- 
ing the  disease.  New  birds  should  be  kept  in  their 
cages  and  not  exposed  to  cold.  There  is  some  evi- 
dence that  exposure  precipitates  the  disease.  They 
should  be  watched  carefully  for  signs  of  illness. 

(Continued  on  Page  59) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  An  Approved 

Clinical  Laboratory 

Definition 

“*  * * A clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application 
of  one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and 
methods,  for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in 
the  human  body." 

"Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  person- 
nel and  records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed 
as  approved .” 

"The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to 
be  properly  carried  out." 

The  Director 

“The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college 
or  university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have 
specialized  in  clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for 
at  least  three  years.  He  must  be  a man  of  good  standing  in  his  profession.” 

"The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major 
part  of  bis  time  to  the  supervision  of  the  laboratory  work.” 

" The  director  may  make  diagnoses  only  when  be  is  a licensed  graduate  of  medicine,  has  special- 
ized in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of 
disease  in  the  patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports." 

"The  director  may  have  assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hemato- 
logic, biochemical,  serologic  and  pathologic  should  be  made  to  the  director.” 

Records 

"Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  labora- 
tory  should  have  appended  pertinent  clinical  data.” 

Publicity 

“ Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bul- 
letins or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the 
name,  address,  telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel, 
Gelds  of  work  covered,  office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain 
misleading  statements.  Only  the  names  of  those  rendering  regular  service  to  the  laboratory  should 
appear  on  letter-heads  or  other  form  of  publicity." 

Fees 

“*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director 
and  any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism.  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


58 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Patient  Types 


The  Chronic 


Ahey  have  worn  holes  in  the  carpets  of  many  a waiting  room  and 
frayed  the  physicians’  patience  to  shreds. 

Often,  underlying  the  chronic  condition  is  bowel  stasis  and 
irrational  use  of  harsh  cathartics. 

In  such  cases  many  chronics  have  been  definitely  benefited  by  a 
period  of  “habit  time”  education  together  with  other  rational 
treatment. 

The  use  of  Petrolagar  will  materially  shorten  the  period  of  bowel 
re-education.  A few  of  the  advantages  of  using  Petrolagar  over 
plain  mineral  oil  are  its  palatability,  its  more  thorough  permea- 
tion of  the  feces,  less  danger  of  leakage,  and  it  has  no  deleterious 


effect  on  digestion. 


Petrolagar 


PETROLAGAR  LABORATORIES,  Inc 


Dr. 


Address 


536  Lake  Shore  Drive, 

Chicago  Dept.  C.  W.  3 

Gentlemen:  - — Send  me  copy  of  the  new 
brochure  "HABIT  TIME”  (of  bowel 
movement)  and  specimens  of  Petrolagar. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 

BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 
Consultants : 

Walter  F.  Schaller,  M.  D. 

Walter  B.  Coffey,  M.  D. 

Charles  Miner  Cooper,  M.  D. 

Walter  W.  Boardman,  M.  D. 

Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSGH  & LOMB  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 

Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty-fourth  Avenue  Oakland,  Calif. 

Telephone  Fruitvale  488 


(Continued  from  Page  56) 

The  hands  should  be  washed  thoroughly  after  hand- 
ling the  parrot  or  its  cage.  Mouth  to  mouth  feeding 
should  not  be  practiced.  Foolish  at  any  time,  it  is 
foolhardy  now. 

If  an  old  bird  becomes  sick,  unless  recently  exposed 
to  a new  one,  it  probably  has  something  not  infectious 
to  human  beings  and  can  be  treated  at  home  with 
reasonable  safety. 

If  a new  bird  becomes  sick  it  is  dangerous.  By 
exercising  great  care  it  may  be  possible  to  nurse  it 
back  to  health  without  becoming  infected.  No  one 
knows  just  what  the  chances  are,  but  the  risk  seems 
hardly  warranted. 

The  germ  that  causes  the  disease  is  not  definitely 
known.  The  so-called  psittacosis  bacillus  has  not  been 
found  in  any  of  the  recent  human  cases  nor  thus  far 


in  any  of  the  parrots  associated  with  them.  Further 
laboratory  work  is  therefore  highly  important.  Health 
officers  are  asked  to  bear  this  in  mind  when  cases 
of  psittacosis  occur  in  their  districts. — Health  New, 
January  27,  1930. 


Vaccination. — United  States  Public  Health  Report, 
November  22,  1929.  Due  to  the  compulsory  vaccina- 
tion law  in  Germany  and  the  service  rendered  the 
public  in  its  enforcement,  smallpox  is  unknown  in  that 
country.  In  1926  seven  imported  cases  were  reported 
for  all  Germany;  in  1927  four  imported  cases  were 
reported;  while  in  1928  only  two  cases,  both  imported, 
were  recorded  for  the  entire  nation.  Such  a record 
as  this  is  the  natural  result  of  universal  vaccination 
and  an  example  of  what  can  be  accomplished  by  the 
people  of  any  country  who  consider  the  prevention  of 
smallpox  seriously. — The  Health  Messenger  (Seattle). 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


LA  VIDA 

Minera  1 Water 

LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  #2.00  per  case  (4  gal.) 
Carbonated : #2.00  per  dozen 

(12  oz.)  bottles 

Tonic  Ginger  Ale:  #2.25  per  doz. 

(12  oz.)  bottles 


*CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

LABORATORIES 

Celestins 

LA 

VICHY 

Grains  per  gallon 

VIDA 

of  France 

3.74 

43.28 

0.98 

5.00 

252.6 

205.53 

Sodium  Chloride  

94.0 

21.94 

0.07 

Trace 

0.13 

6.42 

2.63 

0.001 

Sodium  Sulphate 

14.97 

TOTAL  ....  

357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


Four  Fifty 
I Sutter 


San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


Anesthetic  Found  Successful. — Following  a study 
of  human  and  animal  reactions  to  a new  anesthetic, 
amytal,  recently  adopted  by  some  hospitals  for  surgi- 
cal work,  two  members  of  the  department  of  physi- 
ology of  the  University  of  California  have  succeeded 
in  showing  why  this  hypnotic  has  been  a success  in 
selected  cases. 

The  work  was  done  by  Dr.  J.  M.  D.  Olmsted,  chair- 
man of  the  department  of  physiology,  and  George  M. 
Giragossiantz,  graduate  student,  during  the  course  of 
the  past  year. 

Amytal,  they  explained,  is  a compound  of  barbituric 
acid  closely  related  to  a number  of  well-known  sleep- 
ing potions.  It  is  injected  into  the  veins  of  the  patient 
in  place  of  being  given  by  inhalation  as  a gas.  The 
chief  point  advanced  in  its  favor  was  its  lack  of  effect 
upon  the  internal  workings  of  the  body,  and  particu- 
larly the  freedom  from  nausea  of  patients  coming 
out  of  it. 

Doctors  Olmsted  and  Giragossiantz  found  that 
amytal  does  not  raise  the  blood  sugar  of  the  body 
and  produce  a diabetic  condition  simply  because  it 
arrests  action  of  the  liver  in  which  sugar  is  stored  as 
glycogen,  and  no  action  occurs  while  the  body  is 
anesthetized.  It  also  prevents  passage  of  sugar  from 
the  stomach  into  the  intestine  and  probably  arrests, 
temporarily,  other  bodily  functions. 

This  discovery  that  amytal  leaves  the  body  normal 
because  it  stops  all  action,  temporarily,  does  not  in- 
terfere with  its  use  in  selected  surgical  cases,  but  it 
may  have  some  significance  to  research  men  who  have 
used  amytal  in  experiments  without  knowing  why  it 
anesthetized  without  altering  normal  conditions  fol- 
lowing recovery  from  the  anesthesia. — University  of 
California  Clip  Sheet. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


61 


This  is  the  merger  age— 

Consolidation  and  combination  are  the  twin  screws  of  modern 
business  methods.  Therapeutic  practice  has  long  endorsed 
the  use  of  synergistic  medication.  Combination  of  Lubricant, 
Laxative  and  Antacid  action  assures  successful  results. 

Magnesia-Mineral  jQO  (25) 

HALEY 

formerly  HALEY’S  M-O,  Magnesia  Oil, 

is  a uniform,  permanent,  unflavored  emulsion  of  Magma  Mag  (dram  iii) 
and  Liq.  Petrolatum  (dram  i)  to  the  tablespoonful. 

A countrywide  questionnaire  of  physicians  and  dentists  gives  as  indi- 
cations for  use: 

Gastro- intestinal  hyperacidity,  fermentation,  flatulence,  gastric  or 
duodenal  ulcer,  constipation,  autotoxemia,  colitis,  hemorrhoids,  before 
and  after  operation,  during  pregnancy  and  maternity,  in  infancy,  child- 
hood, old  age,  convalescence,  invalid  or  cachectic  states. 

AN  EFFECTIVE  ANTACID  MOUTH  WASH 
Accepted  for  N.N.R.  by  the  A.M.A.  Council  on  Pharmacy  and  Chemistry 
Generous  sample  and  literature  on  request. 

THE  HALEY  M-O  COMPANY,  INC.,  GENEVA,  N.Y. 


To  Merge  Is  To  Swallow  Up*** 

So  we  are  not  in  any  merger 

We  Still  Retain  Our  Independence  and  Continue  to  Serve  You  as  in  the  Past 

“TRADE  IN  SACRAMENTO’’ 

WITH 

EUGENE  JAY  B. 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 

Surgeons * Instruments  -t  Physicians’  and  Hospital  Supplies 

SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY 

Manufacturers  and  Fitters  of  Orthopedic  and  Surgical 
Appliances 

Agents  for  Bard-Parker  Company 


62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


How  could  we  get  along  without 


the 


Canned  In  ruits 


Canned  fruits  add 
health  and  variety  to 
every  diet  and  menu 


Just  took  at  the  wonderful  assortment 
of  canned  fruits,  jellies,  jams  and  relishes 
every  grocer  offers  you.  You  are  always 
able  to  get  just  what  you  want  at  a nom- 
inal cost. 

Modern  science  has  been  used  by  the 
canner  to  bring  the  finest  fruits  to  you 
cooked  to  uniform  perfection.  And  sugar 
plays  an  important  part  in  such  results. 

Every  cook  should  cultivate  the  habit 
of  using  sugar  as  a flavorer.  Often 


‘ Most  foods  are  more  delicious 


every 
grocer  sells? 


fresh  vegetables,  such  as  corn,  tomatoes, 
peas,  carrots  and  string  beans  need  a 
dash  of  sugar  to  restore  their  sweetness. 
In  making  them  more  palatable,  every- 
body is  eager  to  eat  what  they  need  of 
these  foods.  This  is  especially  true  where 
children’s  meals  are  concerned.  Can  you 
blame  a child  for  shying  at  an  inginid 
vegetable,  a too-sour  fruit-**'—"  Mt- 

ened  cereal?. 


ingwith  Sugar 3 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


63 


IV 

ft 

ft 

V* 

v 

ft 

|v 

ft 

v 

a 

v 


w 


* 


¥ 


Colfax  School  for  the 
Tuberculous 

Qolfaxy  Qalifornia 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


*- 


■J  Patients  are  given  individ- 

* ual  care  by  experienced 

tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 
individual  needs. 

O Patients  are  taught  how  to 

secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 

aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4  The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5  Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  [Medical  ^Director 

Coif ax , California 


ft 

ft 

V 

fk 

v 

ft 

V 
ft 

V 
ft 
ft 


ft 

ft 

[ft 

ft 

ft 

ft 

ft 

ft 

ft 

ft 

ft 

|V 

ft 

V 
ft 

V 
ft 
IV 
ft 


Ift 

V 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


64 


In  pneumonia 

Optochin  Base 

For  the  specific  treatment  of  pneumonia  give 
2 tablets  of  Optochin  Base  every  5 hours, 
day  and  night  for  3 days.  Give  milk  with 
every  dose  but  no  other  food  or  drink. 

Start  treatment  early 

Literature  on  request 

MERCK  C(X  Inc.  Rahway,  N*  J* 


The  Vitalait 
Laboratory 
of  California, 
Inc. 


A Pioneer 
California 
Laboratory,  Noted 
for  the  Quality 
of  Its  Products 


PASADENA 
SAN  FRANCISCO 


Animal  Diseases  that  Occur  in  Man. — Monkeys 
have  many  diseases  that  occur  in  man  and  on  this 
account  they  are  more  and  more  becoming  objects 
of  scientific  study  in  public  health  laboratories,  but 
public  health  investigators  have  heretofore  lacked  a 
convenient  classification  which  would  assist  authors 
in  the  identification  of  these  mammals  and  their  dis- 
eases, such  as  is  presented  in  this  bulletin. 

With  the  increasing  knowledge  of  the  diseases 
which  can  develop  in  monkeys,  questions  of  public 
health  importance  arise  in  regard  to  the  potential  role 
of  the  menagerie,  the  circus,  and  the  zoo  in  spread- 
ing diseases  to  man.  Hygienic  Laboratory  Bulletin 
152  gives  the  desired  information  in  regard  to  the 
apes,  monkeys,  and  lemurs,  for  under  each  animal 
cited  there  is  a list  of  its  parasitic  diseases,  and  in  the 
introduction  under  the  name  of  each  parasite  there 
is  a list  of  all  the  apes,  monkeys,  and  lemurs  for  which 
each  particular  parasite  has  been  reported  and  a nota- 
tion whether  the  parasite  is  transmissible  to  man. 

It  is  interesting  to  note  that  two  of  the  hookworms 
reported  for  man  are  reported  for  apes  also,  and  that 
two  infections  (“tongue  worms”)  which  man  contracts 
from  snakes  are  very  widespread  among  the  apes  and 
monkeys. — United  States  Public  Health  Service. 


Germany’s  Inns  for  Young  Hikers. — A large  num- 
ber of  inexpensive  inns  have  been  opened  in  Germany 
to  shelter  the  enormous  number  of  school  boys  and 
girls  who  go  on  long  walking  tours.  These  inns  are 
maintained  chiefly  by  public  funds,  but  are  managed 
by  the  clubs  of  young  people  that  make  use  of  them. 
So  popular  has  hiking  become  in  Germany  that  about 
3,500,000  school  children  were  accommodated  in  these 
shelters  during  1928 .—United  States  Department  of 
Labor  Children’s  Bureau. 


Analysis 

Comparative  Analysis  of  S.  M.  A.  and  Breast  Milk 


Chemical  and  Physical  Analysis 

S.  M.  A. 

Breast  Milk 

Fat 

3.5-3. 6% 

3.59  s 

Protein  

1.3-1. 4% 

1.23-1.5* 

Carbohydrate 

7. 3-7.5% 

7.57* 

Ash 

0.25-0.30% 

0.215-0.226 

pH 

6. 8-7.0 

6.97* 

A 

0.56-0.61 

0.56** 

Electrical  Conductivity 

0.0022-0.0024 

0.0023 

Specific  Gravity 

1.032 

1.032 

Caloric  Value: 

- per  IOO  c.  c 

68.0 

68.0 

— per  ounce 

20.0 

20.0 

* Average  per  cent  according  to  Holt,  "American  Journal  Diseases  of  Children,”  Vol.  IO,  page  239,  1915. 

**  Davidsohn,  H. — Ueber  die  Reaktion  der  Frauenmilk,  Zeitsch.  for  Kindern.,  Vol.  9,  1913,  page  15. 

***  Fridenthal,  H.  — Ueber  die  Eigenshaften  kuenstlicher  Milchsera  und  ueber  die  Herstellung  eines  kuenstlichen 
MenschenmilcheTsatzes.  Zentralb.  f.  Physiol.,  Vol.  24,  1910,  687. 


What  is  S.  M.  A.? 


S.M.A.  is  an  adaptation  to  Breast  Milk  which 
resembles  Breast  Milk  in  its  essential  physical, 
chemical  and  metabolic  properties  as  shown 
by  the  comparative  table  above.  Only  fresh 
milk  from  tuberculin  tested  cows,  from  dairy 
farms  that  have  fulfilled  the  sanitary  require- 
ments of  the  City  of  Cleveland  Board  of 
Health,  is  used  as  a basis  foT  the  production 
of  S.  M.  A.  In  addition  the  milk  must  meet 
out  own  Tigid  standards  of  quality.  The  cow’s 
milk  fat  is  then  replaced  by  S.M.A.  fat  which 


has  the  same  saponification  number,  iodine 
number,  Polenske  number,  Reichert  Meissl 
number,  melting  point  and  refractive  index  as 
the  fat  in  woman’s  milk.  Cod  liver  oil  forms 
a part  of  the  fat  of  S.  M.  A.  in  adequate 
amounts  to  prevent  Tickets  and  spasmophilia. 
The  protein  and  carbohydrate  are  also  adjust- 
ed --  as  well  as  the  salt  balance  - - so  that 
S.  M.  A.  has  the  same  hydrogen  ion  concen- 
tration, a depression  of  the  freezing  point 
and  reaction  point  within  the  limits  of  those 
found  in  Breast  Milk. 


MAY  WE  SEND  YOU  SAMPLES? 

( Ask  for  descriptive  folder  No.  F-88.  ) 


S.  M.  A.  was  developed  at  the  Babies  and  Childrens  Hospital 
of  Cleveland,  and  is  produced  by  its  permission  exclusively  by 


THE  LABORATORY  PRODUCTS  COMPANY 
West  of  Rockies  : 437-8-9  Phelan  Building.,  San  Francisco,  Cal. 


* CLEVELAND,  OHIO 
In  Canada:  64  Gerrard  St.,  East,  Toronto 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 
E.  A.  TRENKLE,  Manager  Phone  GRAYSTONE  1200 


30  or  more 
doses  if 
necessary 


THE  CUTTER  LABORATORY, 
Berkeley,  California. 

Gentlemen : 

Please  send  me 

□ Booklet  containing  Pollen  Chart. 

Spring  Test  Sets  for  my  region,  for 

which  find  enclosed  my  check  at  $1.00 
each. 

Dr 


Street- 

City..- 


State.. 


POLLEN  EXTRACTS  (CUTTER) 

Produced  for  the  physician  whose  desire  for 
maximum  results  overrides  any  questionable  short- 
cuts; such  as  group  testing,  stock  mixed  treatment 
sets,  spoonfed  dosage,  etc. 

Send  for  Literature  containing 
Geographical  Pollen  Chart. 

THE  CUTTER  LABORATORY 

Established  1897 
Berkeley,  California 


Regional 
Test  Sets 


Convenient! 


Complete! 


Treatment 

Sets 

Containing 

60,000 

Pollen 

Units 

No 

Minimum 

Spoon-fed 

Dosage 


ANNUAL  SESSIONS 

California  Medical  Association,  Del  Monte,  April  28-May  1,  1930 
American  Medical  Association,  Detroit,  Michigan,  June  23-27,  1930 
Nevada  State  Medical  Association,  September  9-11,  1930 
Utah  State  Medical  Association,  September  26-27,  1930 


iff 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and c Published  £ Monthly  by  the  California  £ Medical  c Association 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUME  XXXII 
NUMBER  4 


APRIL  • 1930 


50  CENTS  A COPY 
S5.00  A YEAR 


CONTENTS  AND 

SPECIAL  ARTICLES: 

Thoughts  on  Angina  Pectoris.  By  W.  S. 

Thayer,  Baltimore,  Maryland 217 

Acute  Cholecystitis — Its  Surgical  Treat- 
ment. By  Stanley  H.  Mentzer,  San 
Francisco  .. ....224 

Discussion  by  Stewart  Lobingier,  Los  An- 
geles; O.  O.  Witherbee,  Los  Angeles;  Harold 
Brunn,  San  Francisco. 

Indirect  Treatment  of  a Presumably 
Syphilitic  Child  by  Maternal  Therapy 
During  Lactation.  By  H.  Sutherland 
Campbell  and  Kendal  Frost,  Los 
Angeles  .. 231 

Discussion  by  Harry  E.  Alderson,  San  Fran- 
cisco ; Ernest  Dwight  Chipman,  San  Fran- 
cisco; H.  J.  Templeton,  Oakland. 

Peptic  Ulcer — Its  Management.  By 

Grant  H.  Lanphere,  Los  Angeles 236 

Discussion  by  Frederick  A.  Speik,  Los  An- 
geles; Henry  Snure,  Los  Angeles;  Paul  B. 

Roen,  Hollywood. 

Injuries  of  the  Urogenital  Tract.  By 

Burnett  W.  Wright,  Los  Angeles 240 

Discussion  by  Philip  Stephens,  Los  Angeles ; 

E.  H.  Crabtree,  San  Diego;  Charles  P.  Mathe, 

San  Francisco. 

Glaucoma — Some  Surgical  Considera- 
tions. By  May  Turner  Riach,  San 
Diego  242 

Discussion  by  Frederick  C.  Cordes,  San  Fran- 
cisco; Lloyd  Mills,  Los  Angeles. 

Indications  for  Surgery  in  Pulmonary 
Tuberculosis.  By  H.  E.  Schiffbauer, 

Los  Angeles  245 

Discussion  by  Harold  Brunn,  San  Francisco; 
William  B.  Faulkner,  San  Francisco;  E.  W. 

Hayes,  Monrovia. 

Infection  of  Abdominal  Wall  With  B. 
Welchii  Following  Enterostomy  for 
Bowel  Obstruction.  By  Edmund  But- 
ler and  George  Rhodes,  San  Fran- 
cisco   248 

Hippocratic  Medicine  (Part  II) — The 
Lure  of  Medical  History.  By  Lang- 
ley Porter,  San  Francisco 249 

CLINICAL  NOTES  AND  CASE  REPORTS: 

Ectopic  Ventricular  Tachycardia.  By  R. 

Manning  Clarke,  Los  Angeles 252 

Apparatus  Used  in  Treatment  of  Frac- 
tures of  the  Pelvis.  By  Sam  Herzi- 

koff,  Los  Angeles 253 

Incomplete  Inversion  of  Uterus  with 
Subsequent  Pregnancy.  By  Lawrence 

F.  White,  Los  Angeles 254 


SUBJECT  INDEX 

BEDSIDE  MEDICINE: 

Local  Compression  Therapy  in  the 
Treatment  of  Pulmonary  Tubercu- 
losis   256 

Discussion  by  Frank  S.  Dolley,  Los  Angeles; 

F.  M.  Pottenger,  Monrovia ; Philip  H.  Pier- 
son, San  Francisco;  William  B.  Faulkner,  Jr., 

San  Francisco. 

EDITORIALS: 

The  Fifty-ninth  Annual  Session  of  the 
California  Medical  Association  at  Del 
Monte — To  be  held  on  April  28  to 

May  1,  1930 259 

Modern  Hospital  Construction  Costs — 
The  Los  Angeles  County  General 

Hospital  as  an  Example 260 

William  Taylor  McArthur,  1866-1930.. ..263 

Board  of  Medical  Examiners  of  the 
State  of  California — Its  Report 263 

MEDICINE  TODAY: 

Allergy — A Definition.  By  Samuel  H.  Hurwitz, 

San  Francisco 264 

Nitritoid  Reactions,  Immediate  and  Delayed — 

A Technique  Reducing  the  Repeated  Use  of 
Control  Methods.  By  Stanley  O.  Chambers, 

Los  Angeles  265 

Points  on  the  Value,  Safety  and  Methods  of 
Giving  B.  C.  G.  for  Protective  Immuniza- 
tion Against  Tuberculosis.  By  W.  E.  Mac- 
pherson,  Loma  Linda 266 

PROGRAM— ANNUAL  SESSION 267 

STATE  MEDICAL  ASSOCIATIONS: 
California  Medical  Association 284 

Minutes  of  the  Council  of  the  Cali- 
fornia Medical  Association 284 

Woman’s  Auxiliary  294 

Utah  State  Medical  Association  295 

MISCELLANY: 

News  297 

Correspondence  298 

Clippings  from  the  Lay  Press 298 

Twenty-five  Years  Ago 300 

Department  of  Public  Health 301 

California  Board  of  Medical  Examiners. .302 
Directory  of  Officers,  Sections,  County 
Units  and  Woman’s  Auxiliary  of  the 
California  Medical  Association 

Adv.  page  2 

Book  Reviews  Adv.  page  11 

Truth  About  Medicines Adv.  page  23 

ADVERTISEMENTS— INDEX: 

Advertising  page  8 


"Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


w^. 


G R E E N S’ 

EYE  HOSPITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


Resident  Staff 

Aaron  S.  Green,  M.  D. 
Louis  D.  Green,  M.  D. 
Martin  1.  Green,  M.  D. 
Einar  V.  Blak,  M.  D. 
George  S.  Lachman,  M.  D. 
Vincent  V.  Suglian,  M.  D. 


THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in 
the  A.M.  A.  Facilities  are  especially  designed  for  Ophthal- 
mology and  include  X-Ray,  Radium,  Physio-Therapy  and 
Clinical  Laboratories. 

A private  out  patient  department  is  condu&ed  daily  be- 
tween the  hours  of  9 a.  m.  and  5 p.  m.  A report  of  findings 
and  recommendations  for  treatment  are  returned  with  the 
patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for 
patients  of  limited  income.  Examination  fees  in  the  clinic 
are$2.50  for  the  first  visit  and  $1.50  for  subsequent  visits. 
Moderate  fees  for  drugs,  laboratory  work,  X-Rays.  Oper- 
ating fees  are  arranged  according  to  the  circumstances  cf 
each  individual. 


Bush  at  Octavia  Street  * Telephone  WEst  4300  ♦ San  Francisco,  California 

^Address  communications  to  Superintendents 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


r*r 

flii  u a 1{ 

vw n 

vY  7 v\ 

Patronize  Your  Home  Firm 


Because  We  Are  Progressive 


Bullitt’s  Mastoid  Apparatus 

For  Stereoscopic  Roentgenography  of  the  Mastoids 

THE  technical  difficulty  of  stere- 
oscopic Roentgenography  of  the 
Mastoids,  is  well  recognized  and 
has  largely  limited  the  application 
of  this  highly  useful  method  to  the 
examination  of  the  mastoid. 

These  technical  difficulties  have 
been  entirely  eliminated  by  Dr. 
Bullitt’s  Mastoid  Apparatus,  here 
illustrated.  With  this  device  the 
Stereoscopic  examination  of  the 
Mastoids  becomes  a simple  and 
rapid  procedure.  Two  8x10  films 
loaded  in  Cassettes  are  used,  the 
two  mastoids  appearing  side  by  side 
in  symmetrical  pattern,  for  com- 
parative examination. 

In  the  use  of  apparatus  the  patient 
lies  on  his  back,  the  weight  of  the 
--  head  being  borne  on  the  occiput  and 
not  on  the  possibly  painful  and 
tender  mastoid.  This  position  has  obvious  advantages,  the  mastoid  is  in  full  view  and  can  be  accurately 
placed  under  the  eye  to  secure  the  best  result.  Films  of  perfect  symmetry  can  be  produced  and  re- 
produced, by  the  accurate  technician.  The  upright  Cassette  Holders  serve  likewise  as  the  means  of 
fixing  the  head,  being  opened  and  closed  by  a rack  and  pinion  arrangement.  Investigate  this  apparatus 
at  once,  it  will  save  you  time  and  money. 

TO  EMPLOY  the  adapter  it  is 
only  necessary  to  remove  the 
tube  holder  and  place  adapter  in 
position  as  shown.  The  adapter  is 
so  arranged  that  with  slight  adjust- 
ment, it  may  be  used  on  either  side. 

Only  a few  seconds  are  required 
to  make  the  change  from  the  mas- 
toid to  the  Sella  Turcica  position. 

With  this  device,  radiographs, 
either  single  or  stereoscopic,  may  be 
duplicated  at  any  future  date  due 
to  exact  positioning  of  the  patient 
in  the  apparatus. 


Sella 
T urcica 
Adapter 


Manufactured  by 


BUSH  ELECTRIC  CORPORATION 


334  Sutter  Street 

San  Francisco,  Calif. 
SUtter  6088 


1207  West  Sixth  Street 

Los  Angeles,  Calif. 
MUtual  6324 


u a Ij 


yf=rj<=^ 

a 


Officers  of  the  California  Medical  Association 


General  Officers 


President — Morton  R.  Gibbons,  515  Union 
Square  Building,  350  Post  Street,  San 
Francisco. 

President-Elect — Lyell  C.  Kinney,  510  Med- 
ico-Dental Building,  233  A Street,  San 
Diego. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

Vice-Speaker  of  House  of  Delegates — John 


H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw  Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 


Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 


Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  5 th  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam Duffield  (1930),  516  Auditorium 

Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1930),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Crux. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Junius  B.  Harris  (1930), 
Medico-Dental  Building,  1127  Eleventh 
Street,  Sacramento. 


Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 
lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1930),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large— T.  Henshaw  Kelly  (1930),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Robert  A.  Peers  (1931),  Colfax. 


Standing  Committees 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker  of  the  House 
of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair- 
man of  the  Auditing  Committee.  (Committee  Chairman,  T. 
Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego ..1932 

William  Bowman  (Chairman),  Los  Angeles 1931 

George  H.  Kress,  Los  Angeles 1930 

Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach 1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Cayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco 1932 

William  T.  McArthur,  Los  Angeles 1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education  and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 

Committee  on  Medical  Defense 

George  G.  Reinle  (Chairman),  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Mott  H.  Arnold,  San  Diego 1930 


Committee  on  Membership  and  Organization 


Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks  (Chairman),  San  Francisco 1931 

Jesse  W.  Barnes,  Stockton 1930 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Charles  D.  Ball  (Chairman),  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

Emmet  Rixford,  San  Francisco 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 1932 

Percy  T.  Magan  (Chairman),  Los  Angeles 1931 

Frederick  F.  Gundrum,  Sacramento - 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

Joseph  Catton,  San  Francisco 1930 

The  President Ex-officio 

The  President-Elect Ex-officio 

Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland 1931 

Robert  V.  Day,  Los  Angeles - 1930 

Ernest  H.  Falconer,  Sec’y  Sect.  Med.,  San  Francisco 1930 

Sumner  Everingham,  Sec’y  Sect.  Surg.,  Oakland 1930 


Committee  on  Arrangements 

1930  Annual  Session — Del  Monte,  April  28  to  May  1,  1930 

T.  Henshaw  Kelly  (Chairman),  San  Francisco. 

Joseph  Catton,  San  Francisco. 

William  M.  Gratiot,  Monterey. 

Garth  Parker,  Salinas. 

William  H.  Bingaman,  Salinas. 

Alfred  Phillips,  Santa  Cruz.  . 

The  Secretary Ex-officio 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland (1930-1931) 

Albert  Soiland,  Los  Angeles (1930-1931) 

Fitch  C.  E.  Mattison,  Pasadena (1930-1931) 

Victor  Vecki,  San  Francisco (1929-1930) 

Percy  T.  Magan,  Los  Angeles (1929-1930) 

Junius  B.  Harris,  Sacramento (1929-1930) 


ALTERNATES 

Joseph  Catton,  San  Francisco 

..  .William  H.  Gilbert,  Los  Angeles 

James  F.  Percy,  Los  Angeles 

William  E.  Stevens,  San  Francisco 

Charles  D.  Lockwood,  Pasadena 

John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


Special  Motorcycle  Service 

HOURS:  Week  Days,  8 A.  M.  to  9 P.  M.;  Sundays,  9-1,  6-8  Phones:  GArfield  4417-4418-4419 

For  Emergencies  Only — Phone  WEST  1400 

M erthiolate  Lilly 

(SODIUM  ETHYL  MERCURI  THIOS ALIC YLATE ) 

M ERTHIOLATE  is  a new  organic  mercurial  germicide  and  antiseptic,  potent  in  action  in 
the  presence  of  organic  matter,  non-toxic  in  effective  concentration,  and  non-hemolytic 
for  red  blood-cells. 

Merthiolate  is  non-irritating  to  tissue  surfaces.  It  does  not  stain,  is  stable  in  solution. 

Merthiolate  is  an  effective  agent  for  disinfecting  the  skin  and  tissue  surfaces,  for  the  preparation 
of  obstetrical  cases;  for  application  to  fresh  cuts,  abrasions,  denuded  areas;  for  use  as  wet  dressings 
and  packs;  for  topical  application  to  nasopharyngeal  mucous  membranes. 

Merthiolate  is  supplied  in  1:1000  isotonic  solution  in  four-ounce  and  one-pint  bottles. 

Available  at 

Broemmel’s  Prescription  Pharmacy 

SERUMS  VACCINES  ANTITOXINS 

Free  Delivery 

Fitzhugh  Building,  Rooms  201-202-203  Post  and  Powell  Streets,  San  Francisco,  Calif. 


Radium  and  Oncologic  Institute 

1052  West  Sixth  Street,  Los  Angeles 

An  institution  providing  adequate  facilities  for  the  scientific  study,  diagnosis, 
and  treatment  of  cancer  and  other  neoplastic  diseases. 

Recognized  therapeutic  measures  for  the  treatment  of  cancer  are  radium, 
high  voltage  x-ray  and  surgery. 

Results  in  cancer  therapy  are  entirely  dependent  upon  early  diagnosis, 
thorough  study  and  proper  application  of  such  of  the  above  methods  of 
treatment,  either  alone  or  in  combination,  as  each  case  may  indicate. 

We  desire  to  confer  and  cooperate  with  the  medical  profession  in  the 
diagnosis  and  treatment  of  cancer  and  other  neoplastic  diseases. 

DR.  REX  DUNCAN  DR.  H.  H.  HATTERY 

AND  STAFF 

Office  Hours:  10  a.m.  to  4 p.M.  TRinity  3683 
1052  West  Sixth  Street  Los  Angeles 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  Lorruli  A.  Rethwilm,  2217  Web- 
ster Street,  San  Francisco. 

Secretary,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 

Chairman  of  Section  Program  Committee 
Q.  O.  Gilbert,  301  Medical  Building,  1904 
Franklin  Street,  Oakland. 

Pathology  and  Bacteriology 

Chairman,  W.  T.  Cummins,  Southern  Pacific 
Hospital,  San  Francisco. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
H.  A.  Thompson,  907  Medico-Dental 
Building,  233  A Street,  San  Diego. 

General  Surgery 

Chairman,  Clarence  G.  Toland,  902  Wilshire 
Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Secretary,  Northern  Division,  Sumner  Ever- 
ingham,  400  29th  St.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Dermatology  and  Syphilology 
Chairman,  Samuel  Ayres,  Jr.,  517  Westlake 
Professional  Building,  2007  Wilshire 
Boulevard,  Los  Angeles. 

Vice-Chairman,  Stuart  C.  Way,  320  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  George  F.  Koetter,  812  Medical 
Office  Bldg.,  1136  W.  6th  St.,  Los  Angeles. 
Vice-Secretary,  Merlin  T.  Maynard,  408 
Medico-Dental  Building,  San  Jose. 

Pediatrics 

Chairman,  Guy  L.  Bliss,  1723  East  First 
Street,  Long  Beach. 

Secretary,  Donald  K.  Woods,  5 th  and 
Laurel  Streets,  San  Diego. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Industrial  Medicine  and  Surgery 
Chairman,  Charles  A.  Dukes,  601  Wakefield 
Building,  426  17th  Street,  Oakland. 
Secretary,  Edmund  J.  Morrissey,  201  Med- 
ical Bldg.,  909  Hyde  St.,  San  Francisco. 
Chairman  of  Program  Committee,  Arthur  L. 
Fisher,  212  Medical  Building,  909  Hyde 
Street,  San  Francisco. 

Eye,  Ear,  Nose  and  Throat 
Chairman,  Barton  J.  Powell,  510  Medico- 
Dental  Building,  Stockton. 

Vice-Chairman,  Frederick  C.  Cordes,  817 
Fitzhugh  Building,  384  Post  Street,  San 
Francisco. 

Secretary,  Andrew  B.  Wessels,  1305  Medico- 
Dental  Building,  233  A Street,  San  Diego. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Irving  S.  Ingber,  321  Medico- 
Dental  Building,  490  Post  Street,  San 
Francisco. 

Secretary,  William  H.  Sargent,  Franklin 
Building,  1624  Franklin  Street,  Oakland. 
Chairman  of  Section  Program  Committee, 
W.  E.  Chamberlain,  Stanford  Hospital, 
San  Francisco. 

Neuropsychiatry 

Chairman,  Thomas  G.  Inman,  2000  Van  Ness 
Avenue,  San  Francisco. 

Secretary,  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

General  Medicine 

Chairman,  Walter  P.  Bliss,  407  Professional 
Bldg.,  65  North  Madison  Ave.,  Pasadena. 
Secretary,  Ernest  H.  Falconer,  316  Fitzhugh 
Building,  384  Post  Street,  San  Francisco. 

Obstetrics  and  Gynecology 

Chairman,  Karl  L.  Schaupp,  835  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  Clarence  A.  De  Puy,  Strad  Build- 
ing, 230  Grand  Avenue,  Oakland. 

Urology 

Chairman,  Charles  P.  Mathe,  Room  1831, 
450  Sutter  Street,  San  Francisco. 

Secretary,  Harry  W.  Martin,  1010  Quinby 
Building,  650  S.  Grand  Ave.,  Los  Angeles. 

Officers  of  County  Medical  Associations 


Alameda  County  Medical  Association 

2404  Broadway,  Oakland 

President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Monterey  County  Medical  Society 
President,  Charles  H.  Lowell,  Carmel. 
Secretary,  John  A.  Merrill,  308  Spazier 
Building,  Monterey. 

San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Santa  Barbara  County  Medical  Society 
President,  Hugh  F.  Freidell,  1525  State 
St.,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment, Santa  Barbara. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Sepetary,  J.  O.  Chiapella,  Chiapella  Build- 
ing, Chico. 

Orange  County  Medical  Society 
President,  H.  Miller  Robertson,  212  Medical 
Bldg.,  Santa  Ana. 

Secretary,  Harry  G.  Huffman,  615  First 
National  Bank  Bldg.,  Santa  Ana. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building,  San  Jose. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 

Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary,  C.  J.  Durand,  Colfax. 

Santa  Cruz  County  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldg.,  Santa  Cruz. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son Building,  Fresno. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block, 
Riverside. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Glenn  County  Medical  Society  , 
President,  Etta  S.  Lund,  143  North  *Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Sacramento  Society  for  Medical 
Improvement 

President,  Gustave  Wilson,  609  California 
State  Life  Building,  10th  and  J Streets, 
Sacramento. 

Secretary,  Frank  W.  Lee,  510  Physicians 
Bldg.,  1027  Tenth  St.,  Sacramento. 

Siskiyou  County  Medical  Society 
President, 

Secretary,  Ruth  C.  Hart,  Fort  Jones. 

Humboldt  County  Medical  Society 
President,  Edgar  Holm,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street. 
Vallejo. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol. 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Eytinge,  47  East  Vine 
Street,  Redlands. 

Kern  County  Medical  Society 
President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

Stanislaus  County  Medical  Society 
President,  R.  S.  Hiatt,  Beaty  Bldg.,  1024 
J Street,  Modesto. 

Secretary,  Donald  L.  Robertson,  1003  12th 
Street,  Modesto. 

Lassen-Plumas  County  Medical  Society 

President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

San  Diego  County  Medical  Society 

Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 

President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey,  Red  Bluff. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 

1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 
’ Street,  Los  Angeles. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

San  Francisco  County  Medical  Society 
2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street,  San  Francisco. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary,  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  D.  G.  Clark,  130  N Tenth  St., 
Santa  Paula. 

Secretary,  C.  A.  Smolt,  23  S.  California  St., 
Ventura. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary,  L.  L.  Robinson,  Larkspur. 

San  Joaquin  County  Medical  Society 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Yolo-Colusa  County  Medical  Society 
President,  Leo  P.  Bell,  Woodland  Clinic, 
Woodland. 

Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Mendocino  County  Medical  Society 

President,  L.  K.  Van  Allen,  Ukiah. 

Secretary,  Paul  J.  Bowman,  Fort  Bragg. 

Merced  County  Medical  Society 

President,  Chester  A.  Moyle,  6 Bank  of 
Italy  Bldg.,  Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building. 
Merced. 

San  Luis  Obispo  County  Medical  Society 
President,  Howard  A.  Gallup,  774  Marsh 
Street,  San  Luis  Obispo. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 

Yuba-Sutter  County  Medical  Society 
President,  Philip  Hoffman,  404  D Street, 
Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 


rCC  VITAMIN  BALANCE 


Maltine 

With  Cod  Liver  Oil 


Medical  research  workers  constantly  are 
discovering  new  facts  about  the  vitamins  and 
their  close  relationship  to  the  health  of  the 
human  body.  Today  we  know  that  a bal- 
anced vitamin  content  is  requisite  in  every 
regimen. 

Very  often  the  most  rigid  diet  varies  in  its 
vitamin  supply.  However,  the  modern  doctor 
has  at  his  command  a food  combination 
which  carries  the  four  essential  vitamins  . . . 
Maltine  With  Cod  Liver  Oil,  combined  with 
orange  juice. 

Maltine  With  Cod  Liver  Oil  has  a Vita- 
min A potency  of  at  least  230  U.S.P.  units 
per  gram.  It  contains  both  the  antineuritic 
and  the  antipellagric  Vitamin  B.  Whan 
orange  juice  (or  any  other  antiscorbutic)  is 
added  in  adequate  dosage,  Vitamin  C is  pro- 


vided. The  Vitamin  D potency  of  this  prep- 
aration is  such  that  rachitic  rats,  fed  20  mg. 
daily,  showed  perceptible  to  distinct  healing 
of  rickets  in  from  6 to  10  days  by  the  line- 
test  method.  Each  of  the  above  potency 
claims  has  been  thoroughly  substantiated  in 
the  laboratory  of  a leading  biological  chem- 
ist. Copies  of  this  report  are  available  to  you. 

Maltine  With  Cod  Liver  Oil  is  much  more 
palatable  than  plain  cod  liver  oil  (by  clinical 
tests) . Easily  administered.  Readily  digested, 
even  by  infants.  It  has  been  accepted  by  the 
Council  on  Pharmacy  and  Chemistry  of  the 
American  Medical  Association.  Caution  your 
patients  to  avoid  substitutes.  The  Maltine 
Company,  20  Vesey  St.,  New  York.  Est. 
1875. 


6 


State  Board  of  Health 

San  Francisco,  337  State  Building 

Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.'Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 

Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 

Secretary,  Albert  K.  Dunlap,  Sacramento 
Hospital,  Sacramento. 

Treasurer,  Walter  E.  Bates,  Davis. 

Southern  California  Medical  Association 
President,  Joseph  K.  Swindt,  Pomona. 
Secretary,  William  J.  Norris,  509  Medical 
Office  Bldg.,  1136  W.  6th  Street,  Los 
Angeles. 

Better  Health  Foundation 

President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 

State  Board  of  Medical  Examiners 

San  Francisco,  623  State  Building 

Los  Angeles,  821  Associated  Realty  Bldg., 
510  West  Sixth  Street 

Sacramento,  420  State  Office  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 

California  Northern  District  Medical  Society 
President,  J.  D.  Lawson,  Woodland  Clinic, 
Woodland. 

Vice-President,  Dan  H.  Moulton,  Chico. 

Woman’s  Auxiliary  of  the  California  Medical  Association 

State  Auxiliary  Officers 

President,  Mrs.  H.  S.  Rogers,  Sunny  Slope 
Road,  Petaluma. 

First  Vice-President,  Mrs.  W.  H.  Geistweit, 
810  Medico-Dental  Building,  San  Diego. 
Second  Vice-President,  Mrs.  John  Hunt 
Shephard,  145  South  Twelfth  Street,  San 

Jose. 

Secretary-Treasurer,  Mrs.  R.  A.  Cushman, 
632  North  Broadway,  Santa  Ana. 

Officers  of  County  Auxiliaries 

Contra  Costa  County — President,  Mrs.  J.  M. 
McCullough,  Crockett ; Secretary-Treasurer, 
Mrs.  S.  N.  Weil,  Rodeo. 

Los  Angeles  County — President,  Mrs.  James 
F.  Percy,  Los  Angeles ; Secretary-Treas- 
urer, Mrs.  Martin  G.  Carter,  Los  Angeles. 
Kern  Gounty — President,  Mrs.  F.  A.  Hamlin, 
Bakersfield  ; Secretary-Treasurer,  Mrs.  C.  S. 
Compton,  Bakersfield. 

Orange  County — President,  Mrs.  F.  E.  Coul- 
ter, Santa  Ana ; Secretary-Treasurer,  Mrs. 
Dexter  R.  Ball,  Santa  Ana. 

San  Bernardino  County — President,  Mrs. 
F.  E.  Clough,  San  Bernardino ; Secretary- 
Treasurer,  Mrs.  C.  L.  Curtiss,  Redlands. 

Sonoma  County— President,  Mrs.  Leslie  G. 
Spear,  Santa  Rosa ; Secretary-Treasurer, 
Mrs.  Sara  J.  Pryor,  Santa  Rosa. 

Nevada  State  Medical  Association 


W.  A.  SHAW,  Elko President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 


HORACE  T.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 

Place  of  next  meeting Reno,  September  26-27,  1930 


H.  P.  KIRTLEY,  Salt  Lake  City President  J.  U.  GIESY,  701  Medical  Arts  Building, 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect  Salt  Lake  City Associate  Editor  for  Utah 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary  Place  of  next  meeting Salt  Lake  City,  September  9-11,  1930 


The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 

Belmont,  Calif. 

FRANKLIN  HOSPITAL 

Limited  General  Hospital 

Fourteenth  and  Noe  Streets,  San  Francisci 

SAN  FRANCISCO  HOME  FOR 
INCURABLES,  AGED  AND  SICK 

2750  Geary  Street,  San  Francisco 

GREENS’  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  01 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 

San  Jose,  California 

JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

ANDERSON  SANATORIUM 

Mental  and  Nervous  Diseases 

2535  Twenty-fourth  Avenue 

Oakland,  Calif. 

JOSLIN’S  SANATORIUM 

Nervous  and  Mental 

Lincoln,  Calif. 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

BANNING  SANATORIUM 

Treatment  of  Tuberculosis  and  Throat 
Diseases 

Banning,  Calif. 

LAS  ENCINAS  SANITARIUM 

Nervous  and  General  Diseases 

Las  Encinas,  Pasadena,  Calif. 

SAINT  FRANCIS  HOSPITAL 

Limited  General  Hospital 

Bush  and  Hyde  Streets,  San  Francisco 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Belmont,  San  Mateo  County,  Calif. 

LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 

ST.  JOSEPH’S  HOSPITAL 

Limited  General  Hospital 

Buena  Vista  and  Park  Hill  Avenues 

San  Francisco,  Calif. 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 

ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 

27th  and  Valencia  Streets,  San  Francisco 

CHILDREN’S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Los  Gatos,  Calif. 

ST.  MARY’S  HOSPITAL 

General  Hospital 

2200  Hayes  Street,  San  Francisco,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

POTTENGER  SANATORIUM 

AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

DANTE  SANATORIUM 

Limited  General  Hospital 

Van  Ness  and  Broadway,  San  Francisco 

RADIUM  AND  ONCOLOGIC 
INSTITUTE 

Diagnosis  and  Treatment  of  Neoplastic 
Diseases 

1052  West  Sixth  Street,  Los  Angeles,  Calif. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


CHU,|,j|  i 


awgssfc 

rrysv, 

•< 


AylNK> 

- N AS 


, ;"rf  is: 


COUNCIL-ACCEPTED 


PITOCIN 

OXYTOCIC  HORMONE  . . . (ALPHA- HYPOPHAMINE ) 


Pitocin,  one  of  the  two  hormones  isolated  from 
the  posterior  pituitary  gland,  acts,  specifically, 
as  an  oxytocic.  It  does  not  raise  blood  pressure 
or  affect  the  symptoms  of  diabetes  insipidus. 

Until  the  isolation  of  Pitocin  (together  with 
Pitressin,  pressor  hormone),  all  pituitary 
extracts  for  obstetrical  use  contained  both 
hormones.  In  order  to  get  the  oxytocic  effect 
it  was  necessary  to  accompany  it  by  a circula- 
tory disturbance  that  was  not  always  desirable. 
Now  each  can  be  obtained  without  the  other. 

What  are  the  clinical  applications  of  Pi- 
tocin? Mainly  as  a stimulant  to  the  uterus 


in  labor  when  the  uterine  contractions  are 
inadequate,  and  especially  in  cases  where  it 
would  be  unwise  to  increase  blood  pressure,  or 
water  retention,  as  in  eclampsia  or  in  cases 
having  an  eclamptic  tendency. 

Pitocin  is  administered  in  the  same  way  and 
in  the  same  dosage  as  Pituitrin  Obstetrical. 
Each  cubic  centimeter  contains  10  International 
Oxytocic  Units,  which  is  the  oxytocic  strength 
of  Pituitrin  Obstetrical. 

Packages:  (Boxes  of  6 and  100  ampoules). 
Ampoule  No.  160,  Pitocin,  1 cc. 


Write  for  'Booklet  on  'Pitocin 


PARKE,  DAVIS  & COMPANY 

DETROIT,  MICHIGAN 

NEW  YORK  KANSAS  CITY  CHICAGO  BALTIMORE  NEW  ORLEANS  MINNEAPOLIS  SEATTLE 


In  Canada:  walkerville 


MONTREAL 


WINNIPEG 


8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 


Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 


ne^DB 


-np* 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

Anderson  Sanatorium,  The 59 

Annual  Meeting  of  American 

Ass’n  for  Study  of  Goiter 58 

Approved  Clinical  Laboratories  57 

Banning  Sanatorium  44 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  and  Rackerby 61 

Benjamin,  M.  J 33 

Bischoff’s  Surgical  House 48 

Bittleston  Collection  Agency 56 

Brady  & Co.,  George  W 39 

Broemmel’s  Prescription  Phar- 
macy   3 

Brown  Press  53 

Bush  Electric  Corporation 1 

Butler  Building  16 

California  Lima  Bean  Growers’ 

Ass’n  58 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co 41 

Camp  & Co.,  S.  H 30 

Canyon  Sanatorium  18 

Certified  Laboratory  Products  ...  38 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 
Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co 35 

Dante  Sanatorium  4 Cover 

Dewar  & Hare 46 

Doctors’  Business  Bureau 19 

Dry  Milk  Co.,  The 47 

Four  Fifty  Sutter 60 

Franklin  Hospital  43 

Frazier,  Delmar  J 53 

Furscott,  Hazel  E... 24 

General  Electric  X-Ray  Corp. 45 

Golden  State  Milk  Products  Co.  30 
Greens’  Eye  Hospital 2 Cover 


Page 

Gunn,  Hubert,  Stool  Examina- 


tion Laboratory  24 

Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Haley  M-O  Company 61 

Hexol,  Inc 16 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H. 10 

Hoffmann-La  Roche,  Inc 13 

Holland-Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning  36 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic  62 

Joslin’s  Sanatorium  31 

Keniston-Root  Corporation  41 

Knox  Gelatin  Laboratories 25 

Laboratory  Products  Co 3 Cover 

Las  Encinas  Sanitarium 12 

La  Vida  Mineral  Water  Co 60 

Lederle  Antitoxin  Laboratories  23 

Lengfeld’s  Pharmacy  24 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 11 

Livermore  Sanitarium  29 

Maltbie  Chemical  Co.,  The 28 

Maltine  Company,  The 5 

Mead  Johnson  & Co 21 

Medical  Protective  Co 15 

Medico-Dental  Finance  Co 40 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc.  42 

Monrovia  Clinic  43 

National  Ice  Cream  and  Cold 

Storage  Co ...  29 

Ne.w  York  Polyclinic  Medical 

School  and  Hospital 9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital 12 

Nichols  Nasal  Syphon 44 

Nonspi  Company  28 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 
ical Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 

Park  Sanitarium  24 

Parke,  Davis  & Co 7 


Page 


Podesta  and  Baldocchi 43 

Pollard’s  High  Tension  Stetho- 
scope, Dr 44 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 52 

Radium  and  Oncologic  Institute  3 

Rainier  Brewing  Co 36 

Reid  Bros 37 

Richter  & Druhe  56 

Riggs  Optical  Company 31 

Saint  Francis  Hospital 14 

San  Francisco  Home  for  Incur- 
ables, Aged,  and  Sick 46 

Sanitarium  For  Sale — 40 

Santa  Barbara  Clinic,  The 52 

Scherer  Co.,  R.  L 26 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  18 

Sharp  & Dohme 34 

Sharp  & Smith  51 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription  Phar- 
macies   24 

Soiland,  Albert  (Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stacey,  J.  W.,  Medical  Books 11 

St.  Joseph’s  Hospital 52 

St.  Luke’s  Hospital 23 

St.  Mary’s  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugarman  Clinical  Laboratory....  16 

Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies....  37 

Towns  Hospital,  Charles  B 39 

Trainer- Parsons  Optical  Co 26 

Travers’  Surgical  Co 33 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Vita-Fruit  Products,  Inc 35 

Vitalait  Laboratory  12 

Waiss  Hollow  Needle  & Holder....  20 

Wallace,  Sidney  J 55 

Walters  Surgical  Company 38 

Wedekind,  Frank  F 39 

Wilson  Laboratories  62 


••<>11 • • -«<>•• 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule,  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


9 


The  Oaks  Sanitarium  Los  Cjfatosy  Qalifornia 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 


WILLIAM  C.  VOORSANGER,  M.  D.  PAUL  C.  ALEXANDER,  M.  D. 

Medical  Director  Asst.  Medical  Director 

San  Francisco  Office  ' 490  Post  Street 


Ten  Acres  of  Beautiful  Grounds 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 

COMPTON,  CALIF. 

30  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  beds  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 

Philip  J.  Cunnane,  M.  D.  G.  Creswell  Burns,  M.  D. 
Helen  Rislow  Burns,  M.  D. 

Office:  1052  iVest  6th  Street,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

(Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 


PHYSICAL  THERAPY 


Lectures  and  demonstrations  of  medical  and  surgical  diathermy;  galvanic,  low  tension  and  static 
currents;  electro-diagnosis;  helio-therapy;  thermo-therapy  and  artificial  light  therapy;  massage  and 
therapeutic  exercise.  Active  clinical  work  in  the  treatment  of  medical  and  surgical  conditions. 


For  information  address  MEDICAL  EXECUTIVE  OFFICER;  345  W.  50th  St.,  New  York  City 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


A Newer,  Better  Lacing  for 
the  Hittenberger  Ptosis 
Supporter 


With  the 
"Block  and 
Tackle”  lacing 
varying  degrees 
of  inward- 
upward  thrust 
may  be 
obtained  with- 
out binding 
the  hips. 


Send  for 
Complete 
Circular 


C.  H,  HITTENBERGER  CO. 


MArket  4244 

1115  Market  Street  460  Post  Street 


Established  1 902 


WATER-SOLUBLE 

BISMUTH  SODIUM 
TARTRATE  (Searle) 

Bismuth  Sodium  Tartrate  (Searle)  is  a water-soluble 
bismuth  complex  administered  intramuscularly  in  aqueous 
solution,  containing  76  per  cent  of  bismuth  on  an  anhydrous 
basis. 

INDICATIONS 

(1)  In  general,  it  is  indicated  as  an  alternative  to  the 
arsenicals  and  mercury  in  the  treatment  of  syphilis. 

(2)  It  is  often  tolerated  by  patients  who  cannot  tolerate 
arsenicals  or  mercury. 

(3)  It  will  often  reverse  the  serum  reaction  in  the  so- 
called  “Wassermann-fast”  cases  which  are  recalcitrant 
to  treatment  with  arsenicals  or  mercury. 

(4)  It  has  proven  of  special  value  in  the  treatment  of 
syphilis  of  the  nervous  system.  It  is  said  by  some  to 
be  superior  even  to  the  arsenicals  in  these  cases. 

(5)  That  it  is  an  unusually  effective  diuretic  and  exerts 
this  effect  without  detriment  to  the  circulatory  sys- 
tem or  the  kidneys,  has  been  shown  by  Hanzlik  and 
collaborators  (J.  A.  M.  A.,  92:1413,  Apr.  27,  1929). 

(6)  It  has  achieved  a most  important  place  in  the  treat- 
ment of  Vincent’s  angina.  Many  physicians  and 
dentists  report  an  almost  specific  action.  A special 
preparation  is  made  for  local  application. 

BOXES  OF  12’s  AND  25’s 
San  Francisco  Distributor 

C.  KCDCLPH  GUT U 

BIOLOGICS  &.  THERAPEUTIC  SPECIALTIES 

WILLIAM  H.  BANKS,  M.  D.,  Medical  Director 

Phone  KEarny  3644 

811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

Frates  a lovotti , Professional  Pharmacists 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less; 
additional  words  5 cents  each. 


FOR  SALE— X-RAY  EQUIPMENT  IN  PERFECT  CONDI- 

tion  suitable  for  small  hospital  or  surgeon.  Make  an  offer. 
909  Hyde  Street,  Room  135,  San  Francisco. 


EDITORIAL  ASSISTANCE— MEDICAL  PAPERS  EDITED 

and  revised,  for  society  meetings  and  publication,  by  physician  now 
engaged  in  medical  editorial  work  and  member  of  American  Medical 
Editors’  Association.  Address  Box  506,  Hagerstown,  Maryland. 


FOR  SALE  IN  CENTRAL  SOUTHERN  CALIFORNIA— 
General  medical  and  surgical  practice.  Thirty  thousand  yearly 
collections.  Fine  opportunity  for  making  money  from  the  start. 
Price  $6,000  with  equipment.  Will  introduce.  Address  Box  1110, 
California  and  Western  Medicine. 


PHYSICIAN  AND  SURGEON,  GRADUATE  “A”  SCHOOL, 

1923,  desires  locum  tenens  or  assistantship  to  busy  surgeon, 
34  years,  married,  Gentile,  three  years’  hospital  experience,  three 
years’  private  practice,  one  year  abroad,  L.  R.  C.  P.  & S.,  Edin- 
burgh. Licensed  in  California.  Write  full  details  first  letter. 
Address,  Box  410,  California  and  Western  Medicine. 


SITUATIONS  WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 


FOR  SALE— DUE  TO  ILLNESS— $12,000  GENERAL  PRAC- 

tice  in  Sacramento  Valley,  established  18  years.  Town  of  1000, 
gives  service  in  seven  adjacent  towns  to  3000  persons.  Will  sell 
office  furnishings  of  five  rooms,  all  equipment  including  instruments, 
x-ray,  therapy  lights  and  drugs.  Rent  or  sell  office  and  home. 
Lodge,  insurance  and  Southern  Pacific  appointments  transferable. 
For  cash,  or  will  take  monthly  payments  from  man  with  high 
recommendations.  Address,  Box  400,  California  and  Western 
Medicine. 


“RAINBOW  RIDGE”  CHARMING  COUNTRY  PLACE  IN 

Los  Gatos  Hills,  1800  feet  altitude  among  wonderful  redwood 
and  sequoia  groves.  Main  bungalow,  guest  cottage,  baths,  servants’ 
cabin,  double  garage  with  ample  storeroom,  tank  house,  hot  and 
cold  showers,  brick  driveways  and  walks.  Beautiful  shrubs,  forty 
trees  of  assorted  fruits.  Ideal  summer  or  all  year  home.  Famous 
health  building  climate.  Unexcelled  for  sanitarium.  Exceptionally 
good  road.  $25,000,  reduced  from  $35,000.  Address,  Howard 
Throckmorton,  Los  Gatos,  California,  or  756  South  Spring  Street, 
Los  Angeles. 


Radio  Quacks. — In  the  ordinary  course  of  its  work 
the  Department  of  Health  has  recently  uncovered 
what  is  believed  to  be  a serious  situation  and  which 
seems  to  indicate  that  the  radio  is  being  fairly  widely 
used  by  companies  alleging  to  cure  diseases  through 
the  sale  of  various  products  and  services.  These 
claims  are,  in  many  of  the  cases  we  have  investi- 
gated, completely  unfounded,  fraudulent  and  inimical 
to  the  public  health.  The  Department  is  powerless, 
under  the  law,  to  protect  the  public  against  these 
charlatans.  The  Commissioner  has,  therefore,  called 
this  menace  to  the  attention  of  the  Federal  Radio 
Commission.  Since  any  form  of  radio  censorship 
would  be  obnoxious  to  our  ideals  and  dangerous,  a 
conference  has  been  called  of  the  forty-six  radio 
broadcasters  within  the  immediate  vicinity  of  New 
York  and  it  has  been  suggested  that  all  radio  health 
programs  be  voluntarily  submitted  to  the  scrutiny 
of  a joint  committee  of  the  medical  societies.  It  is 
believed  this  will  accomplish,  in  a voluntary  way, 
what  under  the  present  laws  seems  impossible  to  do. 

An  invitation  has  also  been  extended  to  the  Na- 
tional Better  Business  Bureau,  the  American  Asso- 
ciation of  Advertising  Agencies,  the  National  Asso- 
ciation of  Broadcasters,  the  federal  and  state  authori- 
ties interested  in  this  work,  to  formulate  a code  of 
broadcasting  ethics.  While  this  is  broader  than  our 
immediate  interests,  it  is  the  only  manner  in  which 
those  who  have  studied  this  question  believe  it  will 
be  possible  to  drive  the  medical  quack  off  the  air. 
In  this  campaign  to  drive  out  the  radio  medical  quack 
the  Health  Department  is  giving  leadership  to  a 
movement  which  has  already  attracted  nation-wide 
attention  and  is  receiving  the  serious  consideration  it 
deserves. — IVeckly  Bulletin  City  of  New  York  Depart- 
ment of  Health,  January  11,  1930. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


// 


BOOK  REVIEWS 

List  of  Books  Received 


BOOKS  RECEIVED 

Insomnia.  How  to  Combat  It.  By  Joseph  Collins.  M.  D. 
Cloth.  Pp.  130.  Price,  $1.50.  New  York:  D.  Appleton  and 
Company,  1930. 


The  Baby’s  First  Two  Years.  By  Richard  M.  Smith, 
A.  M.,  M.  D.,  Assistant  Professor  of  Child  Hygiene,  Har- 
vard Medical  School  and  School  of  Public  Health,  Boston. 
Cloth.  Pp.  159,  with  illustrations.  New  and  revised 
edition.  Price,  $1.75.  Boston  and  New  York;  Houghton 
Mifflin  Company,  1930. 


Roentgenographic  Technique.  A Manual  for  Physicians, 
Students  and  Technicians.  By  Darmon  Artelle  Rhinehart, 
A.  M.,  M.  D.,  Professor  of  Roentgenology  and  Applied 
Anatomy,  School  of  Medicine,  University  of  Arkansas. 
Cloth.  Pp.  388,  with  159  illustrations.  Price,  $5-50  net. 
Philadelphia:  Lea  & Febiger,  1930. 


Recent  Advances  in  Preventive  Medicine.  By  J.  F.  C. 

Haslam,  M.  C.,  M.  D.,  Assistant  Director,  Bureau  of 
Hygiene  and  Tropical  Diseases;  Director  of  Library 
Services,  London  School  of  Hygiene  and  Tropical  Medi- 
cine. With  a chapter  on  the  Vitamins  by  S.  J.  Cowell, 
M.  D.,  M.  B.,  Professor  of  Dietetics  in  the  University  of 
London.  Cloth.  Pp.  328,  with  30  illustrations.  Price, 
$3.50  net.  Philadelphia:  P.  Blakiston’s  Son  & Co.,  Inc., 
1930. 


Surgical  Diagnosis.  By  42  American  authors.  Edited 
by  Evarts  A.  Graham,  M.  D.,  Professor  of  Surgery, 
Washington  University  Medical  School.  Three  octavo 
volumes,  totalling  2750  pages,  containing  1250  illustra- 
tions, and  Separate  Index  Volume.  Cloth.  Price,  $35  a 
set.  Philadelphia:  W.  B.  Saunders  Company,  1930. 


Mortality  Statistics  1927.  Twenty-eighth  Annual  Re- 
port. Part  I.  United  States  Department  of  Commerce, 
Bureau  of  the  Census.  Summary  and  Rate  Tables  and 
General  Tables  for  the  Death  Registration  Area  in  Conti- 
nental United  States,  with  Supplemental  Statistics  for 
Hawaii  and  the  Virgin  Islands.  Cloth.  Price,  $2.  Wash- 
ington: United  States  Government  Printing  Office,  1929. 


The  Bacteriophage  and  Its  Clinical  Applications.  By 

F.  d’Herelle,  Professor  of  Bacteriology  Yale  University 
School  of  Medicine.  Translated  by  George  H.  Smith, 
Professor  of  Immunology,  Yale  University  School  of 
Medicine.  Cloth.  Pp.  254.  Price,  $4  postpaid.  Springfield: 
Charles  C.  Thomas,  1930. 

Bulletin  of  the  National  Research  Council.  Number  73. 
A Survey  of  the  Law  Concerning  Dead  Human  Bodies. 
By  George  H.  Weinmann,  LL.  B.,  Attorney  and  Counselor 
at  Law.  Issued  under  the  auspices  of  the  Committee  on 
Medico-legal  Problems,  National  Research  Council.  Paper. 
Pp.  199.  Washington,  D.  C. : The  National  Research  Coun- 
cil of  The  National  Academy  of  Sciences,  1929. 


BOOK  REVIEWS 

Sterilization  for  Human  Betterment:  A Summary  of 
Results  of  Six  Thousand  Operations  in  California, 
1909-1929.  A publication  of  the  Human  Betterment 
Foundation.  By  E.  S.  Gosney  and  Paul  Popenoe. 
Pp.  202.  New  York:  The  Macmillan  Company,  1929. 
Price  $2. 

This  volume  one  of  the  publications  of  the  Human 
Betterment  Foundation,  which  was  founded  in  1929  by 
E.  S.  Gosney,  may  be  regarded  as  a resume  of  the  numer- 
ous papers  which  the  authors  have  published  in  the  last 
few  years.  In  the  earlier  chapters  there  is  a short  his- 
tory of  the  subject  and  the  following  chapters  are  devoted 
to  the  effects  on  sexual  life,  the  viewpoints  of  patients 
who  have  been  operated  upon,  the  effect  on  the  patient's 
behavior,  and  a refutation  of  the  idea  that  sterilization 
might  prevent  the  birth  of  occasional  geniuses. 

Although  twenty-two  states  have  at  one  time  or 
another  passed  laws  legitimizing  sterilization  of  crim- 
inals, feeble-minded  and  the  insane,  of  8515  operations 
performed  in  the  United  States  up  to  January  1,  1928, 
5820  were  done  in  California.  Other  states  which  have 
done  considerable  numbers  are  Kansas,  647,  and  Oregon, 
511.  Indiana,  which  was  one  of  the  pioneers,  has  done 
no  operations  since  1909  and  New  York  has  done  none 
since  1918.  In  1926,  the  United  States  Supreme  Court 
upheld  the  constitutionality  of  the  Virginia  law  and 
Justice  O.  W.  Holmes  in  writing  the  opinion  said  that 
(Continued  on  Next  Page) 


Exclusively 


PHYSICIANS  < SURGEONS  r DENTISTS 
350  Post  Street,  Facing  Union  Square 
GArfield  1014 


To  the  Physicians  of  California 

You  are  cordially  invited  to  visit  our  new  store. 
On  account  of  the  wonderful  cooperation  which 
we  have  received  from  the  profession  we  have 
had  to  increase  our  space  to  four  times  its 
original  extent. 

All  Books  on  Approval 

J.  W.  STACEY,  Inc. 

Medical  and  Scientific  Books 

236-38  Flood  Building 

SAN  FRANCISCO,  CALIF. 

Telephone  GARFIELD  0838 


LISTERS 


NO 

Starch 


CASEIN  PALMNUT  DIETETIC 

FLOUR 


prescribed  in 

Diabetes 


Strictly  starch-free,  palatable  muffins,  bread,  cakes, 
pastry,  etc.,  are  easily  made  in  any  home  from 
Listers  Flour.  Recipes  are  easy  to  follow  and  Listers 
Flour  is  self-rising.  One  month’s  supply  $4.85 


Ask  for  nearest  Depot  or  order  direct. 
LISTER  BROS.  Inc.,  41  East  42nd  St.,  NEW  YORK,  N.Y. 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


New  York  Post-Graduate  Medical  School  and  Hospital 

Offers  Courses  of  Interest  to  the  General  Surgeon  and  the  Surgical  Specialist 
GYNECOLOGY — Courses  of  one  to  three  months’  duration,  continuous  throughout  the  year. 

ORTHOPEDIC  AND  TRAUMATIC  SURGERY — Courses  of  two  months  duration,  offered  twice  a year,  April  1st  and 
October  1st.  Class  limited  to  ten. 

PROCTOLOGY — Courses  of  two  to  three  months’  duration,  continuous  throughout  the  year. 

PLASTIC  SURGERY — Course  of  six  weeks*  duration,  offered  three  times  a year,  January  2nd,  April  1st,  and  October  1st. 
UROLOGY — Course  of  six  months  offered  twice  a year,  January  2nd  and  July  1st.  Class  limited  to  ten. 

Physicians  from  approved  medical  colleges  are  admitted  to  these  courses. 

For  descriptive  booklet  and  further  information , address 

THE  DEAN  i 313  East  Twentieth  Street  i New  York  City 


BOARD  OF  DIRECTORS:  George  Dock.,  M.D.,  Pres.;  W.  Jarvis  Barlow,  M.D.;  Stephen  Smith,  M.D. ; 

F.  C.  E.  Mattison,  M.D.  ; F.  H.  Macpherson 

Address:  STEPHEN  SMITH,  or  CHARLES  W.  THOMPSON,  Medical  Directors , Pasadena,  California 


LAS  ENCINAS  - - - EAIAEENA,  CALIL. 

A SANITARIUM  FOR  THE  TREATMENT  OF  GENERAL  AND  NERVOUS  DISEASES 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 

"three  generations  of  imbeciles  were  enough.”  Many 
who  have  no  religious  or  sentimental  objections  are  still 
unconvinced  that  the  desired  results  are  being  obtained 
by  the  operation.  The  number  of  operations  alone  might 
lead  to  false  conclusions.  Sterilizing  5000  chronic  insane 
or  hopelessly  feeble-minded  who  are  destined  to  spend 
the  rest  of  their  lives  in  institutions  is  useless.  What 
might  help  would  be  sterilizing  those  discharged  from 
institutions  who  go  back  into  the  world  where,  if  unster- 
ilized, they  might  reproduce.  E.  W.  T. 


The  Nose,  Throat  and  Ear.  By  John  F.  Barnhill.  Pp.  604. 
Illustrated.  New  York  and  London:  D.  Appleton  and 
Company,  1928. 

Barnhill’s  book  is  a very  well  rounded  work  in  ear, 
nose  and  throat.  It  is  pretty  well  up  to  date  and  the 
relation  between  general  medicine  and  the  specialty  is 
kept  in  mind  all  the  way  through. 

Anatomy  is  not  given  very  much  in  detail,  but  is  given 
so  that  it  is  very  easy  to  understand.  The  practical 
anatomy  of  the  pharynx  is  especially  well  given. 

We  find  that  it  is  quite  true,  as  Barnhill  states,  that 
the  term  adenoid  has  come  to  mean  hypertrophied 
adenoid.  He  deals  with  the  question  of  tonsillectomy  in 
an  open-minded  manner,  realizing  that  there  is  a great 
deal  of  disagreement  on  this  subject.  One  important 
point  brought  out  about  tonsillectomy  .is  the  fact  that 
most  of  the  large  tonsillar  vessels  are  found  in  the  loose 
connective  tissue  in  the  tonsillar  fossae;  if,  in  doing  a 
tonsillectomy,  one  does  not  invade  this  area,  very  little 
bleeding  is  encountered. 

A very  good  chapter  found  in  this  book,  which  is 
usually  not  found  in  such  text,  is  the  chapter  on  climate. 
Also  the  chapter  on  headaches  is  excellent. 

Laryngitis  in  children  is  not  given  as  we  see  it  in  this 
part  of  the  country.  He  does  not  give  the  usual  steps 
in  paralysis  of  the  larynx  such  as  is  given  in  most  books. 
He  gives  a good  general  idea  of  laryngoscopy,  bronchos- 
copy and  esophagoscopy,  but  of  course  not  as  it  is  given 
in  Jackson's  work.  The  chapter  on  life  insurance  is  very 
interesting. 

There  are  two  mistakes  noted — one  on  page  203  where 
there  is  a misprint,  the  word  "chemical”  should  be 
“clinical.”  On  page  445  the  author  states  that  Staphylo- 
coccus pyogenes  aureus  is  a bacillus. 

It  might  be  of  interest  to  state  that  while  in  London 
this  summer,  I noticed  that  this  book  was  fairly  popular 
in  its  sale  at  the  medical  book  stores.  A.  G.  R. 


The  Challenge  of  Chronic  Diseases.  By  Ernst  P.  Boas  and 
Nicholas  Michelson.  Pp.  197.  New  York:  The  Mac- 
millan Company,  1929.  Price  $2.50. 

The  authors  of  this  important  little  presentation  enjoy 
a position  of  authority  in  discussing  the  subject  of  the 
disposition,  care  and  treatment  of  patients  incapacitated 
by  chronic  disease.  Doctor  Boas,  as  the  attending  phy- 
sician to  the  Montefiore  Hospital  for  Chronic  Disease  in 


New  York,  has  been  an  ardent  student  and  active  con- 
tributor to  the  literature  pertaining  to  all  phases  of  this 
problem  for  the  past  decade. 

"The  scope  of  the  problem,”  he  says,  "is  indicated  by 
the  many  different  types  of  institutions  which  at  present 
serve  as  refuges  for  chronic  patients — homes  for  incur- 
(Continued  on  Page  14) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


h f*a,n  7iS‘% 

*,*  of  I®  »/*/*'  *h 

'""*</  ' ,**>Co?  if 

-he 

, j®°»»GC.  ' ‘ • 

>*' j t£zpz*,°'’ 

>n  5'?v«rifj.  *Sc6rd- 


teasP<H>n. 


lH'°cor. 


*1* 

,a*Por- 


very  ^ful, 
r ^eer  2Ur*. 

°eceSs„..do8es 


Remember 

when  you  prescribe  Syrup  of 
Thiocol  ?Roche’  for  coughs 
and  cohls  you  are  giving  your 
patients  the  benefit  of  scientific 
medication  of  well  proven 
quality  and  effectiveness  • • • • 


SYRUP 

of 

THIOCOL 

'Roche7 


At  all  pharmacies 
ill  6 oz.  prescription  bottles 
Never  advertised  to  tlie  laity 

( 10.5  g ms.  potassium  guaiacol sulphonate  in  100  cc.) 

HofFmann-La  Roche,  Inc. 

SMakers  of  ^Medicines  of  1{are  Quality 
NUTLEY  NEW  JERSEY 


COUNCIL 

ACCEPTED 

A trial  supply 
sent  to 
physicians 
on  request 

ttff 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 
Telephone  Main  7676 

Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


SAINT  FRANCIS  HOSPITAL 

AND 

SCHOOL  OF  NURSING 

A General  Hospital  With  Accommodations  for  Three  Hundred  Patients 

DIRECTORS 

JOHN  GALLWEY,  M.  D.  W.  W.  WYMORE,  M.  D. 

W.  B.  COFFEY,  M.  D.  JOHN  H.  GRAVES,  M.  D. 

THOS.  E.  SHUMATE,  M.  D.  M.  O.  AUSTIN,  M.  D. 

Managing  Director,  L.  B.  ROGERS,  M.  D. 

Address  Communications 

SAINT  FRANCIS  HOSPITAL 

Bush  and  Hyde  Streets  Telephone  PROSPECT  7600  San  Francisco 


J.  H.  O’CONNOR,  M.  D 
B.  A.  MARDIS,  M.  D. 
H.  E.  MANWARING 


ELASTIC  HOSIERY 

Seamed  or  Seamless 

Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 

Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  / TRUSSES  / ELASTIC  WEAR 


BOOK  REVIEWS 


(Continued  from  Page  12) 

ables,  almshouses,  city  infirmaries,  homes  for  the  aged 
and  infirm.  They  all  minister  to  the  same  class  of  indi- 
viduals, but  hardly  one  of  these  institutions  has  made 
a study  of  the  medical  needs  of  the  inmates  in  an  attempt 
to  fill  its  patent  obligations.  The  individual  suffering  from 
a chronic  ailment  is  preeminently  an  institutional  charge, 
for  whom  in  only  the  rarest  instances  the  proper  facili- 
ties have  been  provided.” 

Having  stressed  the  important  medical  aspects  of 
chronic  disease  and  pointed  out  the  widespread  indiffer- 
ence in  this  country  to  this  class  of  patients,  the  authors 
present  a comprehensive  plan  comprising  the  following 
units — administration,  service,  employees,  hospital  and 
custodial,  which  offers  valuable  principles  and  suggestions 
in  the  construction  of  a modern,  well  equipped  institution 
for  the  care  and  study  of  chronic  disease.  This  is  fol- 
lowed by  a section  on  the  medical  organization  of  such 
an  institution  and  many  pertinent  and  significant  obser- 
vations are  marshalled.  For  example,  to  make  the  work 
in  a chronic  hospital  attractive  to  the  medical  staff  it  is 
suggested  that  each  physician  be  given  a comparatively 
large  service  so  that  the  greater  number  of  beds  com- 
pensates in  part  for  the  slow  turnover  of  patients.  The 
most  important  measure,  however,  which  will  be  sure 
to  build  up  a strong  medical  staff  is  the  provision  of 
adequate  resources  for  complete  diagnostic  study  and 
investigation.  This  I can  heartily  agree  with,  since  it  is 
my  opinion  that  nothing  stifles  the  alert  physician’s 
interest  more  than  inadequate  facilities  for  the  most 
complete  and  exhaustive  work-up  of  unusual  cases. 

Because  the  material  of  this  book  comes  from  the  per- 
sonal experience  of  the  authors  it  is  convincing  and  cer- 
tainly deserves  the  careful  consideration  not  only  of  the 
medical  profession  but  also  of  the  many  social,  economic 
and  other  communal  forces  which  have  to  do  with  the 
problem  of  the  disposition  of  chronic  medical  diseases. 

E.  S.  duB. 


Clark-Gandion  Go.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
322  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


Materia  Medica  and  Therapeutics  Including  Pharmacy 
and  Pharmacology.  By  Reynold  Webb  Wilcox. 
Twelfth  edition.  Pp.  690.  Philadelphia:  P.  Blakiston’s 
Son  & Co.,  Inc.,  1929. 

This  twelfth  edition  of  a recognized  standard  textbook 
has  been  carefully  revised  and  brought  up  to  date.  The 
author  still  displays  his  qualities  of  a good  teacher,  as 
well  as  his  intimate  knowledge  of  the  practical  needs 
(Continued  on  Page  16) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


- “The  Lawyer  for  my  patient  put  me  in  a hole.  Instead  of 
bringing  suit  against  me  alleging  malpractice,  he  worded  the 
complaint  to  read  that  in  accepting  this  patient  (as  is  true 
whenever  any  Doctor  accepts  any  patient)  I had  entered  a 
contract  (not  in  writing  but  by  the  usual  unwritten  unex- 
pressed understanding)  to  exercise  a reasonable  degree  of  care 
and  skill  in  treating  this  patient,  that  I had  failed  to  use  rea- 
sonable care  and  skill,  that  I had  therefore  breached  the  con- 
tract with  this  patient.  He  not  only  asked  for  the  return  of 
all  fees  paid  but  also  for  the  payment  of  damages  to  compen- 
sate for  the  injury  resulting  from  the  alleged  breach  of  contract. 
I notified  my  insuring  company  but  they  denied  liability, 
claiming  that  their  malpractice  contract  does  not  cover 
‘breach  of  contract’  cases.” 

Whole — The  Medical  Protective  Contract  covers  “breach  of  con- 
tract” and  “property  damage”  cases  resulting  from  profes- 
sional services,  as  well  as  many  other  liabilities  not  covered 
elsewhere. 

fYow  can’t  have  a hole  in  your  protection  T 
and  still  have  whole  protection. 

‘"TdJjg  Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Boulevard  : Chicago,  Illinois 


MEDICAL  PROTECTIVE  CO. 

360  North  Michigan  Blvd. 
Chicago,  111. 

Address 

Kindly  send  details  on  your  plan  of 
Complete  Professional  Protection 

4-30 

i6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ANNOUNCEMENT 


OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION,  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION,  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FULGU RATION  OF  BLADDER  TUMORS,  ETC., 
WILL  BE  GIVEN. 


LOUIS  CLIVE  JACOBS,  M.  D.,  Urologist 


FOURTEENTH  FLOOR-FOUR-FIFTY 
SUTTER 

SAN  FRANCISCO,  CALIFORNIA 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  DAvenport  7322 


SUGARMAN  CLINICAL  LABORATORY 


450  Sutter  Street 


SUITE  1439 


San  Francisco,  Calif. 


Telephone:  DAvenport  0342 


Emergency:  WEst  1400 


For  Your  Own  Surgery 

NON-TOXIC  used  in  leading  NON-CAUSTIC 

PACIFIC  COAST  HOSPITALS 

Write  for  Sample 

HEXOL,  INC.,  1040  Larkin  Street,  San  Francisco,  California 

FRANKLIN  1012 


BOOK  REVIEWS 


(Continued  from  Page  14) 

of  the  physician.  This  new  edition  maintains  its  prac- 
tical values  in  being  very  complete  as  well  as  concise. 
The  arrangement  of  the  book  should  also  be  appreciated; 
it  seems  admirably  suited  for  a quick  reference,  and  one 
cannot  help  but  be  relieved  at  not  seeing  lists  of  occa- 
sionally used  or  possible  drugs  for  various  symptoms  and 
conditions.  Each  drug  is  adequately  described  in  its 
physical  and  physiological  properties.  The  clinical  uses, 
as  described  in  the  second  part  of  the  book,  make  one 
feel  that  for  very  little  effort  a very  complete  information 
is  obtained.  The  index  of  symptoms  adds  materially  to 
the  value  as  a quick  reference  without  confusion.  The 
book  is  suited  as  a good  text  for  the  student,  who  having 
become  familiar  with  its  arrangement  can  ever  have, 
close  at  hand,  the  necessary  knowledge  of  practically  all 
the  drugs  now  used  in  the  practice  of  medicine. 

E.  C.  T. 


Pettibone’s  Textbook  of  Physiological  Chemistry.  (With 
Experiments.)  By  J.  F.  McClendon.  Pp.  368.  Fourth 
edition.  St.  Louis:  The  C.  Y.  Mosby  Company,  1929. 
Price  $3.75. 

It  frequently  happens  that  the  busy  physician,  several 
years  removed  from  his  medical  school  training,  desires 
a rapid  survey  of  the  current  ideas  on  various  phases 
of  the  medical  sciences.  The  large  detailed  texts  on  these 
subjects  usually  are  too  formidable  for  him.  There  is, 
however,  a real  need  for  a series  of  condensed  but 
authoritative  works  covering  the  significant  points  of 
view  in  the  medical  sciences  for  the  purpose  of  affording 
rapid  review  to  the  average  practitioner. 


In  the  field  of  physiological  chemistry,  McClendon’s 
revision  of  Pettibone’s  text  affords  an  excellent  example 
of  such  an  effort.  Two-thirds  of  the  book  are  concerned 
with  a general  consideration  of  current  viewpoints  in 
physiological  chemistry  while  the  latter  portion  of  the 
book  is  concerned  with  laboratory  work  and  a well 
selected  set  of  references  to  standard  authorities.  De- 
signed as  an  introduction  to  physiological  chemistry  for 
medical  students,  the  book  gives  an  excellent  survey 
of  the  field  for  the  physician  as  well.  Advance  in  bio- 
chemistry has  been  so  rapid  that  unless  an  individual 
keeps  in  constant  touch  as  a specialist  with  the  literature 
in  the  field,  he  quickly  falls  far  out  of  touch  with  the 
important  practical  developments  which  may  be  used 
daily  in  the  clinic. 

The  discussion  of  the  significant  aspects  of  physical 
chemistry  for  biological  application  is  extremely  simple 
and  well  arranged.  The  chief  types  of  foodstuffs  are  quite 
well  discussed  and  there  is  then  a systematic  discussion 
of  digestion,  absorption,  excretion  and  general  metab- 
olism. The  work  is  by  no  means  a complete  survey  of 
the  field  nor  is  it  designed  to  be.  For  the  student  it  is 
a stimulating  work  raising  many  questions  which  would 
be  sure  to  excite  his  interest,  and  for  the  practicing  phy- 
sician it  is  an  excellent  summary,  very  briefly  and  simply 
presented,  of  a field  that  frequently  is  considered  more 
difficult  to  understand  than  it  really  is.  C.  D.  L. 


Modern  Methods  of  Treatment.  By  Logan  Clendening. 
Third  edition.  Pp.  815.  Illustrated.  St.  Louis:  C.  V. 
Mosby  Company,  1929.  Price  $10. 

Tremendous  is  the  task  Clendening  cut  out  for  himself 
and  yet  he  has  performed  it  excellently.  The  book  is  a 
mine  of  information  and  almost  completely  fulfills  the 
(Continued  on  Page  18) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


'7 


XI  B PC 

(Ethyl  D i i o d o b r a s s i d a t e ) 


Instead  of  Alkaline  Iodides 

Lipoiodine,  “Ciba”  is  particularly  valuable  in  treatments 
of  long  duration  because  of  the  absence  of  irritation  in 
the  digestive  tract  and  because  of  the  absence  of  iodism 
when  administered  in  therapeutic  doses.  The  modern 
way  of  prescribing  the  iodides  is  to  specify  Lipoiodine, 
“Ciba”  Tablets.  They  are  issued  in  tubes  of  20’s  and 
in  bottles  of  100’s — each  tablet  contains  0.3  gram 
(approximately  4V2  grains)  of  pure  Lipoiodine,  “Ciba”. 

Thorough  Distribution  No  Iodism  in  Therapeutic  Doses 
Complete  Absorption  No  Gastric  Irritation 

Pleasant  Tasting  Unusually  Slow  Elimination 

I Lipoiodine, “Ciba”  is  accepted  by  the 
Council  on  Pharmacy  and  Chemistry 
of  the  American  Medical  Association 


CIBA  COMPANY,  INC.,  NEW  YORK  CITY 


i8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


CANYON  SANATORIUM 

REDWOOD  CITY,  CALIFORNIA 


An  Open  Air  Sanatorium  for 
the  Treatment  of  Tuberculosis 


NESTLED  IN  THE  FOOTHILLS 


For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  Douglas  4486 


The  Scripps 
Metabolic  Clinic 

For  the  treatment  and  investigation  of: 

Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


BOOK  REVIEWS 


(Continued  from  Page  16) 

author’s  promise  “to  furnish  an  outline  of  all  the  methods 
of  treatment  used  in  internal  medicine.” 

This  he  does  in  no  desultory  fashion.  Details  of  diet, 
hydrotherapy,  procedures  such  as  lumbar  puncture, 
thoracentesis  and  the  like,  are  given  with  meticulous 
care.  The  reviewer  considers  the  volume  a most  valuable 
addition  to  the  shelf  of  any  practitioner  or  any  senior 
medical  student.  Just  to  fulfill  one  of  the  functions  of  a 
reviewer,  i.  e.,  to  find  something  at  which  to  cavil,  we 
wish  that  in  discussing  the  treatment  of  angina  pectoris, 
the  author  had  made  some  mention  of  the  surgical  pro- 
cedures which  have  attained  some  importance. 

H.  W. 


Hookworm  Disease:  Its  Distribution,  Biology,  Epidemiol- 
ogy, Diagnosis,  Treatment  and  Control.  By  Asa  C. 
Chandler.  Pp.  476.  Illustrated.  New  York:  The  Mac- 
millan Company,  1929. 

Professor  Chandler  condenses  into  476  well  written 
pages,  a complete  and  up-to-date  description  of  hook- 
worm disease,  with  very  adequate  bibliography  and 
appendices.  The  material  is  logically  assembled,  splen- 


didly edited  and  the  volume  is  written  in  the  usual  clear 
and  pleasant  style  of  this  author.  The  thing  which  gives 
particular  value  is  the  fact  that  the  author  spent  three 
years  in  India,  doing  intensive  work  on  hookworm  dis- 
ease. These  extended  personal  studies  in  a foreign  hot- 
bed of  hookworm  infection  lend  an  authority  to  the 
opinions  and  recommendations  which  is  not  to  be  found 
under  any  other  conditions.  The  practical  value  of  the 
book  is  therefore  very  great. 

Every  physician  in  whose  practice  hookworm  disease 
may  be  expected  to  occur,  and  of  course  every  teacher 
and  worker  in  general  parasitology,  will  be  well  advised 
to  find  a place  for  this  volume  on  his  bookshelf. 

A.  C.  R. 


Posture  and  Hygiene  of  the  Feet.  By  Philip  Lewin.  (The 
National  Health  Series,  edited  by  The  National  Health 
Council.)  Pp.  47.  Illustrated.  New  York  and  London: 
Funk  and  Wagnalls  Company,  1929. 

This  book  is  written  by  one  well  qualified  because  of 
his  vast  experience.  It  is  written  for  the  layman.  The 
text  is  in  clear  and  simple  English,  the  illustrations  are 
clear  and  there  are  enough  of  them.  Arrangement  is 
excellent,  starting  with  the  hygiene  of  the  feet,  the  care, 
shoeing,  and  ending  with  a discussion  of  abnormalities. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19 


The  Doctors  Business  Bureau 

701-705  Balboa  Building 

SAN  FRANCISCO,  CALIFORNIA 

Fourteen  years  of  successful  and  satisfactory  service  to  doctors. 

More  than  eighteen  hundred  members  of  the  California  Medical  Association  are  using  the 
Bureau  to  their  advantage. 

At  the  urgent  solicitation  of  doctors  in  Sonoma  County  and  vicinity  an  office  has  been  estab- 
lished at  Santa  Rosa. 

( Ask  the  Sonoma  County  Medical  Society  about  it.) 

Collection  stamps  service  for  your  own  office  use  is  recommended  for  economy  and  efficiency. 
Every  account  referred  to  the  Bureau’s  Collection  Department  receives  the  most  careful  and 
confidential  personal  attention. 

TELEPHONE  OR  WRITE  FOR  PARTICULARS 

COLLECTION  DEPARTMENT 

THE  DOCTORS  BUSINESS  BUREAU 

Balboa  Building,  San  Francisco,  California 

SANTA  ROSA  Phone  GARFIELD  0460  LOS  ANGELES 

BONDED  LICENSED 


The  chapter  on  flat  feet  is  excellent  and  by  far  the 
best  in  the  book. 

The  only  possible  criticism  is  the  occasional  use  of 
technical  terms  without  sufficient  explanation,  i.  e.,  the 
shank  of  the  shoe.  (Terms  that  should  be  familiar  to  all 
laymen,  but  so  often  are  not.)  An  excellent  book  for  the 
general  public.  R.  L.  D. 


Midway  Point,  Seventeen-Mile  Drive 


Alum  Rock  Sanatorium 
TUBERCULOSIS 


California’s  First  Theater,  Monterey. — This  was 
one  of  California’s  proudest  spots  in  early  days.  Here 
Spaniards,  Mexicans,  and  Americans  gathered  for 
entertainment  and  diversion.  In  1847  strolling  Thes- 
pians from  Los  Angeles  played  here  in  the  long-for- 
gotten drama,  “Putnam,  or  the  Lion  Son  of  ’76.”  In 
1849  and  1850  one  of  America’s  most  famous  early 
humorists  regaled  audiences  here.  “John  Phoenix” 
and  “Squibob”  he  was  called,  though  his  name  was 
Lieutenant  John  Derby.  Here  the  beloved  Jenny 
Lind  is  supposed  to  have  sung  on  her  American  tour 
in  1850-52.  This  building  is  now  used  as  an  historical 
museum. 


Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 

RATES  AND  FOLDER  ON  APPLICATION 


Consultants: 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Model  B-l 

(Actual  Size) 

Automatic  type  holder,  with 
magazine  for  suture  ma- 
terial, in  lengths  of  from 
eight  to  twenty  feet.  Su- 
ture passes  from  glass 
container  into  hollow 
needle  by  pressure  of 
surgeon’s  thumb  on 
reel,  or  feed  screw. 


Waiss  Hollow  Surgical  Needles  are  furnished  in  all  standard 
sizes  and  types,  with  three  models  of  holders. 


SURGEONS  MAY  USE  THEIR  OWN  PARTICULAR  BRAND  OF 
SUTURES  WITH  ANY  ONE  OF  THE  WAISS  NEEDLES, 

IF  SO  DESIRED. 


the  inconveniences  and  shortcomings  of 
the  ordinary  surgical  needle  have  been  elimi- 
nated by  the  WAISS  HOLLOW  SURGICAL 
NEEDLE  and  HOLDER  now  being  successfully 
used  by  surgeons  in  suturing.  Five  outstanding 
features  of  this  modern  instrument  are: 

1.  No  doubling  of  suture. 

2.  Suture  is  not  "yanked”  through  wound. 

3.  The  front  end,  not  the  last  end,  of  the 
suture  is  used. 

4.  Suture  is  deposited  in  wound  or  incision, 
ready  for  tying. 

5.  All  annoyance  with  needle  carrier  is  ban- 
ished. 


Write  today  for  free  copy  of  booklet  containing  com- 
plete information  and  photographs  of  the  Waiss 
Hollow  Surgical  Needles  and  Holders,  a safe,  efficient 
suturing  instrument. 


Waiss  instruments  are  rust-proof, 
tarnish-proof  and  stainless,  and  are 
guaranteed  to  be  free  of  mechan- 
ical defects. 


Brackwood  Corporation,  Ltd. 

6331  Hollywood  Boulevard 

LOS  ANGELES  CALIFORNIA 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


21 


, You  Physicians  Who  Play  Golf, 


You  Know  There9 s a Club  for  Every  Stroke 


^n^LMOST  any  player  can  swing  around  the  course 
^ with  a single  club,  dubbing  drives,  lifting  fair- 
way sods  and  bringing  home  a century  mark  or  more 
for  the  final  score.  But  the  finished  golfer  needs  a 
club  for  every  shot — a studied  judgment  of  approach 
or  putt  before  the  club  is  selected. 


Similarly  in  artificial  infant  feeding.  For  the  normal 
infant,  you  prefer  cow’s  milk  dilutions.  For  the 
athreptic  or  vomiting  baby,  you  choose  lactic  acid 
milk.  When  there  is  diarrhea  or  marasmus,  you  decide 
upon  protein  milk.  In  certain  other  situations,  your 
judgment  is  evaporated  milk. 


. 


s 


! 


Dextri-Maltose  is  the  carbohydrate  of  your  choice  for 
balancing  all  of  the  above  “strokes”  or  formulae  and 
aptly  may  be  compared  with  the  nice  balance  offered 
the  experienced  player,  by  matched  clubs. 

To  each  type  of  formula  (be  it  fresh  cow’s  milk, 
lactic  acid  milk,  protein  milk,  evaporated  or  powdered 
milk),  Dextri-Maltose  figuratively  and  literally  supplies 

the  nicely  matched  balance  that  gets  results ♦ 

MEAD  JOHNSON  & COMPANY,  Evansville,  Ind.,U.S.A.  6m| 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 
by  mouth.” 


ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 

ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


ALQUA  WATER — In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 

To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 


Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 


The  Shasta  Water  Company 

Bottlers  and  Controlling  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 

At  All  Druggists 


SOUTHERN  SIERRAS  SANATORIUM 

For  Tuberculosis  and  Allied  Affections 

BANNING,  CALIFORNIA 

Climate  Favorable  Throughout  The  Year 


Many  aids  for  comfort  and  convenience. 
Simmons’  Beautyrest  mattresses  throughout. 
Radio  connection  in  each  apartment. 


Tempting,  tasteful  foods  prepared  by  a woman  cook. 
Special  dietaries  when  required. 

A spot  of  beauty  in  an  atmosphere  of  contentment. 


RATES  WITHIN  THE  MEANS  OF  THE  AVERAGE  PATIENT 
A REPUTATION  FOR  SERVICE  AND  SATISFACTION 

Charles  E.  Atkinson,  M.  D. 

Medical  Director 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


23 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


BENJAMIN  H.  DIBBLEE 
President 


I.  C.  KNOWLTON 
Secretary 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 

W.  G.  Moore,  M.D. 

Harold  P.  Hill,  M.D. 

Geo.  D.  Lyman,  M.D. 

Howard  H.  Johnson, 
M.  D.,  Med.  Dir. 
Secretary,  Executive 
Committee. 


TRUTH  ABOUT  MEDICINES 
New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

United  States  Standard  Products  Company  Diph- 
theria Toxin-Antitoxin  Mixture,  O.  I.  L.  + (Nonsensi- 
tizing).— Prepared  from  sheep  serum. 

Robert  McNeil. — Tincture  Digitalis  Duo-Test  (Mc- 
Neil); Black  Capsules,  Digitalis  Duo-Test  (McNeil). 

Mead’s  Viosterol  in  Oil  One  Hundred  D. — A brand 
of  viosterol  in  oil  100  D,  New  and  Nonofficial  Reme- 
dies (Jour.  A.  M.  A.,  August  31.  1929,  p.  693).  Mead 
Johnson  & Company,  Evansville,  Indiana. 

Lenigallol-Zinc  Ointment.  — It  contains  lenigallol 
(Jour.  A.  M.  A.,  April  6,  1929,  p.  1181),  six  per  cent 
in  a base  composed  of  zinc  oxid  ointment — United 
States  Pharmacopeia.  E.  Bilhuber,  Inc.,  New  York. 

Typho-Serobacterin — Mulford  (Sensitized  Typhoid 
Vaccine)  (New  and  Nonofficial  Remedies,  1929, 
p.  384). — This  product  is  also  marketed  in  packages  of 
three  syringes,  being  three  immunizing  doses.  H.  K. 
Mulford  Company,  Philadelphia. — Jour.  A.  M.  A., 
February  1,  1930,  p.  339. 

FOODS 

The  following  products  have  been  accepted  as  con- 
forming to  the  rules  of  the  Committee  on  Foods  of 
the  Council  on  Pharmacy  and  Chemistry  of  the 
American  Medical  Association.  These  products  are 
approved  for  advertising  in  the  publications  of  the 
American  Medical  Association,  and  for  general  pro- 
mulgation to  the  public. 

Junket  (The  Junket  Folks,  Chr.  Hansen’s  Labora- 
tory, Inc.,  Little  Falls,  New  York). — To  prepare  the 
product  of  dried  blown  or  dried  salted  rennets  in 
ordinary  salt  brine  is  extracted.  The  enzyme  is  then 
precipitated  by  salting  to  saturation,  and  the  result- 
(Continued  on  Page  26) 


HAY 

FEVER 

has  been  prevented  in 
thousands  of  cases  with 

Pollen  Antigen 

J&ederle 

Each  year  has  added  evidence  to  the  value 
of  this  product  in  the  prevention  or  relief 
from  symptoms  of  Hay  Fever,  and  each 
year  an  increasing  number  of  physicians 
have  familiarized  themselves  with  the  Hay 
Fever  problem  and  are  relieving  patients 
of  their  seasonal  attacks. 

Full  information  upon  request 

Lederle  Antitoxin  Laboratories 

NewYohk 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  MArket  0331 


Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with 
especial  reference  to  parasites. 

Containers  will  be  fur- 
nished upon  request. 

HERBERT  GUNN,  M.  D. 

2000  Van  Ness  Avenue 

San  Francisco  Telephone:  GRaystone  1027 


Shumate’s 

PRESCRIPTION  pharmacies 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 
Refrigerated  Biologies  r Prescription 
Technique 

Catering  to  the  Medical  Profession  Since  1890 
SAN  FRANCISCO 


We  solicit  correspondence  from  physicians 
regarding  pharmaceutical  and  proprietary 
preparations. 

-4>- 

LENGFELD’S  PHARMACY 

216  Stockton  Street  San  Francisco,  Calif. 

Telephone  SUtter  0080 


HOLLAND-RANTOS 
COMPANY,  Inc. 

Gynecological  and  Obstetrical 
Specialties 

Descriptive  Leaflets,  Reports  and  Price  List 
Send  on  Request 


156  FIFTH  AVENUE 


NEW  YORK  CITY 


Hazel  E.  Furscott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  DOuglas  9124-  380  Post  St. 

San  Francisco,  California 


THE  HILL- YOUNG  SCHOOL 
OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi- 
culty. Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child’s 
physician.  Testimonials  from  physicians. 

School  Publications — S2.00  each:  "Overcoming  Cleft 
Palate  Speech,”  "Help  for  You  Who  Stutter.” 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 
2809-15  South  Hoover  Street  WEstmore  0512 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


DIET  QUESTIONS  have  GELATINE  ANSWERS 


VARYING  THE  MONOTONY 
OF  THE  LIQUID 
AND  SOFT  DIET! 


KNOX 

is  the  real 

GELATINE 


Most  physicians— and  patients— will  agree  that 
for  cheerless  monotony  nothing  quite  equals  the 
liquid  and  soft  diet.  But  medical  science  now 
knows  that  it  is  no  longer  necessary  to  confine 
the  patient  strictly  to  a tiresome  broth,  milk  and 
egg-nog  regime. 

Pure,  granulated  unflavored  gelatine— for  ex- 
ample, Knox  SparklingGelatine— has  been  found 
of  inestimable  value  in  varying  the  liquid  and 
soft  diet  while  at  the  same  time  supplying  the 
essential  elements  of  nutrition. 

Pure  gelatine  prevents  precipitation  in  the  pres- 
ence of  acids  or  salts  — as  in  the  digestive  juices 
—and  is  itself  digested  and  absorbed  with  mini- 
mum effort.  Knox  Sparkling  Gelatine  has  a food 
value  of  approximately  120  calories  per  ounce 
or  4.3  calories  per  gram.  Care  should  be  taken, 
however,  to  insure  that  the  gelatine  used  is  the 
real,  unflavored,  unsweetened,  unbleached  gel- 
atine—in  other  words,  Knox  Sparkling  Gelatine. 

Please  notice  the  attached  coupon.  If  you  will  mail  it  we 
shall  be  glad  to  send  you  data  prepared  by  one  of  the 
country’s  leading  dietitians  on  how  to  prepare  attractive, 
palate-tempting  dishes  with  Knox  Gelatine  in  correct 
caloric  proportions. 


KNOX  GELATINE  LABORATORIES 
117  Knox  Avenue,  Johnstown,  N.  Y. 

Please  send  me,  without  obligation  or  expense,  the  booklets  which  I have 
marked.  Also  register  my  name  for  future  reports  on  clinical  gelatine  tests 
as  they  are  issued. 

□ Varying  the  Monotony  of  Liquid  and  Soft  Diets.  □ Recipes  for  Anemia. 

□ Diet  in  the  Treatment  of  Diabetes.  □ Reducing  Diet. 

□ Value  of  Gelatine  in  Infant  and  Child  Feeding. 

Name 

Address 

City ¥ 

State - 


26 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


BOULITTE 

ELECTROCARDIOGRAPH 

The  R.  L.  Scherer  Company  has  now  added  the  agency  for  the  "BOULITTE” 
Cardiograph  to  their  other  exclusive  lines.  Prompt  and  expert  service  at 
either  Los  Angeles  or  San  Francisco.  Necessary  replacement  parts  carried 
in  stock. 


SHOCKPROOF  FLUOROSCOPIC 

APPARATUS 

The  Wappler  Electric  Company  now  make  a complete  line  of  Shockproof 
Fluoroscopic  Apparatus.  For  information,  write  or  phone: 

R.  L.  SCHERER  COMPANY 


736  South  Flower  Street 

Los  Angeles,  California 
TRINITY  6377 


679  Sutter  Street 

San  Francisco,  Calif. 
PROSPECT  3248 


CARL  ZEISS,  JENA 

MICROSCOPES 

Represent  the  finest  possible  craftsmanship,  opti- 
cally and  mechanically,  in  the  microscope  field. 
Priced  from  $128.00  up.  Terms  if  desired. 

Trainer-Parsons  Optical  Co. 

228  POST  STREET  SAN  FRANCISCO 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  23) 

ing  precipitate  is  mixed  with  pure  Worcester  salt, 
dried  and  pressed  into  tablets.  Flavored  Junket  con- 
sists of  rennet  powder,  similar  to  that  used  for  Junket 
Tablets,  except  that  this  is  mixed  with  cane  sugar 
and  natural  flavoring.  While  the  rennin  enzyme  itself 
does  not  add  to  the  fuel  value  of  milk,  it  makes  it 
more  wholesome  because  of  its  digestive  action  on 
the  milk. 

Spintrate  (Spinach  Concentrate)  (Spinach  Products 
Company,  Inc.,  Norfolk,  Virginia). — Spinach  in  the 
form  of  a fine  powder  made  from  fresh  spinach  of 
the  Savoy  or  curly  leaf  type.  Spintrate  is  an  excel- 
lent source  of  food  iron,  calcium,  and  phosphorus; 
it  is  also  a rich  source  of  vitamin  A,  B (Bi)  and  G 

(BA- 

Whitefield  Genuine  Grapefruit  Juice  (Whitefield 
Citrus  Corporation,  Long  Island  City,  New  York). — 

This  is  pure  undiluted  juice  of  sun-ripened  grapefruit 
and  contains  no  added  preservatives.  The  process  of 
manufacture  preserves  the  original  character  of  the 
juice. 

Whitefield  Genuine  Orange  Butter  (Whitefield 
Citrus  Corporation,  Long  Island  City,  New  York). — 

This  is  an  orange  preserve  with  a new  and  different 
flavor  and  consistency  made  from  tree-ripened  fruit. 

Aunt  Jemima  Pancake  Flour  (The  Quaker  Oats 
Company,  Chicago).- — The  product  is  a mixture  of 
four  flours — wheat,  corn,  rye,  rice — with  sugar,  milk, 
baking  powder,  and  salt. 

Aunt  Jemima  Buckwheat,  Corn,  and  Wheat  Flour 
(The  Quaker  Oats  Company,  Chicago). — This  is  a 
buckwheat,  corn,  and  wheat  flour. 

Quaker  Crackels  (The  Quaker  Oats  Company, 
Chicago). — This  is  composed  of  corn,  wheat,  and  oats. 

Quaker  Quick  Macaroni  (The  Quaker  Oats  Com- 
pany, Chicago). — This  is  a new-type  macaroni.  A 
(Continued  on  Page  28) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


The 

Hay  fever 
Season 
is  just 
around 
the  corner 


_ R Squibb  & Sons,  New  York 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858. 


Highly  satisfactory  results  have  been  reported  from  the  treatment  of  hay  fever 
by  pollen  extracts  when  properly  and  timely  used.  When  results  are  disappointing 
it  is  often  because  of  failure  to  administer  the  treatments  sufficiently  far  in  advance 
of  the  hay  fever  season. 

Treatments  for  the  desensitization  of  hay  fever  patients  should  commence  not 
less  than  from  five  to  six  weeks  before  the  expected  onset  of  the  attack,  and  unless 
pre-seasonal  and  seasonal  treatments  are  strictly  followed,  the  expected  results  will 
not  be  wholly  satisfactory. 


Pollen  Allergen  Solutions  Squibb 
used  for  the  prevention  and  treatment  of  hay  fever 


Squibb’s  Diagnostic  Pollen  Allergen  Solutions 
afford  the  means  for  determining  the  causative  pollen 


Pollen  Allercen  Solutions  Squibb  are  supplied  in  Treatment  Sets  consisting 
of  10  graduated  doses  and  ampuls  of  sterile  salt  solution  for  making  the  necessary 
dilutions;  also  in  3 vial  packages  containing  solutions  of  strengths  which  enable  the 
physician,  without  further  dilution,  to  administer  a complete  course  of  treatment. 

Special  information  concerning  the  use  of  Pollen  Allergen  Solutions  Squibb 
for  the  diagnosis  and  treatment  of  hay  fever  will  be  supplied  to  physicians  upon 
request. 

Address  the  Professional  Service  Department. 


28 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ACHIEVED  E/NTS 


Compound  Syrup  of  t • t 

Caicreose  which  meet  your 


Tablets 
Caicreose 
4 grains 

Each  tablet  contains  2 
grains  of  pure  creosote 
combined  with  hy- 
drated calcium  oxide. 


Alcohol  5 Per  Cent 
Each  fluid  ounce 
Represents: 
Alcohol — 24  Mins. 
Chloroform  Ap' 
proxvmately 
3 Mins. 

Caicreose  Solution 
160  Mi  ns. 
(Equivalent  to  10 
mins,  of  creosote) 
Wild  Cherry  Bar\ 
20  grs. 

Peppermint  Aro • 
mattes  and  Syrup 
q.  s. 

Tasty,  effective,  does 
not  nauseate. 


therapeutic  requirements! 


HEN  Maltbie  made  Caicreose  available  for 
the  treatment  of  Bronchitis,  Tuberculosis,  In- 
testinal and  Urinary  Affections,  the  medical  profes- 
sion was  given  a produd:  through  which  the  full 
therapeutic  effect  of  creosote  could  be  secured  even 
though  the  patient  may  have  a sensitive  stomach. 

Caicreose  is  a loose  chemical  combination  of  pure 
creosote  and  hydrated  calcium  oxide.  The  creosote 
is  slowly  released  from  Caicreose  and  this  provides  a 
prolonged  and  effective  adion  which  is  very  helpful. 
Leading  druggists  carry  Tablets  Caicreose  4 grs.  and 
Compound  Syrup  of  Caicreose  for  prescription 
purposes.  Samples  gladly  mailed  to  Physicians. 

Maltbie  Chemical  Company,  Newark,  New  Jersey 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  26) 

milk-containing  macaroni  that  cooks  in  five  minutes 
instead  of  twenty. — Journal  A.  M.  A.,  February  8, 
1930,  p.  411. 

Borden’s  Evaporated  Milk  (The  Borden  Company, 
New  York  City). — It  has  the  following  average  com- 
position: fat,  7.85  per  cent;  protein,  6.88  per  cent; 
carbohydrates,  9.67  per  cent;  ash,  1.55  per  cent;  total 
solids,  25.95  per  cent;  water,  74.05  per  cent.  The 
product  is  manufactured  from  whole  milk.  Borden’s 
Evaporated  Milk  is  advertised  for  infant  feeding  and 
for  household  use  in  making  milk  convenient  for 
cooking.  It  is  claimed  that  the  milk  is  clean  and 
sterile;  that  it  resembles  breast  milk  in  ease  of  diges- 
tion; and  that  it  produces  fine  flocculent  curds. 

Cream  of  Wheat  (Cream  of  Wheat  Company, 
Minneapolis). — It  is  a product  made  entirely  from 
wheat.  It  consists  of  tbe  endosperm  of  the  wheat, 
with  only  so  much  of  the  bran  and  germ  as  it  is 
impossible  to  remove.  The  product  is  used  because 
it  is  rich  in  energy  content  and  easily  digested. 

Gerber’s  Strained  Vegetable  Products  (Gerber 
Products  Division,  Fremont  Canning  Company,  Fre- 
mont, Michigan). — Brands:  Gerber’s  Strained  Spin- 
ach, Strained  Carrots,  Strained  Green  Beans,  Strained 
Peas,  Strained  Prunes,  Strained  Tomatoes,  and 
Strained  Vegetable  Soup.  Specially  selected  vege- 
tables, steam-pressure  cooked  and  sterilized  at  high 
temperature.  It  is  claimed  that  by  excluding  air  and 
cooking  under  steam  pressure  without  water  a greater 
conservation  of  mineral  salts  and  vitamin  elements  is 
effected. 

The  New  Pettijohn’s  (The  Quaker  Oats  Company, 
Chicago). — This  product  consists  of  the  whole  wheat 
grain.  It  is  obtained  by  steaming  and  flaking  wheat 
which  has  a tender  bran,  the  bran  being  included  in 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


29 


LIVERMORE  SANITARIUM 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
and  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 

GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational 
Department. 

S.  A resident  medical  staff.  A large  and  well  trained  nursing  staff  so  that  each  patient  is  given  careful 
Individual  attention. 

Information  and  circulars  upon  request  CITY  OFFICES: 

Address:  CLIFFORD  W.  MACK,  M.  D.  San  Francisco  Oakland 

Livermore!  cIlTfoTn.a  450  Sutter  Street  1624  Frankiin  Street 

Telephone  7-J  KEarny  6434  GLencourt  5989 


unground  form.  The  product  contains  all  the  nutri- 
tive elements  of  whole  wheat. 

Post’s  Bran  Flakes  With  Other  Parts  of  Wheat 
(Postum  Company,  Inc.,  Battle  Creek,  Michigan). — 

The  product  is  composed  of  bran  flakes  with  other 
parts  of  wheat,  flavored  with  malt  syrup  and  salt.  It 
combines  the  advantages  of  wheat  bran  in  a nourish- 
ing and  appetizing  food. — Jour.  A.  M.  A.,  February  15, 
1930,  p.  485. 

Muffets  (Irradiated)  (Quaker  Oats  Company,  Chi- 
cago).— Whole  wheat,  cooked,  crushed,  drawn  out  to 
filmy  ribbon  of  wheaten  threads.  Wound  round  and 
round,  baked  and  toasted.  Muffets  (Irradiated)  makes 
vitamin  D available  in  a breakfast  food  for  all  ages 
except  infants.  It  is  not  intended  as  a therapeutic 
agent  to  supplant  cod-liver  oil. 

Quaker  Farina  (Irradiated)  (The  Quaker  Oats 
Company,  Chicago). — Farina  passed  under  the  rays 
of  ultra-violet  lamps  until  it  acquires  vitamin  D.  The 
product  will  improve  calcium  and  phosphorus  reten- 
tion. It  holds  its  irradiation  under  extreme  conditions 
of  cooking  and  storing. 

Quaker  Puffed  Rice  (Quaker  Oats  Company,  Chi- 
cago).— This  product  consists  of  rice  kernels  puffed 
to  eight  times  normal  size,  providing  for  easy  assimi- 
lation and  retaining  important  food  elements. 

Quaker  Milk  Spaghetti  (The  Quaker  Oats  Com- 
pany, Chicago). — The  product  is  made  from  whole 
milk  and  wheat. — Jour.  A.  M.  A.,  February  22,  1930, 
p.  559. 

PROPAGANDA  FOR  REFORM 

Hernial  (Inyecciones  Proliferantes  Obturadoras  del 
Dr.  E.  Pina  Mestre)  Not  Acceptable  for  New  and 
Nonofficial  Remedies. — The  Council  on  Pharmacy 
and  Chemistry  reports  that  the  product  “Inyecciones 
Proliferantes  Obturadoras,”  stated  to  be  manufac- 

(Continued  on  Next  Page) 


TTnnnmnnmnmnnn^^ 


For  Medicinal,  Industrial  and  Drinking  Purposes 


n 1 111 1 irt  1 11 1 hi  hh  1 in  i tii  1 1 1 n 1 


30 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Soiland  Clinic 

Drs.  Soiland,  Costolow  and 
Meland 

1407  South  Hope  Street,  Los  Angeles,  Calif. 
Telephone  WEstmore  1418 
HOURS:  9:00  to  4:00 

An  institution  fully  equipped  for  the  study, 
diagnosis  and  treatment  of  neoplastic  disease. 
Radiation  therapy  and  modern  electro- 
surgical  methods  featured. 

ALBERT  SOILAND,  M.  D. 

WM.  E.  COSTOLOW,  M.  D. 

ORVILLE  N.  MELAND,  M.  D. 

EGBERT  J.  BAILEY,  M.  D. 

A.  H.  WARNER,  Ph.  D.,  Physicist 


nrac. 


Ready  now  for  your  approval.  It  em- 
braces all  therapeutic  requirements 
and  provides  a perfect  ensemble  for 
the  woman  who  prefers  the  “all-in- 
one”  garment.  Reinforced  lower  por- 
tions provide  firm  support  to  the  lower 
abdomen.  The  cup-form  brassiere, 
with  inner  sling,  gives  uplift  to  the 
breast.  A flexible  upper  front  gives 
softness  and  with  side  lacings  allows 
for  figure  increase.  Habit  back,  well 
down  over  gluteus  muscles,  with 
Camp  Patented  Adjustment  for  splen- 
did sacro-iliac  support.  This  design, 
the  first  of  the  kind  on  the  market, 
will  completely  meet  your  idea  of 
what  a combination  maternity  sup- 
port should  be. 

Sold  by  surgical  houses,  department 
stores,  and  the  better  drug  stores 

Write  for  our  physician's  manual 


S.  H.  CAMP  AND  COMPANY 


Manufacturer!,  JACKSON,  MICHICAN 
CHICAGO  LONDON  NEW  YOKE 

69  E.  Madison  St.  252  Regent  St.,  W.  330  Fifth  Ave. 


Supporting  Qarments  J 

Something  Entirely  New 


A Combination 
Maternity  Garment 


Satisfying  the  Most 
Discriminating  ♦ ♦ ♦ 

Qolden  State 

Rigid  safeguarding  of  the 
purity  and  richness  of  its 
products — combined  with 
efficient  service — has  gain- 
ed for  Golden  State  milk 
products  an  enviable 
reputation. 

Its  satisfied  customers  are  Golden 
State’s  best  endorsement 

Golden  State 
Milk  Products  Company 

MILK  / CREAM  y BUTTER 
ICE  CREAM  y COTTAGE  CHEESE 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Preceding  Page) 
tured  by  Dr.  E.  Pina  Mestre  of  Barcelona,  Spain, 
was  presented  to  the  Council  for  consideration  under 
the  name  “Hernial”  by  the  Vincent  Ruiz  Company, 
New  York.  According  to  the  information  submitted 
by  this  firm,  “Each  ampoule  contains  approximately 
98  per  cent  of  alcohol,  and  the  balance  consists  of 
the  following  ingredients  expressed  in  percentages: 
25  per  cent  Krameria,  16  per  cent  Katechu,  15  per 
cent  Rosa  Canina,  15  per  cent  Rosa  Centifolia,  14 
per  cent  Vaccinium  Myrtillus,  15  per  cent  Monesia.” 
The  preparation  is  proposed  for  use  by  injection  in 
the  treatment  of  hernia.  The  Council  declared  Her- 
nial (Inyecciones  Proliferantes  Obturadoras  del  Dr. 
E.  Pina  Mestre)  unacceptable  for  New  and  Non- 
official Remedies  because  it  is  an  unscientific,  indefi- 
nite and  complex  mixture  of  astringent  drugs  pro- 
posed for  use  in  the  treatment  of  hernia,  for  which 
unwarranted  claims  are  advanced  and  the  use  of 
which  is  not  warranted  by  the  available  evidence  but, 
on  the  contrary,  is  considered  to  be  dangerous. — 
Jour.  A.  M.  A.,  February  1,  1930,  p.  339. 

Pinnecksin  Not  Acceptable  for  New  and  Nonofficial 
Remedies. — The  Council  on  Pharmacy  and  Chemis- 
try reports  that  “Pinnecksin,”  according  to  the  label, 
is  a “Laxative”  and  “Stomachic”  and  that,  according 
to  International  Food  Products,  Inc.,  the  importers 
of  the  preparation,  “The  originator  of  this  medicine 
claims  for  same  according  to  original  recommenda- 
tions said  to  be  in  his  personal  possession  and  given 
by  some  of  the  foremost  liver  and  stomach  special- 
ists of  Germany,  that  this  medicine  of  his  would 
without  doubt  cause  a thorough  elimination  of  gall 
stones  without  a surgical  operation;  he  furthermore 
claims  that  his  medicine  would  prove  of  great  benefit 
in  the  treatment  of  most  any  sort  of  intestinal  ail- 
ment outside  of  cancer  or  ulcer.”  The  importer  states 
that  the  preparation  is  a compound  of  extracts  of 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3‘ 


Usage  Demands 

More  Than  One  Pair  of  Glasses 


Recently  there  has  come  into  the  manufacturing  and  wholesale 
optical  fields  a distinct  style  movement.  Frame  and  mounting 
forms  are  being  affected  by  the  artist  as  well  as  the  mechanic.  This 
is  characteristic  of  our  times,  and  we  welcome  the  movement. 

Good  looking  glasses  are  generally  of  greater  benefit,  because 
they  are  worn  more  consistently.  But  style  is  not  the  vital  reason 
for  suggesting  several  pairs  of  glasses  for  your  patient. 

More  important  than  mere  style  are  the  working  (or  playing) 
needs  of  the  individual,  and  the  nature  of  his  correction. 

Just  as  new  and  novel  creations  of  gold  and  zylonite  are 
coming  forth,  so  are  new  and  more  precise  lenses  being  invented. 
Special  optical  combinations  are  especially  interesting  to  the 
refractionist,  because  by  means  of  them  he  is  better  able  to  give 
eye  comfort  and  efficient  vision  to  his  patients. 

When  we  study  the  varied  activities  of  the  average  person,  we 
realize  that  seldom  will  a single  pair  of  lenses  fulfill  the  optical 
needs  of  that  person. 


Usage  Demands  More  Than  One  Pair  of  Glasses 


DISC/  CDTIC4L  CCHPANy 

Featuring  Prompt  Orthogon  Service 

OAKLAND  FRESNO  OGDEN 

SAN  FRANCISCO  RENO  SALT  LAKE  CITY 


“thirty-two  roots  and  herbs.”  The  Council  found 
Pinnecksin  unacceptable  for  New  and  Nonofficial 
Remedies  because  it  is  a complex  mixture  represent- 
ing aromatic,  bitter  and  cathartic  drugs  in  undeclared 
amounts  which  is  offered  under  a noninforming  name, 
with  unwarranted  therapeutic  claims  which  may  lead 
to  its  ill  advised  and  harmful  use  by  the  public. — 
Jour.  A.  M.  A.,  February  1,  1930,  p.  339. 

The  Female  Sex  Hormone. — At  the  thirteenth  In- 
ternational Congress  of  Physiology  in  Boston,  held 
in  August  1929,  E.  A.  Doisy  announced  for  the  first 
time  the  isolation  of  the  female  sex  hormone  in  crys- 
talline form.  Subsequently,  A.  Butenandt  announced 
that  he,  too,  had  isolated  the  hormone  of  the  female 
sex  glands  in  chemically  pure  crystallized  form.  In 
an  article  describing  the  product,  Butenandt  com- 
pletely ignores  the  Doisy  announcement.  Butenandt 
points  out  that  the  substance  is  free  from  nitrogen 
and  sulphur,  and  that  it  has  no  connection  with  pro- 
tein substances  and  carbohydrates.  In  his  opinion,  a 
chemical  analysis  may  make  it  possible  to  produce 
the  hormone  synthetically.  As  might  have  been  an- 
ticipated, the  German  investigator  promptly  conferred 
on  his  product  a trade  name  controlled  through  a 
German  manufacturer.  Doisy,  aided  by  the  Council 
on  Pharmacy  and  Chemistry,  will  no  doubt  choose 
a scientific  name  suitable  to  the  nature  of  the  product 
and  to  American  conditions. — Jour.  A.  M.  A.,  Febru- 
ary 1,  1930,  p.  341. 

New  Treatments  for  Cancer. — In  a letter  Walter 
B.  Coffey  and  John  D.  Humber  outline  their  work 
in  connnection  with  an  experimental  method  of  treat- 
ing cancer  which  involves  the  injection  of  extracts  of 
the  suprarenal  cortex.  The  work  is  in  the  earliest  of 
experimental  stages  and  hardly  sufficient  on  which 
to  base  definite  claims.  The  claims  of  Doctors  Coffey 
(Continued  on  Page  35) 


J oslin  s Sanatorium 

For  Treatment  of 

Nervous  and  Mental 
Disorders 

Home  for  Aged  and 
Infirm 

A quiet,  secluded  place  in  the  country 
RATES  REASONABLE 

Phone  118F2  Lincoln,  Calif. 


32 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


IHKAIANT  No*  JW 

ephedrine  • 
compound^ 


*>*u*ta»  gph^.lrra»  1 p«wm***  c 
“***’  *iui 

Hymns  ta  a n«utr*J 


LILLY’S  Ephedrine  Products 
make  available  to  you  a means 
of  providing  quick  relief  and 
comfort  to  patients  suffering 
from  catarrhal  congestions  of 
the  nasopharynx 
and  sinusitis. 


FOR  HEAD  COLDS 


LILLY’S  Inhalant  No.  20,  Eph- 
edrine Compound,  Inhalant 
No.  21  Ephedrine  (Plain),  or 
Lilly’s  Ephedrine  Jelly  pro- 
motes drainage  and  free  res- 
piration. These  products  are 
distributed  solely  through 
professional  channels. 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXI 1 APRIL,  1930  No.  4 


THOUGHTS  ON  ANGINA  PECTORIS* 

By  W.  S.  Thayer,  M.  D. 

Baltimore,  Maryland 

ILJriGH  or  low,  rich  or  poor,  monarchists,  re- 
publicans  or  communists,  we  poor  human 
beings  labour  alike  under  the  tyranny  of  words. 
To  most  of  us,  to  a greater  or  less  extent,  cer- 
tain terms,  certain  names,  certain  adjectives,  the 
moment  they  are  uttered,  evoke  pictures  in  our 
minds  sometimes  agreeable,  sometimes  repulsive, 
sometimes  menacing,  of  such  vividness  and  inten- 
sity that  the  words  themselves,  ambiguous  though 
they  may  be,  become  to  us  in  a sense  entities. 
Such  words,  such  phrases,  may  have  an  appalling 
influence  on  human  action. 

In  medicine  it  is  as  in  life  in  general.  The  in- 
fluence of  a mere  clinical  term  may  sometimes 
be  considerable.  Such  a term,  while  it  may  de- 
scribe but  a group  of  clinical  symptoms  varying 
in  physiological,  anatomical  or  pathological  im- 
port, comes  to  be  regarded  not  only  by  the  laity 
but  too  often  by  the  profession,  as  such  an  entity. 
The  mere  term  becomes,  in  our  mind’s  eye,  almost 
a living  thing.  Alas,  to  too  many  of  us  the  essence 
is  of  less  significance  than  the  name.  We  are  all 
more  or  less  like  the  good  woman  who  greeted 
my  dear  old  master  after  a lecture  on  astronomy, 
and,  congratulating  him  on  his  fascinating  re- 
marks, said : “But  the  most  extraordinary  thing, 
Mr.  C.,  that  which  I can’t  understand,  is  how  you 
discovered  the  names  of  the  stars !” 

POPULAR  SIGNIFICANCE  OF  TERM 

“angina  pectoris” 

“Angina  pectoris” — what  a picture  these  words 
evoke  in  the  mind  of  the  average  man ! — a picture 
of  hopelessness,  of  agonizing  suffering,  of  the 
constant  menace  of  sudden  death;  a vague,  indefi- 
nite apprehension  of  one  of  the  most  terrible  fates 
imaginable.  One  of  our  vital  duties  as  physicians 
is  to  deliver  our  patients  from  bondage  such  as 
that  under  which  they  labour,  subjects  to  the 
tyranny  of  words  such  as  these. 

Not  infrequently  a patient  in  my  consulting 
room  says : “Doctor,  is  this  angina  pectoris  ?”  In 
response  I usually  laugh  and  say:  “Yes,  if  you 
will,  it  is  ‘angina  pectoris.’  But  what  is  ‘angina 
pectoris’?  It  is  many  things  from  a mere  warn- 
ing that  you  are  growing  older  and  that  you 
mustn’t  be  quite  so  active  as  you  were  twenty-five 

’Read  before  the  Utah  State  Medical  Association,  July  3, 
1929. 


years  ago — it  is  many  things  from  this  up  to  a 
really  distressing  and  painful  disease.”  And  then 
I endeavour  to  enlarge  upon  this  suggestion, 
pointing  out  to  the  patient  the  more  hopeful  side 
of  the  picture  and  dwelling  upon  the  general  man- 
agement of  his  life  until,  usually,  he  leaves  me 
calmed,  encouraged,  hopeful  and  ready,  in  so  far 
as  he  is  able  to  control  himself,  to  lead  the  life 
that  he  ought  to  lead. 

As  a matter  of  fact  “angina  pectoris,”  as  we 
use  the  words,  is  a term  describing  certain  symp- 
toms associated  with  cardiac  and  aortic  disease — a 
syndrome  which  in  itself  varies  widely  in  its 
manifestations  and  in  its  clinical  course  and  prog- 
nosis. The  anatomical  alterations  which  are  found 
post-mortem  are  generally  associated  with  evi- 
dences of  changes  in  the  cardiac  circulation  and 
are,  in  my  experience,  less  commonly  due  to  aortic 
lesions  other  than  those  interfering  with  the  coro- 
nary circulation  than  some  of  the  modern  litera- 
ture would  lead  one  to  fancy. 

WHAT  DO  WE  MEAN  BY  “ANGINA  PECTORIS”  ? 

What  do  we  generally  include  under  the  picture 
of  angina  or  anginoid  manifestations? 

In  a rough  general  way  I should  say : 

1.  Substernal  pains  or  a sense  of  pressure  or 
discomfort  in  the  praecordium,  brought  on  com- 
monly by  emotion  or  effort,  sometimes  by  ex- 
posure to  cold,  always  exaggerated  by  emotion 
or  effort,  always,  if  serious  enough,  necessitating 
the  cessation  of  exercise  or  movement  save  in 
exceptional  instances  of  which  I shall  speak. 
These  sensations  are  associated  generally  with  a 
radiation  of  pain  or  numbness  or  paraesthesia  into 
the  left  arm  more  commonly,  not  infrequently 
into  the  right ; into  the  neck,  especially  on  the  left 
side  and,  more  rarely,  into  odd,  distant  localities. 
The  first  sensations  of  discomfort  are  very  com- 
monly in  one  or  both  arms,  radiating  to  the  sub- 
sternal  region.  Pains  in  these  localities  brought 
on  by  effort  or  emotion  and  yielding  with  rest  are 
always  suspicious.  I have  seen  angina  in  which, 
at  the  onset,  the  pains  were  referred  purely  to 
several  teeth. 

2.  Severe  spasmodic  attacks  coming  on  with 
emotion  or  apparently  without  cause  which,  save 
in  the  graver  forms  associated  with  coronary 
thrombosis,  are  relieved,  almost  always,  tempo- 
rarily, in  their  earlier  stages  by  the  nitrites. 

As  every  physician  knows  perfectly  well,  angi- 
noid sensations  run  all  the  way  from  the  slight, 
tired,  toothache-like  feeling  in  the  left  arm  or  the 


218 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


indefinite  sense  of  substernal  pressure  and  dis- 
comfort, to  the  severe,  vice-like,  gripping,  boring 
pains  of  the  graver  attacks.  A rather  character- 
istic feature  of  the  paroxysm,  especially  in  the 
more  highly  educated  and  sensitive,  is  the  sense 
of  apprehension  that  comes  with  it,  and  this,  in 
itself,  goes  all  the  way  from  a simple  realization 
that  this  is  a warning  signal  to  which  one  must 
pay  attention,  that  he  must  stop,  that  he  cannot 
really  go  on  with  what  he  is  doing,  to  the  intense 
angor  animi  and  fear  of  death  which  is  character- 
istic of  the  graver  attacks.  This  condition  is  often 
associated  with  cutaneous  hyperaesthesia  or  para- 
esthesia  over  the  precordial  area  and  upper  chest 
and  along  the  arms  in  the  region  of  distribution 
of  the  last  cervical  and  first  two  dorsal  nerves. 

Now  it  is  quite  obvious  that  pain  in  the  dis- 
tribution of  a definite  nerve  supply  may  be  caused 
not  only  by  a referred  pain  as  in  these  cardiac 
manifestations,  hut  also  by  pressure  on  or  by  in- 
jury to  the  nerves  themselves;  and  pain  in  that 
distribution  common  in  angina  is  not  so  very  in- 
frequent in  disease  of  the  lower  cervical  or  upper 
dorsal  vertebrae,  that  which  has  given  rise  often 
to  confusion.  But  here  the  conditions  of  onset  of 
the  pain  and  the  nature  of  the  attack  are  always 
different  and  a mistake  should  not  be  made.  Cuta- 
neous paraesthesia  and  hyperaesthesia  in  like  re- 
gions occurs  also  in  cardiac  disease  other  than  in 
angina. 

DIAGNOSTIC  REFLEXIONS 

In  recognizing  the  syndrome  which  we  call  an- 
gina pectoris  those  symptoms  which  are  sugges- 
tive are  not  the  mere  character  and  distribution 
of  pain,  but  the  clinical  course  of  the  manifesta- 
tions, the  way  in  which  the  attacks  come  on,  the 
manner  in  which  they  may  be  induced,  the  pro- 
cedures by  which  they  may  be  relieved,  the  way 
in  which  the  patient  behaves  during  the  attack. 
Often,  the  age  and  physical  conditions  and  sur- 
roundings and  temperament  of  the  patient,  as 
every  practitioner  knows,  play  a part  which  may 
be  conclusive.  For  instance,  a girl  of  sixteen  may 
complain  of  intense  attacks  of  praecordial  pain 
simulating  angina  very  closely,  and  yet  few  of  us 
would  suspect  that  the  manifestation  was  serious. 
We  should  demand  confirmatory  evidence  of 
grave  organic  disease  from  the  history,  the  physi- 
cal signs  or  the  results  of  other  studies,  that  we 
might  not  feel  necessary  in  a man  of  fifty; 
and  we  should  usually  find  evidence  enough  that 
the  attack  was  hysterical. 

In  like  manner  it  is  not  at  all  uncommon  to  find 
in  a young  woman  with  a clean  history,  a story 
perhaps  of  abdominal  pains,  and  a high  degree  of 
pulsation  of  the  abdominal  aorta ; hut  we  should 
not  suspect  an  aneurysm.  I have  seen  men  rash 
enough  to  make  a diagnosis  of  angina  or  abdomi- 
nal aneurysm  in  such  cases,  but  angina  in  a girl 
of  sixteen  or  abdominal  aneurysm  in  a young 
woman  with  good  arteries  elsewhere  and  without 
lues,  are  almost  unheard  of,  and  no  one  need  give 
himself  much  anxiety  under  such  circumstances 
unless  the  evidence  is  overwhelming. 


One  of  the  most  important  and  characteristic 
features  of  angina  is  the  appearance  and  be- 
haviour of  the  patient  during  the  attack.  I shall 
never  forget  the  picture  of  an  old  friend  who, 
one  day,  I found  on  my  doorstep,  grey,  pale, 
sweating,  clinging  to  the  railing,  unable  even  to 
touch  the  button  of  the  doorbell.  This  man,  a 
few  months  before,  had  wanted  to  go  to  a well- 
known  foreign  bath  resort  for  the  treatment  of 
cardiac  disease.  He  was  a native  of  the  country 
in  which  this  bath  resort  lay.  I had  warned  him 
that  if  he  decided  to  go  he  should  first  let  me  give 
him  a letter  to  a distinguished  clinician  in  that 
country;  that  if  he  went  to  the  resort  with  a line 
from  him  he  would  be  well  cared  for ; otherwise 
he  might  easily  receive  a very  careless  sort  of 
treatment — that  which,  alas,  at  that  particular 
resort,  was  painfully  common.  He  did  not  follow 
my  advice.  As  he  approached  my  house,  boiling 
with  indignation  at  the  story  he  was  about  to  tell 
me,  his  attack  came  on.  When  finally  he  was  able 
to  enter  my  consulting  room  his  first  words  were : 
“I  am  ashamed  of  my  countrymen.”  That  picture 
of  the  fixed  attitude,  the  pale,  agonized  ex- 
pression, the  ashen  grey  face  covered  with  beads 
of  sweat — that  is  the  common  picture. 

One  of  the  most  pathetic  instances  that  I re- 
member was  that  of  a man  who,  at  the  moment 
of  the  attack,  was  in  the  habit  of  rising  from  his 
bed,  crossing  the  room  to  the  mantlepiece  on 
which  he  rested  his  left  elbow,  and  stood  swaying 
to  and  fro  as  he  groaned  gently,  the  tears  pour- 
ing from  his  eyes,  the  sweat  from  his  face — a dis- 
tressing picture.  Such  attacks  are  uncommon,  but 
are  unmistakable  when  one  sees  them.  Charles 
Sumner  is  said  to  have  had  the  habit  of  walking 
about  bis  room  in  severe  attacks.  But  such  move- 
ments are  quite  different  from  the  violent  muscu- 
lar spasms  of  an  hysterical  attack. 

Sometimes  the  relation  of  effort  or  emotion  to 
the  onset  of  anginoid  pains  may  be  entirely  un- 
appreciable  to  the  patient.  This  is  quite  true  in 
instances  of  coronary  thrombosis.  But  after 
recovery,  if  recovery  follow,  the  patient  often 
appreciates  the  necessity  of  the  restriction  of 
physical  effort  and  the  relation  of  emotional  strain 
to  subsequent  attacks  of  angina. 

ANATOMICAL  CHANGES  IN  ANGINA 

But  here  let  us  stop  for  a minute  and  consider 
what  we  know  about  those  anatomical  changes 
which  are  associated  with  angina.  At  the  very 
beginning,  in  the  descriptions  by  Heberden  and 
others,  the  calcified,  narrowed  coronary  arteries 
were  considered  the  most  important  elements  in 
the  picture.  Since  then  much  has  been  written 
about  the  frequency  of  coronary  disease  with 
angina,  but  many  have  laid  emphasis  on  the  cir- 
cumstance which  is  undoubtedly  true,  that  the 
gravest  coronary  disease,  even  thrombosis,  may 
occur  without  anginoid  pains.  Others  have  called 
attention  to  the  frequency  with  which  the  aorta 
shows  signs  of  atheroma  or  syphilis.  This  has 
led  some  to  feel  that  well-marked  anginoid  symp- 
toms are  rather  more  characteristic  of  aortic  than 
coronary  disease.  Indeed,  some  are  accustomed 


April,  1930 


ANGINA  PECTORIS — TIIAYER 


219 


to  class  as  angina  those  attacks  of  nocturnal  dysp- 
noea and  anxiety  so  common  in  instances  of  syphi- 
litic aortitis  and  aortic  insufficiency.  No  one 
denies  that  coronary  thrombosis  may  occur  with- 
out much,  or  indeed  perhaps  without  any  of  that 
which  the  patient  actually  describes  as  pain.  No 
one  denies  that  aortic  disease  may  form  the  basis 
for  anginoid  attacks — for  instance,  by  narrowing 
the  mouths  of  the  coronaries — but  the  more  I see 
of  angina  the  more  I am  inclined  to  feel  that  the 
picture  of  spasmodic  attacks  or  discomfort  in- 
duced by  emotion  or  effort  of  the  sort  that  I have 
described,  is  usually  associated  with  coronary  dis- 
ease which  interferes  with  the  nourishment  of  the 
heart  muscle  and  is,  inferentially,  often  associated 
with  painful  coronary  spasm.  It  may  well  be,  as 
Keefer  and  Resnik  1 fancy,  that  the  symptom  is 
definitely  associated  with  myocardial  anoxemia. 
One  of  the  most  striking  characteristics  of  angi- 
noid pains  is  their  relation  to  effort  and  emotion. 
But,  as  I have  said,  the  immediate  exciting  cause 
of  some  of  the  sharp  spasmodic  attacks  is  hard 
to  make  out. 

Those  attacks,  the  gravest  in  their  immediate 
import,  which  are  associated  with  sudden  coro- 
nary thrombosis,  from  which  the  patient  recovers, 
are  sometimes  followed  by  years  of  disability  in 
the  sense  that  after  the  initial  attack  the  patient 
finds  himself  in  the  same  condition  as  does  one 
in  whom  the  onset  of  anginoid  pains  has  been 
gradual ; he  can  no  longer  take  his  accustomed 
physical  exercise  and  he  can  no  longer  stand 
emotional  strain  without  the  appearance  of  angi- 
noid pain.  Here  the  symptoms  have  clearly  fol- 
lowed a primary  damage  to  the  heart  muscle  by 
the  coronary  thrombosis. 

The  onset  of  mild  anginoid  symptoms,  though 
commonly  insidious,  may  then  sometimes  follow 
a definite  coronary  thrombosis.  But  it  may  also 
be  sudden  and  without  apparent  cause,  with  the 
appearance,  when  the  patient  is  at  rest,  of  a slight 
aching  pain  perhaps  in  the  substernal  region  or 
perhaps,  at  first,  only  paraesthesia  or  aching  in 
one  or  both  arms,  pains  which  the  patient  may 
regard  as  rheumatic.  Later,  however,  he  finds 
that  they  are  brought  on  or  exaggerated  by  emo- 
tion or  effort. 

I think  of  such  a patient  whom  I observed 
several  years  ago,  a man  in  the  early  sixties  who 
noticed,  one  evening,  while  getting  ready  for 
dinner,  a rather  uncomfortable  “toothache-like” 
pain  along  the  inner  side  of  both  arms.  This  indi- 
vidual, who  was  a physician,  was  rather  struck  by 
the  location  and  character  of  the  pain,  which  was 
unlike  anything  he  had  ever  felt  before.  He 
avoided  consulting  his  colleagues  and  kept  very 
quiet  for  several  days.  He  found  out  first  that 
after  several  hours  in  bed,  the  pain  disappeared, 
but  recurred  after  rising.  When  it  had  entirely 
disappeared  he  found  that  unusual  effort,  such  as 
brisk  walking,  brought  the  pains  back  immedi- 
ately. Finally,  after  about  a month,  exceptional 
and  unintended  effort  brought  on  an  unmistakable 
attack  of  pain  in  the  arms,  radiating  into  the 
upper  substernal  region,  which  brought  the  sub- 


ject to  a standstill.  With  care  this  man  has  led 
a useful  life  since  then,  with  very  slow  progress 
of  his  symptoms. 

What  happened  to  him  when  first  he  felt  the 
pain?  It  seems  to  me  that  there  is  good  reason 
to  fancy  that  in  such  a case  as  this  there  was  a 
sudden  thrombosis  of  small  terminal  branch  or 
branches  of  diseased  coronaries.  Up  to  the  day 
of  onset  he  had  never  noticed  the  least  disability 
on  exercise  and  he  was  a man  who  had  taken 
rather  violent  exercise  until  the  moment  of  the 
attack.  The  attack  came  out  of  a clear  sky. 
Within  a week  or  two  afterwards  tests  showed 
that  the  characteristic  disability  had  appeared. 

Now  in  those  cases  of  angina  of  gradual  onset 
precipitated  by  emotion  and  effort,  one  usually 
finds  either  definite  coronary  disease  or  single  or 
multiple  areas  of  fibrosis  in  the  heart  muscle  the 
cause  of  which  is  often  not  entirely  clear,  or  both. 
I am  rather  inclined  to  think  that  time  will  show 
that  in  such  cases  as  that  just  referred  to,  in 
which  the  onset,  though  very  mild,  is  sudden  and 
followed  later  by  the  symptoms  characteristic  of 
angina  of  effort — I am  inclined  to  think  that  time 
will  show  that,  in  such  cases,  the  onset  has  been 
associated  with  the  occlusion  of  a small  terminal 
branch  or  branches  of  the  coronary  vessels ; not 
the  brutal  occlusion  of  a large  branch  with  a con- 
siderable area  of  infarction  of  the  heart  muscle 
with  its  characteristic  symptoms,  but  nevertheless 
a sudden  thrombosis  of  final  terminal  branches 
which  has  produced  enough  interference  with  the 
circulation  to  bring  on  thereafter  the  character- 
istic symptoms  of  angina.  I quite  agree  with  my 
friend,  Harlow  Brooks,  that  in  few  instances  of 
angina  which  one  studies  carefullv  anatomically 
do  we  fail  to  find,  at  necropsy,  rather  definite 
coronary  changes. 

The  answer  of  the  opponents  of  the  hypothesis 
that  angina  is  usually  associated  with  coronary 
disease — the  answer,  that  many  show  coronary 
changes  who  have  not  had  angina  and  that  in 
some  dead  of  angina,  coronary  disease  has  not 
been  demonstrated — does  not  seem  to  me  convinc- 
ing. For  coronary  disease  or  multiple  fibrous 
patches  in  the  heart  muscle  are  found  in  the  great 
majority  of  instances,  and  the  most  characteristic 
picture  of  angina  may  be  produced  by  coronary 
thrombosis. 

EXCITING  CAUSES 

What  then  do  we  know  about  the  cause  of  the 
syndrome  which  we  call  angina  pectoris? 

1.  We  know  that  the  severe  spasmodic  attacks 
begin  and  run  their  course  like  spasms  of  involun- 
tary muscle.  We  know  that  they  are  relieved  in 
many  instances  by  antispasmodics  like  the  nitrites, 
which  relax  the  arterial  spasm.  We  know  that  in 
most  instances  the  hearts  of  patients  who  have 
had  attacks  like  this  show  obvious  disease  of  the 
coronary  vessels  postmortem.  We  know  that  in 
those  subject  to  angina,  attacks  may  often  be 
brought  on  or  precipitated  by  emotion  and  efifort. 

2.  We  know  that,  in  another  sort  of  clinical 
picture,  distressing  sensations  in  these  same  re- 
gions and  of  the  same  character,  though  often 


220 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


milder,  may  be  produced  by  effort  or  emotion, 
yielding  in  the  less  severe  instances,  so  soon  as 
the  effort  is  stopped.  We  know  that  in  such 
patients  the  frequency  of  the  paroxysms  increases 
usually  through  the  years.  The  attacks  appear 
on  less  and  less  provocation  until  the  wretched 
patient  is  bedridden.  And  we  know  that,  at 
necropsy,  there  is  generally  either  obvious  disease 
of  the  coronaries  or  numerous  sclerotic  areas  in 
the  heart  muscle  not  improbably  the  result  of  the 
gradual  occlusion  of  terminal  coronaries. 

3.  Finally  we  know  that  the  most  exquisite 
and  persistent  and  unrelievable  pain  of  exactly 
the  same  character,  together  with  other  sugges- 
tive symptoms  of  thrombosis,  tachycardia,  fall 
of  pressure,  fever,  leukocytosis,  may  follow  the 
occlusion  of  a branch  of  a coronary  artery. 

In  other  words,  whatever  justification  there 
may  be  for  other  hypotheses  as  to  the  cause  of 
angina  pectoris  in  instances  in  which  obvious  dis- 
ease of  the  coronaries  has  not  been  recorded,  the 
evidence  that  it  is  related,  for  the  most  part,  to 
coronary  disease  is  very  strong.  We  know  that  it 
may  be  brought  on  by  coronary  thrombosis ; we 
know  that,  excepting  by  the  use  of  morphia,  the 
most  satisfactory  way  in  which  to  relieve  it,  save 
in  coronary  thrombosis,  is  by  the  use  of  the 
nitrites,  which  we  know  relax  vascular  spasm ; 
and,  in  the  third  place,  we  know  that  evidence  of 
actual  disease  of  the  larger  or  smaller  coronaries, 
or  occlusion  of  their  mouths  as  a result  of  disease 
of  the  aorta,  or  evidence  of  disseminated  fibroid 
patches  in  the  heart  muscle  which  mean  the 
replacement  of  necrotic  tissue  which  in  many  in- 
stances may  best  be  accounted  for  by  the  hypothe- 
sis of  the  occlusion  of  terminal  branches  of  the 
coronaries,  are  usually  found  at  necropsy.  These 
circumstances  lead  me  to  believe  that  the  syn- 
drome that  we  call  angina  pectoris  is  usually  of 
coronary  origin.  That  the  character  and  distribu- 
tion of  pain  in  aortic  disease — syphilis,  aneur- 
ysms— is  similar  to  that  in  anginal  attacks  is  un- 
doubted, but  the  spasmodic  attacks  of  dyspnoea 
observed  especially  at  night,  usually  seen  in  hyper- 
tensives, the  “angina  of  rest”  of  Vaquez,  form, 
it  seems  to  me,  a special,  distinct  picture.  This 
picture  I have  not  as  a rule  classed  as  “angina 
pectoris.”  I agree  that  in  such  cases  evidence  of 
coronary  sclerosis  or  of  fibroid  changes  in  the 
heart  muscle  is  not  so  common,  though  sometimes 
narrowing  of  the  mouths  of  the  coronaries  and 
areas  of  fibroid  change  are  found.  So  much  has 
been  written  about  coronary  thrombosis  in  the 
last  few  years  that  it  may  be  hardly  worth  while 
to  enter  into  any  lengthy  discussion  of  the  picture 
here.  The  history  of  the  recognition  of  coronary 
thrombosis  is,  however,  so  interesting  that  I can- 
not refrain  from  saying  a few  words.  I feel  sure 
that  had  we  not  been  so  satisfied  with  the  term 
“angina  pectoris,”  had  we  been  considering  our 
patient  from  the  proper  standpoint,  that  is  from 
the  standpoint  of  one  trying  to  make  out  physio- 
logically what  might  produce  these  given  symp- 
toms, instead  of  being  satisfied  to  classify  them 


under  a name,  the  clinical  picture  of  coronary 
thrombosis  would  have  been  recognized  many 
years  before  it  was. 

CORONARY  DISEASE 

Brought  up  with  the  feeling  that  was  held  by 
the  old  English  authors  that  angina  was  usually 
a manifestation  of  coronary  disease,  it  never  oc- 
curred to  me  that  the  first  instance  of  coronary 
thrombosis  that  I saw — in  1895 — was  anything 
other  than  a coronary  thrombosis,  and  it  never 
occurred  to  me  that  anyone  else  would  have  had 
any  other  view  of  the  case.  The  patient  was  seen 
by  Doctor  Osier.  We  discussed  it  together.  There 
was  no  necropsy,  but  I feel  perfectly  sure  that 
he  regarded  it  as  an  instance  of  coronary  throm- 
bosis as  well  as  I.  When  I met  with  my  second 
case  in  1899,  a most  typical  example,  followed, 
two  days  later,  by  a pericardial  rub,  I recognized 
the  case  equally  clearly,  commented  on  it  in  my 
notes,  and  often  talked  about  it  to  my  students. 
I am  perfectly  sure  that  many  physicians  all  over 
the  world  have  recognized  the  syndrome  in  times 
past.  The  credit,  however,  of  bringing  the  clini- 
cal picture  before  the  medical  public  belongs  to 
my  dear  friend,  Herrick  of  Chicago,  who  first 
really  called  attention  to  it  in  1906.  It  is  truly 
extraordinary  to  see  how  many  instances  have 
been  recorded  since  this  time ; how  frequent  a 
manifestation  it  is.  As  one  of  my  distinguished 
colleagues  observed  the  other  day,  it  is  perhaps 
too  readily  suspected  by  some.  One  might  fancy 
that  it  was  a new  disease.  How  many  new  dis- 
eases are  like  coronary  thrombosis,  under  our  eyes 
every  day  of  our  lives  but  recognized  by  the  world 
only  when  someone  like  Herrick  has  put  the 
matter  clearly  before  the  public?  I am  always 
suspicious  of  new  diseases. 

I have  spoken  of  the  frequency  of  coronary 
disease,  of  the  circumstance  that  coronary  throm- 
bosis followed  by  scarring  of  the  area  of  infarc- 
tion in  the  heart  muscle  and  recovery  may  be 
followed  by  the  development  of  characteristic 
anginoid  pains  on  effort,  and  of  the  possibility 
that,  in  some  cases,  the  sudden  onset  of  mild 
anginoid  symptoms  without  apparent  cause,  with- 
out the  fever,  leukocytosis,  fall  of  pressure,  tachy- 
cardia and  other  signs  of  an  extensive  infarction, 
may  mean  the  sudden  thrombosis  of  smaller  ter- 
minal branches.  Such  an  onset  may  be  followed, 
at  any  rate,  by  the  typical  picture  of  permanent 
angina  of  effort.  I have  mentioned  also  that  the 
symptoms  of  paroxysmal  angina  are,  in  their 
course,  very  like  the  spasm  of  smooth  muscle  fibre 
and  that  they  are  relieved  by  the  nitrites,  as  if, 
in  some  way,  disease  of  the  coronaries  or  increas- 
ing demand  on  insufficient  vessels  brought  on 
vascular  spasm,  though,  of  course,  this  is  but  a 
hypothesis. 

One  should  not  forget,  however,  the  most  in- 
teresting fact  that,  especially  in  hypertensives, 
beginning  dilatation  of  the  heart  with  evidences 
of  pulmonary  engorgement  or  particularly  failure 
of  the  right  side  of  the  heart,  not  infrequently 
mark  the  end  of  anginoid  pain.  A patient  who 


April,  1930 


ANGINA  PECTORIS — THAYER 


221 


for  years  has  suffered  from  angina  may  lose  his 
pains  with  the  onset  of  congestive  cardiac  failure 
and,  as  Harlow  Brooks  has  emphasized  in  a recent 
address,  if  coronary  thrombosis  may  sometimes 
mark  the  beginning  of  anginoid  pain,  it  some- 
times, also,  marks  the  end  in  that  a large  area 
of  infarction  upsets  the  cardiac  compensation,  and 
the  patient  dies  after  weeks  or  months  or,  indeed, 
years  of  congestive  cardiac  failure  without  the 
recurrence  of  angina. 

Indeed  sometimes  an  attack  of  coronary  throm- 
bosis, followed  by  symptomatic  recovery,  may  be 
succeeded  by  a long  remission  in  anginoid  pains. 
This  is  due  sometimes,  I think,  to  the  moral  influ- 
ence of  the  attack  and  the  treatment  which  have 
impressed  on  the  patient  the  necessity  of  leading 
a reasonable  existence. 

REFLEXIONS  AS  TO  TREATMENT 

But  in  this  informal  talk  I want  to  dwell  especi- 
ally on  the  question  of  how  we  may  help  the 
sufferer  from  angina  pectoris.  Years  ago,  in 
speaking  with  my  dear  and  wise  old  instructor, 
Dr.  Frederick  C.  Shattuck  of  Boston,  I observed 
that  I always  felt  depressed  and  discouraged  when 
I saw  a patient  with  angina  because  there  was  so 
little  that  I could  do.  He  laughed  and  said,  in 
effect,  that  there  were  few  conditions  in  which 
he  felt  he  could  do  more.  As  the  years  have  gone 
by  I have  come  to  realize  fully  how  wise  he  was 
and  how  innocent  and  young  1 was.  One  can  do 
much  for  many  patients  with  angina;  indeed  the 
ability  to  help  a patient  with  angina  is  a rather 
good  test  of  the  quality  of  the  doctor.  ’Tis  a 
familiar  truth  and  nowhere  is  it  more  apparent 
than  in  conditions  such  as  this,  that  the  wise  phy- 
sician accomplishes  more  by  his  kindly  and  in- 
telligent advice  and  counsel  than  he  does  by  bis 
prescriptions  and  his  medical  treatment.  " The 
treatment  itself  varies  greatly  with  the  condition 
in  which  we  find  our  patient,  but  under  nearly  all 
conditions  the  personal  element,  the  tact,  the  judg- 
ment, the  kindliness  of  the  doctor,  his  willingness 
to  take  time  to  explain  matters  properly  to  his 
patient,  to  break  unpleasant  truths  to  him  in  such 
a way  that  he  will  look  upon  the  hopeful  side — 
these  are  often  the  most  important  elements  of 
treatment.  This  applies  equally  to  the  family 
practitioner  and  the  consultant.  One  cannot  treat 
the  patient  with  angina  pectoris  without  giving 
him  time  and  careful  consideration. 

Suppose  a man  comes  to  us,  as  he  commonly 
does,  when  he  begins  to  observe  that  effort  pro- 
duces unmistakable  anginoid  symptoms. 

There  is  no  more  fascinating  opportunity  than 
that  afforded  by  this  situation,  to  relieve  suffer- 
ing and  to  prolong  life;  but  it  is  a time-taking 
procedure.  To  begin  with,  to  attempt  to  hide  the 
nature  of  his  condition  from  such  a patient  is  silly, 
and  certain  to  defeat  our  ends.  Does  that  mean 
the  necessary  employment  of  the  word  “angina”  ? 
Of  course  not.  The  word  “angina”  is  the  very 
thing  that  we  are  seeking  to  avoid.  We  are  trying 
to  escape  from  the  tyranny  of  alarming  words, 
and  to  express  the  essence  of  the  situation  in  such 
manner  that  it  may  encourage  rather  than  depress 


the  patient.  In  most  instances  this  is  quite  possi- 
ble to  accomplish.  But  it  demands  time,  time  and 
careful  explanation-r-explanation  of  the  nature  of 
the  situation ; that  it  is  a warning,  a red  flag,  and 
not  a “smash-up” ; that  it  is  evidence  of  some 
defect  in  the  circulation  in  his  heart  muscle ; that 
it  is  the  first  notice  which  every  man  must  have 
at  one  time  or  another,  that,  physically,  he  is  not 
in  the  best  condition ; that  every  man  of  his  age 
has  some  bad  vessels;  that  many  of  us  have  the 
good  fortune  to  have  these  in  positions  where 
they  do  no  harm ; that  he,  perhaps,  has  had  bad 
luck,  but  that,  after  all,  the  warning  may  be  rather 
a bit  of  good  fortune  than  otherwise.  And  here 
I often  refer  to  Osier’s  paper  on  “The  Advan- 
tages of  a Trace  of  Albumen  and  a Few  Tube 
Casts  in  the  Urine  for  a Man  Over  Fifty  Years 
of  Age,”  a diversion  which  often  amuses  and 
encourages  the  patient,  at  the  same  time  impress- 
ing on  him  the  truth.  Or  again  I tell  him  that  he 
is  somewhat  in  the  position  of  the  patient  with 
early  tuberculosis,  whose  first  symptom  is  an 
haemoptysis,  often  the  most  life-saving  of  inci- 
dents in  that  it  draws  attention  to  the  existence 
of  pulmonary  mischief  amenable  to  treatment, 
mischief  which  might  otherwise  be  overlooked 
until  too  advanced  for  relief. 

Here  the  value  of  experience  becomes  especially 
appreciable.  We  should  preserve  with  the  utmost 
care  the  records  of  the  occasional  medical  miracles 
with  which  we  all  meet,  and  of  the  especially 
favorable  cases  in  our  practice.  These  will  be 
among  our  most  precious  implements  in  the  treat- 
ment of  angina;  they  will  be  more  valuable  to 
us  than  most  drugs.  A true  story  of  someone 
who  has  recovered  from  a like  condition  is  often 
almost  life-saving  to  the  sufferer.  He  forgets 
everything  else  but  the  picture  of  that  patient 
who  recovered  and  soon,  in  his  own  heart,  he 
comes  to  fancy  that  this  perhaps  may  be  the  rule 
rather  than  the  exception. 

Only  the  most  confirmed  Christian  Scientist 
exaggerates  the  importance  of  faith  and  hope  in 
the  practice  of  medicine. 

In  almost  every  instance  of  angina  one  is  justi- 
fied in  encouraging  the  hope  that  if  all  goes  well 
the  patient  may  either  recover  entirely  or  at  least 
be  able,  with  certain  reasonable  modifications  of 
his  habits,  to  go  on  for  a long  period.  It  is  a care- 
less and  sloppy  method  of  practice  to  satisfy  one’s 
self  by  a few  words  with  the  patient,  and  by  the 
statement  that  this  is  “false  angina”  and  not  “true 
angina.”  What  we  are  trying  to  do  is  to  escape 
from  the  dominion  of  terrifying  and  misleading 
words,  and  the  words  “false  angina”  produce  in 
the  patient’s  mind  the  picture  of  something  as 
definite  as  his  mistaken  fancies  concerning  the 
meaning  of  “angina.”  Merely  to  give  one’s  symp- 
toms a name  does  not  mean  much.  If  one  can 
make  his  patient  feel  that  the  word  “angina”  does 
not  mean  a sentence  to  suffering  and  death,  but 
only  describes  a certain  set  of  symptoms  which 
vary  enormously  in  their  intensity  and  prognosis ; 
that  there  is  a considerable  element  of  hope  in 
his  case,  you  can  do  far  more  for  him.  One  must 
remember  that  the  essential  feature  of  our  treat- 


222 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


ment  should  be  to  encourage  him  to  modify  his 
life  as  he  should;  one  can  accomplish  this  only 
if  the  patient  realizes  the  necessity. 

And  now  after  one  has  talked  to  him  and  en- 
couraged him  and  led  him  to  feel  that  what  has 
happened  may  be  hard  luck,  but  not  the  end  by 
any  means,  that  it  may  indeed  lengthen  his  life 
by  inducing  him  to  lead  a proper  sort  of  existence, 
after  all  this,  what  else  have  we  that  we  can  do 
for  a patient  with  beginning  anginoid  symptoms? 
We  can,  it  seems  to  me,  do  a great  deal. 

1.  One  must  put  the  patient  into  the  best  possi- 
ble physical  condition.  To  do  this  we  must  care- 
fully go  over  his  manner  of  life.  We  must  find 
out  just  what  it  is.  Very  often  we  find  that  he 
leads  a disordered  and  hurried  life.  We  must 
begin  by  inquiring  into  the  character  of  his  day, 
and  these  inquiries  we  must  make  not  only  of 
himself,  but  of  his  wife  and  others  who  observe 
him.  We  must  see  to  it  that  he  begins  the  day 
without  hurry;  that  his  habits  are  regular;  that 
he  takes  plenty  of  time  for  his  meals ; that  he  eats 
deliberately  and,  of  course,  moderately;  that  he 
avoids  constipation,  and  this  is  a matter  often  that 
needs  the  most  careful  attention  and  is  very  time- 
taking for  the  physician,  for  the  treatment  of  con- 
stipation does  not  consist  in  simply  prescribing 
a laxative.  We  must  look  carefully  into  his  habits 
in  view  of  the  possibility  that  he  may  be  subjected 
to  some  of  the  toxic  influences  which  have  been 
thought  to  play  a part  in  inducing  angina.  Gout 
is  certainly  of  importance.  Tobacco  may  be  of 
importance ; it  is  certainly  in  instances  of  hyper- 
tension. While  I,  myself,  have  never  seen  an  in- 
stance of  angina  which  was  definitely  “cured,” 
if  one  may  use  the  word,  by  the  omission  of 
tobacco,  I am  sure  that  I have  seen  great  benefit 
in  some  cases  of  nervous,  heavy  smokers,  from 
the  abandonment  or  modification  of  smoking.  If 
the  patient  be  one  of  those  unfortunate,  weak- 
minded  invertebrates,  of  whom  there  are  too 
many  in  the  world,  who  “simply  can’t  stop  smok- 
ing,” who  cannot  refrain  from  making  himself  a 
nuisance  to  his  fellow  man  by  standing  around, 
red-eyed  and  “frowsy”  headed,  while  he  smokes 
his  cigarette  in  the  crowded  dressing  room  of  a 
sleeping  car  before  he  can  begin  his  morning 
toilet,  there  is  but  one  thing  for  him  to  do,  and 
that  is  to  stop  it.  Every  man  of  that  sort  has  a 
serious  drug  habit.  If  he  is  obviously  smoking 
too  much,  and  is  a man,  he  should  learn  to  smoke 
in  moderation  and  only  at  leisure  after  his  meals. 

Every  effort  must  be  made  to  induce  the  pa- 
tient to  avoid  hurry.  A hurried  day  is  often  initi- 
ated by  habits  of  rising  and  dressing  in  a few 
minutes.  Some  patients,  if  taught  to  realize  this, 
may  learn  to  add  a quarter  or  even  a half  an  hour 
to  their  dressing  time,  to  read  the  paper  during 
the  hours  of  dressing,  and  arrange  matters  in  such 
a way  that,  the  initial  hurry  avoided,  the  day  goes 
on  with  a calm  with  which  they  have  been  previ- 
ously quite  unfamiliar. 

In  order  to  put  one’s  patient  in  the  best  possi- 
ble condition  the  importance  of  searching  for  and 
relieving  focal  infections  cannot  be  exaggerated. 


It  is  often  impossible  to  say  that  the  relief  of  this 
oral  sepsis  or  that  chronic  prostatitis  has  been  the 
cause  of  so  much  improvement,  but  there  is  no 
doubt  whatever  that  occasionally  the  influence  of 
focal  infections,  apparently  unimportant,  is  far- 
reaching.  I have  had  one  instance  of  the  dis- 
appearance of  an  angina  following  a tonsillectomy 
for  good  cause.  The  improvement,  of  course,  may 
have  been  post  hoc  rather  than  propter  hoc.  How- 
ever that  may  be,  the  incident  is  true,  and  so 
worth  heeding,  while  from  a therapeutic  stand- 
point this  experience  has  been  of  considerable 
value  in  helping  me  to  induce  patients  to  do  what 
it  seemed  to  me  they  should. 

I am  very  apt  to  end  my  conversation  with  a 
patient  of  this  sort  by  reference  again  to  Osier’s 
habit  of  speaking  of  the  advantages  of  a trace  of 
albumen  in  the  urine  for  a man  over  fifty.  “But,” 
one  may  say,  “suppose  this  man  ask  you  about 
sudden  death?”  That  is  a bugaboo  which,  with 
most  patients,  is  dealt  with  very  easily.  It  is  not 
the  patient  who  is  annoyed  about  that ; it  is  the 
family.  To  the  patient  who  asks  you  it  is  easy 
and  true  to  say  that  he  has  a somewhat  better 
chance  than  the  average  man  of  dying  the  most 
blessed  sort  of  a death.  That,  alas,  is  about  all, 
because  many  sufferers  from  angina  die  in  other 
ways.  Too  many,  alas,  go  through  the  distressing 
stages  of  progressive  myocardial  failure.  It  is  not 
hard  as  a rule  to  make  one’s  patient  look  at  the 
possibility  of  sudden  death  as  a blessing  rather 
than  a menace. 

The  medical  treatment  of  such  a patient,  be- 
yond special  emergencies,  is  symptomatic.  If  the 
patient  be  syphilitic  he  has,  of  course,  a door  of 
hope,  but  syphilis  is  not  the  common  basis  of 
angina.  In  syphilitics  it  is  exceedingly  important 
to  begin  treatment  with  mercury  and  iodides,  and 
not  to  use  intravenous  arsenical  treatment  until 
later.  I have  not  happened,  myself,  to  see  sudden 
death  follow  the  abrupt  use  of  arsphenamine,  but 
I have  seen  what  seemed  to  me  grave,  immediate 
reactions. 

The  treatment  of  constipation  I have  already 
referred  to.  The  treatment  of  the  attacks  may 
be  summarized  in  two  words — “nitrites,  morphia.” 
The  nitrites  often  produce  the  desired  result.  It 
is  only  in  the  grave  spasms  that  morphia  is  neces- 
sary when,  of  course,  it  should  be  employed  freely. 

I feel,  as  does  Harlow  Brooks,  that  either  tab- 
let triturates  of  nitroglycerine  or  liquid  tincture 
of  glonoin  are  the  best  forms  in  which  to  employ 
the  nitrites.  They  are  usually  as  good  as  nitrite 
of  amyl.  The  nitrites  should  be  employed  sympto- 
matically. Continued  employment  seems  to  me 
quite  useless.  The  dose  may  be  increased  as  is 
necessary.  It  is  a great  relief  to  many  individuals 
to  feel  that  they  have  in  their  pockets  a ready 
relief  of  this  sort.  Other  drugs,  of  course,  help, 
but  the  nitroglycerine  is  so  much  simpler.  Still 
one  must  not  forget  that  it  is  very  hard  to  make 
any  absolute  rule  in  medicine,  and  sometimes, 
where  nitroglycerine,  even  in  small  doses,  brings 
on  uncomfortable  flushing,  other  preparations 
such  as  Hoffman’s  anodyne  or  sweet  spirits  of 
nitre  may  help. 


April,  1930 


ANGINA  PECTORIS — THAYER 


223 


I have  a dear  friend  who  always  carries  in  his 
pocket  a lovely  cut-glass  cornucopia-shaped  recep- 
tacle with  a silver  top — a receptacle  which  must 
have  been  intended,  I should  think,  for  smelling 
salts.  This  receptacle  contains  about  two  ounces 
of  spiritus  frumenti.  A little  straight  whiskey 
stops  the  attack  and  the  patient  who,  heside  being 
a temperate  man,  is  one  of  the  most  distinguished 
of  our  colleagues,  ought  to  know.  There  are  some 
advocates  of  temperance  who  call  themselves 
Christians  who  might  disapprove  of  this;  but 
there  is  no  intemperance  more  blind  or  more 
cruel,  no  immorality  more  pernicious  than  that 
practised  by  some  well-meaning  fanatics  in  the 
name  of  temperance  and  morality. 

If  the  patient  be  hypertensive  or  obese  these 
conditions  must  be  considered  and  properly  com- 
bated. 

2.  If  the  attacks  become  more  frequent  or,  of 
course,  if  one  find  his  patient  in  an  attack  sug- 
gesting a coronary  thrombosis,  or  indeed,  if,  in 
a progressive  angina,  the  signs  of  myocardial 
failure  come  on,  then  the  urgent  need  is  for  rest — 
a long  rest.  What  is  the  value  of  rest?  In  an 
acute  cardiac  infarction  or  with  a myocardial  in- 
sufficiency the  value  of  rest  is  obvious.  By  saving 
every  heart  beat  the  heart  muscle  is  given  an 
opportunity  to  regain  strength ; the  circulation 
about  an  area  of  infarction  may  have  a chance 
to  become  reestablished  so  far  as  possible ; the 
heart  is  submitted  to  the  least  possible  strain  while 
the  softened  area  is  becoming  scarred.  In  in- 
stances of  angina  where  the  attacks  are  becoming 
more  frequent,  a rest  treatment  is  often  of  great 
value  not  only  in  that  it  spares  an  exhausted 
heart  unnecessary  beats,  but  in  that  it  gives  the 
patient  an  invaluable  opportunity  to  adjust  him- 
self to  the  proper  manner  of  life. 

Under  such  circumstances  what  does  one  mean 
by  rest?  At  what  should  we  aim?  Rest  in  bed 
at  home?  No.  That  is  but  a halfway  measure. 
If  it  be  possible  the  patient  should  be  at  rest  in 
a hospital,  wholly  separated  from  his  afifairs,  or 
if  it  must  be  at  home,  he  should  be  isolated  and 
under  the  care  of  a nurse.  The  patient  almost 
always  asks  why  home  is  not  just  as  good  as  a 
hospital.  Although  he  protests,  it  is  usually  not 
so  very  difficult  to  explain  the  situation.  Few  busy 
men  can  rest,  really  rest,  at  home.  How  many  of 
us  have  tried  to  retire  to  the  upper  floors  of  our 
house  and  sought  to  spend  a few  days  entirely 
freed  from  the  cares  of  everyday  life?  How  im- 
possible it  is ! Every  ring  of  the  doorbell,  every 
rattle  of  the  telephone,  suggests  forgotten  duties. 
The  moment  we  are  left  alone  we  desire  to  get 
out  of  bed  to  arrange  this  or  that  little  thing 
which  must  be  done  before  the  rest  really  begins, 
and  the  rest  never  comes.  More  than  that,  at 
home  one  has  a sort  of  a right,  or  at  any  rate 
feels  a sense  of  duty  to  direct  or  advise  or  meddle 
with  a thousand  little  things.  In  a hospital  or,  if 
impossible,  so  well  as  one  can  at  home,  the  patient 
should  be  guarded  from  every  interruption.  He 
should  be  induced  entirely  to  throw  aside  his  busi- 
ness afifairs.  He  should  be  kept  absolutely  in  bed 


under  rigid  rules ; and  it  seems  to  me  that  the 
importance  of  rigid  rules,  such  as  forbidding  him 
to  rise  from  bed  even  to  use  the  commode,  is  as 
important  here  as  in  any  so-called  “rest  cure.” 
The  value  of  such  rigid,  martinet-like  rules  in  the 
care  of  such  a patient  at  the  beginning,  which 
is  obvious  in  the  instance  of  a grave  coronary 
thrombosis,  lies  in  the  circumstance  that  it  im- 
presses deeply  upon  the  patient  the  necessity  of 
care  in  the  future.  At  the  same  time,  the  im- 
provement which  usually  follows  the  rest  encour- 
ages him  and  gives  him  hope.  There  is  no  manner 
in  which  one  may  so  certainly  induce  the  patient 
to  lead  the  proper  life  in  the  future  as  by  a rigid 
period  of  rest  and  retraining.  The  period  of  rest 
after  a severe  coronary  thrombosis  may  have  to 
be  very  long,  and  it  is  often  wise  to  keep  a patient 
who  has  had  merely  persistent  anginoid  symptoms 
in  bed  for  at  least  a month  and  then  to  give  an- 
other month  in  very,  very  gradual  retraining. 
While  in  bed  it  is  important  that  the  patient 
should  have  thorough  general  massage  so  as  to 
keep  the  muscles  in  the  best  possible  condition. 
When  one  begins  to  allow  the  invalid  to  sit  up 
and  get  out  of  bed  the  progress  should  be  step 
by  step.  A month’s  rest  in  bed  in  a hospital  de- 
mands nearly  a month  of  retraining  and  graded 
exercises  before  he  leaves,  and,  where  it  is  possi- 
ble, I always  like  to  send  the  patient  for  three 
weeks  or  a month  thereafter  to  a good  sanatorium 
where  he  may  be  under  the  care  of  well-trained 
men — a sanatorium  like  Clifton  Springs,  for  in- 
stance— or  to  a resort  like  Atlantic  City,  so  that 
he  may  get  back  into  the  habits  of  a normal  life 
under  proper  observation.  The  permanency  of  the 
improvement  following  such  treatments  is  some- 
times astonishing,  not  only  in  those  patients  who 
have  had  a definite  coronary  thrombosis,  but 
sometimes  in  instances  where  the  anginoid  at- 
tacks have  lasted  for  several  years  and  have  given 
every  promise  of  pursuing  a progressive  course. 

My  friend  X,  aged  forty-eight,  an  engineer 
with  important  responsibilities,  had  begun,  in 
1913,  to  sufifer  from  a sense  of  tightness  across 
the  front  of  the  chest  on  effort.  In  the  fall  of 
1914  he  consulted  me  because  the  attacks,  brought 
on  by  slight  effort  or  emotion,  had  become  very 
severe.  They  were  located  behind  the  sternum, 
were  like  a “red-hot  iron”  and  radiated  down  his 
left  arm  and  to  a lesser  extent  his  right.  The 
pressure  rose  during  attacks.  A long  rest,  first 
in  a hospital,  then  at  Clifton  Springs  and  in  the 
country,  with  gradual  retraining,  was  followed  by 
a complete  disappearance  of  the  attacks.  The 
patient  learned  how  to  live.  He  resigned  his  posi- 
tion, but  soon  was  able  to  take  up  work  as  a con- 
sulting engineer  and  is  today,  after  fifteen  years, 
an  active,  successful  man.  He  has  resumed  golf 
in  moderation.  He  feels  sure  that  violent  effort 
would  bring  on  his  pains,  but  he  has  learned  his 
lesson,  and  while,  fifteen  years  ago,  slight  effort 
brought  on  severe  attacks  in  bed,  today  he  is  lead- 
ing a useful  life. 

My  colleague,  B.  H.  Rutledge,  has  recently  had 
charge  of  a man  of  over  seventy,  who  had  had 


22+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


characteristic  angina  of  effort,  of  increasing  fre- 
quency for  eight  years,  so  bad  that  they  came  on 
under  most  trivial  effort,  and  waked  him  repeat- 
edly at  night.  A treatment  of  complete  rest  and 
retraining  lasting  three  months  has,  for  the  time 
being,  wholly  ended  the  pains.  This  man  has  re- 
sumed his  business  successfully  for  nearly  a year; 
he  has  not  had  an  attack  for  a year.* *  Cured  ? 
Of  course  not,  but  greatly  benefited  and  enabled 
to  live  a comfortable  life  which  may  endure  for 
a considerable  period. 

Medically  we  know  only  palliatives,  but  our 
general  management  of  the  case  may  bring  about 
practical  recovery  for  considerable  periods  of 
time.  There  is  no  condition  where  the  skill  and 
judgment  of  the  physician  comes  into  greater 
play. 

As  I have  said  elsewhere,  the  management  of 
the  family  is  the  most  difficult  problem.  The  pa- 
tient is  usually  one’s  best  confidant.  The  family 
are  very  hard  to  deal  with  and  it  is  in  their  power 
to  make  the  patient’s  life  utterly  miserable.  One 
must  seek  by  every  conceivable  means  to  induce 
the  family  to  let  the  patient  alone,  and  never,  by 
word  or  act,  to  show  their  anxiety.  To  do  this  is 
not  always  possible.  Too  often  a loving  but  ill- 
balanced  wife  or  husband,  by  constant  manifesta- 
tions of  anxiety,  may  ruin  the  life  of  the  patient. 

At  the  outset  of  these  rambling  remarks  I 
spoke  of  the  tyranny  of  words  under  which  we 
all  live.  The  tyranny  of  the  slogan  or  the  shibbo- 
leth, while  it  may  be  a humiliating  evidence  of 
human  weakness  and  impressionability,  is,  at  the 
same  time,  a striking  example  of  the  power  of 
words.  Sometimes,  I think,  we  physicians  forget 
that  if  the  knife  be  the  most  valuable  implement 
of  the  surgeon,  so  is  the  tongue  the  most  precious 
instrument  of  the  physician.  There  are  still  rela- 
tively few  specifics  in  medicine.  It  is  by  our  coun- 
sel, by  our  moral  influence,  by  our  powers  of 
explanation  or  illustration  or  reasoning,  that  we 
induce  the  patient  to  realize  that  which  he  must 
do  to  preserve  himself  and  others  from  disaster. 
It  is  by  the  tongue  that  we  achieve  our  chief  re- 
sults. Without  careful  education  and  training, 
without  a good  head  to  begin  with,  without  expe- 
rience and  the  power  to  profit  by  experience,  no 
surgeon  can  properly  use  his  knife;  no  physician 
can  properly  use  his  tongue.  There  is  no  regular 
rule  by  which  the  physician  may  be  guided.  Medi- 
cine, while  we  remain  human  beings,  can  never 
be  practised  by  rule;  if  it  could,  the  function  of 
the  physician  would  be  much  easier  if,  indeed,  it 
continued  to  exist.  There  is  no  specific  for  that 
syndrome  which  we  call  “angina  pectoris,”  but 
there  are  few  maladies  which  can  be  more  pro- 
foundly influenced  by  the  wise  counsel  of  a judi- 
cious physician.  It  is  easier,  far  easier,  to  sit 
down  and  write  a prescription  which  may  be 
handed  to  the  patient  with  a few  words  of  direc- 

*It  is  now  nearly  two  years.  The  patient  remains  active 
and  in  good  condition. 


tion  in  an  instance  of  tertian  malaria,  than  it  is  to 
guide  a patient  with  early  anginoid  symptoms  into 
that  course  of  life  which  may  enable  him  to  play 
his  full  part  in  the  world’s  activities.  But  the 
results  in  the  latter  instance  may  be  just  as  great, 
if  harder  to  achieve. 

Let  us  beware  of  the  tyranny  of  words,  but  let 
us  not  forget  the  power  of  words ; for  in  wise 
words,  wisely  used,  lies  a great  part  of  our  art. 

1208  Eutaw  Place. 

REFERENCE 

1.  Keefer,  C.  S.,  and  Resnik,  W.  H.:  Arch.  Int. 
Med.,  xli,  769-807,  June  1928. 


ACUTE  CHOLECYSTITIS — ITS  SURGICAL 
TREATMENT*' 

By  Stanley  H.  Mentzer,  M.  D. 

San  Francisco 

Discussion  by  Stewart  Lobingier,  M.D.,  Los  Angeles; 
O.  O.  IVitherbee,  M.  D.,  Los  Angeles ; Harold  Brunn, 
M.  D.,  San  Francisco. 

HPHE  treatment  of  acute  cholecystitis  varies 
markedly.  On  the  Continent  the  treatment  is 
essentially  radical,  in  America  it  is  mainly  con- 
servative, but  within  each  of  these  areas  there  are 
widely  divergent  views  on  the  subject.  The  study 
here  presented  was  undertaken  at  the  San  Fran- 
cisco Hospital  to  establish  the  status  of  the  treat- 
ment of  acute  cholecystic  disease  in  the  San 
Francisco  Bay  region  of  California. 

CASES  IN  THE  LITERATURE 

Hotchkiss  1 in  1894  reported  the  first  case  of 
acute  gangrenous  cholecystitis.  In  1904  Mayo- 
Robson  2 reported  two  cases,  and  in  1906  Ross  3 
reported  five  cases  and  gathered  eleven  from  the 
literature.  Since  that  time  scattered  case  reports 
have  been  published  by  Tate,4  Whitacre,5  Cramp,6 
Cottam,7  Andrew,8  Cameron,9  Ferguson,10  Gould 
and  Whitby,11  and  others  (Table  1).  To  inter- 
pret the  literature  on  this  subject  it  is  necessary 
to  understand  the  different  writers’  conceptions 
of  acute  gangrenous  cholecystitis.  Unfortunately 
this  is  difficult  because  of  the  variations  in  classi- 
fication and  the  personal  element  in  interpretation 
of  the  pathology  of  acute  cholecystitis. 

CLASSIFICATION  OF  GALL-BLADDER  LESIONS 

I have  tried  to  follow  MacCarty’s  12  classifica- 
tions of  gall-bladder  lesions,  considering  acute 
cholecystitis  as  simple  “acute  catarrhal  cholecysti- 
tis” and  “cholecystitis  purulenta  necrotica.” 13 
The  admissions  into  the  San  Francisco  Hospital, 
under  the  heading  of  acute  cholecystitis,  include 
acute  catarrhal  cholecystitis,  acute  exacerbations 
of  chronic  cholecystitis,  the  acute  cholecystitis  of 
pregnancy,  acute  hydrops,  acute  empyema,  acute 
phlegmonous  cholecystitis,  and  acute  gangrenous 
cholecystitis  (Table  2). 

* From  the  Department  of  Surgery,  University  of  Cali- 
fornia Medical  School,  San  Francisco. 

* Read  before  the  General  Surgery  Section  of  the  Cali 
fornia  Medical  Association  at  the  fifty-eighth  annual 
session,  at  Coronado,  May  6-9,  1929. 


April,  1*130 


ACUTE  CHOLECYSTITIS — MENTZER 


225 


Table  1. — Acute  Gangrenous  Cholecystitis — Case 
Reports 


Author 

Year 

No.  of  cases 

Hotchkiss  

1894 

1 

Ferguson  ... 

L89S 

1 

Mayo  Robson 

1904 

2 

Ross  

. 190G 

5 total 

11 

Tate  .. 

1910 

1 

Whitacre  

1911 

1 

Cramp  

1915 

2 

Cottam 

1917 

3 total 

44 

Andrew 

...  1923 

1 

Cameron  

1927 

4 

Gould  and  Whitby  

1927 

2 

Lobingier14  has  added  a group  which  he  calls 
“necrotic  edema.”  This  lesion  belongs  to  the  early 
acute  hydrops  and  to  the  early  or  potential  gan- 
grenes. Many  of  my  cases  of  acute  cholecystitis 
undoubtedly  belong  in  this  group,  but  in  this 
series  of  acute  gangrenous  cholecystitis,  I have 
tried  to  avoid  such  cases  because  I feel  that  many 
of  these  subside  under  conservative  treatment; 
whereas  acute  gangrenous  cholecystitis  could 
scarcely  do  so. 

METHODS  OF  TREATMENT 

Most  authors  agree  that  acute  gangrenous 
cholecystitis  warrants  extirpation  of  the  gall 
bladder  immediately.  If  this  lesion  could  be  iden- 
tified preoperatively,  there  would  be  little  ques- 
tion about  the  proper  procedure.  But  it  is  so  diffi- 
cult to  interpret  the  type  and  the  degree  of  patho- 
logic change  in  the  gall  bladder  clinically  that  the 
surgical  treatment  is  often  in  doubt.  Experience 
has  shown  that  most  acute  lesions  in  the  gall 
bladder  subside  under  conservative  treatment, 
and  the  American  authorities  advise  conservative 
care  in  “acute  cholecystitis”  for  this  reason.  This 
is  especially  true  for  simple  acute  catarrhal  chole- 
cystitis, acute  hydrops,  and  early  acute  empyema 
of  the  gall  bladder.  Even  cases  of  early  perfora- 
tions of  the  gall  bladder  are  often  best  treated 
conservatively.  Therefore  Haggard,35  Deaver,16 
Bunts,17  Lyons,18  Verbrycke,19  DuBose,20  Mc- 
Guire,21 Judd,22  Richardson,23  Muller,24  Archi- 
bald,25 Balfour,26  Martin,34  and  others  have  ad- 
vised conservative  treatment  for  acute  lesions  of 
the  gall  bladder.  On  the  other  hand,  Walton,27 
Leriche,28  Cotte,29  Kirschner,30  and  many  others 
recommend  immediate  cholecystectomy  for  “acute 
cholecystitis.”  The  attitude  of  a group  of  seven 
local  surgeons  in  this  matter  is  indicated  in  this 
present  study. 

SAN  FRANCISCO  HOSPITAL  STATISTICS 

From  1919  to  1928  there  were  76,902  hospital 
admissions  into  the  San  Francisco  County  Hos- 
pital. One  and  a half  per  cent  of  these  were  ad- 

Table  2. — Acute  Lesions  of  the  Gall  Bladder — 
Pathologic  Classification 

Acute  catarrhal  cholecystitis 

Acute  exacerbation  of  chronic  cholecystitis 

Acute  cholecystitis  of  pregnancy 

Acute  hydrops 

Acute  empyema 

Necrotic  edema 

Acute  phlegmonous  cholecystitis 
Acute  gangrenous  cholecystitis 


mitted  or  subsequently  diagnosed  as  “cholecystic 
disease,”  and  31  per  cent  of  the  latter  were  oper- 
ated upon.  One  hundred  and  sixty-one  cases  were 
diagnosed  “acute  cholecystitis,”  and  thirty-eight 
of  these  (23  per  cent)  were  subsequently  proved 
to  be  acute  gangrenous  cholecystitis.  Therefore 
about  0.042  per  cent  of  the  total  hospital  admis- 
sions and  four  per  cent  of  the  total  cholecystitis 
admissions  were  for  acute  gangrenous  cholecys- 
titis. This  unusually  large  number  of  patients 
with  acute  gangrenous  cholecystitis  can  be  ac- 
counted for  by  the  fact  that  this  hospital  receives 
most  of  the  urgent  cases  from  the  Emergency 
Hospital  service  of  the  city  of  San  Francisco, 
and  by  the  fact  that  the  usual  county  hospital 
patient  has  an  advanced  lesion  before  he  enters. 

McGuire  21  has  reported  that  five  per  cent  of 
one  thousand  gall-bladder  operations  were  per- 
formed in  the  acute  stage,  and  MacCarty  and 
Corkery  stated  that  above  five  per  cent  of  five 
thousand  cholecystectomy  specimens  belonged  to 
the  acute  group. 

Seventy-eight  of  the  one  hundred  and  sixty-one 
admissions  for  “acute  cholecystitis”  were  oper- 
ated upon  within  the  first  twenty-four  hours  after 
admission ; thirty-eight  of  these  were  found  to  be 
acutely  gangrenous  gall  bladders. 

Of  the  remaining  eighty-three  cases,  although 
diagnosed  acute  cholecystitis,  sixteen  were  not 
considered  imperatively  operative,  nine  were  acute 
abdominal  lesions  but  not  definitely  acute  chole- 
cystitis, thirty-two  were  observed  for  a period  of 
time  and  finally  diagnosed  as  subacute  lesions 
other  than  cholecystitis  and  not  operated  upon, 
three  were  acute  exacerbations  or  onsets  of  chole- 
cystic disease  associated  with  pregnancy  and  were 
not  operated  upon.  Eighteen  cases  were  definitely 
advanced  acute  cholecystitis  and  were  treated  con- 
servatively without  surgery. 

Among  the  seventy-eight  cases  operated  upon 
within  twenty-four  hours  after  entrance  into  the 
hospital,  thirty-eight  were  found  to  be  acute  gan- 
grenous cholecystitis,  nine  were  acute  exacerba- 
tions of  chronic  cholecystitis  or  acute  empyemas 
with  fibrin  or  purulent  exudate  on  the  serosal  sur- 
face of  the  gall  bladder  but  not  gangrenous  or 
ruptured.  There  were  thirty  acute  or  subacute 
exacerbations  of  chronic  cholecystitis  limited  to 
the  gall  bladder  and  without  gross  involvement  of 
adjacent  structures.  None  of  these  were  gangre- 
nous, but  many  belonged  to  the  groups  of  necrotic 
edema,  subacute  empyema,  and  subacute  hydrops. 
One  was  a true  acute  catarrhal  cholecystitis,  a 
relatively  rare  lesion.  One  patient  was  operated 
upon  for  “acute  cholecystitis,”  but  the  gall  blad- 
der appeared  normal  and  no  other  abdominal 
pathology  was  found. 

ACUTE  GANGRENOUS  CHOLECYSTITIS 

Tbe  thirty-eight  cases  of  acute  gangrenous 
cholecystitis  that  were  operated  upon  immediately 
were  studied  in  detail.  Twenty  of  the  patients 
were  men  and  eighteen  were  women.  Their  ages 
varied  from  nineteen  to  seventy-six  years,  the 


226 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  + 


average  being  forty-nine  years,  but  the  greatest 
number  occurring  about  the  age  of  fifty-five. 

Pathology. — Acute  gangrene  occurs  occasion- 
ally from  torsion  of  the  gall  bladder.  Textbooks 
of  pathology  consider  this  form  of  etiology,  but 
it  is  not  often  encountered.  Cramp6  reported  such 
a case  in  191.5,  and  a few  others  appear  in  the 
literature.  None  of  our  cases  belong  in  this  group. 

The  majority  of  cases  occur  as  a result  of  gall- 
stone impaction  in  the  neck  of  the  gall  bladder 
or  in  the  cystic  duct,  interfering  with  the  blood 
supply  and  so  producing  gangrene.  Gall  stones, 
therefore,  account  for  a large  number  of  these, 
but  in  our  series  stones  were  absent  in  ten  of  the 
thirty-eight  specimens.  We  must  account  for  the 
gangrene  in  these  instances  by  an  acute  virulent 
infection  and,  in  conformity  with  this  thesis, 
six  of  the  ten  noncalculous  gangrenes  were  de- 
scribed by  the  operating  surgeon  as  acute  phleg- 
monous cholecystitis  with  gangrene.  Hotchkiss  1 
attributed  the  gangrene  in  his  case  to  pressure  of 
the  exudate  within  the  gall  bladder  with  conse- 
quent stasis  in  the  blood  vessels.  Gould  and 
Whitby  have  reported  two  cases  of  acute  gan- 
grene of  the  gall  bladder  due  to  the  Bacillus 
welchii,  gas,  and  positive  cultures  having  been 
obtained  from  the  gall-bladder  wall,  bile,  and 
stones  in  one  case  and  from  the  gall-bladder  wall 
and  bile  in  the  noncalculous  specimen. 

Occasionally  localized  areas  of  gangrene  occur 
as  a result  of  embolic  phenomena,  but  these  cases 
do  not  belong  to  the  group  of  acute  gangrenous 
cholecystitis.  They  probably  rupture  early  and 
account  for  those  acute  perforations  that  occur 
without  stones.  Those  specimens  that  show  gan- 
grenous edges  about  the  site  of  a decubitus  ulcer 
from  stone  erosion  or  perforation,  likewise  do 
not  belong  in  this  group,  for  the  pathology  in 
these  cases  is  not  that  of  a true  acute  gangrenous 
cholecystitis  in  which  half  or  more  of  the  vesica 
fellea  is  gangrenous. 

Symptoms  and  Signs. — The  majority  of  the 
patients  operated  upon  for  acute  gangrenous 
cholecystitis  had  had  gastro-intestinal  distress  for 
many  years.  Most  of  them  had  the  characteristic 
signs  and  symptoms  of  cholecystic  disease  for 
long  periods,  and  the  present  attack  resembled 
previous  ones  except  for  its  unusual  severity. 
Eight  patients,  however,  vigorously  denied  ever 
having  had  any  “stomach  trouble”  or  other  symp- 
toms suggestive  of  biliary  disease.  This  point 
was  emphasized  in  the  histories,  and  is  of  par- 
ticular interest  because  of  its  supposed  rarity. 
Tate,4  Ferguson,10  Brunn,31  and  others  have  noted 
the  onset  of  acute  cholecystitis  without  previous 
suggestive  signs  of  gall-bladder  disease  and  it  is 
important  to  emphasize  this  fact,  for  it  is  evident 
that  acute  gangrenous  cholecystitis  may  be  the  pri- 
mary and  initial  manifestation  of  biliary  disease. 

Most  of  the  patients  presented  the  typical  signs 
of  an  acute  abdomen  when  they  entered  the  hos- 
pital, with  fever,  leukocytosis,  localized  tender- 
ness and  rigidity,  and  had  vomited  one  or  more 


times  before  entrance  into  the  hospital.  One  pa- 
tient, however,  was  observed  in  the  hospital  for 
eighteen  days  before  tbe  signs  were  sufficiently 
definite  to  warrant”  surgical  intervention.  She 
had  been  treated  conservatively  for  acute  chole- 
cystitis, but  gangrene  developed  slowly  and  with- 
out manifest  signs  or  symptoms  until  the  eigh- 
teenth day.  Tate  reported  a similar  case  in  which 
one  month  elapsed  before  gangrene  appeared 
while  the  patient  was  observed  during  an  “acute 
cholecystitis.”  Brunn’s 31  case  is  interesting  in 
this  connection,  for  he  observed  a patient  who 
presented  few  signs  or  symptoms,  without  fever 
and  a white  count  of  only  4000,  whose  gall  blad- 
der was  partially  gangrenous  when  removed. 

Preoperative  Diagnosis. — -A  diagnosis  of  acute 
cholecystitis  was  made  in  all  but  six  of  the  thirty- 
eight  cases.  Two  were  considered  ruptured  gas- 
tric ulcers,  one  a diffuse  peritonitis,  one  mesen- 
teric thrombosis,  one  intestinal  obstruction,  and 
one  an  “acute  abdomen.”  Gall  stones  were  con- 
sidered present  in  practically  all  of  the  cases,  but 
were  found  in  only  74  per  cent. 

Operative  Procedures. — Most  of  the  patients 
were  too  ill  on  entrance  to  be  given  any  preopera- 
tive preparation  other  than  the  usual  immediate 
care.  They  were  operated  upon  within  twenty- 
four  hours  after  entrance  except  for  the  one  noted 
above  that  waited  eighteen  days.  Many  of  them 
were  explored  within  one  or  two  hours  after 
entering  the  hospital. 

Exposure  was  effected  in  various  ways,  most 
of  the  surgeons  using  a high  right  rectus  incision. 
I prefer  the  Kocher  incision  as  modified  by  Judd, 
beginning  high  up  on  the  ensiform  and  parallel- 
ing the  costal  margin  about  three  centimeters 
from  its  edge.  The  fascia  is  incised  in  the  same 
plane,  but  the  muscle  fibers  of  the  rectus  are  split 
longitudinally.  The  posterior  sheath  of  the  rectus 
and  the  transversalis  are  incised  with  the  peri- 
toneum parallel  to  the  skin  incision.  The  muscle 
is  then  retracted  laterally  and  medially,  and  good 
exposure  obtained.  Closure  is  not  difficult  after 
this  incision,  and  I have  never  seen  a postopera- 
tive hernia  following  this  closure. 

If  the  round  ligament  of  the  liver  is  severed 
and  used  for  traction,  it  everts  the  under  surface 
of  the  liver  and  adds  materially  to  the  exposure 
of  the  gall-bladder  fossa.  The  operative  pro- 
cedure is  carried  out  as  previously  described,32 
except  that  clamps  are  not  used  for  traction  on 
the  fundus  of  the  acutely  gangrenous  gall  bladder. 
The  vesicle  is  usually  distended  and  firm,  very 
friable  and  easily  ruptured,  and  the  less  it  is 
handled  the  better.  Gentle  traction  with  the 
fingers  of  the  left  hand  is  usually  sufficient  for 
the  necessary  operative  manipulations. 

Cholecystectomy  was  performed  for  twenty- 
two  of  the  thirty-eight  cases  of  acute  gangrenous 
cholecystitis  and  cholecystostomy  in  sixteen  by  the 
seven  surgeons  who  operated  in  this  series.  In 
one  of  the  cases  the  gall  bladder  had  virtually 
dissected  itself  free  and  was  hanging  from  the 
liver  suspended  only  by  the  cystic  duct  much  in 


April,  1930 


ACUTE  CHOLECYSTITIS — MENTZER 


227 


the  same  manner  as  Cameron  0 has  reported  in 
two  cases.  In  many  instances  cholecystectomy  is 
an  easy  procedure  in  these  patients,  for  the  vesicle 
dissects  away  from  its  liver  bed  readily  and  is 
peeled  out  without  serious  venous  oozing.  The 
gall  bladder  was  clamped  off  close  to  the  cystic 
duct  in  all  but  two  cases.  In  one  of  these  about 
a third  of  the  gall  bladder  was  left  with  the  stump 
of  the  cystic  duct  much  as  Cullen  33  has  advised. 
Lobingier  has  suggested  that  the  neck  of  the  gall 
bladder  be  left  and  a drainage  tube  sutured  into 
it.  Martin  proposed  that  the  gall  bladder  should 
be  split  longitudinally  and  the  wall  adjacent  to 
the  liver  left  after  curetting  the  mucosa  from  it. 
I have  done  this  procedure  in  one  instance  with 
good  results,  but  as  a rule  the  gall  bladder  peels 
away  from  the  liver  so  readily  that  it  is  not 
necessary. 

Abundant  drainage  is  indicated  in  these  cases 
and  was  carried  out  in  all  but  one  instance.  The 
patient  had  a cholecystectomy  for  gangrene  in- 
volving the  distal  half  of  the  gall  bladder,  with- 
out stones.  The  abdomen  was  closed  without 
drainage  and  the  patient  made  an  uneventful 
convalescence. 

Some  authors  insist  that  cholecystostomy  is  the 
operation  of  choice  in  acute  gangrene.  There  are 
times  when  it  is  indicated,  of  course.  In  this 
series  it  was  considered  advisable  in  40  per  cent 
of  the  cases.  It  is  often  easier  than  cholecyst- 
ectomy and  certainly  less  shocking,  in  selected 
cases.  It  is  not  the  operation  of  choice  for  true 
acute  gangrene  because  of  the  danger  of  leaving 
gangrenous  tissue  in  the  abdomen.  Furthermore, 
it  is  sometimes  technically  more  difficult  because 
it  is  impossible  to  purse-string  a drainage  tube  in 
friable  gangrenous  tissue.  Coffey  35  recommends 
cholecystostomy  and  the  use  of  abundant  drain- 
age material  as  in  his  “quarantine  pack,”  and,  in 
certain  cases,  it  is  the  method  of  choice.  But  I 
feel  that  cholecystectomy  should  be  done  when- 
ever possible  because  it  effects  the  total  removal 
of  gangrenous  tissue,  avoids  the  necessity  for 
secondary  operations,  and  decreases  the  time  of 
postoperative  convalescence  both  in  the  hospital 
and  at  home.  Eighteen  per  cent  of  the  cholecyst- 
ectomy cases  left  the  hospital  within  fifteen  days 
after  operation,  while  none  of  the  cholecystos- 
tomy patients  left  within  that  time.  Fifty  per  cent 
of  the  cholecystostomy  patients  remained  in  the 
hospital  more  than  thirty  days  postoperatively ; 
whereas  only  18  per  cent  of  the  cholecystectomy 
patients  remained  that  long.  Forty-one  per  cent 


of  the  cholecystectomy  patients  had  their  drains 
removed  before  the  sixth  day;  none  of  the  chole- 
cystostomy patients  had  their  drains  removed 
before  the  seventh  day.  Only  six  per  cent  of  the 
cholecystectomy  patients  had  drainage  persisting 
after  the  third  week;  whereas  20  per  cent  of  the 
cholecystostomy  patients  were  still  draining.  The 
average  duration  of  stay  in  the  hospital  for  the 
cholecystectomy  cases  was  twenty-four  days,  while 
the  cholecystostomy  patients  averaged  thirty-five 
days  (Table  3). 

I do  not  mean  to  suggest  that  all  cases  of  acute 
gangrenous  cholecystitis  should  be  subjected  to 
cholecystectomy.  There  is  a middle  ground,  of 
course,  so  well  described  by  W.  J.  Mayo  36  in  an 
editorial  in  1924.  The  surgical  treatment  of  this 
lesion  must  depend  on  the  type  and  degree  of 
inflammatory  process  and  the  patient’s  reaction 
to  it.  But  when  possible,  cholecystectomy  is  the 
operation  of  choice. 

MORTALITY 

Mortality  statistics  gathered  from  the  literature 
are  difficult  to  evaluate  because  of  the  indefinite 
classification  of  acute  cholecystitis.  Most  authors 
refer  to  acute  empyema,  necrotic  edema,  perfora- 
tion of  the  gall  bladder,  and  acute  gangrenous 
cholecystitis  when  they  quote  surgical  mortality 
statistics  for  acute  cholecystitis.  Bunnell 37  states 
that  the  mortality  in  acute  cholecystitis  is  about 
30  per  cent.  Dowling 38  has  found  it  27)4  per 
cent.  Judd  and  Lyons  39  reported  forty-five  chole- 
cystectomies and  twenty-two  cholecystostomies 
for  acute  cholecystitis,  with  only  one  death.  If 
the  authors  had  limited  themselves  to  acute  gan- 
grenous cholecystitis,  the  mortality  would  un- 
doubtedly have  been  higher.  I have  not  been  able 
to  find  any  data  on  this  subject  in  the  literature. 

For  this  study  I have  grouped  the  mortality 
data  under  four  heads : 

1.  The  clinically  acute  cholecystitis. 

2.  The  clinically  subacute  cholecystitis. 

3.  The  surgical  subacute  cholecystitis. 

4.  The  surgical  acute  gangrenous  cholecystitis. 

1.  The  Clinically  Acute  Cholecystitis. — There 
were  eighteen  cases  of  definitely  acute  cholecysti- 
tis in  the  first  group  that  were  not  subjected  to 
surgery.  All  these  patients  were  acutely  ill,  with 
fever,  leukocytosis,  and  localized  right  costal  mar- 
gin rigidity.  These  patients  were  treated  con- 
servatively by  bed  rest  in  the  Fowler  position, 
ice  bags,  and  morphin.  Four  deaths  occurred 
(mortality  22  per  cent),  two  from  ruptured  gall 


Table  3. — Acute  Gangrenous  Cholecystitis — Operative  Results 


Hospital  Stay 

Drains  Removed 

Persisting  Drainage 

Average 

Hospital 

Stay 

15  days  or  less 

30  days  or  more 

6th  day  or  less 

3 weeks  or  more 

Cholecystectomy 

1S% 

18% 

41% 

6% 

24  days 

Cholecystostomy 

0 

50% 

0 

20% 

35  days 

228 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4- 


Table  4. — Acute  Cholecystitis — Mortality 


Pathology 

No.  of  Cases 

Operative  Procedure 

Mortality 

Cause  of  Death 

Clinically  advanced 

acute  cholecystitis 

18 

None 

4 (22%) 

2 ruptured  gall  bladders 

2 ruptured  gall  bladders  ( ?) 

Acute  abdomen? 

9 

Immediate  exploratory 

1 (11%) 

1 ruptured  gall  bladder  with 

Gall  bladder 

advanced  cancer  pancreas 

Clinically  subacute 

cholecystitis 

40 

None 

2 (5%) 

1 ruptured  duodenal  ulcer 

1 hemorrhage  into  thymus 

3 cholesterin  stones 

Acute  on  a ch.  chol. 

Acute  hydrops 

Acute  empyema 
Perforations  (2) 

9 

Immediate  cholecystectomy 

0 

Subacute  on  ch.  chol. 

Cholecystectomy 

Subacute  hydrops 
Subacute  empyema 
“Normal”  gall  bladder 

30 

Not  immediately 

1 (3%) 

1 pneumonia 

1 

Exploratory 

0 

Acute  gangrenous 

38 

Cholecystectomy  22  (18%) 

10  (26%) 

cholecystitis 

Cholecystostomy  16  (37%) 

bladders  and  two  supposedly  from  ruptured  gall 
bladders  not  proved  by  autopsy. 

There  were  nine  acute  abdomens  in  this  first 
group,  none  of  which  were  definitely  diagnosed 
cholecystic  in  origin,  preoperatively.  One  of  these 
patients  died  from  a ruptured  gangrenous  gall 
bladder  superimposed  on  an  advanced  carcinoma 
of  the  pancreas  (mortality  11  per  cent). 

There  were  sixteen  cases  of  clinically  acute 
cholecystitis  in  this  first  group  that  did  not  seem 
severe  enough  to  require  immediate  surgical  inter- 
vention. Most  of  these  patients  were  operated 
upon  a week  or  so  later.  There  was  no  mortality 
in  this  group. 

2.  The  Clinically  Subacute  Cholecystitis. — There 
were  forty  cases  of  clinically  subacute  cholecysti- 
tis in  the  second  group.  None  of  these  patients 
were  operated  upon.  Two  deaths  occurred,  one 
from  ruptured  duodenal  ulcer,  undiagnosed.  The 
other  death  was  that  of  an  infant  of  three  months 
of  age  that  seemed  to  have  a subacute  abdominal 
lesion.  She  died  of  a hemorrhage  into  the  thymus. 
The  abdomen  was  normal  except  for  three  faceted 
cholesterin  stones  in  a thin-walled  inflammatory- 
free  gall  bladder  (mortality  five  per  cent). 

Six  of  the  patients  left  the  hospital  complain- 
ing of  more  or  less  vague  abdominal  distress,  or 
the  x-ray  showed  “diseased  gall  bladders,”  and 
they  were  considered  clinically  unimproved  even 
though  they  had  been  relieved  of  their  acute  dis- 
tress. The  remaining  thirty-two  patients  were 
dismissed  as  improved. 

3.  The  Surgical  Subacute  Cholecystitis. — The 
third  series  consists  of  a group  of  forty  cases 
considered  acute  cholecystitis  and  operated  upon 
within  twenty-four  hours  after  admission  into  the 
hospital.  Nine  of  these  were  definitely  acute 
exacerbations  of  chronic  cholecystitis,  empyema, 
or  hydrops  with  fibrin  coating  the  serosal  sur- 
face of  the  gall  bladder  but  not  showing  any 
diffuse  gangrene.  Two  of  these  had  perforated 


with  localized  abscesses  adjacent.  Cholecystec- 
tomy was  performed  in  all  of  the  nine  cases  with- 
out mortality. 

There  were  thirty  cases  of  subacute  cholecysti- 
tis or  subacute  exacerbations  of  chronic  chole- 
cystitis, empyema,  or  hydrops  that  clinically 
seemed  acute.  Laparotomy  was  performed  in  all 
of  these  with  one  death  (mortality  three  per 
cent).  That  patient  had  a subacute  exacerbation 
of  a chronic  empyema  with  stones,  and  died  on 
the  fourth  day  postoperatively  of  pneumonia. 
One  patient  in  this  group  was  operated  upon  for  a 
clinically  acute  cholecystitis,  but  the  gall  bladder 
was  grossly  normal  and  no  other  abdominal  pa- 
thology could  be  found.  This  patient  was  “not 
improved.” 

4.  The  Surgical  Acute  Gangrenous  Cholecys- 
titis.— The  mortality  in  the  fourth  group  was,  of 
course,  the  most  interesting.  There  were  thirty- 
eight  patients  in  this  group,  all  operated  cases  of 
acute  gangrenous  cholecystitis.  There  were  ten 
deaths  (mortality  26  per  cent).  This  rate  com- 
pares favorably  with  the  group  of  eighteen  clini- 
cally acute  cholecystitis  patients  who  were  very  ill 
and  not  operated  upon  where  the  mortality  was 
22  per  cent.  These  latter  patients  were  treated 
conservatively  in  conformity  to  the  opinions  of 
many  surgeons  who  advise  conservative  treatment 
for  all  early  acute  gall-bladder  lesions.  If  these 
patients  could  have  been  brought  into  the  hospital 
earlier  in  the  course  of  their  biliary  disease,  many 
of  them  would  have  been  operated  upon,  for  some 
were  moribund  on  entrance.  Others  were  con- 
sidered early  perforations  with  localized  peri- 
tonitis and  they  were  treated  conservatively  until 
the  inflammatory  process  could  be  walled  off.  It 
is  impossible  to  estimate  the  type  of  pathology 
present  in  these  eighteen  cases  except  for  the 
four  patients  who  died.  Two  of  these  were  proved 
ruptured  gall  bladders  with  areas  of  patchy  gan- 
grene, and  two  were  presumably  acute  gangre- 
nous cholecystitis,  but  not  proved  by  necropsy. 


April,  1930 


ACUTE  CHOLECYSTITIS — MENTZEK 


229 


Table  5. — Acute  Gangrenous  Cholecystitis — Mortality 


Operation 

No.  of 

Cases 

Days  or  Hours 
Postoperative 

Cause  of  Death  (Autopsy) 

Cholecystectomy 

1 

1 day 

Pericarditis  with  effusion 

1 

2 days 

Pericarditis  with  effusion 

1 

1 day 

Pericarditis  with  effusion  and 

bronchopneumonia 

1 

3 days 

Pulmonary  edema  and  multiple  abscess  of  liver 

Cholecystostomy 

1 

2 hours 

Bilateral  pyothorax 

1 

12  hours 

Acute  dilatation  heart;  peritonitis 

1 

3 days 

Peritonitis 

1 

6 days 

Obstructive  jaundice,  common  duct  stone 

1 

7 days 

Pneumonia 

1 

12  days 

Common  duct  stones,  enteritis  and  fatty  heart 

The  remainder  were  presumably  not  gangrenous 
and  probably  not  perforations  inasmuch  as  they 
recovered. 

The  thirty-eight  cases  considered  in  the  fourth 
group,  however,  were  proved  cases  of  acute  gan- 
grenous cholecystitis  subjected  to  surgery,  and  the 
mortality  in  these  is  considerably  less  than  might 
be  expected.  This  mortality  rate  is  almost  wholly 
due  to  delay,  for  if  these  patients  had  been  seen 
earlier  by  a surgeon,  most  of  them  at  least  would 
have  been  operated  upon  much  sooner.  They  add 
a plea  for  early  intervention  in  acute  cholecystic 
lesions.  I believe  that  conservative,  nonoperative 
treatment  is  advisable  in  all  cases  of  acute  gall- 
bladder disease  provided  the  patients  be  under  con- 
stant surveillance.  The  majority  of  acute  biliary 
disturbances  are  not  operative,  and  those  that  are 
can  be  best  handled  in  the  subacute  stage.  But  a 
certain  group,  of  which  these  thirty-eight  cases 
are  the  outstanding  examples,  will  need  immediate 
surgical  intervention.  This  group  can  be  distin- 
guished from  the  previously  cited  cases  of  acute 
and  subacute  cholecystitis  only  by  constant  surgi- 
cal observation. 

The  patients  on  whom  a cholecystostomy  was 
performed  were  as  a rule  more  acutely  ill  than 
those  that  had  a cholecystectomy.  That  accounts 
for  the  difference  in  the  mortality  in  these  two 
groups ; for  the  former  was  37  per  cent  while  the 
latter  was  only  18  per  cent.  We  cannot  conclude 
from  this  data  that  cholecystectomy  is  the  opera- 
tion of  choice  for  acute  gangrenous  cholecystitis, 
but  these  facts  coupled  with  others  previously 
given  warrant  serious  consideration  in  favor  of 
cholecystectomy. 

The  cause  of  death  in  the  ten  operated  cases  of 
acute  gangrenous  cholecystitis  was  established  by 
autopsy,  and  is  given  in  Table  5.  Two  patients 
died  of  pericarditis  with  effusion ; two  of  broncho- 
pneumonia, in  one  of  whom  it  was  recognized 
before  surgery;  one  of  pulmonary  edema;  one 
of  bilateral  pyothorax ; two  of  peritonitis ; and 
two  of  liver  insufficiency  secondary  to  common 
duct  stones. 


SUMMARY 

1.  There  are  two  schools  of  therapy  for  the 
treatment  of  acute  cholecystitis — the  radical  and 
the  conservative. 

2.  The  attitude  of  seven  local  surgeons  has 
been  definitely  conservative. 

3.  One  and  a half  per  cent  of  the  admissions 
to  the  San  Francisco  Hospital  were  for  chole- 
cystic disease;  31  per  cent  of  these  were  operated 
upon. 

4.  Seventeen  per  cent  of  the  hospital  admis- 
sions for  cholecystic  disease  were  for  acute 
cholecystitis.  Twenty-three  per  cent  of  these 
(thirty-eight  cases)  were  proved  cases  of  acute 
gangrenous  cholecystitis. 

5.  Gall  stones  were  present  in  only  twenty- 
eight  of  the  thirty-eight  gangrenous  specimens. 

6.  The  present  attack  initiated  the  first  symp- 
toms of  cholecystic  disease  in  eight  of  the  thirty- 
eight  patients. 

7.  A diagnosis  of  acute  cholecystitis  was  made 
in  all  but  six  of  the  thirty-eight  patients. 

8.  All  but  one  were  operated  upon  within  a few 
hours  after  entrance  into  the  hospital. 

9.  Cholecystectomy  was  performed  in  twenty- 
two  cases  and  cholecystostomy  in  sixteen. 

10.  The  duration  of  convalescence  and  the  time 
spent  in  the  hospital  were  considerably  less  for 
the  cholecystectomized  patients. 

11.  The  mortality  in  nonoperated  acute  chole- 
cystitis cases  was  22  per  cent. 

12.  There  was  no  mortality  in  sixteen  patients 
that  were  operated  upon  a few  days  after  the 
acute  symptoms  had  subsided. 

13.  The  mortality  in  forty  nonoperated  cases 
of  subacute  cholecystitis  was  five  per  cent. 

14.  There  were  no  deaths  in  nine  surgical  cases 
of  nongangrenous  acute  cholecystitis. 

15.  The  mortality  in  thirty-eight  cases  of  acute 
gangrenous  cholecystitis  was  26  per  cent. 

CONCLUSIONS 

1.  The  treatment  of  acute  cholecystitis  should 
be  conservative  if  the  patient  is  under  constant 
observation. 


230 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


2.  Immediate  surgical  intervention  is  indicated 
if  the  patient  does  not  respond  to  conservative 
hospital  care. 

3.  There  is  a need  for  a better  classification 
of  acute  cholecystic  disease. 

4.  Acute  gangrenous  cholecystitis  may  be  the 
primary  and  initial  manifestation  of  biliary  dis- 
ease. 

5.  Gangrene  of  the  gall  bladder  may  develop 
slowly  without  manifest  signs. 

6.  Cholecystectomy,  when  possible,  is  the  opera- 
tion of  choice  for  acute  gangrenous  cholecystitis. 

Four  Fifty  Sutter  Street. 

REFERENCES 

1.  Hotchkiss,  L.  W.:  Gangrenous  Cholecystitis,  Ann. 
Surg.,  1894,  xix,  197. 

2.  Mayo-Robson,  A.  W.:  Diseases  of  the  Gall  Blad- 
der and  Bile  Ducts.  Bailliere,  Tindall  & Cox,  London, 
1904. 

3.  Ross,  J.  F.  W. : Cholecystitis  with  Gangrene  of 
the  Gall  Bladder,  Canad.  Pract.  and  Rev.,  1906. 

4.  Tate,  M.  A.:  Gangrene  of  Gall  Bladder,  Amer. 
J.  Obst.  and  Gynec.,  1910,  lxi,  267. 

5.  Whitacre,  H.  J.:  Rupture  and  Gangrene  of  the 
Gall  Bladder  as  an  Emergency  Condition,  Ohio  State 
M.  J.,  May  1911,  vii,  220. 

6.  Cramp,  W.  C. : Gangrene  of  Gall  Bladder  from 
Twisted  Cystic  Duct,  Med.  Rec.,  1915,  lxxxvii,  120. 

7.  Cottam,  G.  G. : Gangrenous  Cholecystitis,  Surg. 
Gynec.  and  Obs.,  1917,  xxv,  192. 

8 Andrew,  J.  M.:  A Case  of  Acute  Gangrenous 
Cholecystitis,  Med.  J.  of  Austral.,  1923,  i,  447. 

9.  Cameron,  M.  K.  V.:  Acute  Gangrenous  Chole- 
cystitis, Canad.  Med.  Assoc.  J.,  January  1927,  xvii,  48. 

10.  Ferguson,  H.:  Care  of  Acute  Phlegmonous 
Cholecystitis  and  Gangrene  of  Gall  Bladder,  Chicago 
Med.  Rec.,  May  1898,  xiv,  408. 

11.  Gould,  E.  P.,  and  Whitby,  L.  E.  H.:  A Case 
of  B.  Welchii  Cholecystitis,  Brit.  J.  Surg.,  April  1927, 
xiv,  646. 

12.  MacCarty,  W.  C.,  and  Corkery,  J.  R. : Early 
Lesions  in  the  Gall  Bladder,  Amer.  J.  Med.  Sci.,  May 
1920,  clix,  646. 

13.  Mentzer,  S.  H.:  The  Status  of  Gall  Bladder 
Surgery,  Based  on  a Study  of  Fourteen  Thousand 
Specimens,  J.  A.  M.  A.,  xc,  607,  February  25,  1928. 

14.  Lobingier,  A.  S. : (1)  The  Principles  and  Tech- 
nique of  Drainage  in  the  Surgery  of  the  Gall  Bladder 
and  Bile  Tract,  Cal.  State  J.  Med.,  February  1924. 
(2)  Pathological  Indications  for  Cholecystectomy, 
Calif.  State  J.  Med.,  November  1919. 

15.  Haggard:  Quoted  by  Cohn,  Isadore.  Personal 
Experiences  in  Abdominal  Surgical  Emergencies, 
Northwest.  Med.,  November  1928,  xxvii,  505.  Quot- 
ing Bruggeman. 

16.  Deaver,  J.  B.:  (1)  Quoted  by  Bruggeman.  (2) 
Gall  Bladder  Disease,  New  Eng.  J.  Med.,  January  24, 
1924,  cc,  159. 

17.  Bunts,  F.  E. : Some  Considerations  Pertaining 
to  the  Diagnosis  and  Surgical  Treatment  of  Diseases 
of  the  Gall  Bladder,  Ann.  Surg.,  August  1925,  p.  232. 

18.  Lyons:  Quoted  by  Bruggeman. 

19.  Yerbrycke,  J.  R. : Cholecystectomy  without 
Drainage,  Med.  J.  and  Rec.,  December  21,  1927,  cxxvi, 
705. 

20.  DuBose,  F.  G.:  Cholecystogastrostomy  and 
Cholecystoduodenostomy,  S.  G.  and  O.,  September 
1924,  p.  295. 

21.  McGuire,  S.:  Opinions  on  Various  Questions  in 
Gall  Bladder  Surgery,  Based  on  One  Thousand 
Operations,  Virginia  Med.  Month.,  January  1924. 

22.  Judd,  E.  S.:  Surgery  of  Gall  Bladder  and  the 
Biliary  Ducts,  J.  A.  M.  A,  July  13,  1919,  lxxi,  79. 

23.  Richardson:  Quoted  by  Cohn. 

24.  Muller:  Quoted  by  Cohn. 

25.  Archibald:  Quoted  by  Bruggeman. 


26.  Balfour,  D.  C.:  Technique  of  Hepaticoduodenos- 
tomy,  with  Some  Notes  on  Reconstructive  Surgery  of 
the  Biliary  Tract,  Ann.  Surg.,  March  1921,  lxxiii,  343. 

27.  Walton:  Quoted  by  Bruggeman. 

28.  Leriche:  Quoted  by  Bruggeman. 

29.  Cotte:  Quoted  by  Bruggeman. 

30.  Kirschner:  Quoted  by  Bruggeman. 

31.  Brunn,  H.:  Personal  communication. 

32.  Woolsey,  J.  Id.,  and  Mentzer,  S.  H.:  Cholecyst- 
ectomy— Modifications  in  Technic,  S.  G.  and  O. 
(In  press.) 

33.  Cullen,  T. : Quoted  by  Cameron. 

34.  Martin,  E.  D.:  Quoted  by  Cameron. 

35.  Coffey,  R.  C.:  Surgery  of  the  Gall  Tracts, 
Northwest.  Med.,  July-October  1925. 

36.  Mayo,  W.  J.:  Editorial,  S.  G.  and  O.,  January 
1924,  xxxviii,  125. 

37.  Bunnell,  S.:  Surgery  of  Gall  Bladder,  Calif, 
and  West.  Med.,  July-August  1923. 

38.  Dowling,  G.  A.:  Dyspepsia  Due  to  Gall-Bladder 
Disease,  J.  A.  M.  A.,  January  5,  1929,  xcii,  7. 

39.  Judd,  E.  S.,  and  Lyons,  J.  H.:  The  Mortality 
Following  Operations  on  the  Liver,  Pancreas,  and 
Biliary  Passages,  Amer.  Surg.,  August  1923,  p.  194. 

DISCUSSION 

Stewart  Lobingier,  M.  D.  (716  Merritt  Building,  Los 
Angeles). — It  is  exceedingly  difficult  in  the  brief  time 
allotted  me  to  adequately  discuss  a paper  of  such  out- 
standing merit.  It  will  pass  into  the  literature  as  a 
distinctive  contribution  and  be  widely  quoted. 

In  any  case  of  positive  obstruction  of  the  cystic 
duct  there  will  be  infection  and  edema.  If  the  ob- 
struction by  any  means  is  relieved,  the  edema  will 
not  go  on  to  necrosis.  When  necrotic  edema  is  well 
established  it  goes  on  to  gangrene  unless  arrested  by 
operation.  True  and  complete  gangrene  of  the  gall 
bladder  is  extremely  rare  in  this  country — a tribute 
to  early  diagnosis.  It  is  a lethal  condition  and  should 
be  wholesomely  feared. 

Many  of  the  cases  of  so-called  empyema  associated 
with  acute  cholecystitis  will  subside  and  clear  up  if 
and  when  the  obstruction  in  the  cystic  duct  is  relieved. 
The  pus  drains  away  and  symptoms  of  infection  dis- 
appear. But  if  this  pathologic  cycle  is  oft-repeated,  as 
it  may  be,  the  gall  bladder  wall  may  become  greatly 
thickened  from  hyperplasia  between  the  mucosa  and 
muscularis.  Necrotic  edema  never  occurs  in  such  a 
gall  bladder  because  the  arterial  distribution  is  too 
well  protected  from  pressure  in  the  cystic  duct.  There 
may  be  a succession  of  acute  infections  of  such  a gall 
bladder  without  ever  passing  on  to  necrotic  edema 
or  gangrene.  In  all  cases  of  acute  cholecystitis,  where 
the  clinical  symptoms  indicate  necrotic  edema  as  the 
probable  issue,  we  feel  we  do  not  dare  to  temporize, 
but  operate  promptly,  draining  the  edematous  and  in- 
fected liver  through  the  gall  bladder  antrum  and 
cystic  duct. 

But  if  the  surgeon  knows  his  patient  has  simply 
acute  catarrhal  cholecystitis  or  acute  so-called  em- 
pyema of  the  gall  bladder,  we  agree  with  the  author 
that  we  may  wait,  for  these  conditions  may  and  fre- 
quently do  subside  and  the  patient  recovers  from  the 
attack  without  operation. 

We  find  some  difficulty,  however,  in  this  admirable 
study  of  acute  gall-bladder  infection,  in  the  accept- 
ance of  the  large  number  of  thirty-eight  cases  classi- 
fied as  acute  gangrenous  cholecystitis,  a difficulty 
which  the  author  himself  recognizes  in  the  early  por- 
tion of  his  discussion;  we  agree  with  him  that  this 
must  be  due  to  “the  variations  in  classification  and 
the  personal  element  in  interpreting  the  pathology  of 
acute  cholecystitis.” 

A?, 

rc 

O.  O.  Witherbee,  M.  D.  (909  California  Medical 
Building,  Los  Angeles). — Doctor  Mentzer’s  paper  on 
acute  cholecystitis  and  its  surgical  treatment,  presents 
a subject  of  great  interest  and  one  which  cannot  be 
briefly  discussed  in  all  its  phases. 


April,  1930 


231 


A SYPHILITIC  CHILD— CAMPBELL  AND  FROST 


The  consideration  of  greatest  importance  is  that  of 
diagnosis.  Clinical  manifestations  are  often  mislead- 
ing, and  even  though  they  seem,  in  most  cases,  to 
accurately  correspond  with  pathologic  changes,  we 
usually  hesitate  to  go  on  record  further  than  to 
recommend  either  a period  of  observation  or  immedi- 
ate surgical  interference. 

Granted,  that  we  have  a case  of  cholecystitis,  the 
question  immediately  arises:  “Is  it  an  acute  condition 
or  an  acute  exacerbation  of  a long-standing  inflamma- 
tory process?”  Patients,  half  in  fear,  are  often  very 
reticent  in  giving  us  a complete  history.  Negative 
answers  are  frequently  given,  only  to  be  contradicted 
later  on,  after  a successful  surgical  procedure  has 
been  done.  The  character  and  duration  of  symptoms 
are  often  too  varied  to  make  a positive  diagnosis, 
while  the  x-ray  and  laboratory  findings  are  as  a rule 
only  suggestive.  The  clinical  manifestations  must  be 
our  guide  whether  these  are,  or  are  not,  supported  by 
the  laboratory,  the  x-ray,  or  even  the  history  itself. 

A definite  surgical  abdomen  calls  for  immediate 
interference,  which  must  be  undertaken  unless  the 
patient  is  moribund;  otherwise  a period  of  observa- 
tion, with  a most  careful  analysis,  should  be  advised. 

Doctor  Lobingier,  in  his  discussion,  says,  that  if 
the  surgeon  knows  his  case  is  simply  acute  cholecys- 
titis, he  agrees  with  the  author,  that  we  may  wait;  in 
other  words,  were  it  possible  to  visualize  the  pathol- 
ogy in  every  case  of  acute  cholecystitis,  its  diagnosis 
and  treatment  would  at  once  become  classic. 

In  Doctor  Mentzer’s  series  he  mentions  eight  cases 
of  gangrenous  gall  bladder  in  patients  who  vigorously 
denied  ever  having  any  stomach  trouble  or  other 
symptoms  suggestive  of  biliary  disease.  The  majority, 
however,  had  gastro-intestinal  distress  for  many  years, 
and  most  of  these  had  the  characteristic  signs  and 
symptoms  of  cholecystic  disease  for  long  periods.  The 
doctor  is  certainly  to  be  congratulated  on  his  ability 
to  correctly  diagnose  thirty-two  of  the  thirty-eight 
cases  he  mentions.  A case  demanding  immediate 
operation  is  usually  regarded  as  a surgical  abdomen, 
and  the  word  “exploratory”  modifies  in  a measure  the 
feeling  of  responsibility  that  rests  upon  the  surgeon 
at  such  a time. 

I was  recently  called  by  Doctor  Churchill  to  San 
Diego,  in  the  night,  to  the  bedside  of  my  own  brother 
who  had  very  suddenly  developed  an  acute  abdomen. 
He  was  a very  sick  man.  A terrific  pain  had  struck 
him  in  the  upper  abdomen  that  evening.  Except  for 
an  attack  of  angina  three  or  four  years  before,  he  had 
not  the  slightest  indication  of  impaired  health.  At 
the  time,  we  found  him  with  abdomen  distended, 
muscles  rigid,  pulse  quickened,  temperature  elevated, 
and  with  a leukocytosis  of  36,600.  What  was  to  be 
done?  Plain  enough.  Exploratory.  What  did  we 
find?  A phlegmonous  gall  bladder  surrounded  by  a 
plastic  exudate,  bathed  in  a creamy  pus.  He  is  here 
this  afternoon,  is  seventy-six  years  old,  and  will  stand 
up  for  your  inspection. 

* 

Harold  Brunn,  M.  D.  (384  Post  Street,  San  Fran- 
cisco).— Doctor  Mentzer  has  done  for  us  a great  ser- 
vice in  collecting  this  group  of  cases  and  in  gathering 
together  the  literature  on  this  subject.  It  is  necessary 
that  we  from  time  to  time  look  back  upon  our  diffi- 
culties and  evaluate  our  results. 

As  I have  seen  this  disease,  it  appears  to  me  that 
there  are  two  distinct  types  of  cases  which  lead  to 
gangrene  of  the  gall  bladder. 

The  one  type  is  due  to  a sudden  blockage  of  the 
arterial  supply  and  may  come  on  during  the  course 
of  even  a mild  gall  bladder  attack. 

_ The  other  type  is  the  result  of  a virulent  inflamma- 
tion of  the  gall  bladder  walls  which  causes  gangrene 
and  necrosis  as  a result  of  blocking  of  many  capilla- 
ries, but  is  not  in  the  same  sense  a thrombosis  of  the 
main  stem. 

In  this  latter  case  I feel  that  mistakes  are  not  so 
likely  to  be  made  as  the  symptoms  are  fulminant,  the 
patient  is  very  ill,  the  acuteness  of  the  disease  does 
not  brook  delay,  and  the  surgeon  is  forced  to  operate 


on  account  of  the  severity  of  the  symptoms.  In  the 
other  type  of  case  the  indications  are  not  so  evident. 
The  easy  onset  and  perhaps  the  sharp  pain  which 
comes  on  at  the  time  of  blocking  of  the  artery  may 
pass  off  into  a period  of  apparent  quiescence,  because 
sudden  gangrene  of  the  gall  bladder,  as  in  certain 
cases  of  gangrene  of  the  appendix,  may  for  a period 
of  time  give  very  few  symptoms,  and  the  laboratory 
findings  are  also  not  at  all  in  line  with  the  picture 
that  one  sees  upon  operation.  It  is  in  this  type  of 
case  that  mistakes  can  easily  be  made. 

The  policy  of  delay  which  most  surgeons  adopt  in 
caring  for  cases  of  acute  cholecystitis  carries  with  it 
a very  considerable  danger,  and  one  should  always  be 
on  guard  in  recommending  such  delay,  having  in  mind 
the  possibilities  of  a gangrene  due  to  a thrombosis 
of  an  artery. 

As  to  treatment,  we  believe  that,  other  things  being 
equal,  it  is  preferable  to  remove  the  gall  bladder,  but 
we  have  no  hesitancy  at  any  time  in  individual  cases, 
because  of  the  serious  condition  of  the  patient  or  the 
technical  difficulty  of  the  operation,  and  especially  in 
the  face  of  a streptococcic  infection,  to  avoid  a major 
procedure  and  be  satisfied  with  a cholecystotomy. 

There  are  many  interesting  points  in  the  summary 
which  Doctor  Mentzer  has  drawn  up  which  are  well 
worthy  of  study.  I believe  he  has  stated  very  tersely 
the  principles  on  which  our  judgment  is  based  at  the 
present  time. 


INDIRECT  TREATMENT  OF  A PRESUMABLY 
SYPHILITIC  CHILD  BY  MATERNAL 
THERAPY  DURING  LACTATION* 

REPORT  OF  CASE 

By  H.  Sutherland  Campbell,  M.  D. 

AND 

Kendal  Frost,  M.  D. 

Los  Angeles 

Discussion  by  Harry  E.  Alderson,  M.  D.,  San  Fran- 
cisco; Ernest  Dwight  Chipman,  M.D.,  San  Francisco; 
H.  J.  T empleton,  M.D.,  Oakland. 

/OjtN  February  3,  1927,  a woman,  age  forty, 
^'presented  herself  at  the  Santa  Rita  Clinic, 
stating  she  was  pregnant,  approximately  the 
eighth  month,  and  that  she  was  “frightened  for 
the  child  because  the  two  other  children  got  sick 
after  they  were  born,  and  there  was  something 
wrong  with  their  teeth.”  The  clinic  records 
showed  that  this  woman  had  been  given  a short 
and  spasmodic  course  of  antiluetic  treatment 
eighteen  months  previously.  It  was  later  learned 
that  she  would  not  attend  regularly,  and  that  her 
children  had  also  been  under  treatment  for  con- 
genital lues. 

REPORT  OF  CASE 

Maternal  History.  — Married  at  nineteen  years  in 
Bucharest.  Six  weeks  later  developed  primary  lesion. 
Was  treated  at  the  hospital  “by  needle,  in  the  but- 
tocks, for  thirty  days.”  Sore  healed.  She  stated  this 
form  of  treatment  was  the  regular  system  in  vogue 
in  Bucharest  at  that  time.  Returned  home,  and  soon 
became  pregnant.  An  abortion  followed  at  the  fifth 
month.  Some  time  later  again  became  pregnant. 
Child  was  stillborn  at  the  seventh  month.  The  hus- 
band was  informed  that  he  had  syphilis,  but  refused 
treatment.  He  died  after  having  been  married  two 
years,  of  (?)  paralysis.  Approximately  two  years  after 
the  thirty-day  treatment  in  the  hospital,  she  took  six 
weeks  of  mercury  rubs  at  home  once  a year  for  five 

* Read  before  the  Dermatology  and  Syphilology  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  at  Coronado,  May  6-9,  1929. 


Vol.  XXXII,  No.  4 


232  CALIFORNIA  AND  WESTERN  MEDICINE 


Fig.  1. — First  living  child.  Female.  Age,  six-  Fig.  2.— Second  living  child.  Male.  Age, 

teen  years.  Wassermann,  four  plus.  seven  years.  Wassermann,  four  plus. 


years.  She  remarried 
seventeen  years  ago  and 
had  no  further  treat- 
ment. She  became  preg- 
nant  and  was  deliv- 
ered of  a baby  girl  at 
full  term  who  seemed 
healthy  until  three 
weeks  old,  when  she  had 
“a  rash  on  the  buttocks 
and  colds  in  the  head.” 

Was  given  some  salve 
to  apply  (not  a rub) 
and  it  gradually  cleared 
up.  Nothing  further  was 
noted  until  at  about  one  year  of  age  the  teeth  began 
to  get  black  and  early  rotted  away.  No  new  teeth 
appeared  until  child  was  seven  and  one-half  years  old. 
These  were  small  and  did  not  grow.  Child  was  ap- 
parently well  until  three  years  ago,  when  her  blood 
was  examined  and  gave  a four-plus  reaction.  Two 
abortions  followed  this  child,  both  at  the  third  month. 
Then  she  was  delivered  of  a full-term  child,  seven 
years  after  birth  of  first  child.  This  baby,  from  the 
description,  was  hydrocephalic  and  lived  only  twenty- 
four  hours. 

Two  years  later  a full-term  male  child  was  born, 
approximately  nine  years  after  birth  of  first  living 
child.  This  baby  was  perfectly  well  at  birth,  but  at 
six  weeks  developed  a cold  in  the  head  and  an  erup- 
tion on  palms  and  soles  of  feet,  which  was  not  diag- 
nosed for  some  four  months,  when  treatment  was 
instituted.  The  child’s  Wassermann  was  four  plus  at 
this  time.  The  mother  and  child  then  began  treatment 
which  was  kept  up  in  irregular  fashion  for  some  six 
months.  From  October  1923  to  May  1924  the  mother 
had  a total  of  eleven  neosalvarsans.  Following  this 
she  had  no  treatment.  Her  blood  Wassermann 
August  20,  1925,  was  plus-minus.  On  February  3, 
1927,  her  Wassermann  was  plus-minus. 

It  was  decided  that  we  would  administer  intra- 
muscular therapy  rather  than  intravenous  at  this 
stage — the  eighth  month  of  pregnancy.  We  therefore 
gave  her  three  intramuscular  injections  of  salicylate 
of  mercury,  grains  one,  at  weekly  intervals.  About 
four  weeks  later  patient  returned  with  an  apparently 
healthy  child,  which  had  been  born  on  March  4,  1927. 

At  this  time,  in  the  face  of  no  slight  degree  of 
criticism,  we  commenced  the  indirect  intravenous 
therapy,  using  neoarsphenamin  alone,  as  we  lean 
favorably  toward  the  conclusions  of  Schamberg,1 
namely,  that  there  is  relatively  much  less  danger  of 
toxic  manifestation  when  one  uses  arsphenamin  alone 
than  when  one  combines  it  with  the  use  of  mercury. 

The  mother  was  given  0.15  gram  of  neoarsphena- 
min, increasing  to  0.6  the  fourth  week,  and  thereafter 
the  regular  weekly  treatments  of  0.6  neoarsphenamin 
were  given  for  nine  months.  Following  this,  weekly 
treatments  of  intramuscular  sulpharsphenamin  were 
given  for  five  months.  During  this  time  she  experi- 
enced no  distress  and  felt  quite  well.  She  was  fortu- 
nately able  to  nurse  the  baby  during  the  entire  time. 
Weaning  was  done  gradually,  supplementing  her 
regular  meals  with  the  breast  feeding  until  she  was 
about  fourteen  months  old.  During  this  entire  time 
it  will  be  noted  the  mother  was  receiving  medication. 
The  child’s  serologic  reaction  at  periodic  intervals  has 
remained  negative.  The  mother’s  Wassermann  has 
remained  plus-minus  throughout. 

Synopsis  of  Pregnancies  and  Therapy. — A synopsis 
presents  the  following  facts: 

Mother  acquired  syphilis  at  nineteen  years  of  age. 

Thirty-day  intramuscular  therapy. 

First  pregnancy:  abortion  fifth  month. 

Second  pregnancy:  stillborn  seventh  month. 

First  husband  died. 

Six  weeks’  mercury  rubs  once  a year  for  five  years. 

Third  pregnancy  (by  second  husband).  Full-term 
living  child,  syphilitic. 


Fourth  pregnancy:  abortion  third  month. 

Fifth  pregnancy:  abortion  third  month. 

Sixth  pregnancy:  full-term  male  child,  syphilitic, 
living. 

Seventh  pregnancy:  full-term  living  male  child; 
hydrocephalic.  Lived  twenty-four  hours. 

Eleven  neoarsphenamins  over  period  of  eight 
months,  then  no  treatment  until  February  3,  1927. 

Eighth  pregnancy:  full-term  living  female  child, 
nonsyphilitic. 

Report  on  Condition  of  Child  at  Two  Years  of  Age. — 
The  following  is  the  report  by  Dr.  M.  J.  Scholl  on 
the  child  at  two  years  of  age: 

Birth  History  and  Development  — Approximately  ten 
days  premature.  Cephalic  presentation  with  easy, 
normal  labor.  Baby  cried  instantly  after  birth.  Entire 
left  side  of  the  body  was  ‘‘blue  and  cold”  for  two 
weeks.  The  mother  had  bronchitis  at  the  time  of 
delivery  and  the  baby  contracted  an  upper  respira- 
tory infection  from  her  which  lasted  three  days. 
Birth  weight,  eight  pounds.  At  six  months,  eighteen 
pounds.  At  one  year,  twenty-one  pounds.  No  history 
of  snuffles,  skin  rash,  fissures,  or  condylomata.  Denti- 
tion began  at  eleven  months.  Lateral  incisors  were 
cut  at  thirteen  months.  First  molars  at  twenty 
months.  She  sat  up  alone  at  eight  months,  walked  at 
ten  months,  talked  at  eighteen  months. 

Feeding. — Breast-fed  exclusively  for  approximately 
nine  months.  After  this  had  various  additions  to  diet 
until  she  is  now  on  a general  diet. 

Diseases. — Has  never  been  ill. 

Habits. — Appetite  has  always  been  good.  No  con- 
stipation or  diarrhea.  Sleeps  quietly.  No  urinary 
symptoms.  Good-natured,  placid  disposition. 

Physical  Examination. — Height,  34  inches.  Weight 
(stripped),  26J4  pounds.  Normal  weight,  27  pounds. 
Temperature  (rectal),  99.  Pulse,  92.  The  patient  is  a 
well  developed,  well  nourished  female  child  of  healthy 
appearance,  and  bright  mentally.  Posture  is  excellent. 
The  skin  is  soft,  smooth  and  free  from  rash.  There 
is  no  evidence  of  rhagades.  The  mucous  membranes 
of  nose  and  mouth  are  pink  and  healthy.  Eyebrows 
are  thick.  Eyes:  Pupils  are  equal  and  react  to  light 
and  accommodation.  No  scars  are  present.  Nose: 
Contour  normal.  There  is  a slight  serous  nasal  dis- 
charge present  in  the  anterior  nares  (child  contracted 
cold  one  week  ago).  Mouth:  Twelve  teeth  are  pres- 
ent; normal  shape  and  intact  enamel.  No  caries. 
Tonsils:  Grade  2 (on  basis  of  grades  1 to  4),  cryptic 
and  slightly  injected.  A small  amount  of  mucus  is 
present  on  the  posterior  pharyngeal  wall.  Ears:  A 
small  amount  of  cerumen  is  present  in  the  canals. 
The  drums  are  white  and  glistening.  The  light  reflex 
is  present.  Glands:  The  lymphatic  glands  in  the 
anterior  cervical  triangles  are  the  size  of  small  peas, 
and  firm.  Other  cervical  glands  are  not  palpable. 
The  axillary,  inguinal,  epitrochlears,  are  not  palpable. 
Chest:  Contour  normal.  No  Harrison’s  grooves  or 
rachitic  rosary  felt.  Lungs:  Equal  expansion  on  both 
sides  with  normal  tactile  fremitus.  Percussion  note 
is  resonant  throughout.  Breath  sounds  are  clear.  No 
adventitious  sounds.  Heart:  Borders  are  within  nor- 
mal limits.  No  thrills.  Valve  sounds  are  clear  and 
of  good  quality.  Rhythm  is  normal.  Abdomen:  Soft 


April,  1930 


A SYPHILITIC  CHILD— CAMPBELL  AND  FROST 


233 


and  not  protuberant.  No  tenderness  is  elicited.  Liver 
and  spleen  are  not  palpable.  No  masses  can  be  felt. 
Genitalia:  Externally  no  inflammation  or  discharge 
is  seen.  No  genital  malformations.  Anal  orifice  is 
smooth.  The  sphincter  is  normal.  No  growths  or 
scars  are  present.  Extremities:  There  are  no  skeletal 
deformities.  The  joints  function  properly.  The  nails 
are  present,  smooth  and  of  normal  contour.  The  spine 
is  negative.  Reflexes:  All  reflexes  are  present.  Babin- 
ski  is  negative. 

Impression. — A child  of  normal  physical  and  mental 
development  for  her  age — two  years — with  no  evi- 
dence of  congenital  syphilis. 

COMMENT 

An  attempt  to  recapitulate  the  various  con- 
siderations for  the  justification  of  our  method 
of  procedure,  which  to  some  of  our  colleagues 
has  seemed  somewhat  lacking  in  foundation,  is 
beyond  the  scope  of  this  paper.  It  is  therefore 
our  purpose,  insofar  as  we  are  able,  to  confine 
ourselves  to  the  most  salient  facts  concerned,  and 
to  attempt  to  consider  fairly  and  in  as  concise  a 
measure  as  possible,  the  conflicting  opinions  of 
others. 

Primarily,  we  are  confronted  with  a woman  in 
the  eighth  month  of  pregnancy.  Her  history  and 
the  physical  stigmata  of  her  only  living  children 
all  prove  her  to  be  syphilitic,  and  while  we  are 
aware  that  both  the  mendelian  and  the  mosaic 
theories  are  far  from  being  applicable  in  the  case 
of  syphilis,  we  have  nevertheless  some  small 
degree  of  reason  to  believe  that  the  child  will 
not  escape  the  disease.  As  the  mother  has  been 
afflicted  for  a lengthy  period  of  time,  it  may  be 
in  order  to  recall  the  opinion  of  Kassowitz,3  who 
stated  that  “the  virus  of  syphilis  gradually  be- 
comes attenuated.”  Many  other  observers  of 
great  clinical  experience  express  themselves  as 
dissatisfied  with  these  conclusions  (Gammeltoft,2 
Buschke,4  Rasche,5  Nobel6).  Gammeltoft,2  in  a 
recent  article,  cites  two  cases  in  a series,  one  born 
ten  years  and  the  other  twenty  years  following 
infection.  Both  of  these  mothers  were  treated  in- 
tensively with  salvarsan  and  mercury  in  the  first 
years  following  infection,  but  had  had  no  recent 
therapy.  Assuming,  therefore,  that  this  child  is 
a potential  syphilitic,  what  justification  have  we 
in  not  treating  both  the  mother  and  the  child  di- 
rectly as  we  were  advised,  and  as  has  been  done 
in  most  instances  in  the  past? 

Concerning  this  situation,  we  find  that  various 
authorities  have  widely  different  opinions.  There 


are  some  who  advocate  that  every  child  of  syphi- 
litic parents  should  receive  direct  treatment,  even 
though  they  do  not  present  any  evidence  what- 
soever of  syphilis.  Others  advise  treatment  only 
in  the  case  of  children  born  of  mothers  with 
recent  syphilis,  though  they  show  no  signs  of  the 
disease.  Others  again,  and  among  them  Gammel- 
toft,2 Ahmann,7  and  Almkvist,8  who  believe  that 
suspected  children  should  not  be  treated  before 
they  show  clinical  signs  of  the  disease  or  mani- 
fest a positive  Wassermann ; but  that  they  should 
be  constantly  under  observation.  In  Gammel- 
toft’s2  series  of  ninety-eight  cases  treated  by  sal- 
varsan during  pregnancy,  only  nineteen  of  the 
children  showed  evidence  of  lues,  seventy-nine 
being  apparently  healthy,  and  remaining  so. 

Almkvist 8 states : “It  has  always  been  consid- 
ered unscientific  procedure  in  cases  of  acquired 
syphilis  to  start  treatment  before  definite  symp- 
toms establish  the  diagnosis,  and  I cannot  see  that 
this  procedure  is  less  scientific  simply  because  it 
involves  little  children  instead  of  adults.” 

The  results  of  intensive  and  direct  therapy  on 
the  congenital  syphilitics  in  our  hands  has  left 
much  to  be  desired.  In  some  instances,  in  the 
reluctance  of  serological  change ; in  others,  in  the 
recurrence  of  evidence  of  activity  following  rest 
periods.  These  findings  are  upheld  by  clinicians 
of  much  greater  experience.  Leonard  Findlay,9 
whose  opinion  is  both  valuable  and  conservative, 
states : “The  treatment  of  congenital  syphilis  is, 
if  not  a failure,  at  least  a great  disappointment.” 
The  consensus  of  opinion  appears  to  bear  out 
Findlay’s  conclusions. 

TOXICOLOGIC  ACTION  OF  CERTAIN  DRUGS 

We  shall  now  consider  a phase  of  the  situation 
which  has  received  but  scant  consideration,  i.  e., 
the  toxicologic  action  of  the  metals  employed. 
For  some  time  previous  to  the  experiments  of 
Kolmer  and  Lucke,10  it  had  always  been  a debat- 
able question  at  postmortems  as  to  whether  the 
disease  or  the  metal  was  responsible  for  the 
parenchymatous  degeneration  found  in  essential 
organs.  These  men  demonstrated  that  arsenic  and 
mercury,  even  in  small  doses,  produced  degenera- 
tive changes  in  the  organs  of  normal  animals. 
Schamberg,11  in  a consideration  of  the  above  ex- 
periments, states : “Both  arsenic  and  mercury 
administered  in  therapeutic  doses  bring  about 

structural  alterations 
in  organs,  arsenicals 
affecting  the  liver,  su- 
prarenals  and  blood 
vessels,  mercury  hav- 
ing an  affinity  for  kid- 
neys and  brain.  Syph- 
ilitic treatment  re- 
quires repeated  use  of 
these  drugs.  When 
used  with  circumspec- 
tion, harmful  results 
may  be  avoided.  When 
used  otherwise, unfor- 
tunate results  may 
take  place.  Fatalities 


Fig.  3.  Third  living  child.  Female.  Age,  Fig.  4. — Same  as  Fig.  3. 

two  years.  Wassermann,  negative.  Milk- 
teeth  structure  only  of  interest  in  point  of 
mother’s  statement  that  both  previous 
children  had  delayed  dentition  with  early 
necrosis  and  loss  of  teeth. 


234 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


have  occurred  after  both  arsenic  and  mercury. 
Many  scores,  if  not  hundreds,  of  deaths  after 
mercury  have  been  reported.” 

In  this  connection  Brown 12  states : “The  de- 
termination of  toxicity  of  new  compounds  for 
experimental  animals,  insofar  as  duration  of  life 
is  concerned,  is  insufficient,  and  the  question  of 
tissue  injury  has  not  attracted  the  attention  that 
the  subject  deserves.” 

The  degree  of  repair  of  the  degenerative 
changes  in  these  essential  organs  is  fortunately 
sufficient  in  most  cases  to  make  the  structural 
changes  negligible  in  point  of  interference  of  per- 
fect functioning,  but  we  should  not  lose  sight  of 
the  fact  that  any  added  strain  upon  those  organs, 
which  would  undoubtedly  ensue  during  a possi- 
ble later  intercurrent  infection,  would  be  attended 
by  an  element  of  grave  danger.  One  is,  we  think, 
justified  in  wondering  whether  this  early  tissue 
damage  might  not  be  one  of  the  factors  which 
tend  to  produce  the  mortality  percentage  among 
the  treated  congenital  syphilitics. 

While  some  maintain,  and  we  believe  it  reason- 
able to  suppose,  that  a syphilitic  would  offer  a 
greater  degree  of  resistance  to  the  metals  than 
would  a normal  individual,  we  think  we  are  justi- 
fied in  assuming  early  tissue  damage  in  essential 
organs  in  the  treated  syphilitic  child,  the  degree 
of  damage  being  fairly  proportionate  to  the  dos- 
age. We  feel,  in  face  of  this  evidence,  that  the 
method  of  body  weight  determination  of  dosage 
of  the  metals,  while  being  well  tolerated  in  an 
adult,  is  too  crude  in  the  case  of  a very  young 
child. 

In  view  of  these  opinions,  we  have  felt  that  a 
Wassermann-fast  reaction  in  a child  following 
adequate  therapy  is  scarcely  sufficient  justifica- 
tion for  the  continuous  and  sometimes  intermit- 
tent long-drawn-out  therapy  which  often  obtains 
as  a matter  of  routine. 

It  is  well  known  that  most  drugs  having  a 
destructive  effect  upon  a parasite  exert  a similar 
action,  but  in  much  lesser  degree,  upon  the  host. 
Therein  lies  the  justification  for  their  use,  but 
if  the  pharmacologic  action  of  a drug  has  been 
demonstrated  to  have  very  little  effect  upon  the 
parasite  over  a measurably  adequate  period  of 
time,  and  we  feel  that  the  toxicologic  action  is 
being  continued,  it  seems  illogical  to  prolong  its 
use.  The  inclination  on  the  part  of  some  clini- 
cians, in  the  face  of  no  response  is,  unfortunately, 
not  to  stop  therapy,  but  rather  to  increase  it. 

REASONS  FOR  INDIRECT  THERAPY 

This  child  after  birth  manifested  no  clinical 
evidence  of  lues,  and  this  was  supported  by  a 
negative  Wassermann.  We  hesitated  to  assume 
the  responsibility  of  not  giving  a possibly  latent 
syphilitic  treatment,  though  many  able  men  advise 
that  course  of  procedure.  Conversely,  we  were 
just  as  reluctant  about  giving  direct  therapy,  pri- 
marily because  of  our  convictions  regarding  early 
tissue  damage,  and,  secondly,  because  we  would 
by  so  doing  classify  this  infant  for  the  rest  of 
her  life  as  a syphilitic.  We  therefore  determined 
to  treat  the  child  indirectly,  by  administering 
arsenic  intravenously  to  the  mother  during  the 


entire  period  of  lactation,  not  only  for  the  thera- 
peutic effect  of  the  arsenic,  but  also  in  the  hope 
that  some  passive  immune  body  formation  might 
be  supplied  to  the  child,  for  it  must  be  admitted 
that  immune  body  formation,  if  it  exists,  must 
be  highly  developed  in  this  mother. 

The  consensus  of  opinion  seems  to  favor  a 
direct  spirocheticidal  action  on  the  part  of  the 
arsphenamin,  and  it  denies  the  immune  body  for- 
mation theory.  However,  it  would  be  well  to 
remember  that  nothing  is  definitely  known  re- 
garding the  action  of  the  arsphenamin  in  the 
body.  Briefly  considered,  Voegtlin’s  13  theory  is 
that  the  arsenic  linkage  is  broken,  and  arsenoxid 
is  formed.  This  toxic  substance  finds  a physio- 
logic antidote  in  the  shape  of  reduced  glutathione, 
a substance  found  in  muscle  tissue  and  liver. 
Arsenoxid  combines  with  this  substance,  and  is 
held  back  by  the  body  tissues.  Whether  the 
arsenic  is  further  oxidized  to  the  pentavalent  or- 
ganic arsenicals  is  unknown,  but  it  is  presumed 
so,  as  all  pentavalent  organic  arsenicals  are 
rapidly  eliminated  by  the  kidney.  The  mecha- 
nism whereby  arsenoxid  destroys  the  spirochetes 
appears  to  be  the  same  as  the  one  responsible 
for  the  toxic  effect  of  arsenoxid  on  mammalian 
tissue  in  the  absence  of  unreduced  glutathione, 
i.  e.,  an  effect  of  the  trivalent  arsenoxid  arsenic 
upon  some  sulphydril  compound  occurring  in  the 
spirochete. 

Voegtlin,13  in  a series  of  experiments  has  com- 
piled much  of  interest  in  the  matter,  but  rejects 
the  theory  of  immune  body  formation  on  the 
grounds  that  six  to  eight  hours  is  too  short  a 
period  of  time  for  their  development,  and  arsenic 
injections  have  been  shown  to  have  spirocheticidal 
action  within  that  time.  The  therapeutic  action 
of  the  arsenicals,  according  to  the  above  theory, 
is  due  to  a chemical  reaction — the  effective  lethal 
agent  arsenoxid  being  prevented  from  harming 
the  body  tissues  by  ( 1 ) slowness  of  formation, 
and  (2)  its  combination  with  the  reduced  gluta- 
thione of  the  tissues. 

NONARSENICAL  DRUGS 

Before  dismissing  the  matter  and  accepting  this 
dictum  as  final,  we  must  recognize  that  other 
substances  differing  widely  in  their  composition, 
give  somewhat  similar  results  to  the  arsenicals 
in  the  matter  of  healing  syphilitic  lesions,  i.  e., 
mercury,  bismuth,  iodid,  and  even  protein  injec- 
tions. Though  perhaps  not  so  permanent  in  their 
effect,  we  have  occasionally  found  the  iodid  salts 
given  intravenously  to  have  even  more  effective 
involuting  action  in  the  case  of  tertiary  lesions 
than  the  arsenicals.  Are  we,  therefore,  to  believe 
that  all  these  various  agents  have  a similar  chemi- 
cal reaction  in  the  body? 

ACTION  OF  THE  DRUGS 

It  seems  to  be  just  as  feasible  to  suppose  that 
these  agents  -destroy  the  spirochete  by  provoking 
or  stimulating  the  body  tissues  to  a relatively 
high  immune  body  formation,  as  that  it  is  due 
to  destruction  by  direct  chemical  combination. 
To  our  minds,  the  time  of  production  of  immune 
bodies  dates  from  the  inception  of  the  spirochete. 


April,  1930 


A SYPHILITIC  CHILD — CAMPBELL  AND  FROST 


235 


and  the  later  injection  of  arsenic  merely  serves  to 
increase  them.  V.  H.  Park,14  quoting  Fisch  and 
Stewart,  states : “Seventeen  apparently  healthy 
infants  failed  to  show  any  signs  of  syphilis,  al- 
though their  mothers  were  in  the  most  contagious 
phase  of  florid  syphilis.  Immunization  by  way 
of  placenta  before  birth,  or  by  suckling  after- 
ward, will  have  to  be  accepted  in  these  cases, 
according  to  the  authors.” 

We  must  confess  to  leaning  strongly  toward 
the  views  of  the  minority  and  have  a firm  convic- 
tion that  immune  body  formation  plays  an  impor- 
tant role  in  the  matter.  If  we  correctly  interpret 
the  disease,  every  one  of  the  various  physical 
phenomena  from  primary  chancre  to  tertiary 
lesions  is  merely  an  external  and  visible  sign  of  the 
warfare  which  is  being  waged  by  the  body.  If 
one  denies  immune  body  formation,  bow  does 
one  account  for  the  fact  that  the  arsphenamins 
are  useless  in  cases  of  malignant  syphilis,  or  that 
the  mother  of  these  children  has  enjoyed  good 
health  all  her  life,  and  is  today,  as  far  as  it  is 
possible  to  determine,  physically  well?  She  has 
had,  it  is  true,  throughout  the  time  she  has  been 
under  observation,  a plus-minus  Wassermann  re- 
action, but  this  we  understand  to  be  interpreted 
as  negative,  in  the  absence  of  other  evidence.  The 
only  positive  evidence  we  have  that  she  is  a 
syphilitic  is  that  made  manifest  at  every  preg- 
nancy, and  in  the  stigmata  of  her  two  older  living 
children.  Many  similar  cases  are  known  to  you. 

It  was  shown  in  1838,  by  analysis,  that  the  milk 
of  women  taking  arsenic  preparations  contained 
arsenic.  During  that  year  Thompson,  after  a 
series  of  experiments  on  the  physiologic  action  of 
iodid  of  arsenic  on  experimental  animals  con- 
cluded that  arsenic  was  found  in  all  the  secre- 
tions ; when  administered  during  lactation,  it 
furnished  a convenient  manner  of  giving  it  to 
infants  at  the  breast  through  the  milk  of  the 
mothers,  and  that  when  used  internally  for  long 
it  accumulated  in  the  system. 

One  might  claim  that  no  therapeutic  action 
follows  oral  administration.  Schamberg  11  states  : 
“The  oral  administration  of  arsphenamin  was 
shown  to  be  followed  by  absorption”  and  Kol- 
mer10a  ranks  the  absorption  of  arsenicals  ad- 
ministered by  mouth  as  higher  than  that  which 
follows  rectal  administration. 

Fordyce,  Rosen,  and  Meyer  13  states : “The  in- 
gestion of  milk  from  treated  patients  has  raised 
this  question  in  our  minds,  as  to  the  possible 
therapeutic  value  of  arsenic  so  received,  and  also 
its  possible  detrimental  effect  in  producing  a toler- 
ance to  arsenic  on  the  part  of  the  nursing  child. 

Noguchi  and  Klauder 16  demonstrated  a de- 
veloping resistance  to  arsenic  in  both  strains  of 
pallida  by  administering  very  small  doses  of 
arsenic  to  rabbits,  transferring  the  strain  to  other 
rabbits  and  gradually  increasing,  until  a 68  per 
cent  resistance  to  arsenic  was  obtained. 

It  would  appear  that  we  are  justified  in  believ- 
ing that  direct  therapy  to  the  child,  judging  by 
the  results  obtained  clinically,  is  ineffective  in 
coping  with  a spirochete  which  has  in  most  in- 
stances already  been  subjected  to  the  action  of 


a comparatively  higher  dose  of  the  metal  while 
in  a former  host  (maternal)  and  in  all  probability 
in  a less  resistant  state. 

And  presuming  that  this  increased  spirochetal 
resistance  obtained  in  this  child,  the  difference  in 
dosage,  direct  or  indirect,  would  make  but  little 
difference  to  the  end  result  unless,  as  we  believe, 
passive  immune  body  formation  was  also  being 
supplied.  In  that  case,  if  our  conviction  be  cor- 
rect, indirect  therapy  would  probably  prove  the 
more  efficacious.  We  do  not  presume  to  prove 
anything  by  this  paper,  as  we  start  with  an  un- 
known premise.  We  have  no  means  of  knowing 
whether  this  child  would  have  developed  syphilis. 
We  have  known  many  cases  of  normal  children 
born  of  syphilitic  mothers  that  have  remained  so, 
but  we  think  sufficient  justification  for  its  presen- 
tation lies  in  the  fact  that  it  offers  a method  of 
treatment  for  those  who  very  rightly  hesitate  to 
subject  an  apparently  normal  child  to  direct  anti- 
syphilitic medication,  and  yet  are  loath  to  refuse 
treatment  in  the  face  of  the  possibility  of  positive 
signs  of  syphilitic  activity  developing  at  a later 
date. 

1930  Wilshire  Boulevard. 

REFERENCES 

1.  Schamberg:  Arch.  D.  and  S.,  April  1921,  p.  571. 

2.  Gammeltoft:  Am.  Jour.  Syph.,  April  1929,  pp. 
194-205. 

3.  Kassowitz:  Ibid.  'Cited  by  Gammeltoft. 

4.  Buschke:  Ibid.  Cited  by  Gammeltoft. 

5.  Rasche:  Ibid.  Cited  by  Gammeltoft. 

6.  Nobel:  Ibid.  Cited  by  Gammeltoft. 

7.  Ahmann:  Ibid.  Cited  by  Gammeltoft. 

8.  Almkvist:  Ibid.  Cited  by  Gammeltoft. 

9.  Findlay:  Am.  Jour.  Dis.  Child.,  August  1924, 
Vol.  xxviii,  p.  133. 

10.  Kolmer  and  Lucke:  Arch,  of  D.  and  S.,  April 
1921,  part  2,  pp.  483-515. 

10a.  Kolmer:  Chem.  Therapy  of  Syph.  Saunders 
Company,  p.  241. 

11.  Schamberg:  Jour.  Exper.  Med.,  1912,  pp.  15,  498. 

12.  Brown:  Bull.  Johns  Hop.  Hosp.,  1918,  pp.  26, 
309,  315. 

13.  Boegtlin:  Pharmacology  of  Arsph.,  Phys.  Rev., 
January  1925,  Vol.  v,  p.  63. 

14.  Park:  Dis.  of  Child.,  1919,  p.  442. 

15.  Fordyce,  Rosen,  and  Meyer:  Amer.  Jour.  Syph., 
Vol.  vii,  January  1924,  pp.  34-65. 

16.  Noguchi  and  Klauder:  Arch.  D.  and  S.,  Vol.  vii, 
April  1924,  p.  446. 

DISCUSSION 

Harry  E.  Alderson,  M.  D.  (490  Post  Street,  San 
Francisco). — We  have  been  able  many  times  to  ob- 
serve the  benefit  derived  by  the  nursing  syphilitic 
infant  whose  mother  was  given  neoarsphenamin,  and 
feel  that  it  is  a valuable  method.  Certainly,  in  this 
case  reported  by  Campbell  and  Frost,  no  harm  was 
done,  and  even  though  it  is  possible  that  the  child 
might  have  remained  well  without  the  treatment,  it 
was  the  duty  of  the  physicians  to  make  every  effort 
to  prevent  future  trouble.  Delayed  manifestations  of 
congenital  syphilis  are  only  too  common.  At  the 
Stanford  skin  and  syphilis  clinic  we  frequently  treat 
pregnant  syphilitics  and  we  always  administer  neo- 
arsphenamin and  bismuth,  continuing  the  same  during 
the  nursing  period. 

Ernest  Dwight  Chipman,  M.  D.  (350  Post  Street, 
San  Francisco). — This  paper  deals  with  a problem 
that  is  rich  in  both  medical  and  human  interest.  The 
authors  set  up  no  claim  that  their  solution  is  the  only 
one  or  the  correct  one. 


236 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4- 


A syphilitic  mother  may,  of  course,  begin  with  mis- 
carriage at  the  first  or  second  month,  pass  through 
progressively  longer  terms  of  pregnancy  until  full 
term  syphilitic  offspring  issue.  Finally,  if  persistent 
enough,  she  may  bring  forth  full-term  progeny  free 
from  clinical  stigmata  and  serologically  negative.  It 
is  such  a case  as  this  last  that  is  under  discussion. 

There  are  three  possible  ways  of  meeting  the  situ- 
ation, viz.:  first,  with  direct,  active  treatment;  second, 
with  no  treatment  at  all;  third,  with  a compromise 
by  indirect  treatment  through  the  maternal  milk.  In 
making  a decision,  the  question  largely  resolves  itself 
into  this:  Are  we  justified  in  the  administration  of 
toxic  and  potentially  harmful  substances  into  the 
circulation  of  any  subject,  adult  or  infant,  on  the 
mere  presumption  that  he  is  syphilitic?  My  own  view 
is  that  treatment  should  never  be  undertaken  in  the 
absence  of  both  clinical  and  serologic  indications, 
subject  of  course  to  the  reservation,  in  the  case  of 
infants,  that  one  is  in  duty  bound  to  follow  the  case 
as  closely  as  possible  lest  late,  hereditary  stigmata 
develop. 

In  this  particular  case,  even  though  in  the  title  the 
authors  use  the  term  “a  presumably  syphilitic  child,” 
I do  not  feel  sure  that  the  presumption  of  syphilis 
is  justified.  A subject  is  or  is  not  syphilitic,  and  in 
the  absence  of  both  clinical  and  serologic  evidence 
it  does  not  seem  to  me  that  we  are  warranted  in 
saddling  a diagnosis  of  syphilis  upon  one  even  though 
his  mother  and  “his  sisters  and  his  cousins  and  his 
aunts”  are  infected. 

With  respect  to  treatment  the  authors  decided  upon 
a middle  course  and  whether  the  child  would,  or  will, 
ever  develop  definite  stigmata  or  positive  blood  re- 
action, we  shall  perhaps  never  know.  It  is  note- 
worthy, however,  that  the  physical  findings  at  the 
end  of  two  years  revealed  nothing  which  could  be 
attributed  to  adverse  result  of  treatment. 

It  would  be  interesting  if  in  the  treatment  of 
frankly  syphilitic  infants  the  results  of  direct  and 
indirect  therapy  might  be  compared  not  only  with 
respect  to  serologic  and  clinical  response,  but  to  the 
general  physical  condition  after  two  years  or  more  of 
treatment. 

The  authors  are  deserving  of  praise  for  a paper 
rich  in  thought  and  philosophical  flavor  that  should 
prove  a stimulus  to  every  one  of  us. 

* 

H.  J.  Templeton,  M.  D.  (3115  Webster  Street, 
Oakland). — The  authors  of  this  paper  have  given 
us  considerable  food  for  thought  and  at  the  same  time 
have  reopened  the  discussion  of  an  old  problem,  viz., 
in  regard  to  the  desirability  of  treating  an  apparently 
normal  child  of  a syphilitic  mother.  This  question 
has  been  debated  in  dermatologic  circles  for  many 
years,  but  we  are  still  only  able  to  say,  as  did  Omar 
Khayyam,  “and  heard  great  argument,  but  evermore 
came  out  by  the  same  door  wherein  I went.” 

The  conservative  school  believes  that,  just  as  we 
never  treat  an  adult  for  syphilis  until  a positive  diag- 
nosis has  been  made,  we  should  never  treat  the  child 
of  a syphilitic  mother  until  we  can  definitely  prove 
that  it  has  the  disease.  The  authors  followed  this 
conservative  course  and  their  judgment  would  seem 
to  have  been  vindicated  by  the  excellent  result  which 
they  obtained,  the  child  being  clinically  and  serologi- 
cally well  at  the  age  of  two  years.  And  yet,  one  may 
be  permitted  to  speculate  as  to  what  will  happen  to 
this  child  in  future  years.  Stokes  has  said,  “Infants 
who  appear  well  and  perhaps  respond  negatively  to 
the  earlier  Wassermann  tests  may,  in  later  life,  under 
the  influence  of  trauma,  lowered  resistance,  and  the 
onset  of  puberty,  develop  active  and  unmistakable 
signs  of  the  disease.” 

It  is  my  belief  that  no  definite  rule  can  be  laid 
down  for  the  treatment  or  withholding  of  treatment 
of  the  normal  baby  of  a syphilitic  mother.  Each  case 
must  be  determined  on  its  individual  merits.  Thus, 
if  the  child  has  been  born  many  years  after  the  date 


of  the  mother’s  infection,  if  her  Wassermann  is  only 
weakly  positive  and  she  presents  no  clinical  evidence 
of  syphilis,  and  if  she  has  given  birth  to  other  appar- 
ently normal  children,  one  would  be  justified  in  with- 
holding treatment.  On  the  other  hand,  if  the  mother’s 
infection  is  of  a comparatively  recent  date,  if  her 
Wassermann  is  strongly  positive,  if  she  presents  clini- 
cal signs  of  syphilis  and  has  given  birth  to  syphilitic 
children,  I believe  that  her  baby  should  be  treated 
regardless  of  apparent  clinical  and  serologic  normality. 

In  the  case  which  we  are  discussing,  the  mother’s 
Wassermann  was  only  weakly  positive  and  she  was 
apparently  healthy.  These  two  facts  might  influence 
us  to  withhold  therapy.  But  when  we  note  that  every 
one  of  her  seven  previous  pregnancies  ended  disas- 
trously we  must  stop  and  ponder.  I must  confess  that 
had  I been  confronted  with  this  same  problem,  I 
would  have  regarded  the  baby  as  probably  syphilitic 
and  would  have  instituted  prolonged  treatment  with 
bismuth  and  sulpharsphenamin. 

Doctors  Campbell  and  Frost  (Closing). — With  ref- 
erence to  Dr.  E.  D.  Chipman’s  observation: 

We  also  feel  that  it  would  be  of  interest  to  utilize 
this  mode  of  therapy  on  the  frankly  syphilitic  child. 
Only  in  this  manner  could  its  value  be  determined, 
and  while  at  the  outset  it  would  seem  a very  radical 
departure,  the  results  of  direct  medication  would  ap- 
pear to  warrant  it  and  are,  without  doubt,  a justifica- 
tion for  its  trial. 

One  must  realize  at  the  outset,  however,  that  this 
method  has  its  limitations,  namely,  that  the  mother 
must  be  able  to  breast-feed  the  child;  she  must  be 
able  to  tolerate  the  drug,  and  we  would  emphasize 
the  necessity  of  keeping  a careful  and  constant  check 
on  the  mother  during  the  entire  time  she  is  under 
therapy,  stressing  that  she  should  report  anything 
untoward  that  may  occur,  however  slight  it  may  seem. 
The  length  of  time  the  mother  has  to  be  kept  under 
weekly  treatments  constituted  in  our  minds  the  great- 
est drawback  to  this  mode  of  therapy.  However,  this 
patient  tolerated  the  drug  well  for  some  fourteen 
months,  and  has  been  perfectly  well  ever  since.  This 
is  a moot  question,  and  to  us  one  which  time  and 
experience  alone  can  answer. 


PEPTIC  ULCER — ITS  MANAGEMENT* 

REPORT  OF  CASES 

By  Grant  H.  Lanphere,  M.  D. 

Los  Angeles 

Discussion  by  Frederick  A.  Speik,  M.  D.,  Los  Angeles; 
Henry  Snure,  M.D.,  Los  Angeles;  Paul  B.  Roen,  M.D., 
Hollywood. 

r II ''HE  management  of  peptic  ulcer  depends  upon 
a careful  consideration  of  its  probable  loca- 
tion, duration  and  complications. 

Ulcers  of  the  stomach  and  duodenum  are 
fundamentally  alike.  Such  differences  as  exist 
are  due  very  largely  to  the  complications  peculiar 
to  the  stomach  and  duodenal  location  of  the  ulcer. 

The  cause  of  ulcers  of  the  stomach  and  duo- 
denum as  they  occur  clinically  has  not  been  satis- 
factorily established.  It  is  probable  that  there  are 
many  factors  which  predispose  to  their  forma- 
tion. Two  of  the  more  recent  theories  are  a con- 
stitutional predisposition  or  an  irritability  of  the 
autonomic  nervous  system  associated  with  chronic 
oral  sepsis,  and  foci  of  infection  which  are 
drained  by  the  portal  vein. 

* Read  before  the  General  Medicine  Section  of  the  Cali- 
fornia Medical  Association  at  the  fifty-eighth  annual 
session  at  Coronado,  May  6-9,  1929. 


April,  1930 


MANAGEMENT  OF  PEPTIC  ULCER — LANPITERE 


237 


SYMPTOMS 

The  symptomatology  of  well  established  ulcer 
is  quite  characteristic.  The  start  is  usually  ob- 
scure, due  no  doubt  to  the  fact  that  in  the  begin- 
ning and  before  the  ulcer  has  eroded  through  the 
muscular  and  serous  coats  and  involved  the  peri- 
toneum, the  disturbance  is  slight. 

A detailed  account  of  the  distress  symptoms 
as  they  appear  during  a usual  twenty-four-hour 
period,  is  of  vast  importance.  When  ulcer  is 
associated  with  the  conditions  essential  to  the 
production  of  clinical  manifestations,  subjective 
symptoms  are  often  present  in  such  characteristic 
form  that  a very  probable  diagnosis  may  be  made 
from  the  clinical  history  alone. 

The  following  facts  are  diagnostic  of  peptic 
ulcer,  providing  there  are  no  definite  or  un- 
explained incompatibilities : 

1.  The  distress  of  ulcer  is  absent  when  the 
stomach  is  normally  empty. 

2.  The  distress  appears  usually  from  one  to 
three  hours,  and  seldom  as  late  as  five  hours  after 
eating  an  ordinary  meal.  It  seldom  appears  before 
breakfast  unless  complications  are  present. 

3.  The  distress  is  as  a rule  completely  relieved 
by  food  and  alkalis. 

4.  It  is  associated  usually  with  an  adequate  free 
hydrochloric  acid  content  of  the  stomach.  The 
epigastric  distress,  which  may  vary  from  a feel- 
ing of  fullness  or  slight  burning  to  severe  pain, 
appears  in  attacks,  lasting  from  a few  days  to  a 
few  weeks  at  one  time,  and  recurring  several 
times  a year.  During  the  interval  between  attacks, 
the  patient  is  often  free  from  distress.  The  dura- 
tion of  the  ulcer  may  be  from  a few  months  to 
many  years. 

DIAGNOSIS 

The  diagnosis  of  peptic  ulcer  should  involve 
a careful  consideration  of  the  distress  symptoms 
that  have  caused  the  patient  to  seek  relief  and 
careful  observation  for  the  purpose  of  demon- 
strating the  correctness  of  the  clinical  facts  ob- 
tained by  the  history  and  physical  examination. 
Thorough  search  should  be  made  in  every  case 
for  evidence  of  the  complications  and  sequelae 
of  ulcer. 

Pyloric  obstruction,  whether  due  to  pyloro- 
spasm  with  acute  inflammatory  swelling,  or  de- 
pendent on  induration  and  callus  formation,  is 
the  most  common  complication  of  peptic  ulcer. 
Other  sequelae  of  ulcer  are  hemorrhage,  perfora- 
tion, hourglass  stomach,  and  malignancy.  The 
roentgen  ray  examinations  give  the  most  accurate 
evidence  of  the  location  of  ulcer,  as  well  as  the 
presence  of  its  complications. 

TREATMENT 

Before  instituting  treatment  in  a given  case  of 
gastric  or  duodenal  ulcer,  a careful  study  should 
be  made  of  the  conditions  that  attend  the  ulcer. 
Whether  the  patient  should  be  treated  medically 


or  surgically  depends  upon  a careful  considera- 
tion of  the  clinical  facts,  and  evidence  of  the  com- 
plications of  ulcer. 

REPORT  OF  CASES 

Pylorospasm  with  Peptic  Ulcer. — The  first  case 
is  presented  to  show  evidence  of  pylorospasm. 
Very  frequent  causes  of  this  condition,  especially 
in  young  people  are  chronic  colitis,  chronic  ap- 
pendicitis and  tubo-ovarian  disease.  The  basic 
phenomenon  underlying  the  symptomatology  of 
peptic  ulcer  is  pylorospasm. 

Case  1.  T.  R.,  a girl  twenty  years  of  age,  com- 
plained of  epigastric  distress,  constipation  alternating 
with  diarrhea,  attacks  of  soreness  in  the  region  of  the 
appendix  and  dysmenorrhea.  The  duration  of  symp- 
toms was  about  two  years.  The  important  points  of 
the  examination  were  a hyperchlorhydria,  occult  blood 
in  the  feces,  tenderness  in  the  epigastrium  over  the 
appendix  region  and  the  lower  right  quadrant. 

Clinically,  peptic  ulcer,  colitis,  and  tubo-ovarian  dis- 
ease were  evident.  Roentgenologic  study  confirmed 
evidence  of  ulcer  in  the  first  portion  of  the  duodenum, 
a considerable  retention  of  gastric  residue  at  the  six- 
hour  observation,  and  a segmented  appendix. 

Laparotomy  was  advised  and  the  patient  submitted 
to  operation.  Appendectomy,  right  salpingectomy  and 
a cyst  removal  from  the  right  ovary  were  done.  Ad- 
hesions from  a periduodenitis  with  some  induration 
of  the  first  portion  of  the  duodenum  were  found. 
After  the  operation  the  patient  was  placed  on  ulcer 
management  for  nonobstructive  peptic  ulcer,  consist- 
ing of  three  ounces  of  equal  parts  of  milk  and  cream 
given  each  hour  from  7 a.  m.  until  7 p.  m.  About 
fifteen  to  twenty  ounces  of  bland  foods  were  given 
morning,  noon,  and  night. 

Comment. — The  control  of  the  free  hydro- 
chloric acid  is  to  be  maintained  from  the  begin- 
ning by  means  of  insoluble  alkalis  such  as  cal- 
cium carbonate,  tribasic  calcium  phosphate,  and 
calcined  magnesia;  for  excess  of  these  beyond 
the  needs  of  acid  neutralization  do  not  lead  to 
development  of  free  alkali.  When  such  alkalis 
are  employed  without  soda  bicarbonate,  alkalemia 
is  decidedly  less  severe  and  the  clinical  symptoms 
of  alkalosis  are  unlikely  to  appear,  especially  if 
the  complication  of  obstruction  or  vomiting  does 
not  occur. 

For  the  convenience  of  the  patient,  the  powders 
are  marked  numbers  one  and  two.  Powder  num- 
ber one  consists  of  calcium  carbonate  grains  ten, 
and  tribasic  calcium  phosphate  grains  twenty, 
given  each  hour  from  7 :30  a.  m.  to  7 :30  p.  m. 
Powder  number  two  consists  of  calcined  mag- 
nesia and  tribasic  calcium  phosphate  each  grains 
ten,  as  needed  or  directed  in  number  and  as  indi- 
cated by  the  consistency  of  the  stool. 

Thirty  to  forty  minims  of  tincture  of  bella- 
donna are  given  daily.  Special  attention  and  in- 
struction are  given  to  the  patient  in  regard  to  the 
treatment  of  an  associated  constipation  or  diar- 
rhea, and  to  prevent  a bowel  distress  from  too 
much  magnesia. 

If  possible,  the  patient  should  remain  at  rest 
in  bed  for  three  weeks  during  the  initial  part  of 
his  ulcer  management,  and  a careful  study  made 


238 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


for  focal  infection.  Oral  sepsis  is  a very  common 
condition. 

Subsequent  study  of  Case  1 by  means  of  the 
roentgen  rays  revealed  the  stomach  to  function 
normally  and  no  gastric  residue  at  the  six-hour 
observation.  Patient  is  well  and  at  work. 

Management  suitable  for  the  obstructive  type 
of  ulcer  differs  from  that  of  the  nonobstructive 
ulcer  in  the  following  points : 

1.  In  many  cases  a larger  quantity  of  powder 
is  required  to  control  the  free  hydrochloric  acid 
of  the  day  secretion,  and  powders  are  given  until 
midnight. 

2.  The  best  results  are  obtained  by  emptying 
the  stomach  at  night  with  the  stomach  tube  one- 
half  hour  after  the  last  powder  is  taken.  The 
greatest  stimulus  to  an  excessive  night  secretion 
is  thereby  removed. 

Otherwise  the  management  is  the  same  as  that 
used  for  the  treatment  of  the  nonobstructive  type 
of  ulcer. 

Cases  2 and  3.  Duodenal  Ulcer  with  Partial  Pyloric 
Obstruction. — G.  D.  and  E.  P.,  two  women,  one  aged 
forty-six  and  the  other  aged  thirty-five  years  respec- 
tively, had  duodenal  ulcers  with  considerable  six-hour 
retention  of  gastric  residue.  Each  gave  a history  of 
long  standing  epigastric  distress,  constipation,  and 
evidence  of  foci  of  infection  elsewhere  in  the  body. 
The  younger  patient  had  an  associated  condition  of 
hyperthyroidism,  and  a fibroid  uterus,  which  was  re- 
moved previous  to  the  time  the  patient  came  for 
examination.  No  doubt  there  was  considerable  or- 
ganic change  and  stenosis  of  the  pylorus  in  each  of 
these  two  patients. 

They  were  treated  at  home,  their  stomachs  as- 
pirated at  night.  Subsequent  study  disclosed  the 
deformity  caused  by  duodenal  ulcer  to  be  present, 
but  absence  of  tenderness  over  the  cap,  freedom  from 
symptoms,  and  no  retention  of  gastric  residue  at  the 
six-hour  study. 

The  prognosis  is  good  in  this  type  of  ulcer  if  the 
patient  will  stay  accurately  on  the  management  for 
months  with  frequent  observation  and  supervision. 
This  is  the  most  common  type  of  ulcer  in  patients 
between  twenty  and  fifty  years  of  age. 

i i i 

Case  4.  Duodenal  Ulcer  with  Nearly  Complete  Pyloric 
Obstruction. — P.  P.,  a man  sixty-eight  years  old,  had 
a peptic  ulcer  for  many  years  with  much  callus  for- 
mation and  stenosis  of  the  pylorus.  The  walls  of  the 
stomach  were  dilated,  and  there  was  evidence  of 
hyperperistalsis  with  much  gastric  residue  at  six 
hours.  It  was  possible  to  see  evidence  of  peristaltic 
waves  through  the  abdominal  wall  passing  from  left 
to  right,  and  a small  tumor  in  the  region  of  the 
pylorus  could  be  felt.  Due  to  the  fact  that  he  was 
a poor  surgical  risk  when  first  seen,  the  medical  treat- 
ment of  a peptic  ulcer  that  is  causing  obstruction  was 
given,  namely;  increase  in  the  amount  of  each  powder, 
removal  of  the  gastric  contents  with  the  stomach  tube 
after  the  last  powder  at  night,  and  the  routine  ulcer 
management  described  above.  The  patient  continued 
medical  management  for  about  three  months,  and 
because  he  continued  to  have  nearly  complete  obstruc- 
tion, laparotomy  was  advised,  the  patient  consenting 
to  the  operation.  Through  a midline  incision  the 
stomach  was  noted  to  be  very  dilated,  and  there  were 
adhesions  binding  the  first  portion  of  the  duodenum 
to  the  pars  pylorica.  Palpation  revealed  a dense  and 


thickened  pylorus  with  narrowed  lumen,  evidence  of 
healed  duodenal  ulcer  with  scar  formation.  A pos- 
terior gastro-enterostomy  was  done  and  ulcer  man- 
agement for  nonobstructive  type  of  ulcer  was  given. 
The  patient  made  an  uneventful  recovery,  which  was 
partly  due  to  his  preoperative  preparation,  and  at 
present  is  comfortable  and  gaining  in  weight. 

r i r 

Case  5.  Duodenal  Ulcer  with  Complete  Pyloric  Ob- 
struction.— W.  H.,  a man  fifty-six  years  old,  had  a 
peptic  ulcer  for  many  years. 

His  symptoms  were  those  similar  to  the  patient  of 
sixty-eight  years  (Case  4).  Because  he  had  a hyper- 
chlorhydria,  loss  of  weight,  epigastric  distress  two 
to  three  hours  after  meals,  and  after  midnight,  occult 
blood  in  the  stools,  complete  obstruction  with  much 
retention  of  gastric  residue,  laparotomy  was  advised. 
A pylorectomy  was  done.  Subsequent  to  the  opera- 
tion medical  treatment  for  nonobstructive  type  of 
peptic  ulcer  was  given.  The  patient  at  present  is 
comfortable,  has  gained  in  weight,  and  is  at  work. 

Gastric  Ulcer  Complicated  with  Hemorrhage 
and  Obstruction. — Gastric  ulcer  occurs  in  a ratio 
of  about  one  to  twelve,  as  compared  to  the  fre- 
quency of  duodenal  ulcer.  The  treatment  of  gas- 
tric ulcer  usually  is  that  of  medical  management, 
especially  if  the  ulcer  is  a recent  one,  less  than 
one  centimeter  in  diameter,  and  associated  with 
a hyperchlorhydria.  The  treatment  may  be  surgi- 
cal, as  one  must  be  ever  mindful  of  the  danger 
of  gastric  ulcer  undergoing  malignant  change.  If 
it  is  a large,  old,  indurated,  calloused  ulcer,  it  is 
very  unlikely  that  a cure  will  be  effected  by 
medical  treatment. 

Case  6.  C.  P.,  a man  fifty-four  years  old,  gave  a 
history  of  the  classical  symptoms  of  ulcer,  just  given, 
of  many  years  duration.  This  patient  had  a severe 
hemorrhage  nine  years  previous.  Following  this  a 
laparotomy  was  done  and  the  ulcer  was  removed  from 
the  lesser  curvature  of  the  stomach  by  cauterization. 
Later  another  ulcer  developed  near  the  pylorus  with 
a return  of  nausea,  gnawing  epigastric  distress,  vomit- 
ing, hyperchlorhydria,  gastric  retention,  and  occult 
blood  in  the  stools.  Gastro-enterostomy  was  advised, 
but  just  previous  to  this  procedure,  before  any  type 
of  treatment  was  given,  the  patient  had  another  severe 
gastric  hemorrhage.  He  was  immediately  placed  on 
the  medical  management  for  treatment  of  acute  hemor- 
rhage from  peptic  ulcer,  which  consisted  of  the 
following: 

1.  Absolute  rest  in  bed. 

2.  Adequate  nursing  attention. 

3.  Morphin  sulphate  to  control  restlessness. 

4.  Hourly  doses  of  alternate  powders  of  calcined 
magnesia  and  calcium  carbonate  in  sufficient  amounts 
to  control  the  free  hydrochloric  acidity  from  the 
beginning.  These  preparations  do  not  produce  gas 
and  the  magnesia  prevents  stasis  in  the  colon,  of 
feces,  blood,  and  the  precipitated  chalk. 

5.  Blood  transfusion,  to  promote  clotting  at  the  site 
of  the  hemorrhage  and  to  sustain  the  patient,  may 
be  given. 

6.  Later,  ulcer  management  was  given. 

Comment. — In  the  great  majority  of  patients 

with  ulcer  complicated  by  hemorrhage,  the  appli- 
cation of  medical  treatment  for  acute  hemorrhage 
controls  the  bleeding,  clotting  is  promoted,  the 
hemorrhage  ceases  and  occult  blood  rapidly  dis- 
appears from  the  stool  and  does  not  recur  while 
the  patient  is  on  accurate  ulcer  management. 


April,  1930 


MANAGEMENT  OF  PEPTIC  ULCER — LANPIIERE 


239 


A gastro-enterostomy  was  done  on  this  patient, 
based  on  the  following  indications  : 

(a)  A history  of  two  severe  attacks  of  hem- 
orrhage. 

(b)  Nearly  complete  obstruction  from  pyloric 
stenosis  and  induration. 

(c)  No  relief  from  an  excessive  continued 
secretion. 

After  the  operation  the  patient  was  placed  on 
the  treatment  of  the  nonobstructive  type  of  ulcer 
management  to  promote  the  healing  of  the  present 
ulcer  and  prevent,  if  possible,  the  recurrence  of 
another  ulcer.  The  patient  was  advised  to  have 
evident  foci  of  infection  removed.  Subsequent 
roentgen-ray  study  showed  that  the  new  opening 
in  the  stomach  was  functioning  normally  with  no 
retention  at  the  six-hour  study.  The  patient  is 
now  free  of  symptoms,  has  gained  in  weight,  and 
is  at  work. 

Case  7.  Gastric  Ulcer  Complicated  with  Malignant 
Change  and  Hemorrhage. — D.  B.,  a woman  thirty-two 
years  old  had  epigastric  distress  for  several  years. 
Recently  there  had  been  a severe  hemorrhage  from 
the  stomach.  The  application  of  the  treatment  for 
acute  hemorrhage  from  peptic  ulcer  was  given,  and 
the  bleeding  stopped.  The  patient  was  subsequently 
examined  and  an  ulcer  was  found  in  the  lesser  curva- 
ture of  the  stomach.  There  was  no  free  hydrochloric 
acid  in  the  stomach  contents,  a negative  Wassermann, 
occult  blood  was  present  in  the  feces,  and  persistent 
pain  while  on  accurate  ulcer  management.  Operation 
was  advised,  a gastrotomy  was  done,  and  a tumor 
with  two  ulcers  in  the  mucosa  was  removed  from 
the  posterior  wall  of  the  stomach. 

Microscopic  examination  disclosed  a sarco-leio- 
myorna  of  the  round-celled  and  infiltrating  type. 

Comment. — According  to  the  statistics  of  the 
Mayo  Clinic,  only  one  in  two  hundred  gastric 
tumors  is  benign,  and  one  in  five  hundred  and 
fifty  is  a myoma.  Persistent  hemorrhage  or  occult 
blood  in  the  stools,  while  the  patient  is  accurately 
on  ulcer  management,  is  suspicious  of  malignancy. 

Case  8.  Gastro-Enterostomy. — J.  M.,  a man  forty- 
nine  years  old,  had  a gastro-enterostomy  in  1927  for 
relief  of  symptoms  of  many  years  duration.  The 
patient  was  free  from  distress  for  only  a short  time. 
Then  he  began  to  have  a recurrence  of  nausea,  heart- 
burn, belching,  diarrhea,  occult  blood  in  the  stool,  and 
loss  of  weight.  He  was  very  irritable  and  nervous. 
Many  ulcerated  teeth  had  been  removed. 

Roentgenologic  study  disclosed  a jejunal  ulcer  at 
the  stoma  which  was  painful  under  pressure.  The 
distal  portion  of  the  stomach  and  duodenum  appeared 
to  be  normal  in  outline  and  function.  He  was  placed 
on  medical  treatment  for  nonobstructive  type  of  ulcer, 
and  was  quite  free  of  his  symptoms  most  of  the  time. 

However,  there  were  periods  of  belching,  sour 
stomach,  and  soreness  in  the  region  of  the  stoma. 
Two  to  five  per  cent  of  patients  who  have  had  gastro- 
enterostomy have  a complication  of  a gastrojejunal 
or  jejunal  ulcer.  If  medical  treatment  does  not  affect 
a cure,  the  procedure  of  choice  is  to  take  down  the 
gastro-enterostomy  and  close  the  stoma,  providing,  of 
course,  that  the  pylorus  is  patent,  and  there  is  no  evi- 
dence of  chronic  ulcer  or  obstruction  at  the  outlet  of 
the  stomach.  Due  to  mental  disturbances,  the  patient 
here  reported  committed  suicide  three  months  after 


he  was  placed  on  ulcer  management,  and  necropsy 
revealed  the  jejunal  ulcer  in  a subacute  condition  and 
in  the  process  of  healing. 

Peptic  Ulcer  Complicated  with  Diverticula  of 
the  Duodenum. — The  association  of  ulcer  with 
diverticula  of  the  duodenum  is  emphasized  in 
many  case  reports.  These  may  be  congenital  or 
acquired,  they  may  be  clinically  silent,  or  may 
be  the  site  of  major  pathology.  Diverticula  of  the 
duodenum  are  found  chiefly  in  the  latter  half  of 
life,  are  acquired,  and  are  often  produced  by  the 
contracting  scar  of  ulcer. 

Case  9.  E.  A.,  a woman  aged  seventy-two,  com- 
plained of  periods  of  heartburn,  sour  stomach,  vomit- 
ing, and  constipation  during  the  previous  twelve  years. 
These  attacks  appeared  regularly  two  to  three  hours 
after  meals  and  were  completely  relieved  by  vomit- 
ing. There  was  frequently  epigastric  distress  after 
midnight  which  was  relieved  by  soda  and  vomiting 
of  sour  material. 

The  important  points  of  the  examination  were  a 
hyperchlorhydria  tenderness  and  soreness  in  the  epi- 
gastrium, constipation,  and  a paroxysmal  auricular 
fibrillation. 

Roentgenologic  study  showed  a niche  of  the  lesser 
curvature  of  the  stomach,  which  was  near  the  pylorus. 
The  six-hour  observation  revealed  a diverticulum  of 
the  second  portion  of  the  duodenum  and  one  of  the 
third  portion.  The  former  was  tender  under  pressure. 

The  patient  was  placed  on  ulcer  management  for 
several  months.  Subsequent  study  and  observation 
revealed  the  patient  to  be  free  of  symptoms  with 
absence  of  pain  and  vomiting,  and  enjoying  good 
health.  The  heart  condition  was  successfully  treated 
with  quinidin  sulphate. 

CONCLUSIONS 

1.  The  symptoms  of  ulcer  are  completely  con- 
trolled and  relieved  in  uncomplicated  ulcer. 

2.  Alkalosis  is  not  likely  to  occur  with  the  use 
of  the  insoluble  alkalis. 

3.  Pyloric  obstruction  is  influenced  in  the 
manner  previously  described. 

4.  Hemorrhage  ceases  and  occult  blood  rapidly 
disappears  from  the  stool  and  does  not  recur  while 
on  accurate  management. 

5.  Gastro-enterostomy  is  the  procedure  of 
choice  to  relieve  complete  pyloric  obstruction. 

6.  Medical  management  should  follow  surgical 
treatment  for  peptic  ulcer. 

1052  West  Sixth  Street. 

DISCUSSION 

Frederick  A.  Speik,  M.  D.  (800  Auditorium  Build- 
ing, Los  Angeles). — Although  gastro-duodenal  ulcers 
heal  under  proper  medical  treatment,  we  must  be  con- 
stantly on  the  alert  for  associated  pathology.  Intelli- 
gent observation,  with  frequent  x-ray  examinations, 
finds  that  the  biggest  and  deepest  ulcers  gradually 
get  smaller  until  they  disappear,  and  the  patient  is 
symptom  free.  However,  many  cases  in  which  lesions 
of  the  portal  lymphatic  system  exist  may  have  a re- 
turn of  symptoms  or  a recurrence  of  ulcer,  because 
these  lesions  are  foci  of  infection  in  the  gall  bladder 
or  appendix. 

Sippy  stated  that  in  order  to  treat  peptic  ulcer  in- 
telligently it  is  necessary  to  determine  the  age,  the 
type,  the  location  and  complication  of  ulcer.  It  is 


240 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


necessary  to  go  further  and  determine  if  there  are 
any  lesions  of  the  portal  system,  such  as  cholecysti- 
tis, appendicitis,  pancreatitis,  hepatitis,  or  peritoneal 
adhesions. 

The  taking  out  of  an  acute  or  chronic  appendix 
does  not  cure  the  ulcer.  Many  appendectomies  are 
done  before  an  ulcer  was  discovered.  This  is  one 
reason  why  patients  do  not  always  get  well  follow- 
ing an  appendectomy.  There  is  pathology  elsewhere. 

Patients  with  foci  of  infection  in  the  portal  lym- 
phatic system  should  have  them  removed  at  earliest 
recognition.  If  physicians  are  on  the  alert  for  asso- 
ciated ulcer  pathology,  the  diagnosis  will  be  made 
more  promptly  and  better  end  results  will  be  had. 

& 

Henry  Snure,  M.  D.  (1501  South  Figueroa  Street, 
Los  Angeles). — The  use  of  the  roentgen  ray  in  the 
management  of  peptic  ulcer  has  been  well  covered  in 
this  presentation  for  each  type  of  ulceration. 

Another  important  condition,  dealing  perhaps  more 
with  the  diagnosis  of  peptic  ulcer  than  the  manage- 
ment of  same,  has  not  been  mentioned,  namely,  duo- 
denitis. It  should  be  considered  before  Case  1,  as 
some  investigators,  Konjetzny,  for  instance,  believe 
that  it  is  the  forerunner  of  peptic  ulcer.  On  the  other 
hand,  Judd  believes  it  to  be  a separate  pathologic 
entity.  The  symptomatology  of  duodenitis  is  practi- 
cally the  same  as  that  outlined  for  peptic  ulcer  in 
Doctor  Lanphere’s  report;  however,  if  the  duodenum 
is  opened  and  the  mucous  membrane  inspected,  no 
distinct  ulcer  is  visualized.  The  mucous  membrane 
presents  a fine  stippling,  congestion  and  edema, 
usually  over  a small  area;  bleeding  occurs  easily  on 
handling.  The  serosa  is  seldom  thickened;  occasion- 
ally small  scar  formation  has  been  noted.  Roentgeno- 
logically,  the  duodenal  cap  is  small,  difficult  to  fill  and 
properly  outline,  and  “writhing”  is  present.  Also  there 
is  no  constant  niche  present  and  no  retention  of 
barium  meal  in  the  stomach. 

I would  like  to  emphasize  the  point  made  by  Doctor 
Speik,  of  the  need  of  frequent  examination  to  check 
up  on  the  efficacy  of  the  treatment  and  to  aid  in  the 
search  for  associated  pathology,  particularly  when  the 
patient  does  not  respond  in  the  usual  manner  to  ulcer 
management  as  outlined  in  the  author’s  paper. 

* 

Paul  B.  Roen,  M.  D.  (1680  North  Vine  Street, 
Hollywood). — Inasmuch  as  the  exact  cause  of  peptic 
ulcer  is  as  yet  undetermined,  the  management  of  the 
treatment  must  be  directed  toward  relief  of  the  symp- 
toms, and  of  other  pathology,  if  found  present,  as 
has  been  indicated  by  Doctor  Lanphere  in  his  paper. 

Peptic  ulcers  are  very  frequently  associated  with 
other  pathology,  particularly  of  the  nasal  sinuses,  the 
teeth,  the  gums,  and  the  tonsils,  as  well  as  the  gastro- 
intestinal tract.  The  symptom  complex  may  be  due 
to  irritative  lesions  of  the  gastro-intestinal  tract  pro- 
ducing deformity  of  the  duodenal  cap,  or  may  be 
entirely  functional.  Either  one  or  any  combination 
of  these  factors  may  be  present  in  the  same  patient, 
rendering  a positive  diagnosis  almost  impossible. 

Regardless  of  the  exact  pathology,  a percentage  of 
patients  with  this  hyperacid  syndrome  so  character- 
istic of  ulcer  will  recover  on  mental  and  physical  rest 
treatment,  combined  with  a bland  diet  and  proper 
alkaline  medication  at  frequent  intervals. 

T.  he  results  of  treatment  frequently  prove  or  dis- 
prove the  diagnosis.  If  the  treatment  does  not  pro- 
duce the  desired  relief,  or  should  there  be  a recur- 
rence of  the  symptoms,  a further  and  more  intensive 
study  is  indicated,  to  be  followed  in  turn  by  appro- 
priate treatment. 


INJURIES  OF  THE  UROGENITAL  TRACT* 

REPORT  OF  CASES 

By  Burnett  W.  Wright,  M.  D. 

Los  Angeles 

Discussion  by  Philip  Stephens,  M.  D.,  Los  Angeles; 
E.  H.  Crabtree,  M.D.,  San  Diego;  Charles  P.  Mathe, 
M.  D.,  San  Francisco. 

HPHE  task  of  the  urologist  engaged  in  examin- 
ing  industrial  accident  cases  is  not  always  an 
easy  one.  He  is  rarely  privileged  to  see  these 
patients  immediately  after  injury,  when  external, 
visible  evidence  of  trauma  is  so  often  present, 
or  when  the  immediate  signs  and  symptoms  of 
injury  are  in  evidence  to  aid  him  in  making  a 
diagnosis.  Aside  from  the  exceptional,  severely 
injured  patient  who  requires  immediate  hospitali- 
zation, most  of  his  industrial  patients  are  seen  in 
his  office,  days  and  often  weeks  after  an  alleged 
injury,  with  urinary  complaints  which  only  the 
patient  himself,  in  most  instances,  attributes  to 
his  accident.  He  has  nearly  always  received  some 
treatment  at  the  hands  of  others. 

PROBLEMS  CONFRONTING  THE  UROLOGIST 

When,  still  complaining,  he  comes  to  the  urolo- 
gist, he  brings  two  distinct  problems:  (1)  Is  pa- 
thology present  in  the  urogenital  tract  or  not? 
and  (2)  If  present,  did  it  exist  prior  to  the  in- 
jury or  develop  as  the  result  of  injury  or  occur 
subsequent  to  and  entirely  independent  of  the 
injury. 

The  patient’s  story  cannot  always  be  relied  on. 
Some  willfully  and  skillfully  misrepresent  the 
facts ; others  are  entirely  honest  in  the  belief  that 
the  symptoms  date  from  the  injury,  when  it  may 
later  be  proved  that  there  was  preexisting  pa- 
thology and  that  the  condition  was  either  aggrav- 
ated by  the  injury  or  that  the  patient’s  attention, 
for  the  first  time,  was  called  to  symptoms  which 
he  previously  ignored. 

The  reports  of  the  surgeons  who  first  exam- 
ined him  or  later  treated  him  are  of  necessity 
often  incomplete  from  a urological  standpoint, 
because  these  men  do  not  generally  employ  the 
diagnostic  procedures  used  by  the  urologist,  or 
possess  the  special  equipment  necessary  for  these 
examinations.  To  see  blood  being  ejected  from 
the  orifice  of  a ureter,  following  injury,  for  ex- 
ample, is  infinitely  more  valuable  than  to  read  or 
to  be  told  that  there  was  blood  in  the  voided  urine 
shortly  after  the  accident.  The  task  of  fixing  the 
degree  to  which  trauma  is  a factor  in  this  class 
of  cases  rests  largely  with  the  urologist  therefore, 
for  usually  his  information  is  based  on  the  only 
urological  examination  made  in  a given  case. 

In  suspected  cases  of  injury  to  the  upper  uri- 
nary tract,  seen  remotely  after  the  accident,  usu- 
ally nothing  short  of  a complete  urological  study 
will  suffice.  This  includes  a plain  x-ray  of  the 
kidneys,  ureters  and  bladder,  examination  of 
voided  urine,  test  for  residual  urine,  cystoscopy, 


* Head  before  the  Industrial  Medicine  and  Surgery  Sec- 
tion of  the  California  Medical  Association  at  the  Fifty- 
Eighth  Annual  Session,  Coronado,  May  6-9,  1929. 


April,  1930 


INJURIES  OF  UROGENITAL  TRACT — WRIGHT 


241 


bilateral  ureteral  catheterization,  collection  of 
urine  from  each  kidney  with  examination,  per- 
haps culture  or  guinea-pig  inoculation  of  the  sepa- 
rate urines,  a differential  functional  test  and,  at 
times,  a pyelogram  or  pyelo-ureterogram.  The 
value  of  these  procedures  is  illustrated  by  the 
following  case. 

REPORT  OF  CASES 

Case  1. — Walter  W.,  age  thirty-one;  occupation, 
moving-picture  actor.  Was  referred  on  August  2, 
1928,  complaining  of  pain  in  the  upper  right  quad- 
rant. He  stated  that  on  June  5,  1928,  while  engaged 
in  his  occupation  of  making  pictures,  he  was  required 
to  fall  from  a running  horse  and  “play  dead.’’  After 
several  such  falls  (for  which  he  was  paid  at  the  rate 
of  $10  per  fall)  he  felt  a sudden  sharp  pain  in  the 
right  lumbar  region  which  persisted  and  caused  him 
to  be  confined  to  bed  until  July  4,  1928.  Since  that 
date  he  had  felt  a constant  soreness  and  tenderness 
on  pressure  over  the  right  kidney.  Since  his  injury 
he  had  had  no  urinary  disturbance  except  an  occa- 
sional nocturia  of  one  to  two  times.  Prior  to  his 
injury  he  had  always  been  well.  He  had  never  passed 
blood  in  the  urine. 

Examination. — Examination  revealed  a palpable,  mov- 
able, and  tender  right  kidney,  larger  than  normal. 
Voided  urine  was  negative  except  for  a few  shreds  in 
the  first  glass.  The  external  genitalia  were  normal. 
No  urethral  discharge.  X-ray  showed  no  shadows. 
Kidney  outlines  were  not  clearly  seen.  There  were 
multiple  strictures  in  the  anterior  urethra,  the  smallest 
of  which  admitted  a No.  14  French  searcher.  After 
dilating  the  strictures,  a cystoscopic  examination 
showed  a moderately  inflamed  right  ureteral  orifice, 
but  no  other  bladder  pathology.  No  urine  could  be 
seen  coming  from  the  right  orifice  and  no  peristaltic 
waves  were  visible  on  that  side.  A catheter  met  a 
distinct  obstruction  in  the  right  ureter,  eighteen  centi- 
meters from  the  bladder,  which  could  not  be  passed 
with  the  smallest  filiform.  A No.  6 catheter  passed 
easily  to  the  left  kidney  pelvis,  without  obstruction. 
No  urine  was  excreted  from  the  right  side  in  twenty 
minutes.  Urine  dripped  freely  from  the  left  side. 
Phenolphthalein  injected  intravenously  appeared  from 
the  left  side  in  four  minutes,  with  35  per  cent  excreted 
in  thirty  minutes.  No  dye  appeared  from  the  right 
side.  The  right  ureter  was  injected  with  sodium  iodid 
and  x-ray  made.  There  was  a complete  blockage  of 
the  ureter  in  the  upper  third,  near  the  ureteropelvic 
juncture,  with  none  of  the  fluid  entering  the  pelvis 
of  the  kidney.  The  upper  third  of  the  ureter,  below 
the  obstruction,  was  distinctly  narrowed. 

Conclusions. — The  conclusions  were : a walled- 
off  hydronephrosis,  with  neoplasm  of  the  kidney 
to  be  considered.  Nephrectomy  was  advised. 

Subsequent  Course.  — The  patient  chose  an 
osteopath  to  remove  his  kidney,  and  the  operator 
reported  to  the  State  Compensation  Insurance 
Fund  on  December  15,  1928  that  he  had  removed 
a hydronephrotic  kidney  containing  720  cubic 
centimeters  of  purulent  urine,  with  the  outlet  into 
the  ureter  completely  blocked.  His  conclusions 
were  that  the  condition  was  the  result  of  the 
ureter  having  been  torn,  with  the  subsequent  scar 
formation  occluding  the  lumen  and  producing  the 
hydronephrosis.  The  specimen  was  secured  by 
the  State  Compensation  Fund  and  examined  by 
the  Brem,  Zeiler  & Hammack  Laboratory  which 
reported  a tumor  involving  the  upper  third  of 
the  ureter,  which  on  section  was  a myoma,  origi- 
nating in  the  musculature  of  the  ureter,  obstruct- 
ing its  lumen.  Liability  was  refused. 


The  urologist  engaged  in  this  class  of  work 
soon  learns  not  to  attach  too  much  importance  to 
a patient’s  description  of  his  injury  or  the  symp- 
toms he  enumerates.  An  example  of  how  easy  it 
is  to  be  misled  occurred  with  the  following  case. 

Case  2. — C.  F.,  age  fifty-one.  Was  referred  on  De- 
cember 18,  1928.  He  stated  that  on  November  5, 
while  in  a tree  at  work,  he  fell  astride  a limb,  bruis- 
ing the  perineum.  He  felt  considerable  pain,  _was 
nauseated,  but  did  not  vomit.  The  first  urine  voided 
seven  hours  later  contained  blood.  He  noticed  blood 
for  several  days,  and  on  the  fourth  day  the  left 
testicle  became  swollen  and  exceedingly  sore.  On 
December  11,  a competent  surgeon  reported  him  as 
having  a ruptured  urethra  with  urinary  extravasation 
into  the  scrotal  sac,  with  formation  of  an  abscess, 
which  he  had  drained.  We  found  the  left  half  of  the 
scrotum  was  indurated  and  enlarged,  with  a small 
fistula  in  the  lower  portion.  The  urine  was  infected, 
and  he  voided  with  some  difficulty.  The  prostate  felt 
slightly  enlarged. 

We  concluded  that  an  incomplete  rupture  of 
the  urethra  had  occurred,  with  extravasation,  and 
considered  it  unwise  to  introduce  an  instrument 
into  the  bladder  and  recommended  him  for  com- 
pensation. Soon  after,  a second  urologist  cysto- 
scoped  him,  found  a calculus  impacted  in  the  pos- 
terior urethra  which  had  ruptured  the  canal  by 
pressure  necrosis  and  that  extravasation  had 
occurred.  The  prostate  was  adenomatous.  Com- 
pensation was  justly  refused. 

The  commonest  type  of  case  seen  by  the  urolo- 
gist remotely  after  injury  is  the  epididymitis  for 
which  a direct  blow  or  a “strain”  is  given  as  the 
cause.  In  our  opinion,  trauma  alone  does  not 
cause  epididymitis.  A careful  examination  of  the 
secretions  of  the  prostate  and  seminal  vesicles 
will  nearly  always  reveal  a focus  of  infection 
which  supplied  the  organism  to  tissue  devitalized 
by  trauma.  Acute  gonorrhea  must  be  excluded. 

We  believe  that  the  interests  of  the  insurance 
carrier,  the  employer,  and  those  of  the  injured 
employee  who  has  symptoms  referable  to  the  uro- 
genital tract,  will  be  better  guarded  and  the  prob- 
lems of  the  consulting  urologist  greatly  simplified 
if  the  interval  between  the  injury  and  the  exami- 
nation is  reduced  to  a minimum. 

1137  Roosevelt  Building. 

DISCUSSION 

Philip  Stephens,  M.  D.  (1136  West  Sixth  Street, 
Los  Angeles). — We  have  been  very  much  interested 
in  Doctor  Wright’s  paper  and  the  various  points 
which  he  has  developed  therein.  We  note  his  insist- 
ence upon  thorough  routine  examinations  and  his  at- 
tempt to  impress  us  with  the  fact  that  if  certain 
features  are  omitted,  or  short  cuts  are  attempted,  that 
we  will,  in  all  probability,  miss  certain  features  which 
we  will  afterward  regret;  or  which  might  tend  toward 
the  loss  of  certain  points  which  would  be  useful  in 
preventing  us  from  making  diagnostic  mistakes  so 
important  in  establishing  the  causal  relationship  of 
certain  symptoms  of  the  alleged  disability. 

One  special  point  which  we  would  like  to  have  im- 
pressed upon  general  practitioners,  employers,  insur- 
ance companies,  and  others  interested  in  this  work, 
is  the  impossibility  of  so-called  epididymitis,  or  con- 
ditions of  this  character,  being  caused  by  what  is 
termed  ordinary  strain  incident  to  strenuous  work — 
that  they  are  infectious  in  character  and  that  the  in- 
fection necessarily  need  not  be  the  result  of  venereal 
disease.  We  who  are  more  or  less  active  in  industrial 
practice  see  many  such  conditions  which  are,  as  a 


242 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


rule,  attributed  to  a lift  or  strain,  and  we  feel  that  a 
better  understanding  or  standard  procedure  of  de- 
cision should  be  established  among  all  concerned. 

E.  H.  Crabtree,  M.  D.  (706  Medico-Dental  Build- 
ing, San  Diego).- — I have  taken  a great  deal  of  in- 
terest in  Doctor  Wright’s  paper,  as  I think  it  is  very 
important  to  ascertain  the  cause  of  cases  of  epididy- 
mitis that  present  themselves  to  us  in  compensation 
work. 

We  all  recognize  the  fact  that  an  epididymitis  can- 
not come  from  a strain  unless  there  is  infection  of 
some  sort  present.  But  the  thing  that  interests  me 
most  is  the  fact  that  in  many  cases  we  are  given  a 
history  of  a severe  strain  from  lifting,  which  is  fol- 
lowed by  a swelling  in  the  scrotum.  The  doctor  must 
deal  fairly  with  the  company  and  with  the  patient, 
and  it  seems  to  me  that  in  cases  where  there  is  no 
history  of  any  venereal  or  other  infection,  it  is  hard 
to  tell  a man  who  is  incapacitated  because  of  a con- 
dition which  has  come  on  following  a strain  which 
occurred  at  his  work,  that  it  is  not  a compensation 
case.  In  other  words,  although  he  may  have  had  some 
latent  infection  in  his  urogenital  tract,  it  may  not  have 
been  Neisserian  in  type,  and  whatever  the  infection 
was,  the  man  was  not  cognizant  of  the  fact. 

I would  appreciate  a little  more  discussion  on  this 
point  as  to  what  the  attitude  of  the  Commission  is  in 
this  type  of  case.  ^ 

Charles  P.  Mathe,  M.  D.  (450  Sutter  Street,  San 
Francisco). — Doctor  Wright  has  emphasized  an  im- 
portant point  in  his  paper  in  calling  attention  to  the 
fact  that  the  patient  suffering  from  an  alleged  injury 
to  the  genito-urinary  tract  is  often  seen  at  such  a late 
date  that  it  is  hard  to  determine  the  exact  role  that 
trauma  has  played  in  producing  the  pathological  lesion 
in  question.  Although  an  injury  will  often  call  the 
patient’s  attention  to  an  insidious  pathological  lesion 
that  had  already  existed  for  some  time,  it  often  lowers 
the  resistance  of  the  injured  organ  or  structure,  mak- 
ing it  susceptible  to  immediate  or  subsequent  infec- 
tion. Many  urologists,  notably  Hagner,  Brewer, 
Squier,  and  Rehn,  in  discussing  pyelonephritis  have 
emphasized  the  role  of  trauma  in  reducing  the  resist- 
ance of  the  kidney,  making  it  more  susceptible  to  even 
the  mildest  form  of  infection. 

There  is  no  question  as  to  the  etiologic  role  of 
trauma  when  there  is  a ruptured  kidney  presenting  a 
large  tear;  lesser  injuries,  including  contusions,  slight 
tears,  hemorrhagic  exudation,  etc.,  are  often  over- 
looked and  are  hard  to  determine  by  the  methods  of 
diagnosis  now  at  our  disposal. 

The  question  of  compensation  in  injuries  of  the 
genito-urinary  tract  is  still  confused.  In  order  to 
arrive  at  a fair  decision  for  the  injured  worker,  em- 
ployer, and  insurance  carrier,  a careful  study  and 
correct  interpretation  of  the  pathological  processes 
directly  or  subsequently  resulting  from  injury  should 
be  made.  Four  types  of  cases  present  themselves: 
(1)  Cases  in  which  there  is  no  question  as  to  the 
trauma  causing  the  signs  and  symptoms  from  which 
the  patient  suffers,  e.  g.,  ruptured  kidney,  ruptured 
urethra,  ruptured  bladder,  etc.  (2)  Cases  in  which 
trauma  causes  no  appreciable  immediate  bad  effect 
but  lowers  the  resistance  of  the  organ  or  structure, 
making  it  more  susceptible  to  subsequent  infection, 
e.  g.,  pyelonephritis,  epididymitis,  etc.  This  category 
wTould  also  include  cases  in  which  a slight  tear  in  the 
urethra  due  to  trauma  caused  no  appreciable  immedi- 
ate harm  but  resulted  in  progressive,  extensive,  and 
damaging  stricture  formation.  (3)  Cases  in  which 
trauma  will  light  up  or  cause  a preexisting  pathologi- 
cal lesion  to  give  immediate  trouble.  This  group  in- 
cludes cases  in  which  a stone  was  dislodged  by  a 
violent  blow,  the  urethra  containing  a stone  ruptured 
by  sudden  violence,  the  lighting  up  of  a previous  more 
or  less  nonactive  tubercular  process,  etc.  (4)  Cases 
in  which  trauma  has  called  attention  to  a preexisting 
lesion  in  which  it  is  reasonable  to  assume  that  trauma 
had  played  no  part  in  the  immediate  symptoms.  This 


type  is  well  exemplified  by  cases  one  and  two  reported 
by  Doctor  Wright. 

Although  immediate  examination  of  the  injured  per- 
son by  a competent  urologist  will  establish  the  role  of 
trauma  in  the  production  of  the  alleged  pathological 
lesion,  it  renders  no  aid  in  ascertaining  subsequent 
ill  effects.  The  role  of  lowered  resistance  resulting 
from  injury  is  the  source  of  considerable  debate  and 
can  only  be  determined  by  a thorough  understanding 
of  pathological  processes  of  lesions  of  the  organs  and 
structures  making  up  the  genito-urinary  tract. 

* 

Doctor  Wright  (Closing). — Concerning  the  ques- 
tion raised  by  Doctor  Crabtree,  and  mentioned  in 
Doctor  Stephens  discussion,  the  Industrial  Accident 
Commission,  replying  to  an  inquiry  from  me,  has 
written  as  follows: 

“The  Industrial  Accident  Commission  has  no  fixed 
policy  which  it  publishes  to  cover  the  question  which 
you  ask.  The  Commission  feels,  however,  that  in- 
asmuch as  some  strain,  accident,  or  misadventure, 
causes  disability  through  lighting  up  or  further  injur- 
ing some  defective  part,  there  should  be  compensa- 
tion, in  part,  at  least. 

“Infections  of  the  prostate  and  seminal  vesicles  are 
very  common,  and  may  be  present  when  there  never 
has  been  any  Neisserian  infection.  The  workman  is 
accepted  as  he  is  with  his  defects  and  weaknesses  and 
tendencies  to  failure.  Therefore,  when  in  the  pres- 
ence of  an  infection  and  a strain  precipitating  a dis- 
abling condition,  the  Commission  usually  rules  that 
the  case  is  wholly  or  partially  compensable.” 


GLAUCOMA — SOME  SURGICAL  CONSIDERA- 
TIONS* 

By  May  Turner  Riach,  M.  D. 

San  Diego 

Discussion  by  Frederick  C.  Cordes,  M.  D.,  San  Fran- 
cisco; Lloyd  Mills,  M.  D.,  Los  Angeles. 

ir\\UKE-ELDER  expresses  the  hope  that  some 
day  we  may  overcome  glaucoma  and  cataract 
by  physicochemical  means.  Some  encouraging 
work  is  being  done  along  this  line,  but  I believe 
that  operative  interference  will  continue  to  hold 
its  strong  position  for  a good  many  years ; and 
it  merits  all  the  thought  and  discussion  we  can 
bring  to  bear  from  every  standpoint. 

I make  no  claim  for  originality  for  any  point 
raised  in  this  paper,  but  the  seriousness  and 
prevalence  of  glaucoma  and  our  present  inability 
to  master  it  may  excuse  one  from  apology  in 
repetition. 

I served  an  internship  at  the  New  York  Eye 
and  Ear  Infirmary  in  1918  and  1919.  Dr.  John 
E.  Weeks  and  the  late  Dr.  Robert  G.  Reese  were 
active  surgeons  at  the  infirmary  during  my  resi- 
dency. Doctor  Weeks  did  the  Lagrange  opera- 
tion and  Doctor  Reese  did  his  iridectomy  almost 
entirely  for  glaucoma.  As  house  surgeon  I as- 
sisted at  most  of  these  operations  and  followed 
the  end  results  of  the  ward  cases,  taking  fields, 
visions  and  tensions ; comparing  the  value  of  the 
Lagrange,  as  done  by  Doctor  Weeks,  and  the 
iridectomy,  as  done  by  Doctor  Reese.  I con- 
sidered each  surgeon  a master  who  had  perfected 
his  technique,  and  felt  that  their  results  would 
give  a true  estimate  of  the  effectiveness  of  the 
two  operations. 

* Read  before  the  Eye,  Ear,  Nose,  and  Throat  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  Coronado,  May  6-9,  1929. 


April,  1930 


GLAUCOMA— RIAGH 


243 


After  close  observation  of  these  cases  running 
side  by  side,  I concluded  that  their  percentage 
of  successes  was  very  high  and  about  equal ; and 
this  conclusion  is  substantiated  by  the  reports 
given  below. 

LAGRANGE  OPERATION 

In  Doctor  Weeks’  report,  given  in  Archives 
of  Ophthalmology,  May  1920,  he  states:  “The 
Lagrange  operation,  which  I have  performed  at 
least  three  hundred  times,  is  relied  on  for  the 
forms  of  glaucoma  other  than  those  reserved  for 
the  Elliot  operation.  The  operation  is  performed 
as  described  by  Lagrange  except  that  the  incision 
is  seldom  more  than  five  millimeters  long.  The 
shorter  incision  is  employed  to  avoid  the  danger 
of  prolapse  of  the  head  of  the  ciliary  body  or  of 
the  lens  into  the  wound,  and  to  lessen  the  possi- 
bility of  escape  of  vitreous.  In  this  series  of  cases 
there  has  been  deep  intra-ocular  hemorrhage 
twice.  The  opening  has  been  occluded  by  the 
falling  forward  of  the  head  of  the  ciliary  body 
in  four.  There  has  been  loss  of  vitreous  in  three 
cases.  Hypertension  has  recurred  to  an  extent  to 
nullify  the  result  in  only  four  instances.  There 
have  been  but  two  light  cases  of  iritis  and  no  case 
of  late  infection.” 

IRIDECTOMY  OPERATION 

Later  I was  office  and  clinical  assistant  to 
Doctor  Reese  and  had  the  opportunity  to  follow 
up  the  end  results  of  some  of  his  private  cases 
as  well  as  the  hospital  ones. 

Doctor  Reese  reported  237  iridectomies,  which 
he  performed  on  private  patients  for  glaucoma ; 
172  noncongestive  and  65  congestive.  The  report 
of  his  results  and  the  technique  of  his  iridectomy 
is  described  in  detail  in  Transactions  of  Section 
on  Ophthalmology  of  the  American  Medical  As- 
sociation, 1923.  He  states : “We  have  been  suc- 
cessful in  relieving  the  tension  and  restoring  the 
vision  that  had  not  been  destroyed  by  pressure 
atrophy  in  every  case  of  congestive  glaucoma  in 
which  we  operated.  In  noncongestive  cases  the 
vision  was  kept  in  statu  quo  and  the  tension  kept 
below  thirty  (Schiotz)  in  all  but  five  of  these 
which  could  be  followed  for  any  length  of  time, 
in  these  the  tension  remained  about  thirty-seven. 
In  twenty-five  noncongestive  cases  two  iridec- 
tomies were  performed,  and  in  eleven  three  iridec- 
tomies had  to  be  done  before  tension  was  relieved. 
There  was  not  a single  case  of  expulsive  hemor- 
rhage; this  was  accounted  for  by  the  fact  that 
the  aqueous  was  expelled  drop  by  drop.  In  no 
case  was  the  lens  injured  with  the  keratome,  or 
was  there  loss  of  vitreous  or  the  lens  dislocated, 
nor  did  the  head  of  the  ciliary  body  prolapse  or 
become  adherent  to  the  incision.  Never  was  an 
anterior  chamber  found  to  be  so  shallow  that  it 
could  not  be  entered  with  this  model  of  kera- 
tome.” (A  special  broad  one  bent  at  an  angle 
of  twenty-one  degrees.) 

It  is  to  be  remembered  that  Doctor  Reese  ex- 
cised a piece  of  sclera  from  the  anterior  lip  of 
the  incision  in  all  noncongestive  cases. 

When  analyzed  the  Lagrange  and  the  iridec- 
tomy as  done  by  Doctor  Reese  in  chronic  cases 


are  practically  identical  operations  in  principle. 
In  the  former  the  knife  moves  from  below  up- 
ward, and  in  the  latter  from  above  downward. 
“The  sclerectomy  is  the  basic  element  of  the 
operations,”  as  stated  by  Doctor  Weeks  in  a per- 
sonal communication  of  recent  date. 

ELLIOT  OPERATION 

During  my  internship  the  Elliot  operation  was 
not  generally  practiced  at  the  infirmary,  and  in 
the  cases  where  it  was  performed  the  end  results 
did  not  compare  favorably  with  those  of  the  two 
operations  above  discussed ; but  later  in  London, 
where  the  trephine  was  more  frequently  done 
than  any  other  operation  for  glaucoma,  I observed 
the  technique  and  the  end  results  of  the  trephine 
at  the  Westminster  Ophthalmic  and  Moorfield 
hospitals,  especially  the  work  of  Mr.  Elmore  C. 
Brewerton  and  Sir  William  T.  Lister,  and  I 
learned  that  their  results  were  as  good  as  those 
of  Doctors  Weeks  and  Reese. 

lister’s  method 

I wish  to  quote  five  special  points  emphasized 
by  Sir  William  T.  Lister : 

“1.  In  reflecting  the  conjunctival  flap,  take  all 
the  episcleral  tissue  with  the  conjunctiva  that  you 
can  get,  in  order  to  make  the  flap  as  thick  as 
possible. 

“2.  Make  the  corneal  incision  with  a Tooke’s 
corneal  splitter. 

“3.  Raise  the  flap  at  right  angles  to  the  cornea 
and  slide  the  trephine  on  as  far  as  it  will  go  in 
order  that  the  aperture  may  be  situated  right  up 
to  the  furthest  extent  of  your  incision. 

“4.  When  trephining,  place  the  trephine — in 
the  first  instance— symmetrically,  but  as  soon  as 
you  feel  it  gripping  and  cutting,  turn  the  hand 
over  to  your  left  in  order  that  the  disk  may  have 
a hing-e  and  not  be  completely  separated.  Also  I 
prefer  to  leave  the  stilette  in  the  tube  so  that  on 
removal  of  the  trephine  from  the  wound,  you 
may  tend  to  suck  the  disk  out.  (In  order  to  pre- 
vent the  disk  getting  into  the  anterior  chamber. 
If  it  does  I do  not  think  it  matters,  but  it  is  not 
so  artistic.) 

“5.  In  making  the  iridectomy,  take  hold  of  the 
iris  as  far  above  as  possible  and  at  its  base,  and 
then  push  downward  in  order  to  make  an  irido- 
dialysis  before  cutting  the  buttonhole  iridectomy.” 

The  above  is  quoted  from  a personal  letter  to 
me  recently  received. 

PERSONAL  OBSERVATIONS 

During  the  last  ten  years  I have  had  under  my 
care  487  cases  operated  upon  for  glaucoma. 
These  occurred  in  New  York,  London,  Serbia, 
Constantinople,  and  in  Egypt.  The  end  results  of 
the  work  I did  myself  in  the  East  did  not  com- 
pare favorably  with  that  done  in  New  York  and 
in  London,  as  mentioned  above,  except  perhaps 
in  the  acute  cases.  I worked  under  great  diffi- 
culties. Postoperative  care  and  observations  were 
necessarily  far  from  satisfactory.  At  first  in 
Macedonia,  where  I started  my  work  abroad,  I 
could  not  speak  the  language,  and  I had  no  assist- 


244 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


ant  trained  in  eye  work.  The  work  was  over- 
whelming in  amount.  Much  of  the  equipment  had 
to  be  improvised.  Visions  and  fields  were  taken 
by  interpreters  I trained  myself,  but  the  tensions, 
upon  which  I relied  mostly,  were  carefully  and 
repeatedly  taken  by  myself  (using  the  Schiotz). 
Some  of  my  cases  were  under  observation  for  a 
very  short  time ; so  that  some  of  those  labeled 
successes  may  very  well  have  proved  to  have  been 
failures  if  they  had  been  under  observation  for 
a longer  period.  The  cases  were  mostly  of  the 
acute,  well  advanced  or  absolute  glaucomas.  The 
end  results  were  observed  over  a period  ranging 
from  two  to  six  months  in  Serbia,  and  from  two 
weeks  to  two  years  in  Constantinople  and  in 
Egypt. 

I did  the  Reese  iridectomy  almost  entirely  at 
first.  In  the  noncongestive  cases  I removed  a 
piece  from  the  anterior  lip  of  the  scleral  incision 
in  its  entire  thickness  with  either  the  scissors  or 
the  punch.  In  absolute  glaucoma,  where  the  fields 
were  very  narrow  or  where  there  was  very  much 
cupping,  I employed  the  Elliot  trephine.  I learned 
to  refrain  from  doing  the  trephine  where  any 
inflammatory  condition  existed,  as  the  opening 
often  subsequently  closed  in. 

In  Macedonia  there  was  no  trachoma  compli- 
cating, but  later  in  Constantinople  and  in  Egypt, 
where  the  complications  of  trachoma  and  puru- 
lent ophthalmia  had  to  be  reckoned  with,  I found 
the  Lagrange  and  trephine  easier  to  do  than  the 
Reese  iridectomy.  As  time  went  on  I did  the 
trephine  more  and  more,  especially  where  I felt 
that  after  treatment  would  be  neglected. 

I have  often  employed  the  scissors  to  advan- 
tage in  some  cases  where  the  anterior  chamber 
was  practically  obliterated,  e.  g.,  as  in  adherent 
leukoma,  making  a scleral  flap  with  keratome  so 
that  the  opening  into  the  anterior  chamber  is  two 
or  three  millimeters  in  length — just  large  enough 
to  admit  the  point  of  the  scissors.  In  this  way 
the  lens  can  be  more  easily  avoided.  This  is  also 
useful  in  secondary  glaucoma  with  a deep  anterior 
chamber,  where  it  is  imperative  to  avoid  a sudden 
gush  of  aqueous.  This  is  done  in  a somewhat 
similar  way  as  described  by  Luedde  in  his 
“winged”  iridectomy  incision. 

In  making  each  linear  incision  for  glaucoma, 
I visualize  the  angle  and  direct  the  instrument 
that  the  anterior  chamber  may  be  opened  into 
about  1.75  millimeter  posterior  to  the  limbus,  in 
the  medium-sized  eye,  so  that  the  canal  of  Schlem 
may  be  entered  in  its  posterior  part,  the  pectinate 
ligament  severed,  and  any  adhesions  of  the  iris 
separated  from  the  cornea.  The  posterior  scleral 
incision  allows  the  iris  to  be  detached  at  its  junc- 
tion with  the  ciliary  body.  In  doing  the  iridec- 
tomy I tried  to  effect  a dialysis  by  pulling  the  iris 
under  tension  to  the  opposite  side  as  I made  the 
cuts,  as  described  by  Doctor  Reese.  Gradually, 
with  experience  in  these  operations,  my  tech- 
nique improved  and  my  results  also  improved 
pari  passu. 

I wish  to  emphasize  the  importance  of  massage 
following  the  filtering  scar  operations.  The  ten- 
sion may  be  regulated  more  or  less  by  it.  I begin 


this  gently  on  the  third  day  after  operation  and 
continue  it  daily,  as  the  case  requires.  The  patient 
may  be  taught  to  do  this  at  home.  I believe  that 
success  in  a large  number  of  cases  rests  on  the 
exercise  of  this  point. 

I have  endeavored  to  compare  the  operations 
performed  for  glaucoma  of  similar  type,  viz.,  the 
noncongestive.  After  careful  survey  of  the  end 
results  from  my  notes  of  such  cases,  I found  that 
83  Reese  iridectomies  with  sclerectomy,  95 
Lagranges  (with  the  short  incision  as  done  by 
Doctor  Weeks),  and  118  Elliot  trephines  gave 
in  my  hands  practically  the  same  percentage  of 
successes  for  each  of  the  three  operations,  viz., 
from  65  to  70  per  cent. 

My  belief  is  that  the  secret  of  success  lies  in 
the  finesse  of  technique  more  than  in  the  choice 
of  operation. 

SUMMARY 

To  sum  up  on  broad  lines,  the  operating  sur- 
geon in  glaucoma  must  be  prepared  to  perform 
two  operations : In  acute  cases,  a deep,  broad 
iridectomy,  after  the  type  advised  by  Doctor 
Reese ; and  in  the  chronic  ones  some  form  of 
filtering  cicatrix  operation,  and  here  I would  ad- 
vise the  Elliot  trephine.  It  is,  in  my  opinion, 
easier  to  perform  and  carries  less  risk  than  any 
of  the  other  filtering  scar  operations  and  the  re- 
sults are  just  as  good. 

If  the  surgeon  concentrates  on  the  technique 
required  for  these  two  operations,  he  is  well 
equipped  to  deal  with  most  cases  of  glaucoma 
which  require  operation. 

1007  Medico-Dental  Building. 

DISCUSSION 

Frederick  C.  Cordes,  M.  D.  (384  Post  Street,  San 
Francisco). — Doctor  Riach’s  paper  gives  a clear,  con- 
cise resume  of  the  subject.  As  the  author  points  out, 
the  surgical  consideration  of  glaucoma  must  be  re- 
garded under  two  separate  headings:  the  acute  and 
chronic  forms  of  the  disease. 

In  acute  glaucoma,  iridectomy  has  long  been  a 
satisfactory  and  well  recognized  procedure.  The  re- 
sults in  this  operation  are  uniform  the  world  over. 

In  chronic  simple  glaucoma  various  operations  are 
done  to  produce  a filtering  cicatrix.  It  was  very  in- 
teresting to  note  that  under  the  author’s  observation 
the  Elliot  trephine  did  not  compare  favorably  with 
the  Reese  and  Lagrange  in  this  country,  while  in 
England  the  results  with  the  Elliot  were  excellent. 
I agree  with  Doctor  Riach  that  this  is  probably  a 
question  of  technique.  We  have  all  had  the  experi- 
ence of  rather  disappointing  results  in  some  new 
operative  procedure  until  some  apparently  minute 
detail  in  technique  was  called  to  our  attention. 

One  operation  not  mentioned  by  the  author  is  iri- 
dotasis.  This,  as  done  by  Wilder,  or  the  modification 
used  by  Gifford,  gives  results  that  compare  favorably 
with  the  other  operations.  The  simplicity  and  ease 
of  performance  are  important  factors  in  its  favor. 
The  iris  is  not  wounded  and  for  this  reason  there 
is  less  liability  of  hemorrhage.  This  is  important  in 
hemorrhagic  glaucoma  or  in  cases  of  high  blood  pres- 
sure. It  should  not  be  used,  however,  in  an  eye  that 
has  a developing  cataract,  for  the  misplaced  pupil 
and  iris  would  complicate  the  incision. 

In  glaucoma,  following  cataract  extraction,  I have 
found  cyclodialysis  very  valuable  and  feel  it  is  the 
best  operation  for  this  condition. 

The  selection  of  an  operation  producing  a filtering 
cicatrix  is  largely  a personal  matter.  The  surgeon 


April,  1930 


SURGERY  IN  TUBERCULOSIS — SCHIFFBAUER 


245 


should  choose  that  one  to  which  he  is  best  adapted 
and  which  in  his  hands  gives  the  maximum  con- 
sistency. ^ 

Lloyd  Mills,  M.  D.  (609  South  Grand  Avenue,  Los 
Angeles). — The  fundamental  surgical  considerations  of 
glaucoma  seldom  have  been  presented  more  clearly 
or  practically  than  in  this  able  paper.  Doctor  Riach’s 
conclusions  will  meet  with  the  approval  of  most  eye 
surgeons.  Three  points  are  evident  in  the  surgical 
treatment  of  glaucoma: 

1.  All  glaucoma  should  be  considered  as  surgical 
unless  there  is  prompt  therapeutic  proof  to  the  con- 
trary, as  in  simple  hypertension  without  involvement 
of  the  optic  nerve. 

2.  The  measure  of  importance  in  all  the  filtering- 
scar  operations,  whether  Lagrange,  Reese,  or  Elliot, 
is  the  sclerectomy  and  the  correct  formation  of  its 
covering  flap  of  conjunctiva. 

3.  The  art  of  the  surgery  of  chronic  glaucoma  lies 
in  the  adaptation  of  the  form  and  size  of  the  sclerec- 
tomy to  the  surgical  needs  of  the  given  case.  The 
presence  or  absence  of  inflammatory  and  exudative 
changes  in  the  anterior  segment  and  of  progressive 
degenerative  changes  in  the  optic  nerve,  regardless 
of  the  degree  of  hypertension,  should  determine  the 
form  of  the  operative  measure. 

I have  seen  so  many  of  these  glaucomatous  eyes 
which  have  gone  blind  after  inadequate  measures  that 
I have  long  ago  given  up  the  Elliot  operation  in 
severe  cases,  believing  that  the  Lagrange,  or  the 
Reese  operation  with  sclerectomy,  offered  the  patient 
the  best  chance  of  the  maintenance  of  sight  and  the 
mastery  of  individual  hypertension.  I cannot  believe, 
out  of  my  own  experience,  that  the  Elliot  operation 
permits,  as  a rule,  the  breadth  of  opening  of  the  filtra- 
tion angle  or  the  breadth  and  depth  of  the  iridectomy 
which  is  necessary  to  be  fully  effective.  If  there  is 
one  place  in  ocular  surgery  where  radicalism  must 
enter  it  is  in  the  cases  of  typical  amaurotic  excava- 
tions in  glaucomatous  degeneration.  Accordingly,  in 
the  simple  cases,  my  sclerectomy  is  made  about  as 
small  as  can  be  done  easily  with  the  Graefe  blade, 
but  in  the  cases  showing  progressive  degeneration 
I use  the  full  width  sclerectomy  as  advised  by 
Lagrange  and  believe  that  my  results  have  justified 
the  really  minor  risks. 

It  is  well  recognized  that  the  relief  of  hypertension 
is  the  relief  of  only  one  part  of  the  syndrome  of 
glaucoma.  The  prevention  or  halting  of  the  other 
important  element,  optic  atrophy,  very  often  follows 
the  successful  relief  of  hypertension.  The  cases  yet 
to  be  mastered  are  those  where  the  atrophy  is  pro- 
gressive, regardless  of  the  degree  of  reduction  of 
ocular  tension.  The  mastery  of  such  cases  probably 
will  come  through  earlier  diagnosis  and  earlier  and 
more  radical  operation. 


INDICATIONS  FOR  SURGERY  IN  PULMO- 
NARY TUBERCULOSIS* 

By  H.  E.  SCHIFFBAUER,  M.  D. 

Los  A ngeles 

Discussion  by  Harold  Brunn,  M.  D.,  San  Francisco ; 
William  B.  Faulkner,  M.D.,  San  Francisco ; E.  W . Hayes, 
M.D.,  Monrovia. 

HPHE  purpose  of  this  paper  is  to  discuss  the 
selection  of  patients  suffering  from  pulmonary 
tuberculosis  who  are  suitable  for  surgery. 

The  term  “surgery”  is  applied  to  the  various 
methods  of  extrapleural  thoracoplasty,  operation 
on  the  phrenic  nerve,  external  and  internal  pneu- 
molysis. The  application  of  these  methods  will 
not  be  considered. 

* Read  before  the  General  Medicine  Section  of  the  Cali- 
fornia Medical  Association  at  the  Fifty-Eighth  Annual 
Session,  at  Coronado,  May  6-9,  1929. 


Surgery  in  pulmonary  tuberculosis  is  based  on 
a sound  physiological  principle  and  an  accurate 
knowledge  of  its  pathology.  The  object  of  all 
surgical  interventions  is  to  obtain  a relaxation  of 
the  lung,  with  the  ensuing  atelectasis  which  places 
the  diseased  lung  at  rest,  obliterates  cavities  and 
decreases  the  toxemia,  increases  fibrosis  and  so 
secures  scarring  and  retraction. 

It  must  be  impressed  upon  the  patient  that  the 
operation  does  not  eradicate  the  diseased  lung 
but  only  assists  the  patient  in  increasing  his  re- 
sistance and  in  preventing  reinoculation  and 
hemorrhage. 

If  surgery  is  confined  to  the  ideal  cases,  opera- 
tion will  be  refused  to  many  who  would  be  bene- 
fited by  it.  Results  from  operation  on  improperly 
selected  cases  will  be  unfavorable  and  a discredit 
to  surgery. 

POINTS  FOR  CONSIDERATION  IN  SELECTION 
OF  CASES 

Resistance. — The  selection  of  patients  suitable 
for  surgery  is  of  the  utmost  importance.  It  re- 
quires a careful  consideration  of  all  the  phases 
of  pulmonary  tuberculosis,  especially  tbe  immuno- 
logical reactions,  and  the  closest  collaboration 
with  a tuberculosis  specialist. 

The  accurate  estimation  of  the  patient’s  resist- 
ance to  surgery  as  manifested  by  the  various 
clinical  symptoms,  with  a clear  understanding  of 
the  immunological  processes,  will  greatly  assist  in 
the  selection  of  the  appropriate  time  for  operation. 

Interpretation  of  Roentgenograms. — The  cor- 
rect interpretation  of  a series  of  roentgenograms, 
taken  over  a period  of  months  is  of  extreme  im- 
portance. A decision  should  not  be  based  upon 
a few  plates.  It  is  advisable  for  the  surgeon  to 
make  an  exacting  study  of  the  roentgenograms 
with  a competent  roentgenologist.  Such  study, 
made  over  a period  of  years,  will  aid  him  in  the 
selection  of  cases,  the  type  and  extent  of  surgery 
to  be  performed. 

Physical  Findings. — The  physical  findings  and 
clinical  observations  are  perhaps  of  more  impor- 
tance than  the  roentgenological  studies.  The  sur- 
geon should  be  adept  in  the  use  of  the  stetho- 
scope. It  will  often  prevent  him  from  operating 
on  unsuitable  cases. 

The  pathological  condition  of  the  diseased  lung 
is  an  important  factor.  For  our  consideration  it 
is  sufficient  to  classify  pulmonary  tuberculosis 
into  two  groups : the  exudative  and  the  prolifera- 
tive fibrotic  types.  The  primary  tuberculous 
lesion  of  the  lung  is  always  exudative.  When  the 
initial  lesion  is  slight,  with  good  resistance,  it 
readily  changes  into  the  proliferative  type  with  a 
tendency  to  fibrosis.  The  less  resistance  produced 
by  the  patient  the  more  extensive  the  exudative 
lesion.  After  the  initial  lesion,  dependent  upon 
the  extent  of  infection  and  the  patient’s  resist- 
ance, there  always  exists  the  mixed  form.  It  is 
important  to  know  whether  the  exudative  or  the 
proliferative  type  predominates,  and  to  what  ex- 
tent. Experience  has  proved  that  surgery  in  the 
preponderant  exudative  lesion  gives  the  poorest 
result,  whereas  in  the  slow  progressive  proliferat- 


2+6 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


ing  type  the  best  results  have  been  obtained. 
Operation  in  the  stage  of  defense  is  inadvisable. 
It  is  only  after  this  stage  has  been  passed  and  the 
patient  is  not  making  satisfactory  progress  that 
surgery  should  be  taken  into  consideration.  Fur- 
ther procrastination  is  inconsistent  with  the  expe- 
rience of  the  present  results  from  surgery. 

INDICATIONS  FOR  SURGERY 

1.  Unilateral  chronic  fibrotic  ulcerative  tuber- 
culosis with  or  without  cavities,  in  which  con- 
servative methods  have  failed,  with  a contralateral 
lung  which  has  no  activity  in  the  apex,  nor  the 
presence  of  a hilar,  or  lower  lobe  lesion  is  a 
condition  favorable  for  surgical  intervention. 

2.  Some  cases,  with  a basal  exudative  lesion, 
which  are  progressive,  with  extensive  pleural  ad- 
hesions, with  a normal  contralateral  lung,  in 
young  patients,  with  good  resistance  may  be  con- 
sidered. Extreme  care  should  be  exercised  in  the 
selection  of  the  exudative  cases.  The  highest 
mortality  and  the  poorest  results  follow  surgical 
interference. 

3.  Hemoptysis  is  not  an  indication  for  urgent 
surgery.  As  a rule,  strict  rest  with  other  con- 
servative treatment  is  usually  sufficient  to  arrest 
the  bleeding. 

Repeated  hemorrhages  in  suitable  cases  are 
greatly  benefited  by  surgery.  Internal  pneumo- 
lysis is  effective  when  an  incomplete  pneumo- 
thorax, due  to  adhesions,  prevents  the  compres- 
sion of  the  diseased  lung  which  is  bleeding. 

Phrenic  interruption  will  often  control  repeated 
hemorrhage  from  cavities.  Extrapleural  thora- 
coplasty is  an  efficient  method  of  permanently 
stopping  bleeding  in  the  chronic  ulcerative  dis- 
eased lung. 

4.  Tuberculous  empyema  with  mixed  infection, 
in  which  conservative  methods  have  failed,  calls 
for  surgery.  In  this  condition  we  cannot  be  too 
particular  about  the  contralateral  lung. 

5.  Incomplete  pneumothorax  is  helpful  for  a 
unilateral  involvement  which  is  not  making  satis- 
factory progress. 

6.  Early  surgery  will  prevent  the  development 
of  empyema  and  save  many  patients  with  a 
pleural  effusion,  secondary  to  artificial  pneumo- 
thorax with  or  without  tubercle  bacilli,  which 
accumulates  after  repeated  aspirations,  and  in 
which  expansion  does  not  take  place  after  the 
withdrawal  of  the  fluid.  Ordinarily  15  per  cent 
of  these  patients  would  develop  empyema. 

7.  Spontaneous  pneumothorax  with  bronchial 
communication  is  helped  by  the  intervention  of 
surgery. 

Too  much  consideration  of  the  existing  patho- 
logical condition  of  the  involved  lung  should  not 
be  given,  but  more  attention  to  the  patient’s  re- 
sistance to  surgery.  Individuals  with  bad  family 
history  of  tuberculosis  are  poor  operative  risks. 
The  emaciated  and  the  obese  patients  do  not  toler- 
ate surgery  and,  if  possible,  their  condition  should 
be  improved. 

The  outward  signs  of  fibrosis  of  the  lung, 
manifested  by  the  narrowed  and  insunken  inter- 


costal spaces;  marked  supra-  and  infraclavicular 
grooves ; atrophy  and  slight  rigidity  of  the  mus- 
cles attached  to  the  anterior  and  posterior  chest 
walls ; these,  associated  with  the  roentgenological 
findings  of  a deviation  of  the  trachea  to  the 
affected  side,  fixation  of  the  mediastinum,  a ris- 
ing of  the  diaphragm,  and  a drawing  over  of  the 
base  of  the  heart,  are  indications  that  every  effort 
is  being  made  by  nature  to  put  the  diseased  lung 
at  rest,  but  that  further  aid  is  required. 

CONTRALATERAL  LUNG 

Patients  with  unilateral  tuberculosis  are  seldom 
seen  by  the  surgeon.  Surgical  need  is  not  a ques- 
tion of  whether  one  lung  is  free  from  disease, 
but  it  is  a question  of  the  type,  location,  extent, 
probable  duration,  and  whether  there  is  any 
activity. 

It  is  obvious  that  any  diseased  condition  of  the 
good  lung  requires  adequate  observation;  if  the 
condition  is  progressive,  surgery  is  contraindi- 
cated ; should  the  disease  remain  stationary,  or  be 
retrogressive,  graded  surgery  may  be  considered. 

It  is  not  unusual  to  observe  improvement  in 
the  contralateral  lung  after  a phrenicectomy,  and 
a continued  improvement  after  a complete  thora- 
coplasty has  been  performed. 

It  is  in  this  class  of  patients  that  the  test  opera- 
tion of  phrenicectomy  is  of  value.  After  the 
diaphragm  is  paralyzed  and  the  patient  has  an 
elevation  of  temperature,  increase  in  pulse  rate, 
and  moisture  over  the  suspected  area,  further 
surg'ery  is  contraindicated  at  this  time. 

The  existence  of  a chronic  disease  of  the  good 
lung,  such  as  emphysema,  chronic  bronchitis, 
bronchial  asthma,  bronchiectasis,  extensive  ad- 
hesions between  the  base  of  the  lung  and  dia- 
phragm, is  a contraindication  for  surgery. 

CONTRAINDICATIONS  TO  SURGERY 

In  Early  and  Late  Cases. — Early  cases  in  the 
defense  stage,  and  advanced  bilateral  cases,  are 
an  absolute  contraindication. 

Lack  of  Defense  Mechanism. — Constitutional 
symptoms,  manifested  by  a high  temperature, 
rapid  pulse  rate,  increased  respiration,  dyspnea, 
cyanosis,  a low  blood  pressure,  are  all  symptoms 
indicating  exhaustion,  with  a complete  breakdown 
of  the  defense  mechanism.  Surgery  will  hasten 
the  end. 

Blood  Picture. — A gradual  decrease  of  the  eryth- 
rocytes, low  hemoglobin,  increase  in  the  lympho- 
cytes, with  a continued  absence  of  the  eosinophils, 
and  a decrease  in  the  sedimentation  time,  are  all 
factors  indicating  a failing  resistance. 

Age. — Operations  should  be  limited  to  patients 
between  the  age  of  fifteen  and  forty-five.  The 
best  results  are  obtained  between  the  age  of 
twenty  and  thirty-five.  Age  is,  however,  not  an 
important  factor  in  the  selection  of  cases.  Pa- 
tients at  the  age  of  twelve  and  fifty-seven  have 
been  operated. 

Choice  in  Left  and  Right-sided  Operations. — 
Operations  on  the  left  side  give  better  results  than 


April,  1930 


SURGERY  IN  TUBERCULOSIS — SCIIIFFBAUER 


i 


247 


on  the  right.  The  left  lung,  consisting  of  two 
lobes,  smaller  in  volume,  assisted  by  the  heart  in 
aiding  compression,  are  the  important  factors  in 
determining  the  end-result.  Cardiac  embarrass- 
ment is  more  frequent  when  operation  has  been 
on  the  left  side. 

Circulatory  System  Contraindications. — A per- 
sistent pulse  rate  over  one  hundred,  with  a blood 
pressure  under  a hundred,  is  a relative  contra- 
indication to  major  surgery. 

Myocardial  degeneration  is  an  absolute  contra- 
indication to  thoracoplastic  operations.  Valvular 
lesions  without  myocardial  damage  are  satisfac- 
tory risks.  In  all  doubtful  heart  conditions  an 
electrocardiogram  is  a valuable  aid  in  estimat- 
ing the  patient’s  resistance  to  surgery.  After  a 
thoracoplastic  operation  an  additional  amount  of 
work  is  placed  on  the  heart,  first,  by  the  dis- 
placement of  the  heart ; second,  by  an  increased 
resistance  in  the  lesser  circulation;  and  third,  by 
the  autotuberculization  of  the  patient,  causing  an 
increase  in  the  heart  rate. 

Kidney  Impairment. — Patients  with  kidney  con- 
ditions which  give  an  impaired  functional  test, 
with  changes  in  the  blood  chemistry,  should  not 
be  submitted  to  major  surgery.  A mild  degree  of 
toxic  albuminuria  is  not  a contraindication. 

T uberculosis  of  the  Intestines.— A mild  chronic 
tuberculous  condition  of  the  intestines  which  does 
not  interfere  with  proper  nutrition  is  not  an  abso- 
lute contraindication.  A tuberculous  ischiorectal 
abscess  should  not  deter  one  from  considering 
major  surgery  of  the  chest. 

Tuberculosis  of  Other  Organs. — Tuberculosis 
of  the  larynx,  with  a severe  perichrondritis  is  a 
relative  contraindication;  a mild  laryngeal  tuber- 
culous involvement  usually  improves  after  a 
thoracoplasty. 

Chronic  tuberculosis  of  the  bones,  joints,  or 
skin  are  not  an  absolute  contraindication  to 
surgerv. 

SUMMARY 

This  paper  is  a plea  to  that  group  of  physicians 
who  are  well  informed  on  the  results  that  have 
been  accomplished  by  surgery  but  have  not  had 
the  courage  to  abandon  their  conservative  treat- 
ment in  chronic  destructive  processes  of  the  lung 
which  show  no  improvement.  May  they  recon- 
sider these  cases,  realizing  that  they  can  save 
many  from  an  early  death,  cure  at  least  one-third, 
improve  another  third,  and  prevent  an  enormous 
economic  loss  of  time  and  money. 

The  selection  of  cases  is  of  paramount  impor- 
tance, but  the  end-results  will  be  in  direct  pro- 
portion to  the  surgeon’s  skill  in  his  preoperative 
management,  his  operative  technique,  and  the 
postoperative  treatment. 

520  West  Seventh  Street. 

DISCUSSION 

Harold  Brunn,  M.  D.  (384  Post  Street,  San  Fran- 
cisco).— Doctor  Schiffbauer  has  given  us  in  a master- 
ful way  the  indications  and  contraindications  for  the 
adoption  of  surgery  in  pulmonary  tuberculosis.  We 
will,  therefore,  not  discuss  the  operative  procedures 


themselves,  but  confine  ourselves  to  the  subject  as 
outlined  by  him  in  his  paper. 

I am  glad  to  note  the  very  evident  conservatism 
which  marks  the  work  of  Doctor  Schiffbauer.  The 
general  surgeon  taking  up  this  type  of  work  must 
more  or  less  reconstruct  himself  and  take  a different 
attitude  than  has  been  his  custom  in  his  ordinary 
surgical  work. 

Patients  suffering  from  tuberculosis  that  are  brought 
to  his  attention  for  surgery  require  careful  study,  long 
observation,  and  consideration  of  preliminary  pro- 
cedures before  the  major  operation  is  undertaken,  and 
a close  association  with  the  specialist.  This  is  not  the 
place  for  quick  judgments  and  dogmatic  generaliza- 
tion. Each  case  must  be  decided  upon  its  own  merits. 

As  has  been  pointed  out,  certain  groups  of  these 
patients  do  not  respond  to  surgery;  on  the  contrary 
a surgical  procedure  may,  in  one  of  several  ways, 
tend  to  extend  the  disease.  I think  I can  say  that 
where  we  have  undertaken  surgery  with  grave  doubt 
that,  for  the  most  part,  we  have  had  regrets. 

We  believe  that  thoracoplasty  and  phrenicotomy 
are  two  surgical  procedures  of  great  value  in  well- 
chosen  cases,  and  will  shorten  the  time  of  cure  that 
cannot  be  obtained  by  other  methods. 

We  quarrel  at  times  with  the  tuberculosis  specialist 
who,  although  a believer  in  collapse  therapy  (artifi- 
cial pneumothorax),  still  persists  in  this  when  it  is 
not  bringing  about  a result,  either  because  of  ad- 
hesions or  other  Jactors,  and  refuses  to  accept  thora- 
coplasty which  so  perfectly  meets  the  requirements. 

Theoretically  they  admit  the  value  of  the  operation 
but  practically  they  refuse  to  submit  their  patients 
to  it.  The  line  of  cleavage  lies  in  the  fact  that  they 
believe  these  patients  will  with  rest  and  time  get  well, 
as  many  have,  and  that  thoracoplasty,  while  it  may 
hasten  recovery,  might  throw  them  over  on  the  other 
side  and  they  refuse  to  take  the  chance. 

We  who  believe  in  thoracoplasty  think  that  .the 
tuberculosis  specialist  fails  to  give  a certain  propor- 
tion of  his  patients  the  advantage  of  this  operation 
and  waits  too  long  until  finally  the  indication  for  it 
has  passed. 

Education  is  necessary  on  both  sides.  We  believe 
there  is  a common  ground,  but  this  can  only  be 
accomplished  by  intimate  association  and  discussion. 

William  B.  Faulkner,  Jr.,  M.  D.  (University  of 
California  Hospital,  San  Francisco). — The  value  of 
collapse  therapy  in  pulmonary  tuberculosis  has  already 
been  definitely  established.  The  successful  outcome 
in  many  cases  following  artificial  pneumothorax  has 
been  recognized  by  all  familiar  with  this  type  of  work. 
There  is  a group  of  cases,  however,  in  which  pleural 
adhesions  so  fix  the  lung  to  the  diaphragm  and  chest 
wall  as  to  interfere  with  an  efficient  collapse  by  arti- 
ficial pneumothorax  alone.  It  is  in  this  group  that 
section  of  the  phrenic  nerve  or  thoracoplastic  pro- 
cedures find  their  greatest  use.  As  has  been  pointed 
out  by  Doctor  Schiffbauer,  the  success  to  be  obtained 
following  these  surgical  measures  is  in  direct  pro- 
portion to  the  care  employed  in  the  selection  of  cases 
and  the  choice  of  operative  procedure.  This  selection 
of  cases  calls  for  the  greatest  cooperation  between  the 
chest  specialist,  thoracic  surgeon,  and  roentgenologist. 

It  is  by  such  cooperative  work  that  exceptional  im- 
provement often  follows  the  use  of  surgery.  There 
are  a few  scattered  cases,  however,  in  which  surgical 
treatment  is  followed  by  a persistence  of  the  symp- 
toms, or  an  extension  of  the  patient’s  disease.  The 
unfavorable  impression  which  these  present  leads  to  a 
hesitancy  in  recommending  surgery  for  other  patients 
in  whom  all  the  indications  are  present  for  an  opera- 
tive improvement. 

If  symptoms  persist  following  operation  they  are 
as  a rule  due  to  an  incomplete  collapse  of  the  dis- 
eased lung.  The  localization  of  the  remaining  disease 
within  the  lung  can  sometimes  be  made  by  the  injec- 


248 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


tion  of  bromifin  into  the  tracheobronchial  tree  or  by 
bronchoscopic  examination.  Further  operative  pro- 
cedures aiming  at  collapse  should  then  be  carried  out 
at  the  site  at  which  bromifin  has  localized  the  dis- 
ease. We  have  had  one  such  patient  who  had  an 
incomplete  relief  of  symptoms  following  section  of 
the  phrenic  nerve  and  posterior  thoracoplasty.  (The 
sputum  had  been  reduced  from  two  cups  to  one-half 
cup  a day.)  The  remaining  disease  was  localized  in 
the  anterior  portion  of  the  chest.  An  anterior  thora- 
coplasty was  then  done,  and  the  patient  had  an  im- 
mediate and  complete  relief  of  all  symptoms.  This 
particular  patient  illustrates  the  need  for  further  sur- 
gery rather  than  less  surgery  in  certain  instances  that 
fail  to  improve  with  the  usual  operative  procedures. 

The  extension  of  the  disease  following  surgery  has 
been  attributed  to  the  aspiration  of  pus  from  the 
compressed  area  of  the  diseased  lung  with  resulting 
aspiration  bronchopneumonia.  This  can  be  prevented 
if  the  patient  is  bronchoscoped  immediately  before 
the  chest  operation  so  as  to  remove  pus  from  the  dis- 
eased areas.  This  procedure  can  readily  be  done  in 
a very  few  minutes  under  local  anesthesia  without 
pain  and  with  little  discomfort  to  the  patient. 

We  believe  that  with  the  employment  of  the  bron- 
choscope, the  use  of  bromifin,  and  the  adoption  of 
further  operative  procedures,  the  favorable  results 
following  surgery  should  be  even  more  marked. 
However,  as  Doctor  Schiffbauer  emphasizes,  surgery 
does  not  give  an  immediate  cure  of  the  disease;  the 
patient  still  has  tuberculosis  and  should  continue 
medical  care  and  general  tuberculosis  regimen  long 
after  the  operative  convalescence 

#- 

E.  W.  Hayes,  M.  D.  (129  North  Canyon  Drive, 
Monrovia). — Surgery  in  pulmonary  tuberculosis,  as 
Doctor  Schiffbauer  has  pointed  out,  is  based  on  sound 
physiological  principles.  Artificial  pneumothorax  has 
demonstrated  the  effectiveness  of  collapse  therapy  in 
this  disease  and,  as  a consequence,  it  stands  out  to- 
day as  the  one  great  addition  to  our  therapeutic  arma- 
mentarium in  this  field  during  the  past  twenty-five 
years. 

Collapse  of  the  lung  by  surgical  measures,  while 
yet  relatively  new  in  its  application,  bids  fair  to  take 
its  place  alongside  induced  pneumothorax  as  another 
real  addition  to  the  therapy  of  pulmonary  tubercu- 
losis. Chest  surgery,  however,  is  considered  and  ap- 
plied, for  the  most  part,  only  when  pneumothorax 
cannot  be  effectively  induced.  It  is  a more  serious 
undertaking  than  pneumothorax.  Consequently  it  re- 
quires more  careful  study  and  selection  of  cases. 

Doctor  Schiffbauer  has  covered  the  points  to  be 
considered  in  this  selection  so  thoroughly, and  brought 
out  his  points  so  clearly  that  I can  add  but  little  to 
what  he  has  said.  As  an  internist  dealing  entirely 
with  chest  conditions,  I do  want  to  emphasize  one  or 
two  of  the  points  he  has  made. 

We  must  bear  in  mind  the  importance  of  a careful 
study  and  an  understanding  of  cases  of  pulmonary 
tuberculosis  that  are  to  be  subjected  to  surgery  lest, 
on  the  one  hand,  it  will  be  denied  to  those  who  could 
be  benefited  by  it,  and,  on  the  other,  it  will  be  applied 
to  cases  unsuited  and  will  bring  this  means  of  therapy 
into  disrepute.  There  should  exist  the  closest  collabo- 
ration between  the  tuberculosis  specialist  and  the 
chest  surgeon,  or  better  still,  as  the  doctor  has  said, 
the  chest  surgeon  should  familiarize  himself  with  the 
physical  signs  and  clinical  course  of  pulmonary  tuber- 
culosis and  the  chest  specialist  should  aim  to  famili- 
arize himself  with  those  factors  which  a patient  must 
withstand  when  subjected  to  the  additional  and  always 
severe  strain  incident  to  surgery  of  the  chest.  Under 
these  circumstances  the  chest  specialist  will  be  in  a 
position  to  intelligently  select  patients  for  surgical 
consideration;  while  the  chest  surgeon  will  then  be 
able  to  render  to  his  patient  a more  intelligent  and 
more  effective  preoperative  study  and  care,  and  post- 
operative management. 


INFECTION  OF  ABDOMINAL  WALL  WITH 
B.  WELCHII  FOLLOWING  ENTEROSTOMY 
FOR  BOWEL  OBSTRUCTION* 


REPORT  OF  CASES 
By  Edmund  Butler,  M.  D. 

AND 

Georce  Rhodes,  M.  D. 
San  Francisco 


TAjL'RING  the  last  five  years  one  hundred  and 
eighty  patients  have  been  operated  upon  for 
bowel  obstruction.  Many  of  these  patients  came 
into  the  hospital  late  and  frequently  enterostomy 
was  performed.  We  have  always  strongly  advo- 
cated enterostomies  in  the  first  loop  above  the 
region  of  the  obstruction  in  late  cases.  The  im- 
provement following  enterostomy  has  been  so 
obvious  that  we  are  inclined  to  make  use  of  it  in 
many  patients  who  would  recover  without  drain- 
age. The  opening  of  the  bowel  under  the  most 
perfect  technique  results  in  contamination  of  the 
peritoneum  and  the  wound. 

B.  welchii  or  other  pathogenic  anaerobes  are 
always  present  in  the  lower  ileum.  This  finding 
is  the  observation  of  many  careful  investigators. 
Dudgeon  cultivated  B.  welchii  from  the  stools 
of  35  per  cent  of  two  hundred  ward  patients. 
Williams  cultivated  B.  welchii  from  the  vomitus 
of  eleven  out  of  nineteen  cases  of  bowel  obstruc- 
tion, from  nineteen  out  of  twenty  advanced  cases, 
and  no  growth  of  B.  welchii  from  the  vomitus 
of  three  patients  with  pyloric  obstruction.  In  a 
reprint  of  patients  treated  with  gas  gangrene  anti- 
toxin, Williams  shows  a reduction  in  mortality 
in  appendicitis  from  6.3  to  1.17  per  cent,  and  in 
bowel  obstruction  from  24.8  to  9.3  per  cent, 
crediting  the  use  of  gas  gangrene  antitoxin  for 
this  remarkable  reduction. 

Spinal  anesthesia  is  particularly  suitable  for 
patients  suffering  from  bowel  obstruction.  The 
use  of  spinal  anesthesia,  and  the  milking  of  bowel 
contents  into  the  colon,  from  which  the  toxic 
material  is  rapidly  evacuated,  will  greatly  reduce 
the  number  of  enterotomies  and  enterostomies. 
Many  border-line  cases  will  clear  up  without 
operation  following  the  use  of  spinal  anesthesia. 

Organic  intestinal  obstruction  is  a surgical  con- 
dition requiring  an  early  diagnosis  and  early  oper- 
ation. Tissue  fluids  and  chlorid  lost  by  vomitus 
must  be  replaced  by  intravenous  and  subcutane- 
ous salt  solution.  Tube  drainage  of  the  stomach 
is  advisable ; the  tube  should  be  left  in  place  as 
long  as  nausea  is  present.  Enterostomy  may  be 
replaced  in  certain  cases  by  threading  a long 
stomach  tube  of  large  diameter  through  anus, 
rectum,  sigmoid,  ascending  colon,  transverse 
colon,  and  descending  colon.  Through  this  tube 
fluid  contents  and  gas  may  be  evacuated. 

The  use  of  B.  welchii  antitoxin,  as  advocated 
by  Williams,  has  a very  definite  place  in  the  treat- 
ment of  severe  toxemia  following  bowel  obstruc- 
tion, and  many  investigators  not  so  impressed 


* Read  before  the  General  Surgery  Section  of  the  Cali- 
fornia Medical  Association  at  its  fifty-eighth  annual 
session  at  Coronado,  May  6-9,  1929. 


April,  1930 


HIPPOCRATIC  MEDICINE  PORTER 


249 


with  the  glowing  statistics  of  such  optimists  as 
Williams,  nevertheless  advocate  its  use.  We  be- 
lieve that  every  case  of  bowel  obstruction  and 
peritonitis  which  shows  toxemia  should  receive 
anti-gas  gangrene  serum. 

The  following  two  cases  were  treated  in  our 
wards  at  the  San  Francisco  Hospital.  The  first 
was  an  infection  of  the  operated  wound  with  a 
pure  culture  of  B.  welchii  following  enterotomy ; 
the  second,  a peritonitis  and  polymicrobic  wound 
infection  following  enterostomy,  the  outstanding 
finding  being  the  presence  of  anaerobes  which 
produced  excessive  gas  and  gangrene  in  the  an- 
terior abdominal  wall. 

REPORT  OF  CASES 

Case  1. — December  4,  1929.  V.  C.,  No.  116934,  female, 
age  fifty-four. 

Condition  on  Examination. — Bowel  obstruction  com- 
plete. Symptoms  began  seventy-two  hours  before  en- 
trance to  the  hospital. 

Operation. — Adhesion  that  completely  obstructed 
ileum  four  feet  from  ileocecal  valve  was  released. 
Bowel  was  completely  drained  after  the  method  de- 
scribed by  Halden.  Opening  in  bowel  was  closed, 
and  laparotomy  wound  closed  without  drainage. 
Forty-eight  hours  later  wound  opened;  the  subcutane- 
ous tissues  were  edematous  and  contained  bubbles  of 
gas.  Marked  evidence  of  general  toxemia  was  present, 
but  no  gangrene.  Entire  rectus  muscle  was  found 
liquefied  into  a chocolate-like  solution.  Hematoge- 
nous jaundice  was  marked. 

Treatment. — One  hundred  cubic  centimeters  of  an- 
aerobic antitoxin  in  four  hundred  cubic  centimeters  of 
10  per  cent  glucose  was  given  intravenously.  One 
hundred  cubic  centimeters  anaerobic  antitoxin  was 
injected  subcutaneously  and  intramuscularly  around 
the  involved  area. 

Improvement  in  general  condition  was  almost  im- 
mediate. Jaundice  cleared  rapidly.  Twenty-four  hours 
later,  one  hundred  cubic  centimeters  of  antitoxin  was 
given  intravenously.  Patient  recovered  slowly,  and 
was  discharged  as  well  on  February  15,  1929. 

Cultures  showed  pure  growth  of  B.  welchii. 

Case  2. — December  1,  1928.  No.  116830,  female,  age 
fifty-five. 

Condition  on  Examination. — Strangulated  postopera- 
tive ventral  hernia.  Symptoms  began  ninety-six  hours 
before  entering  hospital. 

Operation. — Adhesions  were  freed  and  enterostomy 
was  performed  in  loop  proximal  to  the  loop  incarcer- 
ated in  hernia  sac.  The  intestine  was  not  gangrenous. 

Twelve  to  five,  patient’s  bowels  moved;  there  was 
no  vomiting  and  fluids  were  retained  by  mouth. 

Twelve  to  seven,  skin  discolored  in  the  region  of 
the  wound;  crepitation  extending  several  centimeters 
wide  of  incision.  Opened  wound  wide  of  the  limits 
of  gangrene  present  and  excised  the  necrotic  tissue. 
Dakin  tubes  were  inserted  and  the  excavation  was 
flooded  with  Dakin’s  solution. 

One  hundred  cubic  centimeters  of  anaerobic  anti- 
toxin and  four  hundred  cubic  centimeters  of  10  per 
cent  solution  of  glucose  were  given  intravenously. 
The  general  condition  showed  a definite  improvement 
after  the  debridement  and  the  administration  of  anti- 
toxin. 

On  December  9 the  patient  expired. 

Cultures  contained  B.  welchii  and  other  anaerobic 
bacteria  and  colon  bacilli. 

Autopsy  Report.  — Gangrene  of  operative  wound; 
general  peritonitis,  acute;  pelvic  peritonitis,  chronic; 
salpingitis,  chronic. 

We  feel  the  anaerobic  antitoxin  was  a valuable 
aid  in  the  treatment  of  these  two  patients  and  that 
it  should  be  more  generally  used  in  any  toxemia 
resulting  from  bowel  obstruction  or  peritonitis. 

490  Post  Street. 


THE  LURE  OF  MEDICAL  HISTORY 


HIPPOCRATIC  MEDICINE* 

PART  II 

By  Langley  Porter,  M.  D. 

San  Francisco 

TIIE  ASKLEPIAD 

¥ TNDER  these  circumstances  it  could  not 
be  expected  that  scientific  medicine  should 
hold  the  field  undisputed.  Theurgic  medicine,  the 
Christian  Science  of  that  day,  flourished,  so  much 
so,  that  the  Asklepiad  Brotherhood,  in  whose 
ranks  the  Hippocratic  tradition  was  born  and 
nurtured,  had  its  origin  indirectly  from  temple 
healing.  So  many  were  the  patients  that  flocked 
to  the  shrines  of  the  god  of  healing,  Asklepius, 
that  there  was  an  overflow  of  sick  people  who 
had  to  be  treated.  Furthermore  the  priests  ac- 
cepted only  those  they  had  invited  for  treatment, 
so  that  at  Epidaurus,  at  Cos,  or  at  Tricca,  and  a 
score  of  other  temple  towns,  there  were  always 
many  sufferers  in  need  of  aid.  There  arose  then 
this  group  of  lay  physicians  bound  in  a brother- 
hood, called  the  Asklepiad,  who  devoted  them- 
selves to  the  care  of  such  invalids.  So  successful 
were  they,  and  so  divorced  from  temple  practice, 
that  through  them  developed  a truly  scientific 
attitude  toward  the  study  and  treatment  of  dis- 
ease. Although  some  students  of  the  subject  are 
unconvinced,  it  seems  undoubted  that,  in  this  way, 
unattached  to  the  temple,  but  dependent  on  it  for 
patients,  the  Asklepiad  Brotherhood  rose  and 
flourished.  So  successful  was  it  that  it  produced 
great  masters  of  the  art,  like  Hippocrates,  and 
great  schools  like  those  at  Cos  and  Cnidus.  So 
entirely  successful  that,  based  on  the  tradition  it 
established,  there  arose  later  on,  the  still  greater 
schools  of  Alexandria,  Pergamos,  Smyrna,  and  a 
host  of  others,  and  there  emerged  such  famed 
physicians  as  Herophilus,  Erasistratus  in  Alex- 
andria, and  Galen  in  Pergamon  and  Rome. 

The  temples  of  Asklepius  were  always  placed 
in  beautiful  situations,  charming  and  salubrious, 
where  sparkling  springs  rose  near  pleasant 
wooded  hillsides.  These  temples  had  all  those 
attributes  of  restful  attractiveness  that  lie  at  the 
root  of  the  popularity  enjoyed  by  the  European 
spas.  People  flocked  to  the  temples  certain  of  the 
healing  power  of  the  god  and,  almost  invariably, 
they  went  away  refreshed  and  heartened,  if  not 
healed.  Many  times  they,  as  do  some  of  our 
friends  of  today,  played  one  power  against  an- 
other, and  resorted  to  the  practitioners  of  lay 
medicine  on  their  way  to  or  from  their  treatment 
at  the  hands  of  the  servants  of  the  divinity,  the 
temple  priests. 

One  feature  of  interest  to  the  modern  physician 
was  the  abaton.  This  was  a lofty  outdoor  sleep- 
ing porch  where  the  patients,  lying  in  their  beds 
day  and  night,  awaited  the  pleasure  of  the  god. 
It  was  understood  that  the  deity  would  visit  them 

*Read  before  the  San  Francisco  County  Medical  Society, 
January  14,  1930. 

Part  I was  printed  in  the  March  issue. 


250 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


as  they  slept,  revealing  himself  as  they  dreamed. 
He  always  did — his  priests  saw  to  that — and  a few 
days,  or  hours  later,  the  patient  left  the  abaton. 

Of  course,  the  treated  one  made  proper  returns 
in  the  shape  of  donations  of  money  and  of  various 
small  animals  or  birds,  sacrificed  on  the  altars  of 
the  temple ; and  these  had  to  be  purchased  at  a 
price  from  the  priests.  Another  type  of  offering 
was  the  so-called  votive  gifts;  these  were  terra- 
cotta casts  (sometimes  they  were  fabricated  of 
ivory  or  precious  metals)  of  the  afflicted  parts. 
These  were  left  at  the  temples,  much  as  patent 
medicine  testimonials  are  written  by  the  grateful 
today.  Sometimes  they  were  placed  before  the 
altar  of  the  god  preceding  a cure,  in  order  that 
he  might  not,  in  his  hurry  and  the  stress  of  over- 
work, forget  the  part  that  the  supplicant  wanted 
healed.  These  votive  offerings  make  a fascinating 
collection  of  primitive  pathology.  To  a gather- 
ing like  this  those  votives,  representing  diseased 
pulmonary  organs  and  various  manifestations  of 
bone  tuberculosis,  might  be  of  great  interest. 
There  are  many  of  them  to  be  found  in  various 
European  museums  and  some  also  are  depicted  in 
the  literature  of  medical  history. 

SOME  EXCERPTS  FROM  ANCIENT  TEMPLE 
RECORDS 

In  his  history  of  medicine.  Singer  deals  inter- 
estingly with  the  matter  of  the  temple  methods 
and  quotes  the  records  of  several  of  their  reputed 
cures — among  the  most  interesting,  that  of  the 
man  who  had  an  abdominal  abscess.  “He  saw  a 
vision  and  thought  that  the  god  ordered  the  slaves 
who  accompanied  him  to  lift  him  up  and  hold 
him  so  that  his  abdomen  could  be  cut  open.  The 
man  tried  to  get  away,  but  his  slaves  caught  him 
and  bound  him.  So  Asklepius  cut  him  open,  rid 
him  of  the  abscess,  then  stitched  him  up  again, 
releasing  him  from  his  bonds.  Straightway  he 
departed  cured,  and  the  floor  of  the  abaton  was 
covered  with  blood.” 

Another  such  record  runs : 

“A  certain  Teucer,  afflicted  with  epilepsy,  went  to 
the  Asclepieion  at  Pergamus  and  besought  the  god  to 
heal  him.  Asklepius  appeared,  as  usual,  in  a dream, 
and  asked  whether  he  would  like  another  disease 
instead.  Teucer  replied  this  was  not  his  most  earnest 
desire — in  fact,  he  would  rather  be  healed  entirely;  but 
if  that  was  impossible,  and  the  other  disease  less 
troublesome,  he  would  accept  it.  The  god  replied  that 
it  was  less  troublesome,  and  was  also  the  best  cure 
for  his  complaint.  Thereupon  he  was  attacked  by  a 
quartan  fever,  but  was  delivered  from  his  epilepsy.’' 

This  suggests  that  the  influence  of  malarial 
fever  in  mitigating  convulsive  seizures  was  not 
unknown  as  long  ago  as  500  B.  C. 

The  entire  freedom  of  the  lay  medicine  of  the 
Hippocratic  tradition  from  such  supernatural  in- 
fluences is  clearly  demonstrated  by  the  writer  of 
the  book  called  “Concerning  the  Sacred  Disease" 
who  discourses  as  follows : 

“I  am  about  to  discuss  the  disease  called  ‘sacred.’ 
It  is  not,  in  my  opinion,  any  more  divine  or  more 
sacred  than  other  diseases,  but  has  a natural  cause 
and  its  supposed  divine  origin  is  due  to  men’s  in- 
experience and  to  their  wonder  at  its  peculiar  char- 


acter. Now  while  men  continue  to  believe  in  its  divine 
origin  because  they  are  at  a loss  to  understand  it, 
they  really  disprove  its  divinity  by  the  facile  method 
of  healing  which  they  adopt,  consisting,  as  it  does,  of 
purifications  and  incantations.  But  if  it  is  to  be  con- 
sidered divine  just  because  it  is  wonderful,  there  will 
be  not  one  sacred  disease,  but  many,  for  I will  show 
that  other  diseases  are  no  less  wonderful  and  por- 
tentous. ...” 

The  contrast  between  the  methods  of  these 
temples  and  the  practice  of  the  Hippocratic  phy- 
sicians is  nowhere  better  illustrated  than  in  the 
paragraphs  of  the  Corpus  dedicated  to  “Operative 
Requisites  in  the  Surgery,”  which  reads : 

“The  patient,  the  operator,  assistants,  their  number; 
the  light,  where  and  how  placed;  the  instruments 
which  he  uses,  how  and  when;  the  patient’s  person  and 
the  apparatus.  The  operator,  whether  seated  or  stand- 
ing, should  be  placed  conveniently  to  the  part  being 
operated  upon  and  to  the  light.  Now  there  are  two 
kinds  of  light,  the  ordinary  and  the  artificial,  and  while 
the  ordinary  is  not  in  our  power,  the  artificial  is  in 
our  power.  Each  may  be  used  in  two  ways,  as  direct 
light  and  as  oblique  light.  Oblique  light  is  rarely 
used.  With  direct  light,  so  far  as  available  and  bene- 
ficial, turn  the  part  operated  upon  toward  the  brightest 
light,  except  such  parts  as  should  be  unexposed  and 
are  indecent  to  look  at;  thus,  while  the  part  operated 
upon  faces  the  light,  the  surgeon  faces  the  part,  but 
not  so  as  to  overshadow  it.  For  the  operator  will  in 
this  way  get  a good  view.  . . .The  nails  of  the  opera- 
tor neither  to  exceed  nor  come  short  of  the  finger  tips. 
Practice  using  the  finger  ends.  Practice  all  operations 
with  each  hand  and  with  both  together,  your  object 
being  to  attain  agility,  speed,  painlessness,  elegance 
and  readiness.  Let  thos£  who  look  after  the  patient 
present  the  part  for  operation  as  you  want  it,  and 
hold  fast  the  rest  of  the  body  so  as  to  be  all  steady, 
keeping  silence  and  obeying  their  superior.  . . . ” 

HIPPOCRATES 

Of  Hippocrates  himself,  we  know  little — the 
time  of  his  birth,  460  B.  C.,  the  fact  that  Plato 
referred  to  him  with  approval  and  that  Aristotle 
acclaimed  him  “The  Great” ; that,  within  a few 
years,  legend  had  enshrined  him  in  an  immortality 
of  the  supernatural.  Bees  building  their  hives  on 
his  grave  produced  a honey,  it  is  said,  which  was 
a panacea  for  aphthous  stomatitis.  Miraculously 
he  stayed  the  plague  in  Athens,  although  reliable 
historians  tell  us  he  never  was  in  that  city.  We 
do  know  that,  of  the  writings  attributed  to  him, 
some  were  written  before  he  was  born,  many  after 
his  death,  and  only  a few  could  possibly  have  been 
from  his  own  hand.  The  works  attributed  to 
Hippocrates  constituted,  in  fact,  a library  gath- 
ered at  one  of  the  great  schools  of  medicine  which, 
after  Hippocrates’  death,  carried  on  the  high 
Asklepiad  tradition  at  Alexandria,  Pergamon, 
Smyrna,  and  a number  of  other  centers  in  Asia 
Minor.  Asia  Minor  and  Egypt,  we  must  remem- 
ber, in  the  third  and  second  century  B.  C.,  were 
the  richest  parts  of  the  world,  alive  with  commer- 
cial, artistic  and  intellectual  activity. 

THE  HIPPOCRATIC  WRITINGS 

The  Hippocratic  writings  most  probably  were 
from  Pergamon,  which  was  the  city  nearest  to  the 
ancient  school  of  Cos,  whence  came  Hippocrates 
himself. 


April,  1930 


1 1 1 PPOCRATIC  M EDICINE — PORTER 


251 


Jones  analyzes  the  Books  of  the  Corpus  as 
falling  into  six  categories : 

1.  Texts  for  physicians. 

2.  Texts  for  laymen. 

3.  Prospects  for  or  reports  on  research. 

4.  Lectures  or  essays,  some  given  to  students 
of  medicine,  some  to  laymen. 

5.  Essays  by  philosophic  minded  laymen  inter- 
ested enough  in  medicine  to  want  to  philosophize 
about  it. 

6.  Notebooks  or  scrap  books — a medley. 

Three  hundred  years  elapsed  between  the  ori- 
gins of  the  earliest  and  of  the  latest  books,  which 
divided  into  a pre-Idippocratic  and  a Hippocratic 
group. 

A reading  of  the  Hippocratic  books  makes  it 
quite  evident  that  the  great  mass  of  diseases,  other 
than  surgical,  which  came  to  the  Greek  physician 
for  treatment,  were  diseases  of  long  duration. 
The  commonest  were  epidemics  of  various  types, 
malaria,  fevers  of  the  typhoid  group,  epileptic 
seizures  and  phthisis,  so  named  because  of  its 
most  striking  symptoms,  wasting.  Even  today, 
with  all  our  instruments  and  all  our  organized 
efforts  to  make  an  early  diagnosis  of  pulmonary 
tuberculosis,  we  fail  very  often.  Is  it,  then,  any 
wonder  that  the  Greeks,  two  thousand  years  ago, 
under  the  social  and  scientific  circumstances,  knew 
the  disease  imperfectly  and  only  in  its  more  de- 
veloped stages?  Yet,  what  they  did  know  re- 
mained practically  all  that  was  known  down  to 
the  days  of  Laennec,  except  for  a little  that  was 
added  in  the  fourth  century  A.  D.  by  Areatus 
the  Cappadocian,  who  took  empyema  out  of  the 
category  of  pulmonary  phthisis  and  wrote  illumi- 
natingly  of  cavitation — ulcer  he  called  it. 

One  of  the  most  striking  things  in  the  Greek 
literature  of  the  disease  is  the  expressed  belief 
in  the  influence  of  external  surroundings  as  a 
factor  in  producing  it. 

The  Hippocratic  physician  was  keenly  inter- 
ested in  prognosis — this  for  two  reasons.  As  has 
been  said,  he  had  to  sell  scientific  medicine  to  a 
skeptical  and  stiff-necked  generation.  His  chance 
of  success  was  greater  if  he  could  impress  the 
sick  man  by  recounting  the  various  pains  and  dis- 
comforts that  had  followed  his  falling  ill,  and 
outline  for  him,  with  a fair  degree  of  probability, 
what  the  future  held  in  store;  also  it  was  to  his 
advantage  if  he  could  foretell  death  or  recovery 
with  a reasonable  approximation  to  accuracy.  In 
the  former  case,  he  could  clear  his  skirts  of  blame 
and  in  the  latter,  gain  credit  for  good  work  accom- 
plished. When  it  is  considered  that  most  of  the 
Greek  physicians  were  passing  from  town  to  town, 
and  from  city  to  city,  strangers  to  those  they 
served,  the  need  for  some  impressive  approach, 
such  as  accurate  prognosis,  becomes  apparent. 

The  most  famous  Hippocratic  passage  taken 
from  the  book  entitled  “Prognostics”  is  an  in- 
struction in  foretelling  the  approach  of  death. 
Thus  it  is  written  : 

“You  should  observe  thus  in  acute  diseases:  first, 
the  countenance  of  the  patient,  if  it  be  like  those  of 
persons  in  health,  and  especially  if  it  be  like  itself,  for 


this  is  best  of  all.  But  the  opposite  are  the  worst,  such 
as  these:  a sharp  nose,  hollow  eyes,  collapsed  temples; 
the  ears  cold,  contracted,  and  their  lobes  turned  out; 
the  skin  about  the  forehead  rough,  stretched  and 
parched;  the  colour  of  the  face  greenish,  dusky,  livid 
or  leaden. 

“If  the  countenance  be  such  at  the  beginning  of  the 
disease,  and  if  this  cannot  be  accounted  for  by  the 
symptoms,  inquiry  must  be  made  whether  the  patient 
has  been  sleepless,  whether  his  bowels  have  been  very 
loose,  or  whether  he  has  wanted  food.  If  any  of  these 
be  confessed,  the  danger  is  to  be  reckoned  so  far  the 
less,  and  it  will  become  obvious  in  a day  and  night 
whether  or  not  the  appearance  came  of  these.  But  if 
no  such  cause  exist  and  if  the  symptoms  do  not  sub- 
side in  this  time,  be  it  known  for  certain  that  the  end 
is  at  hand.” 

THE  HIPPOCRATIC  TEACHING  CONCERNING 
NATURE 

The  great  underlying  thought  in  the  Hippo- 
cratic teaching  was  that  nature  tended  to  bring 
about  a cure,  and  that  the  physician’s  duty  was 
to  intervene  as  little  as  possible,  and  then  only  to 
remove  hindrances  to  the  natural  processes.  The 
role  that  air  plays  in  maintaining  life  was  recog- 
nized, the  breath  was  identified  with  the  soul,  and 
as  the  source  of  innate  heat  without  which  life 
and  thought  were  impossible.  The  idea  that  Aris- 
totle later  expressed,  of  “fire  without  flame  or 
spark,”  runs  throughout  the  Hippocratic  teach- 
ings. In  the  book  “Concerning  Ancient  Medi- 
cine,” which  there  is  good  reason  to  believe  is 
from  Hippocrates’  own  hand,  it  is  written : 

“Medicine  has  long  had  all  its  means  to  hand,  and 
has  discovered  both  a principle  and  a method  through 
which  the  discoveries  made  during  a long  period  are 
many  and  excellent,  while  full  discovery  will  be  made, 
if  the  inquirer  be  competent,  conduct  his  researches 
with  knowledge  of  the  discoveries  already  made,  and 
make  them  his  starting  point.”  The  writer  goes  on 
to  make  the  following  criticism:  “For  most  physicians 
seem  to  me  to  be  in  the  same  case  as  bad  pilots;  the 
mistakes  of  the  latter  are  unnoticed  so  long  as  they 
are  steering  in  a calm,  but  when  a great  storm  over- 
takes them  with  a violent  gale,  all  men  realize  clearly 
then  that  it  is  their  ignorance  and  blundering  which 
have  lost  the  ship.  So  also  when  bad  physicians,  who 
comprise  the  great  majority,  treat  men  who  are  suffer- 
ing from  no  serious  complaint,  so  that  the  greatest 
blunders  would  not  affect  them  seriously — such  ill- 
nesses occur  very  often,  being  far  more  common  than 
serious  disease — they  are  not  shown  up  in  their  true 
colours  to  laymen  if  their  errors  are  confined  to  such 
cases;  but  when  they  meet  with  a severe,  violent  and 
dangerous  illness,  then  it  is  that  their  errors  and  want 
of  skill  are  manifest  to  all.” 

The  same  clear-sighted  search  for  the  practical 
is  manifest  when  the  author  writes : 

“I  declare,  however,  that  we  ought  not  to  reject 
the  ancient  art  on  the  ground  that  its  method  of 
inquiry  is  faulty,  just  because  it  has  not  attained  exact- 
ness in  every  detail,  but  much  rather,  because  it  has 
been  able  by  reasoning  to  rise  from  deep  ignorance  to 
approximately  perfect  accuracy,  I think  we  ought  to 
admire  the  discoveries  as  the  work,  not  of  chance, 
but  of  inquiry  rightly  and  correctly  conducted.”  “I 
also  hold  that  clear  knowledge  about  natural  science 
can  be  acquired  from  medicine  and  from  no  other 
source,  and  that  one  can  attain  this  knowledge  when 
medicine  itself  has  been  properly  comprehended,  but 
till  then  it  is  quite  impossible — I mean  to  possess 
this  information — what  man  is — by  what  causes  he  is 
made,  and  similar  points  accurately.  I think  a phy- 
sician must  know,  and  be  at  great  pains  to  know  about 
natural  science,  if  he  is  going  to  perform  aught  of  his 
duty,  what  man  is  in  relation  to  foods  and  drinks  and 


252 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


to  habits  generally,  and  what  will  be  the  effects  of 
each  on  each  individual.  It  is  not  sufficient  to  learn 
simply  that  cheese  is  a bad  food,  as  it  gives  a pain  to 
one  who  eats  a surfeit  of  it;  we  must  know  what  the 
pain  is,  the  reason  for  it,  and  which  constituent  of 
man  is  harmfully  affected.” 

In  those  days  the  errors  of  approach  seem  to 
have  been  much  the  same  as  today,  for  the  writer 
says : 

“I  am  aware  that  most  physicians,  like  laymen,  if 
the  patient  has  done  anything  unusual  the  day  of  the 
disturbance— taken  a bath  or  a walk,  or  eaten  strange 
food,  these  things  being  all  beneficial — nevertheless 
assign  the  cause  to  one  of  them,  and  while  ignorant 
of  the  real  cause,  stop  what  may  have  been  of  the 
greatest  value.” 

Again  there  is  insistence  on  the  need  for  reality 
as  the  guiding  principle  of  practice,  as  expressed 
in  the  following  lines : 

“Time  is  that  wherein  there  is  opportunity,  and 
opportunity  is  that  wherein  there  is  no  great  time. 
Healing  is  a matter  of  time,  but  it  is  sometimes  also 
a matter  of  opportunity.  However,  knowing  this,  one 
must  attend  in  medical  practice  not  primarily  to 
plausible  theories,  but  to  experience  combined  with 
reason.” 

The  likeness  of  the  thinking  that  these  ancients 
did  about  structures  and  function  to  our  own,  is 
illustrated  in  many  other  places  in  “Ancient  Medi- 
cine” ; by  this  passage  in  particular : 

“I  hold  that  it  is  also  necessary  to  know  which  dis- 
eased states  arise  from  powers  and  which  from  struc- 
tures. What  I mean  is,  roughly,  that  a “power”  is 
an  intensity  and  strength  of  the  humours,  while 
“structures”  are  the  conformations  to  be  found  in  the 
human  body.  ...” 

The  word  “powers”  really  is  used  to  mean  what 
we  call  function.  Of  course,  as  Littre,  the  greatest 
modern  student  of  Hippocrates,  said : 

“Things  were  in  a rudimentary  state,  that  is,  so  far 
as  background  and  the  theory  went;  but  not  on  the 
side  of  observed  fact  and  of  deduction  from  observa- 
tion. In  the  matter  of  treatment,  especially  of  surgi- 
cal treatment,  there  are  records  in  the  Hippocratic 
writings  that  the  best  modern  physicians  would  have 
no  need  to  be  ashamed  of.  For  instance:  ‘The  aged 
endure  fasting  more  easily;  next  adults;  next  young 
persons,  and  least  of  all  children,  and  especially  such 
as  are  the  most  lively.’  Again:  ‘Growing  bodies  have 
the  most  innate  heat;  they  therefore  require  the  most 
nourishment,  and  if  they  have  it  not,  they  waste.’  ” 

If  fever  persisted  fifteen  days  after  the  onset 
of  a pneumonia  the  Hippocrateans  presumed  the 
presence  of  pus,  and  proceeded  to  evacuate  it  by 
incision  with  knife  or  cautery.  Their  advice  shows 
that  they  knew  something  of  immediate  ausculta- 
tion. The  physician  is  instructed  to  shake  the 
patient  by  the  shoulders,  placing  his  ear  to  the 
patient’s  chest  in  order  to  determine  by  the  loca- 
tion of  the  sound  on  which  side  the  fluid  is.  (Also, 
the  wash  leather-like  creak  of  dry  pleurisy  is  de- 
scribed.) If  no  sound  is  heard,  one  is  to  choose 
for  incision  the  point  where  there  is  most  pain ; 
or,  failing  such  a localization  of  pain,  a procedure 
based  on  the  presence  of  a localized  increase  in 
temperature  is  advised  as  follows : 

“Cover  and  wrap  the  thorax  in  a thin  linen  cloth 
that  has  been  wrung  out  in  a warm  suspension  of 
potter’s  clay  and,  on  the  side  that  cools,  cut  or  cau- 
terize as  near  as  possible  to  the  diaphragm,  taking 
care  not  to  wound  it.” 

That  they  knew  of  appendicitis,  perityphlitis 
and  peritonitis,  is  clear  to  those  who  read  the  book 
called  “Prognostics,”  which  says : 


“It  is  best  for  the  hypochondrium  to  be  free  from 
pain,  soft  and  with  the  right  and  left  sides  even;  but 
should  it  be  inflamed,  painful,  distended,  or  should  it 
have  the  right  side  uneven  with  the  left — all  these 
signs  are  warnings.”  “A  swelling  in  the  hypochon- 
drium that  is  hard  and  painful  is  the  worse,  if  it  ex- 
tends all  over  the  hypochondrium;  should  it  be  on  one 
side  only  it  is  less  dangerous  on  the  left.  Such  swell- 
ings at  the  commencement  indicate  that  soon  there 
will  be  a danger  of  death,  but  should  the  fever  con- 
tinue for  more  than  twenty  days  without  the  swell- 
ing subsiding,  it  turns  to  suppuration.”'  . . . “But 
whenever  the  swellings  in  these  regions  are  pro- 
tracted one  must  suspect  suppurations.  Collection  of 
pus  there  ought  to  be  judged  of  thus.  Such  of  them 
as  turn  outward  are  most  favorable  when  they  are 
Small,  and  bend  as  far  as  possible  outward,  and  come 
to  a point;  the  worst  are  those  which  are  large  and 
broad,  sloping  least  to  a point.  Such  as  break  inwards 
are  most  favourable  when  they  are  not  communicated 
at  all  to  the  outside,  but  do  not  project  and  are  pain- 
less, while  all  the  outside  appears  of  one  uniform 
colour.  The  pus  is  most  favourable  that  is  white  and 
smooth,  uniform  and  least  evil  smelling.  Pus  of  the 
opposite  character  is  the  worst.”  . . . 

University  of  California  Medical  School. 

(Part  III  of  this  paper  will  be  printed  in  the 
May  issue.) 


CLINICAL  NOTES  AND  CASE 
REPORTS 


ECTOPIC  VENTRICULAR  TACHYCARDIA 

WITH  PROBABLE  ACUTE  CORONARY  THROMBOSIS, 
AND  HAVING  A VERY  UNUSUAL  ELECTRO- 
CARDIOGRAPHIC TRACING 

REPORT  OF  CASE 

By  R.  Manning  Clarke,  M.  D. 

Los  Angeles 

MRS.  T.  S.,  age  fifty-three  years,  had  been  a very 
well  woman  until  forty-four  years  of  age.  At 
this  time  she  was  operated  upon  for  a tumor  of  the 
uterus.  Patient  suffered  an  attack  of  bronchopneu- 
monia twice  in  the  same  year  following  the  surgery. 
There  was  no  other  infectious  history.  After  this 
experience,  trouble  with  her  heart  increased  until  the 
time  of  her  death,  which  occurred  thirty-six  hours 
after  my  consultation. 

My  physical  examination  revealed  the  following 
essentials : 

The  temperature  was  100  to  104  degrees,  pulse  90 
to  120,  blood  pressure  150-90,  having  suddenly  dropped 
from  200-110  the  day  before. 

Cyanosis,  dyspnea,  edema,  and  coughing  were  ex- 
treme, there  having  been  a sudden  increase  of  dyspnea 
coincidentally  with  the  drop  in  blood  pressure  the  day 
before. 

There  were  no  thrills.  The  liver  was  five  centi- 
meters below  the  costal  margin.  The  left  leg  was 
larger  than  the  right  and  very  sore  and  painful, 
especially  below  the  knee. 

The  left  border  of  the  heart  was  fifteen  centimeters 
from  the  midsternal  line.  The  right  border  was  not 
located.  There  was  marked  dullness  in  both  bases 
and  along  the  spine. 

The  rate  was  120.  The  sounds  were  very  hard  to 
distinguish  and  tick-tack  in  character.  There  were  no 
murmurs.  There  were  heavy  rales  in  both  lungs. 

Laboratory  Findings. — The  urine  showed  a specific 
gravity  of  1.018;  Ph  5.8.  Hyaline  and  granular  casts 
were  both  present,  with  albumin  1.25  per  cent. 

There  was  a leukocytosis  of  21,700,  with  polymor- 
phonuclears  88  per  cent.  Wassermann  and  blood  cul- 
ture were  both  negative. 


April,  1930 


CASE  REPORTS 


253 


The  electrocardiographic 
tracing  is  shown  in  the 
accompanying  illustration. 

The  unusual  thing  about  it 
is  the  alternation  of  the 
QRS  complex. 

We  know  that  the  im- 
pulses are  of  ventricular 
origin  because  the  auricles 
are  beating  on  a separate 
rhythm,  and  can  be  seen 
disturbing  the  constancy  of 
the  iso-electric  line  between 
the  QRS  complexes. 

The  paroxysm  began  be- 
fore I saw  the  case  and 
continued  until  her  death. 

Were  it  possible  to  see  the 
beginning  and  ending  of 
the  attack  on  an  electro- 
cardiographic tracing  we 
would  then  have  further 
proof  that  the  origin  of  the 
impulses  was  ventricular. 

In  other  words,  the  attack 
would  begin  with  an  aber- 
rant ventricular  complex  that  would  be  premature 
(not  preceded  by  a P wave)  and  there  would  be  a 
postparoxysmal  compensatory  pause,  after  the  last 
beat  as  after  any  ventricular  extrasystole.  Such  a 
tracing,  identical  with  this  one,  is  reported  by  Reid  of 
Boston  in  his  excellent  book,  “The  Heart  in  Modern 
Practice,’’  second  edition,  1928,  Lippincott,  pp.  257. 
In  this  tracing,  Reid  was  fortunate  enough  to  obtain 
the  entire  paroxysm,  and  the  above  stipulations  show 
very  nicely. 

This  case  was  seen  by  several  consultants  in  rapid 
succession,  and  the  controlling  physician  was  also 
changed  twice  in  the  last  few  weeks  of  her  life.  On 
this  account  supervision  was  more  or  less  erratic. 
I was  unable  to  determine  the  dosage  of  digitalis 
except  in  the  last  eleven  days  of  life.  During  this  time 
the  average  daily  dose  was  1.5  drams  of  the  tincture  or 
its  equivalent  in  digifolin. 

The  cases  I have  been  able  to  check  occurred 
with  excessive  digitalis  administration,  or  coronary 
thrombosis  with  infarction  of  the  myocardium,  or 
both. 

In  this  case  no  necropsy  was  obtainable,  but  I made 
a diagnosis  of  acute  coronary  thrombosis,  based  on 
sudden  increase  of  dyspnea  and  drop  in  blood  pressure 
occurring  the  day  before  my  consultation,  along  with 
the  thrombosis  of  the  posterior  tibial  and  popliteal 
veins  in  the  left  leg. 

606  South  Hill  Street. 


APPARATUS  USED  IN  TREATMENT  OF 
FRACTURES  OF  THE  PELVIS* 

By  Sam  Herzikoff,  M.  D. 

Los  Angeles 

READ  with  interest  an  article  recently  pub- 
-1*-  lished  in  California  and  Western  Medi- 
cine, submitted  by  Doctor  Harding  of  San  Diego, 
in  which  he  described  his  method  of  treating 
fractures  of  the  pelvis  by  the  use  of  a sling  and 
suspension  of  the  patient.  I was  prompted  by  the 
article  to  mention  that  I have  been  using  this 
method  at  the  Golden  State  Hospital  for  the  past 
five  years  in  cases  of  fractures  of  the  pelvis  where 
there  is  wide  separation  of  the  fragments,  especi- 
ally in  the  region  of  the  symphysis  pubis.  I quite 
agree  with  Doctor  Harding  on  his  condemnation 
of  the  swathe,  plaster  spica,  Bradford  frame,  and 

* FYom  the  Golden  State  Hospital,  Los  Angeles. 


Thomas  splint.  I have  never  been  able  to  see  the 
value  of  applying  a spica  cast  to  these  cases  ex- 
cept for  the  comfort  which  it  gives  the  patient. 
The  cast  could  not  be  used  to  maintain  com- 
pression of  the  fragments  during  healing  with- 
out inflicting  soft  tissue  damage  from  pressure. 
The  doctor  has  covered  well  the  various  points  in 
the  treatment  of  these  cases. 

About  five  years  ago  the  idea  of  treating  these 
cases  by  suspension  and  a sling  first  came  to  me 
when  I was  called  upon  to  treat  a patient  with 
at  least  a two-inch  separation  of  the  symphysis. 
By  means  of  a “block  and  tackle”  apparatus  we 
were  able  to  suspend  the  patient,  supported  on  a 
sling,  at  any  height  desired.  By  the  use  of  multi- 
ple pulleys  we  were  able,  by  the  application  of 
only  a few  pounds  of  weight,  to  perfectly  balance 
the  position  of  the  patient.  A sketch  of  our  appa- 
ratus is  submitted.  It  is  extremely  simple  and  can 
be  applied  in  a few  moments.  The  patient  can 
be  raised  and  lowered  in  the  bed  at  will  to  permit 
nursing  care  and  the  use  of  the  bedpan.  If  the 
weights  are  properly  balanced  the  patient  will 
remain  in  any  desired  position.  The  pelvis  can 
be  partially  or  completely  lifted  from  the  bed  as 
the  individual  case  indicates  and  in  this  way  one 
can  control  the  amount  of  lateral  pressure  in- 
duced. It  will  be  noted  from  the  sketch  that  there 
are  two  overhead  bars.  Each  end  of  the  sling, 


Fig.  1. — Apparatus  used  in  treatment  of  fractures 
of  the  pelvis. 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


254 


being  suspended  from  a separate  bar,  permits  the 
application  of  any  desired  amount  of  lateral  pres- 
sure by  adjusting  the  distance  between  the  two 
bars.  No  special  apparatus  is  required.  A wind- 
lass is  not  necessary. 

Our  method  is  essentially  the  same  as  Doctor 
Harding’s,  but  I feel  that  it  is  advantageous 
because : 

1.  The  suspension  can  be  balanced  and  permits 
greater  comfort  to  the  patient. 

2.  The  position  of  the  pelvis  can  be  raised  or 
lowered  by  the  use  of  one  hand  and  very  little 
force. 

3.  If  the  patient  raises  himself,  the  sling  also 
raises,  and  thus  pressure  is  kept  constant.  This 
is  not  possible  with  Doctor  Harding’s  apparatus. 

4.  It  is  also  possible  to  turn  the  patient  par- 
tially on  the  side  and  still  maintain  constant 
compression. 

5.  No  special  apparatus  is  necessary. 

I agree  with  Doctor  Harding's  ideas  in  the 
treatment  of  these  cases  and  feel  that  his  method 
is  very  useful. 

1212  Brockman  Building'. 


INCOMPLETE  INVERSION  OF  UTERUS  WITH 
SUBSEQUENT  PREGNANCY 

REPORT  OF  CASE 

By  Lawrence  F.  White,  M.  D. 

Los  Angeles 

TNCOMPLETE  inversion  of  the  uterus  follow- 
ing  delivery  and  expression  of  the  placenta, 
though  not  rare,  is  an  uncommon  accident,  and 
is  ordinarily  recognized  at  the  time  of  its  occur- 
rence. It  is,  therefore,  of  especial  interest  that 
this  condition  could  have  been  present  in  a young 
woman  for  a period  of  six  weeks,  causing  only 
bleeding  and  a rather  severe  secondary  anemia, 
and  that  it  should  have  remained  so  long  without 
attention  or  recognition. 

REPORT  OF  CASE 

On  April  19,  1929,  the  patient,  a white,  married 
woman,  age  twenty,  was  admitted  to  the  California 
Hospital  on  the  surgical  service.  She  complained 
of  extreme  weakness  and  continued  vaginal  bleed- 
ing. Her  history  revealed  that  she  had  been  deliv- 
ered of  a living  baby  six  weeks  before.  So  far  as 
she  knew,  the  labor  and  delivery  had  been  quite 
normal,  but  she  had  had  more  than  the  usual  amount 
of  bloody  discharge  during  her  ten-day  stay  in  the 
hospital.  She  had  continued  to  bleed,  vaginally,  after 
going  home,  at  times  discharging  large  clots.  She  had 
had  no  cramps  nor  pain,  but  had  become  increasingly 
weak.  There  had  been  no  other  pregnancies.  The 
past  history  and  family  history  were  not  unusual. 

On  hospital  entry  (six  weeks  following  delivery) 
physical  examination  showed  the  skin  and  mucous 
membranes  to  be  very  pale:  the  eyes  and  skin  sug- 
gested dehydration,  the  face  drawn  and  apprehensive. 
Temperature,  98.4  Fahrenheit.  Pulse  rate,  104  (easily 
compressed).  Blood  pressure,  105/70.  Respiration,  20. 
The  blood  picture  was:  hemoglobin,  40  per  cent;  color 
index,  62;  red  cells,  3,224,000;  white  cells,  7300;  neu- 
trophils, 76.5  per  cent;  lymphocytes,  17.5  per  cent; 
large  mononuclears,  5.5  per  cent;  eosinophils,  0.5  per 
cent. 


She  was  grouped  for  blood  transfusion  and  on 
April  20  was  given  700  cubic  centimeters  of  whole 
blood  by  the  Unger  method,  using  fasting  donors, 
whose  serum  and  cells  had  been  cross-agglutinated 
with  those  of  the  patient.  Immediately  following  the 
transfusion,  examination  under  gas  anesthesia  re- 
vealed a large,  globular  mass  protruding  through  a 
dilated  cervix  into  the  vagina.  The  picture  was  one 
of  incomplete  inversion  of  the  uterus,  which  had  been 
present  for  six  weeks.  The  endometrium  of  the  in- 
verted portion  was  not  grossly  ulcerated  nor  inflamed, 
but  was,  however,  very  edematous  and  boggy  to  the 
touch.  Manipulation  and  attempts  at  replacing  the 
inverted  fundal  portion  resulting  only  in  placing  the 
mass  just  within  the  external  os  of  the  cervix,  it  was 
thought  expedient  to  pack  the  vagina  and  await  im- 
provement in  the  patient’s  general  condition  before 
making  further  attempts  at  reposition. 

On  April  22,  under  general  anesthesia,  another  at- 
tempt was  made  to  replace  the  inverted  organ  from 
the  vaginal  route.  This  was  without  success.  The 
uterine  tissue  appeared  to  be  too  friable  to  per- 
mit of  abdominal  reposition  by  the  use  of  mul- 
tiple Allis  forceps  as  advocated  by  Huntington, 
Frederick  and  Kellogg.3  Therefore  two  heavy  chro- 
mic sutures  were  placed  in  the  apex  of  the  mass, 
a small  incision  was  made,  and  these  sutures  or 
guys  were  pushed  through  into  the  abdominal 
cavity.  The  vagina  was  carefully  treated  with  anti- 
septic solutions  and  then  the  abdominal  cavity 
opened  by  a subumbilical  midline  incision.  From  this 
aspect  a typical  picture  of  incomplete  uterine  inver- 
sion was  seen.  The  fallopian  tubes,  the  broad  liga- 
ments, and  the  round  ligaments  were  tightly  drawn 
downward  into  the  outpocketing  formed.  The  color 
of  these  tissues  was  good,  but  they  were  more  friable 
than  normal.  By  gentle  but  firm  traction  upon  the 
guy  sutures  previously  placed,  the  inversion  was  cor- 
rected and  the  structures  restored  to  their  usual  rela- 
tions. The  incised  wound  in  the  fundus  was  carefully 
repaired,  drainage  tubes  placed,  and  the  abdominal 
wound  closed. 

A pelvic  peritonitis  of  mild  degree  developed,  but 
this  cleared  up  shortly  and  the  patient  made  an 
otherwise  uneventful  recovery.  Examination,  approxi- 
mately three  months  after  discharge  from  the  hospi- 
tal, revealed  that  the  patient  was  pregnant  again.  The 
uterus  was  in  good  position  and  the  cervix  normal  in 
appearance. 

It  is  an  interesting  fact  that  a considerable 
number  of  individual  cases  of  inversion  of  the 
uterus  are  reported  in  the  literature,  while  most 
authorities  state  that  this  condition  is  extremely 
rare.  Eden  2 found  it  occurring  in  England  once 
in  180,000  labors;  Williams  says  that  Beckmann 
reported  250,000  cases  with  none  of  inversion 
at  St.  Petersberg  Lying-In  Hospital,  and  that 
Madden  reported  190,833  cases  of  labor  with  one 
inversion  at  Dublin. 

Several  different  methods  have  been  suggested 
for  effecting  reposition  of  the  displaced  organ. 
The  technique  of  these  various  operative  pro- 
cedures is  carefully  discussed  by  Dr.  Reuben 
Peterson,5  to  whose  excellent  articles  those  inter- 
ested are  referred.  It  appears  that  as  a rule 
manual  reduction  vaginally  becomes  increasingly 
difficult  in  proportion  to  tbe  length  of  time  the 
condition  has  existed.  Certain  cases  of  spontane- 
ous reposition  have  occurred,  the  uterus  appar- 
ently automatically  resuming  a normal  position 
after  the  swelling,  edema,  and  cervical  spasticity 
of  a recent  inversion  have  subsided.  Hysterec- 
tomy is  rarely  necessary,  even  in  cases  of  rather 
long  duration.  Miller  4 cites  an  instance  in  which 
inversion  was  corrected  after  seven  months,  and 


April,  1930 


CASE  REPORTS 


255 


in  which  a normal  pregnancy  and  labor  subse- 
quently occurred.  This  same  writer  has  collected 
fifty-six  cases  of  inversion  in  the  literature  in 
which  one  or  more  subsequent  pregnancies  took 
place. 

Meddlesome  procedures  in  the  third  stage  of 
labor  are  held  responsible  for  a major  portion  of 
the  inversions  encountered.  Probably,  as  stated 
by  several  writers,  a fundamental  weakness  of  the 
uterus  and  its  supporting  structures  is  essential, 
but  haste  and  overenthusiasm  usually  unite  with 
such  weakness  to  produce  the  lesion.  Donavon  1 
emphasizes  the  following  causes  of  uterine  in- 
version, of  which  the  first  two  are  much  the  most 
important : 

1.  Traction  on  the  cord. 

2.  Too  vigorous  compression  of  the  fundus. 

3.  Sudden  delivery,  especially  if  the  mother  is 
standing. 

4.  Exertion  after  delivery,  e.  g.,  coughing. 

5.  Short  cord,  of  whatever  etiology. 

all  California  Medical  Building. 

REFERENCES 

1.  Donavon,  Daniel  M.:  Complete  Inversion  of  the 
Uterus,  Brit.  M.  J.,  i,  756,  May  5,  1928. 

2.  Fatheringham,  J.  C.:  Inversion  of  the  Uterus, 
Brit.  M.  J.,  ii,  350,  August  27,  1927. 

3.  Huntington,  James  L.,  Irving,  Frederick  C.,  and 
Kellogg,  Foster  S.:  Abdominal  Reposition  in  Acute 
Inversion  of  the  Puerperal  Uterus,  Am.  J.  Obst.  and 
Gynec.,  xv,  34-40,  January  1928. 

4.  Miller,  Norman  F. : Pregnancy  Following  In- 
version of  the  Uterus,  Am.  J.  Obst.  and  Gynec.,  xii, 
307-322,  March  1927. 

5.  Peterson,  Reuben:  Incision  of  Anterior  Uterine 
Wall  (Anterior  Colpohysterotomy)  as  Treatment  for 
Chronic  Inversion  of  the  Uterus,  Surg.  Gynec.  and 
Obst.,  v,  196-213,  August  1907.  Conservative  Opera- 
tive Treatment  of  Chronic  Inversion  of  the  Uterus, 
Amer.  Gynec.,  ii,  489-507,  June  1903. 


Psittacosis-— Or  Parrot  Disease. — Following  the  dis- 
covery of  several  cases  of  psittacosis  in  Annapolis  and 
Baltimore,  traced  to  parrots  supplied  by  a wholesale 
dealer  in  this  city,  an  investigation  is  now  being  made 
of  several  suspicious  cases  reported  to  the  Department 
of  Health  from  various  parts  of  New  York  City. 

The  disease  in  parrots  has  been  recognized  for  over 
fifty  years,  the  first  cases  occurring  in  various  parts 
of  Europe.  The  causative  organism  is  the  Bacillus 
psittacosis,  an  organism  related  to  the  paratyphoid 
group.  In  parrots  the  disease  is  characterized  by 
enteric  symptoms;  transmitted  to  man,  the  infection 
more  usually  manifests  febrile  and  respiratory  symp- 
torris  resembling  influenza,  pneumonia  being  a com- 
mon complication.  The  course  of  the  disease  in 
humans  varies;  at  times  there  is  a case  fatality  of 
20  to  25  per  cent.  The  following  excerpt  from  Chal- 
mers and  Castellani’s  work  on  tropical  medicine  may 
be  of  interest  to  our  readers: 

“History. — Ritter,  in  1879,  was  the  first  to  suspect 
that  there  was  a connection  between  small  epidemics 
of  pneumonia  limited  to  certain  houses  and  an  illness 
among  parrots  in  the  same  houses.  In  1880  Eberth 
obtained  large  numbers  of  micrococci  from  the  bodies 
of  gray  parrots.  Ritter’s  observations  were  confirmed 
by  Ost  of  Berne,  in  1882,  and  by  Wagner  of  Leipsic, 
in  1885.  In  1892,  500  parrots  were  shipped  from 
South  America  for  Paris,  but  no  less  than  300  died 
en  route  from  enteritis.  On  arrival  in  Paris  the  sur- 
viving birds  were  divided  into  two  lots  and  sold  to 
various  people,  with  a result  that  within  twenty-six 
days  of  their  arrival  an  epidemic  of  psittacosis  broke 


out,  which  resulted  in  forty-nine  cases,  with  sixteen 
deaths.  The  epidemic  was  characterized  by  being  of 
the  house  type,  by  which  is  meant  that  several  persons 
in  the  same  house  were  attacked  by  the  complaint. 

“Smaller  epidemics  occurred  in  1893  and  1894,  and 
in  the  same  year  Banti,  Malenchini  and  Palamidessi 
reported  an  epidemic  in  Florence.  In  1895  there  were 
outbreaks  in  Prato,  Cologne  and  Paris;  in  1897  at 
Genoa;  in  1898  at  Cologne;  in  1901  at  South  Elpidio, 
Ancona  and  Hull;  in  1904  at  New  Hampshire,  one  of 
the  eastern  United  States  of  America.  Beddoes  in 
1914  reported  several  cases  in  England.  We  have 
seen  epidemic  enteritis  of  this  nature  develop  in 
parrots  in  the  Sudan,  but  prophylactic  measures  being 
immediately  instituted  it  did  not  spread  to  man. 

“Etiology. — The  disease  is  apparently  due  to  a 
bacillus  belonging  to  the  genus  Salmonella  Lignieres 
of  our  classification,  first  isolated  from  the  wings  of 
parrots  which  had  died  from  the  disease  by  Nocard 
in  1893,  and  subsequently  found  by  Gilbert  and  Four- 
nier in  1897  in  the  intestine  of  the  sick  birds,  and 
also  in  the  heart  blood  of  a man  who  died  from  the 
disease.  The  bacillus  in  question  is  pathogenic  for 
parrots  and  other  birds.  It  is  possible  that  this  bacillus 
exists  normally  in  parrots,  and  only  becomes  patho- 
genic under  circumstances  of  bad  hygiene,  when  it 
causes  an  enteritis.  The  feathers,  becoming  contam- 
inated with  fecal  matter,  are  cleaned  by  the  parrot 
with  its  tongue  in  the  usual  way,  so  that  its  mouth 
and  bill  become  infected,  and  by  this  means  the  dis- 
ease is  spread  to  persons  who  feed  or  caress  the  bird. 
Very  rarely  the  disease  spreads  from  man  to  man. 
According  to  Bainbridge,  Bacillus  psittacosis  is  identi- 
cal with  Bacillus  aertryke. 

“Symptomatology. — The  incubation  period  varies 
from  seven  to  twelve  days,  after  which  the  disease 
may  begin  suddenly  with  a chill,  but  more  usually 
commences  insidiously,  like  typhoid  fever,  with  head- 
ache, malaise,  etc.,  and  a rise  of  temperature  from 
102  to  104  degrees  Fahrenheit,  with  a pulse  rate  of 
100  to  120  per  minute,  quickened  respirations,  cough, 
and  mucopurulent  expectoration.  Rales  may  be  heard 
over  the  lungs,  while  the  spleen  is  enlarged,  the  tongue 
dry  and  furred,  and  diarrhea  or  constipation  may  be 
present.  Rose-colored  spots  appear  on  the  skin,  and 
the  patient  becomes  dull  and  stupid,  in  which  con- 
dition he  may  remain  for  several  days,  and  as  a rule 
will  recover  in  about  fifteen  to  twenty  days  if  no 
pneumonic  complication  intervenes.  If,  however, 
pneumonia  sets  in,  the  patient  becomes  much  worse, 
and  as  a rule  dies. 

“Diagnosis. — The  diagnosis  is  to  be  made  by  the 
discovery  of  sick  parrots  in  houses  in  which  people 
are  suffering  from  typhoid-like  fevers  and  pneumonia. 
Bacteriologically,  attempts  may  be  made  to  obtain 
cultures  of  the  bacilli  from  the  blood. 

“Prognosis. — The  prognosis  is  grave  in  old  people 
and  when  pneumonia  sets  in,  the  mortality  being 
stated  to  be  about  35  to  40  per  cent. 

“Prophylaxis. — The  infected  parrots  appear  always 
to  come  from  South  America;  therefore  care  should 
be  taken  that  only  healthy  birds  are  allowed  to  be 
shipped,  and  that  these  are  kept  in  good  hygienic 
conditions  during  the  voyage.  On  arrival  at  their  des- 
tination, they  should  be  quarantined  for  about  a couple 
of  weeks,  and,  if  found  to  be  infected,  should  be 
destroyed,  and  their  dead  bodies  and  cages  burned. 
The  places  in  which  they  were  kept  should  also  be 
thoroughly  disinfected.  Parrots  should  not  be  al- 
lowed to  take  food  out  of  people’s  mouths,  and  should 
always  be  kept  in  good  hygienic  conditions.” 

Physicians  encountering  suspicious  cases  are  re- 
quested to  notify  the  Department  of  Health,  which 
will  gladly  carry  on  the  bacteriological  and  epidemio- 
logical investigations  necessary  to  determine  the 
nature  of  the  disease.  In  all  such  cases  it  will  be  well 
to  see  that  any  sick  or  dead  parrot  is  not  disposed  of, 
for  the  bacteriological  examinations  of  the  bird  are 
very  important  in  establishing  the  source  of  the 
infection. — Weekly  Bulletin  City  of  New  York  Depart- 
ment of  Health,  January  11,  1930. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 


LOCAL  COMPRESSION  THERAPY  IN  THE 
TREATMENT  OF  PULMONARY 
TUBERCULOSIS 

Frank  S.  Dolley,  Los  Angeles. — Given  a 
patient  with  chronic  productive  infraclavicular 
tuberculosis  with  general  pleural  adherence  where 
healing  is  prevented  by  the  presence  of  one  or 
more  small  cavities,  the  procedure  that  will  sacri- 
fice the  least  amount  of  lung  tissue  with  minimal 
danger  to  the  patient  is  pneumolysis  with  local 
pulmonary  compression. 

Bilateral  chronic  apical  disease  with  cavitation, 
which  is  responsible  for  the  continued  presence  of 
tubercle  bacilli  in  the  sputum,  constantly  endan- 
gers the  patient  by  possible  extension.  Thoraco- 
plasty is  definitely  contraindicated.  Pneumothorax 
is  prevented  by  pleural  adhesions.  Pneumolysis 
and  local  compression,  applied  first  to  one  side 
and  later  the  other,  may  serve  to  accomplish  a 
cure. 

Occasionally  following  an  extensive  thoraco- 
plasty a pulmonary  cavity  persists ; a menace  to 
the  contralateral  lung.  If  further  rib  resection 
seems  inadvisable,  local  compression  often  achieves 
success. 

Pulmonary  hemorrhage  may  be  arrested  by 
pneumolysis  and  local  compression  if  thoraco- 
plasty seems  too  severe  and  other  methods  are 
unsuccessful. 

Pneumolysis  is  the  initial  procedure  in  all  local 
surgical  compression  therapy.  This  is  accom- 
plished by  careful  freeing  of  the  lung  together 
with  its  visceral  and  parietal  pleura  from  the 
chest  wall  well  around  the  involved  area,  so  allow- 
ing the  pulmonary  tissues  of  this  region  to  col- 
lapse downward  and  inward.  The  immediate 
result  is  very  satisfactory  if  the  cavity  walls  are 
not  too  stiff.  Without  an  extensive  thoracoplasty, 
however,  and  this  is  just  what  a local  operation 
aims  to  avoid,  a dead  space  is  left  which  eventu- 
ally will  be  obliterated  by  the  formation  of  ad- 
hesions between  the  collapsed  lung  and  chest  wall. 
Later  contraction  of  these  adhesions  would,  more 
or  less  completely,  return  the  lung  to  its  original 
position.  Pneumolysis  alone,  therefore,  is  seldom 
successful  in  accomplishing  permanent  cavity 
collapse. 

The  prevention  of  reexpansion  can  be  accom- 
plished in  two  ways ; either  by  gauze  tamponade, 
allowing  the  extrapleural  space  to  heal  by  granu- 
lation, or  by  the  permanent  insertion  of  some 
material  that  will  compress  the  diseased  pulmo- 
nary tissues  and  at  the  same  time  fill  the  extra 
pulmonary  dead  space,  thus  preventing  pulmo- 
nary reexpansion. 

256 


1.  Pneumolysis  and  gauze  tampon:  Sections  of 
several  ribs  are  resected  wide  about  the  area  to 
be  compressed  in  order  to  prevent  adhesions 
which,  forming  between  the  collapsed  lung  and 
ribs,  would  pull  apart  the  cavity  walls.  Rubber 
tissue  is  placed  within  the  wound  and  sufficient 
gauze  tightly  packed  in  this  to  fill  the  space 
created  by  the  lung  collapse.  The  soft  tissues  are 
tightly  closed  over  this  packing  and,  if  no  infec- 
tion occurs,  the  gauze  is  allowed  to  remain  undis- 
turbed eight  to  twelve  days.  It  is  then  removed 
and  the  wound  is  packed  wide  open,  allowing  the 
space  to  heal  gradually  by  granulation. 

2.  Pneumolysis  with  the  insertion  of  some  sub- 
stance that  is  not  to  be  removed : A short  section 
of  one  rib  only  is  removed.  The  parietal  pleura 
is  separated  carefully  from  the  chest  wall  until 
the  lung  over  the  area  to  be  collapsed  is  freed. 
Many  substances  have  then  been  inserted  to  exert 
pulmonary  compression ; fat,  lipomas,  muscle, 
fascia,  etc.  All  these  gradually  shrink  in  size  and 
allow  the  lung  partially  to  reexpand,  thus  decreas- 
ing considerably  the  probability  of  operative  cure. 
Of  the  materials  so  far  utilized,  paraffin  is  prob- 
ably the  most  efficacious.  It  shrinks  little,  is  some- 
what elastic,  and  is  practically  nonirritating.  Its 
melting  point  must  be  somewhat  higher  than  body 
temperature.  The  addition  of  one  per  cent  bis- 
muth makes  it  radiotranslucent.  It  is  inserted 
warm  and  plastic,  small  portions  at  a time  until 
sufficient  compression  is  obtained.  The  soft  tis- 
sues are  then  tightly  and  permanently  closed  over 
it.  It  is  essential  for  its  use  that  pleural  adhesions 
he  present  below  in  order  that  the  paraffin,  by 
its  own  weight,  may  not  sink  below  the  level  of 
the  pulmonary  tissues  to  be  collapsed.  Hemo- 
stasis must  be  complete,  since  serum  forming 
about  the  paraffin  may  burrow  to  the  surface,  dis- 
charge and  eventually  lead  to  the  extrusion  of  the 
paraffin. 

If  infection  occurs,  the  wound  must  be  at  once 
opened,  the  paraffin  removed  and  gauze  tampon- 
ade with  wide  rib  resection  resorted  to. 

Local  compression  is  contraindicated  if  the 
cavity  or  cavities  are  near  the  pulmonary  surface. 
The  pressure  of  tampon  or  wax  easily  sloughs 
through  a comparatively  thin  abscess  wall. 

The  advantages  of  pneumolysis  with  local 
pulmonary  compression  are : ( 1 ) The  operation 
is  a comparatively  minor  one  and  is  attended  with 
little  or  no  shock.  (2)  Paradoxical  respiration 
does  not  follow,  so  the  danger  of  aspiration  into 
the  lung  areas  is  minimized.  (3)  The  sacrifice  of 
actively  functioning  lung  tissue  is  very  little.  (4) 
It  can  be  carried  out  bilaterally  where  other  pro- 
cedures are  contraindicated. 


April,  1930 


BEDSIDE  MEDICINE 


257 


Its  disadvantages  are:  (1)  Rupture  into  pleural 
cavity.  If  the  pleural  leaves  are  not  solidly  ad- 
herent, an  extensive  pleuritis  that  often  proves 
fatal  may  develop.  If  pleural  space  is  well  walled 
off  the  pulmonary  abscess  drains  externally, 
sometimes  persisting  for  years.  (2)  Occasionally 
long  after  implantation  the  area  surrounding  the 
paraffin  may  become  infected,  demanding  the 
latter’s  removal.  Rib  resection  and  gauze  tampon- 
ade is  then  the  resort  of  choice. 

* * * 

F.  M.  Pottenger,  Monrovia. — Doctor  Dolley’s 
discussion  shows  the  ingenuity  that  the  surgeon 
has  been  obliged  to  use  in  coping  with  the  de- 
structive phases  of  tuberculosis.  It  is  a clear  and 
concise  presentation  of  the  subject. 

It  was  formerly  taught  that  tuberculosis  is  an 
insidious  disease  and  that  all  cases  showing  de- 
structive lesions  had  been  neglected  in  diagnosis. 
We  now  know  that  this  is  untrue;  for  tubercu- 
losis often  comes  on  as  an  acute  process  and 
shows  cavity  formation  soon  after  clinical  symp- 
toms have  first  manifested  themselves.  The  ap- 
preciation of  the  fact  that  tuberculosis  often 
comes  on  as  an  acute  destructive  process  is  one 
of  the  real  advances  in  our  clinical  conception. 
The  fact  that  tuberculosis  with  insidious  onset 
sooner  or  later  goes  over  into  an  acute  process, 
often  with  cavity  formation,  emphasizes  the  im- 
portance of  immediate  treatment  when  active  dis- 
ease has  been  diagnosed. 

When  acute  destructive  process  with  cavity 
forms  in  the  lung,  if  the  patient  is  put  at  rest 
immediately,  preferably  in  an  institution,  and 
given  the  benefit  of  the  well-recognized  methods 
of  treatment,  a large  percentage  of  arrests  will 
result  without  collapse  therapy  of  any  kind.  The 
danger  of  waiting  is  that  pleural  adhesions  will 
form  and  that  these  will  prevent  effective  col- 
lapse, should  pneumothorax  treatment  be  under- 
taken later.  From  the  standpoint  of  choice,  how- 
ever, every  patient  who  can  secure  healing  of  his 
pulmonary  tuberculosis  without  any  form  of  in- 
terference with  his  pleural  space  is  in  a better 
position  as  regards  future  physical  efficiency  than 
he  would  be  were  this  principle  disregarded.  A 
cure  may  be  brought  about  by  the  usual  dietetic, 
hygienic  regimen  with  bed  rest  in  a large  pro- 
portion of  such  patients  in  about  a year’s  time ; 
whether  such  method  is  going  to  be  successful 
can  usually  be  determined  in  five  or  six  months’ 
time.  The  disadvantage  of  a noninterference  policy 
lies  in  the  danger  that  pleural  adhesions  may 
form  in  the  meantime  and  make  pneumothorax 
out  of  the  question.  This  has  caused  many  to 
collapse  such  acute  cavities  as  soon  as  the  diag- 
nosis is  made.  Pneumothorax  does  not  produce 
its  results  any  more  quickly,  for  the  lesion  cannot 
heal  short  of  many  months.  It  does,  however, 
permit  the  patient  to  be  up  and  about  sooner 
because  it  reduces  or  abolishes  symptoms.  This, 
however,  is  often  of  doubtful  advantage,  because 
rest  and  a careful  regimen  for  a prolonged  time 
is  the  best  guarantee  of  permanent  healing, 
whether  a collapse  therapy  is  employed  or  not. 


Many  of  these  cases  start  in  apices  which  have 
previously  been  infected  and  which  already  are 
surrounded  by  a cap  of  pleural  adhesions  which 
preclude  collapse  by  pneumothorax ; others  form 
adhesions  during  the  period  between  cavity  for- 
mation and  attempted  compression.  In  both  of 
these,  pneumolysis  may  bring  about  a favorable 
result. 

One  other  group  of  cases  in  which  pneumolysis 
is  the  ideal  operation,  provided  it  can  produce  a 
satisfactory  collapse,  is  the  type  in  which  a per- 
manent cavity  forms  in  an  apex  surrounded  by 
a pleural  cap  and  adherent  mediastinum.  Tension 
from  all  sides  holds  such  a cavity  open  and  pre- 
vents compensatory  closure.  If  such  are  treated 
by  pneumolysis,  or  pneumolysis  and  a limited  rib 
resection,  the  patient  attains  his  result  with  the 
least  loss  of  pulmonary  tissue.  Since  most  of  these 
cases  have  had  extensive  involvement  of  pulmo- 
nary tissue  outside  of  the  area  involved  in  the 
operative  field,  it  is  of  great  importance  that  the 
operation  be  done  with  the  sacrifice  of  as  little 
lung  tissue  as  possible.  For  this  reason  pneumo- 
lysis makes  a special  appeal  in  such  cases. 

* * * 

Philip  H.  Pierson,  San  Francisco. — Doctor 
Dolley’s  discussion  of  this  subject  is  naturally 
from  the  surgical  point  of  view  and  very  well 
taken,  for  there  are  instances  in  which  surgical 
compression  therapy  is  very  helpful. 

There  are  frequently  medical  measures  which 
may  be  undertaken  to  much  advantage  before 
resorting  to  the  therapy  which  Doctor  Dolley  has 
outlined.  We  are  all  often  surprised  at  the 
marked  healing  power  which  absolute  bed  rest, 
to  the  point  of  “typhoid  rest,”  will  achieve.  This 
method  has  to  be  carefully  explained  to  the  pa- 
tient in  order  to  get  his  complete  cooperation. 
Complete  relaxation  periods  of  ten  minutes  by 
the  clock,  ten  times  a day,  will  accomplish  more 
than  months  of  restless  bed  rest.  It  should  always 
be  tried  before  any  form  of  surgical  therapy  is 
undertaken. 

The  next  thing  which  may  be  tried  before 
surgical  compression  is  the  use  of  the  sandbag. 
This  form  of  therapy  has  been  found  to  be  most 
beneficial  in  many  cases.  The  sandbag  should 
be  properly  shaped  to  the  affected  side  and  held 
in  position  by  straps  to  the  head  of  the  bed.  This 
works  to  advantage  particularly  if  the  patient  lies 
in  a recumbent  or  semirecumbent  position.  I have 
used  a sandbag  weighing  seven  pounds  and  think 
it  of  sufficient  weight.  When  applied  one  hour  on 
and  one  hour  off  it  may  accomplish  the  desired 
effect.  Judicious  waiting  for  this  form  of  therapy 
to  show  its  result  is  often  tedious  but  worth  while. 

The  best  form  of  mechanical  brace  that  I have 
seen  is  one  where  a screw,  supporting  a pad,  is 
adapted  to  the  thorax  and  increasing  pressure  is 
applied  over  the  desired  area.  Here  again  spec- 
tacular results  are  seen  in  some  instances. 

Artificial  pneumothorax  is  a well-recognized 
form  of  therapy  for  local  lung  compression. 
Nature  uses  this  cushion  of  air  in  a selective 
manner,  more  over  the  affected  part  of  the  lung 


258 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


than  the  good  portion.  This  is  explained  by  the 
resiliency  of  the  normal  lung  tissue  keeping  it  in 
a more  expanded  state  than  over  the  diseased 
area,  where  the  relief  of  pleural  suction  allows 
internal  contractures  to  set  up  a localized  com- 
pression. I recently  saw  a case  in  Davis  where 
pneumothorax  was  only  partially  successful  in 
collapsing  a subclavicular  cavity,  it  being  held 
open  by  two  adhesions  about  one  centimeter  in 
diameter.  Thoracoscopic  study  had  shown  these 
too  large  to  be  burned  by  the  Jacobeus  method. 
Doctor  Jessen  removed  about  eight  centimeters 
of  the  two  ribs  overlying  this  area  and  the  relaxa- 
tion of  these  adhesions  brought  about  the  local 
compression  that  was  originally  desired.  In  other 
instances  adhesions  may  be  severed  and  the  local 
compression  obtained. 

The  problem  of  apical  cavities  is  one  of  the 
most  difficult  to  handle,  for  thoracoplasty  has  fre- 
quently failed  in  its  therapeutic  value  when  ap- 
plied to  that  region.  It  is  here  that  pneumolysis 
or  the  resection  of  not  only  the  posterior  but  the 
lateral  and  some  of  the  anterior  portion  of  the 
rib  brings  about  the  best  compression.  While 
speaking  of  thoracoplasty  it  should  be  said  that 
lesions  in  the  middle  or  lower  portions  of  the  lung 
are  greatly  benefited  by  thoracoplasty  in  a con- 
siderable number  of  cases,  particularly  if  that 
thoracoplasty  takes  the  ribs  off  up  to  and  includ- 
ing the  tips  of  the  transverse  processes  of  the 
vertebrae. 

I feel  that  we  are  often  in  too  much  haste  in 
performing  more  radical  operations  than  phrenic- 
ectomy  when,  if  sufficient  time  were  allowed,  the 
benefits  of  a less  extensive  operation  would  be 
manifest.  Cavitation  even  as  high  as  the  clavicle, 
if  given  three  or  four  months  or  even  six  months, 
may  be  completely  closed  and  healed  by  phrenic- 
ectomy.  There  are  other  instances  in  which  a mere 
crushing  of  the  nerve  will  bring  about  a tempo- 
rary paralysis  of  the  diaphragm  and  thus  give 
nature  an  opportunity  to  start  the  healing  process 
even  in  disease  of  the  upper  portion  of  the  lung. 
* * * 

William  B.  Faulkner,  Jr.,  San  Francisco. 
Doctor  Dolley’s  proposal  of  pneumolysis  and 
tamponage  as  means  of  compression  in  the  treat- 
ment of  pulmonary  tuberculosis  is  both  timely  and 
rational ; and  in  selected  cases  this  combined  pro- 
cedure should  offer  promising  results ; since  it 
fulfills  the  strictest  requirements  of  accepted 
therapy  by : 

1.  Closing  open  lesions,  controlling  hemor- 
rhage, and  preventing  spread  of  the  disease. 

2.  Affording  local  pulmonary  rest,  compress- 
ing principally  the  diseased  area,  and  preserving 
the  actively  functioning  lung  tissue. 

3.  Minimizing  mechanical  disturbances  of  the 
intrathoracic  structures. 

4.  Being  of  benefit  to  patients  in  whom  other 
compression  methods  have  failed,  or  in  whom 
other  methods  have  been  contraindicated. 

5.  Offering  a low  operative  risk. 

The  successful  employment  of  pneumolysis  is 
so  dependent  on  generalized  adhesions  overlying 
the  diseased  lung  that  one  must  determine  in  ad- 


vance the  presence,  type,  location,  and  extent  of 
the  pleural  adhesions.  This  information  cannot 
always  be  obtained  from  the  study  of  plain  x-ray 
plates,  but  following  the  use  of  a preliminary 
diagnostic  pneumothorax  and  the  interpretation  of 
the  accompanying  postural  roentgenograms,  one 
is  in  a position  to  select  that  type  of  compression 
which  seems  best  suited  to  the  individual  patient. 
If  the  diagnostic  pneumothorax  demonstrates  an 
absence  of  generalized  pleural  adhesions,  pneumo- 
lysis, tamponage,  and  other  methods  of  treatment 
must  give  way  to  the  continuance  of  pneumo- 
thorax. However,  when  “string-like”  adhesions 
prevent  a satisfactory  lung  compression,  thoraco- 
scopic examination,  with  severing  of  the  adhesions 
by  cautery,  is  both  feasible  and  helpful. 

If  the  diseased  lobe  is  adherent  to  the  dia- 
phragm and  to  only  that  portion  of  the  chest 
wall  overlying  the  cavity,  the  respiratory-dia- 
phragmatic movements  exert  an  unfavorable  tug 
on  the  walls  of  the  cavity  and  tend  to  prevent 
healing.  In  such  instances  phrenic  nerve  section 
or  avulsion  is  much  more  stronglv  indicated  than 
is  pneumolysis ; but  a patient  with  an  immobile 
diaphragm  and  generalized  pleural  adhesions  can 
expect  little  from  a phrenic  nerve  section  and 
must  look  to  pneumolysis  and  tamponage  for 
relief. 

The  employment  of  pneumolysis  is  also  justifi- 
able in  the  control  of  pulmonary  hemorrhage  if 
the  surgeon  can  determine  from  which  side  the 
blood  is  coming,  and  if  pneumothorax  has  not 
been  effective.  This  localization  of  the  source  of 
bleeding  is  not  always  an  easy  task ; for  the  ab- 
normal physical  signs  may  be  equally  marked  and 
strikingly  similar  over  both  lungs,  and  one  must 
depend  on  a bronchoscopic  examination  in  select- 
ing the  site  of  operation. 

Pneumolysis  will  find  an  almost  universal  place 
in  the  treatment  of  patients  afflicted  with  bilateral 
apical  cavernous  tuberculosis,  and  will  offer  a ray 
of  hope  to  those  who  are  beyond  the  scope  of 
other  methods  of  treatment. 


China  Raises  Medical  Standards. — The  passing  of 
the  old-style  uneducated  Chinese  physicians  becomes 
imminent  as  a result  of  a resolution  passed  by  the 
National  Board  of  Health  at  its  conference  in  Nan- 
king in  June.  Science  Service  reports  that  the  Board 
decided  not  to  grant  new  licenses  to  unscientific 
practitioners  after  December  31,  1930. 

Considerable  agitation  resulted  among  the  two 
thousand  or  so  old-style  doctors  in  Shanghai.  A 
meeting  of  protest  was  held  and  a strike  of  medicine 
shop  employees  took  place.  Posters  appeared  on  the 
shutters  of  medicine  shops  pointing  out  the  need  of 
the  old-style  physicians  and  medicines,  and  the  harm 
that  would  accrue  to  the  nation  if  they  were  abolished. 
On  the  other  hand,  advanced  opinion,  while  admitting 
the  hardship  worked  on  the  old-style  physicians, 
takes  the  stand  that  such  an  important  step  as  refus- 
ing them  new  licenses  should  not  be  delayed  for 
almost  two  years.  It  is  pointed  out  that  the  ignorant 
classes  in  China  will  long  continue  to  go  to  native 
old-style  physicians,  regardless  of  whether  they  are 
licensed  to  practice  or  not,  so  that  the  sooner  definite 
steps  are  taken  to  fight  this  evil  the  better. 

The  old  Chinese  physicians  are  little  more  than 
quacks,  and  cause  incalculable  harm,  both  directly  by 
their  treatments  and  indirectly  by  keeping  patients 
from  seeing  scientific  physicians  until  too  late  to  save 
the  patients’  lives. — The  Dip! ornate,  November  1929 


April,  1930 


EDITORIALS 


259 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Official  Organ  of  the  California,  Utah  and  GNjrvada  £ Medical  oAssociatiom 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 

Telephone  “Douglas  0062 


Editors 

Associate  Editor  for  Nevada 
Associate  Editor  for  Utah 


Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 
single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  Address. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned. 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects.  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 

Contributions — Exclusive  Publication. — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


( GEORGE  H.  KRESS 
’ ( EMMA  W.  POPE 
. HORACE  J.  BROWN 
. . . . J.  U.  GIESY 


EDITORIALS 


THE  FIFTY-NINTH  ANNUAL  SESSION  OF 

THE  CALIFORNIA  MEDICAL  ASSOCIA- 
TION AT  DEL  MONTE— TO  BE 
HELD  ON  APRIL  28-MAY  1,  1930 

The  Program  of  This  Fifty-Ninth  Annual 
Session. — In  this  issue  of  California  and  West- 
ern Medicine  is  printed  the  program  of  this 
year’s  annual  session  of  the  California  Medical 
Association.  This  is  the  fifty-ninth  year  in  which 
the  California  Medical  Association  may  be  said 
to  have  provided  means  for  its  members  to  meet 
in  conference  to  discuss  the  various  scientific 
and  other  problems  of  organized  medicine,  and 
through  personal  contacts  with  one  another  to  fit 
themselves  to  return  to  their  work  with  renewed 
strength  and  enthusiasm. 

;jc 

Members  of  the  California  Medical  Association 
Should  Plan  to  Attend  This  Del  Monte  Session. — 
Recent  annual  sessions  of  the  California  Medical 
Association  have  seemingly  given  members  of  the 
organization  who  attended  the  meetings  a more 
than  adequate  return  for  the  time  and  expense 
involved  in  such  attendance.  This  year’s  session 
at  Del  Monte,  while  lacking  somewhat  in  the 
generous  hospitality  which  is  usually  extended  by 
component  county  units  of  larger  size,  is  never- 
theless in  one  of  California’s  most  charming  set- 
tings. All  who  have  attended  annual  sessions  at 
Del  Monte  in  the  years  gone  by  will  desire  to 
again  renew  their  acquaintance  with  this  region 
and  its  alluring  scenery,  and  with  our  colleagues 


of  that  district.  Members  who  have  not  had  that 
pleasure  should  make  a special  effort  to  attend  this 
session,  which  will  begin  on  Monday,  April  28, 
and  adjourn  on  Thursday,  May  1. 

'f'  -fc 

The  Scientific,  Social  and  Business  Features  of 
the  Session. — A perusal  of  the  scientific  program 
as  found  in  this  issue  will  indicate  how  many  are 
the  interesting  and  important  scientific  topics 
which  will  come  up  for  consideration  and  discus- 
sion, in  the  general  and  special  sections.  Our 
guest  speakers  are  prominent  colleagues  from 
different  sections  of  the  country  and  our  Califor- 
nia essayists  are  also  well  known  fellow  prac- 
titioners. 

The  scenic  charm  and  the  hotel  environment 
of  Del  Monte  foretell  also  the  best  of  fellowship, 
reunions  and  of  social  contacts. 

What  with  meetings  of  the  scientific  assemblies 
and  of  scenic  drives  and  walks  and  golf  and 
dances  in  the  way  of  social  diversion,  and  of 
important  business  problems  up  for  considera- 
tion by  the  House  of  Delegates,  it  may  be  taken 
for  granted  that  the  five  days  and  their  hours 
will  flit  by  with  amazing  rapidity  for  all  who  can 
stay  throughout  the  session. 

* * * 

Pre-Convention  Bulletin  and  Standing  Commit- 
tees.— This  will  be  the  first  annual  session  to  be 
held  under  the  provisions  of  the  revised  consti- 
tution and  by-laws.  For  the  members  of  the 
House  of  Delegates,  the  Pre-Convention  Bulletin, 
containing  abstracts  of  reports  of  officers  and 
standing  committees,  will  make  its  first  appear- 
ance. It  is  believed  that  members  of  the  House, 
through  this  new  medium,  will  be  able  to  get 
a better  orientation  of  the  problems  which  will 
come  up  for  their  consideration. 

The  House  of  Delegates  will  also  have  its  first 
experience  with  an  official  speaker.  That  plan 
should  work  out  as  advantageously  in  California 
as  it  does  in  the  national  association. 

It  is  important  for  members  of  the  standing 
committees  to  meet  and  organize  and  to  discuss 
the  problems  which  their  respective  groups  are 
expected  to  investigate.  The  Del  Monte  session 
will  make  such  conferences  possible.  The  co- 
operation of  additional  colleagues,  which  can  be 
secured  through  the  appointment  of  two  to  ten 
advisory  members  to  each  committee,  as  provided 
in  the  constitution  and  by-laws,  might  likewise 
be  one  of  the  matters  to  which  the  members  of 
standing  committees  could  give  consideration  in 
their  conferences. 

^ ^ ^ 

The  Woman’s  Auxiliary  of  the  California 
Medical  Association. — The  Woman’s  Auxiliary 
of  the  California  Medical  Association,  which 
formed  a tentative  state  organization  at  the  last 
annual  session  at  San  Diego,  will  convene  at  Del 
Monte  with  at  least  a half  dozen  component 
county  units  represented.  In  passing,  it  is  of 
interest  to  note  that  the  newly  formed  auxiliary 
unit  at  Los  Angeles,  at  the  time  of  this  writing 
reports  a membership  in  excess  of  three  hundred 


260 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


and  fifty.  A leaflet  compiled  by  order  of  the 
Council  of  the  California  Medical  Association 
should  make  it  easy  for  other  county  auxiliaries 
to  come  into  existence  in  California. 

It  is  to  be  remembered  that  these  Woman’s 
Auxiliaries  are  not  to  take  up  work  belonging  to 
the  county  medical  societies,  but  to  maintain  inter- 
ests and  affiliations  in  fields  and  in  organizations 
where  the  physician  members  of  county  medical 
societies  do  not  contact,  but  where  intelligent 
cooperation  by  members  of  a Woman’s  Auxiliary 
may  be  an  additional  means  for  promotion  of  the 
public  health,  through  allegiance  to  proven  stand- 
ards of  preventive  medicine.  The  members  of  the 
Woman’s  Auxiliary  in  California  each  year  will 
no  doubt  find  more  and  more  pleasure  and  profit 
in  these  state  meetings. 

* * * 

Scientific  and  Fellowship  Contacts  Go  Hand 
in  Hand. — -As  has  been  so  often  stated  in  this 
column,  medical  men  need  not  only  to  know  one 
another  in  their  serious  professional  work,  but 
also  in  their  social  and  fellowship  relations. 
Through  such  social  contacts  mutual  understand- 
ings are  created  which  make  for  better  coopera- 
tion and  more  efficient  end-results  for  organized 
medicine.  In  other  words,  these  annual  meetings 
make  for  a stronger  California  Medical  Associa- 
tion and  its  component  county  units,  and  for 
higher  and  better  standards  of  practice,  and  of 
greater  protection  to  the  public  health.  If  an 
annual  session  can  promote  ends  such  as  these, 
then  the  meetings  of  such  an  annual  session  cer- 
tainly are  worth  attending.  Every  member  who 
can  possibly  do  so  is  urged  to  make  an  effort  to 
register  at  this  Del  Monte  session.  The  reward 
through  such  attendance  will  be  more  than  ample. 


MODERN  HOSPITAL  CONSTRUCTION  COSTS 

—THE  LOS  ANGELES  COUNTY  GEN- 
ERAL HOSPITAL  AS  AN  EXAMPLE 

The  Estimated  Size  and  Cost  of  the  New 
"Acute”  Unit  of  the  Los  Angeles  County  Hos- 
pital.— In  the  editorial  columns  of  the  last  two 
issues  of  this  journal,  mention  was  made  of  the 
new  unit  of  the  Los  Angeles  County  Hospital 
which  is  now  in  course  of  erection  and  comple- 
tion, and  of  its  estimated  cost,  which  the  press 
has  stated  will  vary  between  the  stupendous 
amounts  of  ten  to  sixteen  millions  of  dollars! 

This  new  “acute  unit” — so-called  because  in- 
tended particularly  for  indigent  citizens  suffering 
from  acute  diseases  or  injuries — was  planned 
originally  for  some  1500  beds,  but  will  have  actual 
provision  for  some  1911  beds  when  completed; 
with  possibilities,  it  has  been  stated,  of  accessory 
crowding — according  to  the  amount  of  crowd- 
ing— up  to  a capacity  of  2444  beds,  or  even  up  to 
3300  to  3600  beds.  For  the  basis  of  proper  cal- 
culation or  estimate  of  construction  cost  per  bed, 
the  figure  1911  would  probably  be  the  proper  one 
to  use,  since  the  term  “cost  per  bed”  when  prop- 
erly used  implies  somewhat  definite  space,  equip- 
ment and  service  standards. 


Why  the  Attention  of  California  Medical  Asso- 
ciation Members  Is  Called  to  These  Construction 
Costs. — The  attention  of  members  of  the  Califor- 
nia Medical  Association  is  being  called  to  certain 
aspects  of  the  Los  Angeles  County  General  Hos- 
pital situation  for  several  reasons. 

One,  because  the  members  of  the  California 
Medical  Association  have  a natural  interest  in  all 
efforts  to  provide  additional  hospital  facilities  for 
citizens  of  California;  two,  because  this  hospital 
building  now  being  built  at  Los  Angeles  is  prob- 
ably the  most  expensive  hospital  unit  thus  far 
erected  anywhere  in  the  world ; three,  because  its 
physical  attractiveness  and  conveniences — as  good 
or  better  than  the  great  majority  of  public  and 
private  hospitals  in  the  United  States  and  Europe 
— may  be  provocative  of  state  medicine  propa- 
ganda among  lay  citizens;  and  four,  what  may 
be  said  to  be  last  but  not  least,  the  danger  that 
seems  to  be  lurking  in  the  present  atmosphere  of 
things,  that  before  or  after  this  new  and  very 
expensive  hospital  structure  is  completed  and 
equipped,  the  medical  profession  may  find  itself 
subjected  to  criticism  or  fault-finding  by  tax- 
paying  lay  citizens,  for  presumably  having  been 
in  part  responsible  for  what  undoubtedly  are  very 
high  or  at  least  unforetold  or  unexpected  costs  of 
construction ; which  costs,  the  airing  of  which 
seems  to  be  looming,  certain  newspapers  and  tax- 
paying  groups  are  more  than  apt  to  consider  as 
having  been  extravagant  and  even  wasteful. 
When  taxpayers  feel  that  public  moneys  have 
been  wasted,  newspapers  and  taxpayers  alike 
usually  look  for  an  “official  goat.”  Believing  that 
there  is  danger  that  the  medical  profession  may 
be  looked  upon  as  an  easy  mark  for  such  a doubt- 
ful honor,  and  knowing  that  it  cannot  justly  be 
held  responsible  for  mistakes  in  construction 
expenditures,  it  seems  proper  to  establish  its 
record  before  the  storm  breaks. 

>k 

How  and  Why  This  New  Unit  Came  Into 
Existence. — The  writer,  by  virtue  of  over  twenty 
years’  continuous  membership  and  service  on  a 
medical  advisory  board  to  four  different  hospital 
superintendents  or  medical  directors  of  the  Los 
Angeles  County  General  Hospital,  may  be  pre- 
sumed to  be  in  a position  to  know  what  were  the 
steps  preceding  the  present  building  program  at 
Los  Angeles. 

To  start  with  an  initial  fact  or  condition,  the 
Los  Angeles  County  Hospital,  owing  to  the 
rapid  growth  of  population  in  the  county  and 
because  no  public  municipal  hospitals  existed,  has 
been  more  or  less  congested  for  the  last  twenty 
or  thirty  years. 

A half  dozen  or  so  years  ago,  at  a time  when 
Mr.  Norman  R.  Martin  was  superintendent  of 
the  institution,  the  situation  became  somewhat 
more  acute  and  was  thoroughly  discussed ; the 
Advisory  Medical  Board  at  that  time  recommend- 
ing to  the  Los  Angeles  County  Board  of  Super- 
visors that  a bond  issue  of  five  million  dollars  be 
presented  to  the  voters,  this  money  to  be  used  for 
the  erection  of  a new  unit  or  buildings  for  the 


April,  1930 


EDITORIALS 


261 


county  hospital,  and  for  extension  of  infirmary 
wards  for  certain  chronic  patients  at  the  county 
farm  and  for  development  of  the  tuberculosis 
branch  facilities.  The  bond  issue  was  voted,  and 
a contract  was  made  by  the  board  of  supervisors 
with  the  Allied  Architects’  Association  of  Los 
Angeles  for  plans  and  superintendence  (this  con- 
tract was  later  changed,  because  the  first  contract 
brought  into  play  the  principle  or  right  of  a cor- 
poration to  practice  the  profession  of  an  archi- 
tect). Much  of  this  five  million  dollar  bond 
issue  was  spent  on  the  County  Farm,  on  the  Olive 
View  Sanatorium  and  on  other  activities,  but 
with  what  was  left  the  start  was  made  for  the 
new  building  or  buildings  of  the  “Acute  Unit” 
(Unit  No.  3)  of  the  county  hospital. 

* * * 

The  Results  of  the  Allied  Architects  and  Med- 
ical Board  Conferences. — At  that  time  the 
medical  advisory  board  of  the  attending  staff 
of  the  hospital  had  frequent  meetings  with  an 
executive  or  director  group  of  five  from  the 
Allied  Architects’  Association  and  after  much 
discussion  the  basic  principles  of  the  new  hos- 
pital unit  were  agreed  upon. 

Included  among  such  decisions  were  items  as 
follows : 

One.  It  was  agreed  that  the  present  hospital 
site  was  the  proper  place  for  the  new  building 
or  buildings,  rather  than  branch  county  hospitals 
in  Hollywood,  Long  Beach  and  other  towns,  as 
had  been  proposed  by  others. 

Two.  The  pavilion  system,  of  which  the  Cin- 
cinnati General  Hospital  is  one  of  the  most  recent 
expressions,  was  set  aside  as  being  undesirable 
from  the  standpoint  of  hospital  efficiency  and 
economy.  The  large  office  or  loft  building,  in 
line  with  modern  architectural  construction,  was 
decided  upon  as  being  best  adapted  to  modern 
hospital  needs. 

Three.  The  essential  nature  of  the  ward  unit 
which  would  be  represented  in  all  the  different 
wings  and  different  floors  was  worked  out. 
(That,  however,  is  a story  in  itself ; especially 
the  ineffectual  struggle  by  some  members  of  the 
medical  board  to  have  a simple  temporary  one- 
story  ward  built  to  try  out  through  actual  use, 
the  proposed  ward  unit  which  had  been  decided 
upon.  The  story  of  that  unsuccessful  effort  must 
abide  for  its  portrayal,  for  some  other  occasion 
than  this.) 

Four.  The  available  free  ground  in  the  county 
hospital  area  being  of  low  elevation  and  not  well 
located,  the  writer  urged  the  medical  board  to 
recommend  to  the  board  of  supervisors  the  pur- 
chase of  two  city  blocks  to  the  rear  of  the  exist- 
ing acreage.  This  recommendation  was  made  to 
and  was  accepted  by  the  five  members  of  the 
board  of  supervisors  ; and  the  bungalows  thereon 
and  also  the  hilltop  were  razed,  and  the  site  of 
the  new  building  located  thereon. 

Five.  Efforts  were  made  to  have  consulting 
hospital  experts  placed  on  retainer,  to  help  guide 
general  and  special  plans  from  start  to  finish. 
These  efforts  were  only  partially  successful  but 


early  in  the  planning,  Mr.  Chapman  of  the  Mt. 
Sinai  Hospital  of  Cleveland  and  the  late  Doctor 
Brodrick  of  Highland  Hospital  of  Oakland,  both 
well  known  for  their  extensive  knowledge  and 
experience  in  hospital  construction,  were  en- 
gaged and  did  visit  Los  Angeles  for  a week  or  so, 
and  brought  in  a report  on  the  general  basic 
plans  as  these  had  been  outlined  in  the  confer- 
ences between  the  architect  group  and  the  advis- 
ory medical  board.  Attempts  to  have  continued 
cooperation  and  supervision  by  these  and  by  other 
hospital  construction  experts  and  consultants 
such  as  Doctor  Goldwater  of  New  York,  failed. 

Here,  as  in  the  matter  of  building  a one-story 
try-out  ward,  the  answer  which  always  came 
back,  was  “economy.”  In  other  words,  the  money 
of  the  taxpayers  was  to  be  safeguarded,  even 
though  it  was  many  times  suggested  to  the 
medical  board  and  to  other  authorities,  that  these 
experts  would  probably  save  their  fee  retainers 
many  times  over,  because  of  their  superior  experi- 
ence and  knowledge  of  hospital  construction. 
One  resolution  presented  to  the  medical  board 
by  the  writer  and  urging  such  retainer  of  experts 
was  finally  passed  but  when  presented  to  the 
board  of  supervisors  by  the  medical  director  of 
the  hospital,  was  accompanied  by  the  medical 
director’s  personal  recommendation,  that  the 
supervisors  should  not  engage  such  experts.  In 
the  light  of  what  has  since  transpired,  it  seems 
more  than  unfortunate  that  the  valuable  knowl- 
edge and  advice  which  such  experts  could  have 
given  should  not  have  been  constantly  at  the  dis- 
posal of  those  who  proceeded  with  the  plans  and 
construction. 

Six.  The  general  arrangements  of  the  operat- 
ing rooms,  of  the  wings  and  floors  in  which  the 
different  professional  services  in  medicine  and 
surgery  were  to  be  located,  were  also  worked  out 
in  considerable  detail  in  these  conferences  be- 
tween the  architects’  committee  and  the  board. 

* * * 

Two  Possible  Sources  of  Error. — The  above  in 
brief  indicate  some  of  the  high  points  in  which 
the  medical  profession,  through  the  medical 
board  (which  may  be  said  to  have  represented 
the  attending  staff),  was  involved  in  the  construc- 
tion of  this  new  unit. 

If  mistakes  were  made  at  that  stage,  they  may 
be  said  to  have  been  due  in  good  part  to  the  fact 
that  it  was  not  possible  to  have  expert  hospital 
consultants  on  retainer,  other  than  in  the  one 
brief  initial  visit  already  mentioned,  and  also 
because  it  was  not  possible  for  certain  members 
of  the  medical  board  (the  writer  being  one  of 
such)  to  persuade  the  authorities  to  erect  at  mod- 
erate cost,  a try-out  ward  unit,  before  going 
ahead  with  a building  which  for  a considerable 
time  was  thought  would  not  cost  much  more  than 
the  originally  estimated  five  million  dollars,  but 
which  as  time  has  gone  on,  has  already  passed 
the  ten  million  dollar  mark,  with  a possibility, 
if  newspaper  accounts  are  true,  of  reaching, 
exclusive  of  much  equipment,  as  high  as  sixteen 
millions  of  dollars ! 


262 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  + 


In  the  matter  of  this  vast  amount  of  money, 
coming  from  the  pockets  of  taxpayers,  it  is  proper 
to  state  that  after  the  initial  bond  issue  of  five 
million  dollars  was  voted  by  the  citizens,  that 
subsequent  money  needs  for  construction  costs 
were  met  by  the  yearly  placement  of  a special 
levy  or  item  in  the  annual  general  county  tax 
budget,  whereby  the  moneys  needed  would  be 
provided.  It  may  be  assumed  that  this  method 
was  adopted  by  the  political  powers  of  the  county, 
because  in  annual  tax  levies,  the  taxpayers  would 
notice  construction  costs  far  less  than  they  would, 
had  their  attention  been  directly  called  to  the 
building  and  its  costs  through  recurrent  county 
hospital  bond  issues. 

* * * 

When  the  Medical  Board  “Faded”  Out  of  the 
Picture. — The  foregoing  events  practically  cov- 
ered the  period  into  the  year  1927. 

Then  came  a lull  or  interlude,  covering  vir- 
tually the  last  two  years,  during  which  the 
advisory  medical  board  may  be  said  to  have 
‘‘faded”  out  of  this  hospital  construction  picture, 
in  much  the  gradual  and  soft  fashion  in  which,  on 
the  silver  screen,  certain  actors  are  permitted  to 
pass  out  of  a scene  when  their  supposed  useful- 
ness, in  the  minds  of  the  producers  or  directors, 
has  come  to  an  end. 

During  this  quiescent  period  of  1928  and  1929 
and  up  to  the  present  the  medical  board  was  not 
called  on  to  continue  the  previously  somewhat 
frequent  conference  meetings  with  the  architects, 
and  was  obliged  to  content  itself  with  monthly 
board  meetings  at  which  applications  for  leaves 
of  absence  by  staff  members  and  other  routine 
matters  were  presented. 

% * 

Recent  Newspaper  Publicity  Concerning  Hos- 
pital Costs. — About  the  middle  of  February  of  the 
present  year,  as  noted  in  last  month’s  editorial  in 
California  and  Western  Medicine,  the  news- 
papers of  Los  Angeles  began  to  print  articles 
about  the  very  high  total  costs  of  the  new  hospital 
buildings,  stating  that  some  of  the  bids  for  com- 
pletion (exclusive  of  much  of  the  equipment) 
indicated  that  the  total  cost  of  such  construction, 
instead  of  being  within  a ten  or  eleven  million 
dollar  limit,  might  approximate  something  like 
sixteen  million  dollars ! 

In  this  editorial  column  of  California  and 
Western  Medicine  it  is  not  possible  to  go  into 
details  concerning  the  cost  of  many  construction 
items  (in  which  members  of  the  medical  profes- 
sion. by  virtue  of  the  fact  that  hospitals  are  built 
primarily  to  make  it  possible  for  physicians  and 
surgeons  to  render  more  efficient  service  to  lay 
citizens)  have  a very  natural  interest.  Two  or 
three  phases  of  construction,  however,  may  be 
worthy  of  comment,  readers  being  referred  to  the 
Miscellany  department  of  this  issue,  where,  under 
the  caption  “Clippings  from  the  Lay  Press,” 
excerpts  may  be  found  which  will  give  more 
details  on  the  matters  here  briefly  discussed. 

It  may  be  of  interest  to  note  that  the  Los  An- 


geles newspapers  have  quoted  supervisors  as 
stating  that  the  sum  of 

“$7,822,055  had  either  already  been  expended  or 
obligated  by  pending  contract  awards.” 

Also  that 

“bids  for  work,  now  pending  before  the  county 
board  of  supervisors  total  $8,686,121.” 

In  the  Los  Angeles  Times  of  March  4 last, 
Supervisor  Shaw  was  thus  quoted  : 

“We  have  already  paid  the  architects  more  than 
$600,000.” 

The  Los  Angeles  Examiner  of  March  4 
printed  : 

“Supervisor  Beatty  stated  that  the  board  of  super- 
visors had  invested  $792,967  in  the  Allied  Architects.” 
(For  professional  services  in  drawing  plans  and  super- 
vising construction.) 

But  in  an  editorial  entitled  “General  Hospital 
Costs,”  the  Los  Angeles  Times  of  March  2 
stated : 

“The  incident  (the  discussion  of  the  supposed  total 
cost  of  a new  hospital  unit)  has  served  one  good  pur- 
pose in  bringing  to  public  attention  the  desirability 
of  such  expert  and  disinterested  services  as  are  being 
given  the  General  Hospital  project  by  the  board  of 
architects.”  (!! — Exclamation  marks  are  those  of  the 
editor.) 

Further,  in  the  Los  Ang'eles  Evening  Express 
of  February  25  appeared  the  following: 

“Bids  now  before  the  board  which  Supervisor 
Graves  declared  would  all  probably  be  rejected  tomor- 
row, follow: 

Cement  floor  finishing $ 378,030 

Doctors’  paging  equipment.... 413,610 

Refrigeration  198,997 

Lathing  and  plastering 1,430,696 

Ornamental  metal 80,998 

Kitchen  equipment 474,466 

Marble  and  tile 1,478,280 

Albarene  (a  form  of  soapstone  containing 

acid-resisting  qualities) 897,275 

Miscellaneous  equipment 694,482” 

5}s  ?j;  * 

Above  Estimates  and  Bids  on  Certain  Con- 
struction Costs  Most  Surprising. — The  above  are 
certainly  figures  of  astounding  proportions,  not 
the  least  of  the  above  list  being  the  bid  which  was 
submitted  on  a “paging  system  for  doctors” 
(the  doctors  of  the  attending  staff  practically 

being  innocent  in  this  matter  and  knowing  little 
or  nothing  concerning  the  elaborate  system  which 
seemingly  was  under  consideration  for  them). 

* * * 

Cost  of  the  Paging  System  in  the  Alameda 
County  Hospital. — When  one  remembers  that  in 
the  comparatively  new  Alameda  County  Hospital 
of  four  hundred  beds,  designed  by  the  late 

Doctor  Brodrick,  the  Holzer-Cabot  paging  sys- 
tem was  installed  at  a cost  of  “eleven  thousand 
dollars,  and  we  were  given  to  understand  that 
after  installing  initial  parts  of  the  system,  units 
would  be  cheaper  in  proportion”  (quotation 
from  a personal  letter  from  Doctor  Hamlin  of 
Oakland,  who  gave  gratuitous  service  as  super- 
intendent for  two  years  or  so)  one  must  neces- 
sarily be  somewhat  bewildered  at  the  bid  of 
$413,610  which  was  offered  on  the  equipment  of 
a doctors’  paging  system  for  this  new  building 
which  is  being  erected  for  the  Los  Angeles 


April,  1930 


EDITORIALS 


263 


County  Hospital.  It  may  be  taken  for  granted 
that  in  any  later  criticisms  by  the  public  press 
of  such  an  expenditure  that  the  majority  of  lay 
fellow  citizens  and  taxpayers  would  probably  feel 
that  the  said  expenditure  was  brought  about 
largely  through  request  or  demand  of  the  attend- 
ing physicians.  Yet  such  an  imputation  would 
be  most  unfair.  * * ^ 

Further  References  to  This  Subject  in  the 
Miscellany  Dcpartmoit  of  This  Issue. — Readers 
of  California  and  Western  Medicine  who  are 
interested  in  these  construction  costs  of  a new 
hospital  building  to  care  for  some  of  the  sick 
poor  of  Los  Angeles  County  may  find  further 
items  in  the  quotations  from  the  lay  press  which 
are  printed  in  the  Miscellany  department  of  this 
issue.*  A perusal  of  the  same  will  indicate  why 
the  editor  closed  last  month’s  editorial  in  Califor- 
nia and  Western  Medicine  with  the  following 
words : 

“We  must  all  agree  that  it  will  be  most  interesting 
to  note  the  different  influences  and  effects  which  this 
large  public  hospital,  now  in  course  of  construction 
for  the  care  of  indigent  citizens  of  Los  Angeles 
County,  will  have  on  the  lay  public,  and  on  private 
medical  practice,  both  in  and  beyond  the  geographical 
domain  of  that  county.” 


WILLIAM  TAYLOR  McARTHUR 
1866-1930 

Death  has  again  taken  from  our  midst  one  of 
the  ex-presidents  of  the  California  Medical 
Association.  Our  genial  colleague,  William  Tay- 
lor McArthur  of  Los  Angeles,  who  was  president 
of  our  state  medical  association  in  1927,  was 
called  from  his  earthly  work  on  March  11,  1930. 
For  several  years,  in  fact  even  during  his  term 
as  president  of  the  California  Medical  Associa- 
tion, Doctor  McArthur,  because  of  poor  health, 
had  found  it  necessary  to  safeguard  and  conserve 
his  energy,  but  this  fact,  known  to  his  friends, 
he  quietly  kept  from  others. 

Doctor  McArthur  was  an  excellent  type  of  the 
true  physician — able,  gentle,  kind,  generous  and 
thoughtful ; and  possessing  in  addition  to  all  these 
virtues,  a charming  and  lovable  personality  that 
endeared  him  to  all  who  had  the  good  fortune 
to  meet  and  to  know  him,  whether  in  the  relation- 
ship of  patient,  colleague,  neighbor,  friend  or 
fellow  citizen.  His  was  a life  of  quiet,  unostenta- 
tious uplift.  The  world  and  the  medical  pro- 
fession are  the  better  for  his  having  lived. 
Requiescat  in  pace. 

BOARD  OF  MEDICAL  EXAMINERS  OF  THE 
STATE  OF  CALIFORNIA— ITS  REPORT 

State  Examining  Board  Now  a Division  of  the 
Department  of  Professional  and  Vocational 
Standards. — The  first  annual  report  of  the  Cal- 
ifornia Board  of  Medical  Examiners  to  be 
brought  out  since  its  existence  as  a division  of 
the  Department  of  Professional  and  Vocational 
Standards  has  just  come  off  the  press. 

It  contains  much  information  worthy  of  con- 
sideration by  all  members  of  the  medical  profes- 

*  See  page  298  of  this  issue. 


sion  who  believe  in  accepting  their  share  of 
responsibility  in  the  maintenance  of  proper 
professional  standards  for  practitioners  of  the 
healing  art.  An  inspection  of  the  pages  of  this 
report  indicates  how  many  and  difficult  are  the 
problems  which  must  be  solved  by  the  colleagues 
who  accept  service  as  members  of  this  board. 

In  the  memories  of  older  members  of  the 
California  Medical  Association  are  recollections 
of  controversies  which  were  centered  around  our 
state  examining  board,  and  which  at  times  were 
carried  on  with  much  fierceness.  In  recent  years 
the  work  of  the  board  of  examiners  has  gone 
forward  so  smoothly  that  a goodly  number  of 
members  of  the  California  Medical  Association 
almost  forget  its  existence,  while  others  are  prone 
to  think  that  because  of  the  absence  of  newspaper 
publicity  it  must  be  side-stepping  its  responsi- 
bilities. Such  is  not  the  case  however.  It  may 
be  said  that  our  examining  board  has  never  ren- 
dered more  efficient  or  conscientious  service  than 
in  recent  years,  and  its  members  deserve  and 
have  the  thanks  of  the  medical  profession  for 
their  loyal  and  altruistic  efforts  to  maintain  proper 
standards  and  to  carry  out  the  various  provisions 
of  the  state  medical  practice  act  which  have 
been  provided  to  better  safeguard  the  public 
health.  * * * 

Why  Should  Not  This  Annual  Report  Be 
Printed  as  a Part  of  the  Yearly  Directory? — 
Members  of  the  California  Medical  Association 
who  are  interested  should  write  to  the  California 
Board  of  Medical  Examiners,  623  State  Building, 
San  Francisco,  and  request  a copy  of  this  report. 
Which  suggests  the  thought  that  inasmuch  as 
every  California  physician  must  pay  an  annual 
licensure  tax,  that  this  annual  report  might  well 
be  printed  in  next  year’s  annual  directory,  a copy 
of  which  directory  is  sent  to  every  licensed  phy- 
sician. The  members  of  the  medical  profession 
are  not  only  entitled,  but  should  know  what  are 
the  activities  and  problems  of  this  examining 
board;  and  since  that  board  is  supported  not  by 
funds  from  general  taxation  sources  but  by  a 
special  levy  on  members  of  the  profession,  no 
legitimate  objection  should  be  raised  to  such  use 
of  printers’  ink  by  either  the  director  of  profes- 
sional and  vocational  standards,  or  by  any  other 
state  executive  or  executives.  If  such  objection 
is  raised  because  of  presumable  legal  obstacles, 
then  a proper  enabling  act  should  be  submitted  to 
the  next  legislature.  In  an  effort  of  this  kind,  the 
proper  officers  of  the  California  Medical  Asso- 
ciation would  no  doubt  be  glad  to  cooperate. 

^ ^ 

Excerpts  from  the  Report  Printed  in  This 
Issue. — In  the  California  Board  of  Medical  Ex- 
aminers column  in  this  issue  are  printed  some 
excerpts  which  indicate  how  worth  while  this 
information  is  and  especially  so  if  the  annual 
report  of  the  board  could  reach  every  physician 
as  a part  of  his  yearly  directory.  It  is  hoped  that 
the  Board  of  Medical  Examiners  will  see  fit  to 
consider,  and  if  possible  to  adopt  the  suggestions 
here  made. 


MEDICINE  TODAY 

Current  comment  on  medical  progress,  discussion  of  selected  topics  from  recent  books  or  periodic  literature,  by 
contributing  members.  Every  member  of  the  California  Medical  Association  is  invited  to  submit  discussion 
suitable  for  publication  in  this  department.  No  discussion  should  be  over  five  hundred  words  in  length. 


Allergy 

A Definition. — That  great  confusion  exists  in 
regard  to  the  use  of  the  term  “allergy”  is 
shown  by  the  fact  that  the  editors  of  the  new 
Journal  of  Allergy,  the  first  number  of  which 
appeared  in  November  1929,  have  felt  it  neces- 
sary to  define  the  sense  in  which  the  term  is  used 
in  the  title  of  their  journal.  When  von  Pirquet 
and  Schick1  coined  the  word  “allergy”  (alios, 
“altered”;  ergia,  “reactivity”),  they  had  in  mind 
the  use  of  a comprehensive  term  to  cover  various 
manifestations  of  hypersensitiveness  observed  in 
human  beings,  but  more  especially  the  altered 
reactions  in  man,  giving  rise  to  a more  rapid 
appearance  of  the  symptoms  of  serum  disease 
following  a second  injection  of  horse  serum. 
Until  comparatively  recent  years,  the  term  has 
been  employed  interchangeably  with  anaphylaxis, 
such  phenomena  as  serum  disease,  asthma,  hay 
fever  and  food  and  drug  idiosyncrasies  being 
referred  to  as  allergic  or  anaphylactic  manifesta- 
tions of  disease.  Indeed  so  loose  had  become  its 
employment  that  allergy,  as  a descriptive  desig- 
nation of  a pathologic  state,  ceased  to  possess  an 
established  meaning  in  scientific  usage. 

The  editors  of  the  Journal  of  Allergy  define 
the  term  as  a condition  of  “specific  hypersensi- 
tiveness exclusive  of  anaphylaxis  in  lower  ani- 
mals.” To  the  physician  who  has  not  followed 
the  recent  clinical  and  immunologic  studies  of  this 
subject,  the  reasons  for  such  a definition  may  not 
be  obvious,  and  may  require  further  elaboration. 

That  the  type  of  hypersensitiveness  which  ap- 
pears spontaneously  in  human  beings  (asthma, 
hay  fever,  and  certain  urticarias  and  eczemas)  is 
remarkably  similar  to  experimental  anaphylaxis 
in  animals  was  early  recognized,2  3 but  the  evi- 
dence that  the  two  phenomena  have  fundamental 
differences  has  come  only  from  recent  immuno- 
logic studies. 

The  term  “anaphylaxis”  has  come  to  have  a 
special  meaning  and  should  be  restricted  to  the 
condition  of  induced  hypersensitiveness  produced 
in  animals  by  definitely  antigenic  substances.  The 
mechanism  of  anaphylactic  shock  always  implies 
the  interaction  of  a specific  antibody-antigen  com- 
bination. The  anaphylactic  antibodies  are  precipi- 
tins.  The  idea  that  the  phenomena  now  desig- 
nated as  allergic  are  also  the  result  of  an  antibody- 
antigen  reaction  originated  in  the  theory  of  von 
Pirquet  and  Schick  regarding  serum  allergy,  a 
view  which,  in  point  of  time,  actually  preceded 
the  discovery  of  the  mechanism  of  anaphylaxis. 
Subsequent  immunologic  studies  have  shown,  how- 
264 


ever,  that  anaphylactic  antibodies  are  not  present 
in  the  conditions  usually  classified  under  allergy, 
namely,  the  asthma-hay  fever-eczema  group,  cer- 
tain food  and  drug  idiosyncrasies,  serum  disease 
and  tuberculin  hypersensitiveness.  Immunologi- 
cally  these  conditions  are  characterized  by  the 
presence  in  the  blood  of  some  of  them  of  a skin- 
sensitizing  antibody  designated  by  some  workers 
as  all er gin  4 and  by  others  as  reagin.5  This  medi- 
ating, blood-borne  body  is  not  a true  antibody  in 
the  sense  that  it  is  not  produced  under  the  stimu- 
lation of  an  antigen.  By  immunologic  criteria, 
therefore,  allergy  and  anaphylaxis  are  very  dis- 
tinct phenomena. 

Of  the  allergic  conditions  observed  in  man, 
asthma,  hay  fever  and  certain  eczemas  are  strictly 
subject  to  hereditary  influences,  while  others, 
serum  disease,  the  tuberculin  type  of  bacterial 
allergy  and  dermatitis  venenata  are  not.  To  the 
first  group  of  allergic  diseases  Coca 6 has  given 
the  designation  “atopy”  (atopia,  “a  strange  dis- 
ease”). The  propriety  of  classifying  as  allergic, 
idiosyncrasy  to  substances  of  definite  chemical 
nature,  such  as  drugs  or  the  little  understood 
hypersensitiveness  of  the  individual  to  other 
forms  of  bacterial  protein  is  still  a moot  question. 

Finally,  the  definition  of  allergy  and  its  impor- 
tance in  the  etiology  of  disease  will  be  much 
clarified  by  adopting,  whenever  possible,  the 
postulates  of  Cooke  7 before  assuming  or  prov- 
ing that  any  protein  or  other  chemical  substance 
is  a causative  factor  in  a case  of  hypersensitive- 
ness. In  brief  these  are:  first,  a history  of  con- 
tact by  the  individual  in  some  way  with  the  sus- 
pected substance  in  order  to  permit  it  to  act  as 
an  etiologic  factor ; second,  the  demonstration  of 
sensitization  by  a positive  local  reaction,  cutane- 
ous, intradermal  or  ophthalmic;  and  third,  the 
reproduction  at  will  of  the  original  allergic  mani- 
festation on  introduction  of  the  substance,  either 
by  inhalation,  ingestion,  or  subcutaneous  injection. 

Samuel  H.  Hurwitz, 

San  Francisco. 

REFERENCES 

1.  Von  Pirquet,  C.  E.,  and  Schick,  B.:  Munchen. 
Med.  Wchnschr.,  1906,  53,  66. 

2.  Wolff-Eisner,  A.:  Das  Heufieber:  sein  Wesen 
und  seine  Behandlung,  Munchen,  1906. 

3.  Meltzer,  S.  J.:  Bronchial  Asthma  as  a Phe- 
nomenon of  Anaphylaxis,  J.  A.  M.  A.,  1910,  55,  1021. 

4.  Kolmer,  John  A.:  A Critical  Review  of  the 
Mechanism  and  Terminology  of  Allergy,  J.  Lab.  and 
Clin.  Med.,  1928,  13,  905. 

5.  Coca,  A.  F. : Essentials  of  Immunology  for  Medi- 
cal Students.  The  Williams  and  Williams  Company, 
Baltimore,  1925,  p.  74. 


April,  1930 


MEDICINE  TODAY 


265 


6.  Coca,  A.  F.,  and  Cooke,  A.  R. : J.  Immunol., 
1923,  8,  163. 

7.  Cooke,  Robert  A.:  Bronchial  Asthma,  Practice 
of  Medicine,  edited  by  Frederick  Tice,  W.  F.  Prior  & 
Company,  Hagerstown,  Maryland,  1921,  p.  493. 

Syphilology* 

Nitritoid  Reactions,  Immediate  and  De- 
layed— A Technique  Reducing  the  Re- 
peated Use  of  Control  Methods. — A variety  of 
techniques  for  the  control  of  immediate  and 
delayed  nitritoid  reactions  following  the  adminis- 
tration of  arsphenamin  or  its  derivatives  has  long 
been  available  and  well  known  to  all  syphilolo- 
gists.  The  Bezredka,  the  injection  of  atropin  sul- 
phate subcutaneously  and  their  combinations  and 
modifications  are  methods  in  common  use  by  all 
of  us.  The  application  of  these  methods  in  an 
institution  or  private  practice  is  frequently  a 
source  of  time  consumption  for  both  the 
patient  and  physician,  and  although  extremely 
practical,  represents  a technical  obstacle  which 
could  be  agreeably  dispensed  with.  It  seems  un- 
necessary in  this  report  to  enter  into  a discussion 
of  such  methods,  for  the  literature  contains  many 
references  which  are  of  unusual  interest  and 
bring  the  subject  up  to  date.  It  is  my  desire  at 
this  time  merely  to  offer  a method  which,  in  our 
hands,  has  proved  of  value.  In  dealing  with  a 
large  group  of  patients,  time-consuming  treatment 
is  at  times  a difficult  problem.  Experiments,  there- 
fore, were  conducted  in  an  effort  to  eliminate  this 
elaborate  method  and  to  make  possible  a return 
of  the  patient  to  the  usual  routine  methods  of 
treatment  without  evidence  of  reaction. 

In  a few  instances  we  observed  that  patients 
regularly  receiving  the  Bezredka  technique  did 
not  act  unfavorably  when  such  technique  was 
accidentally  omitted  during  the  course  of 
treatment.  This  observation  led  to  a system- 
atic attempt  to  determine  the  possibility  of 
gradually  “desensitizing”  (if  such  a term  could 
be  used)  all  patients  under  treatment  with  the 
modified  Bezredka  technique.  The  method  which 
has  been  in  use  in  this  hospital  could  well  be 
termed  “a  modified  Bezredka  technique,”  for  the 
principles  of  that  technique  are  Eere  embodied 
in  combination  with  the  subcutaneous  injection 
of  atropin  sulphate,  after  the  method  described 
by  Stokes.  The  Bezredka  technique  largely  con- 
sists of  time  intervals  between  an  injection  of 
one-tenth  of  the  total  dose  of  arsphenamin  or  its 
derivatives,  and  a second  injection  of  the  re- 
mainder of  the  total  dose.  Stokes  advised  the  use 
of  the  subcutaneous  injection  of  atropin  sulphate 
preceding  the  first  injection  of  arsphenamin  or 
its  derivatives  by  twenty  minutes.  The  method 
here  offered  is  based  upon  a gradual  diminution 
of  those  time  intervals,  and  also  of  the  amounts 
of  atropin  sulphate,  as  well  as  an  increase  in  the 
amount  of  the  arsphenamin  or  its  derivatives 


given  at  the  first  injection  until  the  time  inter- 
vals and  the  atropin  sulphate  injections  are  elimi- 
nated and  the  entire  dose  of  the  arsphenamin  or 
its  derivatives  is  given  at  one  time.  We  found 
that  patients  reacting  to  such  drugs  could  readily 
be  placed  on  such  a “cut  down”  method,  and  after 
their  sixth  treatment  tolerated  the  injection  of 
the  arsphenamin  or  its  derivatives  in  full  dosage 
at  one  time.  The  first  treatment  given  a patient 
placed  upon  a modified  Bezredka  technique  con- 
sists of  the  subcutaneous  injection  of  atropin  sul- 
phate in  doses  of  1/150  grain  to  1/75  grain, 
depending  upon  the  body  weight,  and  precedes 
the  first  injection  of  the  arsphenamin  or  its  de- 
rivatives by  twenty  minutes.  The  first  injection 
of  the  latter  consists  of  one-tenth  of  the  total 
dose,  which  likewise  is  dependent  upon  body 
weight.  A second  time  interval  of  twenty  minutes 
is  allowed  between  this  injection  and  the  last  in- 
jection of  the  arsphenamin  or  its  derivatives. 
The  latter  consists  of  the  remainder  of  the  total 
dose,  and  is  given  at  one  time.  This  technique 
is  efficient  in  controlling  reactions  by  both  the 
intravenous  and  intramuscular  routes  of  admin- 
istration. While  using  the  technique  described 
by  Stokes  for  the  control  of  nitritoid  reactions 
following  intramuscular  medication,  we  found 
that  the  placing  of  the  second  injection  of  the 
drug  in  exactly  the  site  of  the  first  is  unneces- 
sary. Results  are  the  same,  without  regard  to 
which  buttock  receives  the  second  injection.  The 
“cut  down”  method  resolves  itself  into  the  giving 
of  six  treatments  at  weekly  intervals,  with  the 
factors  noted  above  so  arranged  as  to  eliminate 
them  by  the  seventh  injection.  The  time  intervals 
are  diminished  after  the  following  fashion.  At 
the  first  treatment  the  interval  is  twenty  minutes ; 
the  second,  fifteen  minutes;  the  third  and  fourth, 
ten  minutes;  the  fifth  and  sixth,  five  minutes. 
The  injections  of  atropin  sulphate  are  diminished 
from  1/75  grain  for  the  first,  second  and  third 
treatments  to  1/150  grain  for  the  fourth,  fifth 
and  sixth  treatments.  The  first  arsphenamin  in- 
jection is  increased  from  one-tenth  of  the  total 
dose  for  the  first  and  second  treatments  to  one- 
fourth  for  the  third  and  fourth,  and  one-half  for 
the  fifth  and  sixth.  By  the  seventh  treatment  the 
patient  is  able  to  receive  the  entire  dose  of  the 
arsphenamin  or  its  derivatives  without  prepara- 
tion, and  can  continue  from  then  on  in  a normal 
and  routine  fashion. 

A total  of  twenty-five  cases  giving  evidence  of 
nitritoid  reactions,  either  immediate  or  delayed, 
have  been  observed  for  a period  of  time  sufficient 
to  render  them  reactionless  by  the  method  de- 
scribed above.  Eight  of  these  cases  were  "“cut 
down”  in  four  treatments,  but  three  of  them  de- 
veloped reactions  upon  the  institution  of  routine 
methods.  The  remainder,  or  seventeen  cases,  were 
carried  through  the  sixth  treatment,  and  there- 
after failed  to  develop  reactions. 

Stanley  O.  Chambers, 

Los  Angeles. 


* From  the  Los  Angeles  General  Hospital. 


266 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  + 


Tuberculosis 

Points  on  the  Value,  Safety,  and  Methods 
of  Giving  B.  C.  G.  for  Protective  Immuni- 
zation Against  Tuberculosis. — Few  topics  in 
the  field  of  tuberculosis  have  assumed  so  much 
prominence  as  the  present  discussion  on  the  value 
and  safety  of  Professor  Calmette’s  prophylactic 
immunization  method  against  tuberculosis. 

The  B.  C.  G.  vaccine  is  the  discovery  or  the 
production  of  Professor  Calmette,  the  assistant 
director  of  the  Pasteur  Institute  in  Paris,  and 
his  coworker  Guerin,  a veterinary  surgeon.  The 
Bacillus  of  Calmette  and  Guerin  is  abbreviated 
“B.  C.  G.”  It  consists  of  living,  slightly  virulent 
tubercle  bacilli  of  the  bovine  type,  having  been 
attenuated  by  being  cultured  on  an  ox-bile-gly- 
cerin medium  for  the  past  twenty-one  years. 

It  is  pointed  out  that  from  35  to  90  per  cent 
of  children  reaching  the  age  of  puberty  react  to 
tuberculin,  and  that  infants  are  born  with  no  ap- 
preciable resistance  to  the  infection.  In  many 
instances,  contact  with  tubercle  bacilli  leads  to 
progressive  disease,  ending  with  an  infection 
large  and  severe  enough  to  produce  death.  On 
the  other  hand,  apparently,  if  the  infant  comes 
in  contact  with  only  a few  microorganisms  and 
at  infrequent  intervals,  it  escapes  serious  conse- 
quences. The  latter  type  of  case  has  apparently 
been  successfully  immunized  against  tuberculosis, 
due  to  the  fact  that  he  has  never  been  over- 
whelmed with  a host  of  virulent  organisms. 

According  to  Calmette,  an  infection  of  mild 
nature  is  very  desirable.  The  excessive  infections 
must  be  avoided  and  the  intervals  of  periodic  im- 
plantation well  regulated.  The  microorganism 
used  for  producing  mild  infection  should  be  of 
low  virulence.  Calmette  is  supported  by  a large 
following  in  his  belief  that  the  attenuated  B.  C.  G., 
properly  used,  is  capable  of  producing  this  de- 
sired immunity.  Believing  that  most  of  the  in- 
fections in  children  take  place  by  the  digestive 
route  for  the  reason  that  the  intestinal  mucosa 
of  the  infant  during  the  first  ten  days  of  life  ab- 
sorbs the  microorganisms  much  more  readily 
than  at  any  other  later  period,  Calmette’s  vacci- 
nations have  been  carried  on  in  most  cases  by 
feeding  the  microorganisms  to  newborn  babies. 
Some  were  vaccinated  by  the  subcutaneous  or  the 
intracutaneous  route. 

In  his  series  of  cases,  Calmette  claims  that  not 
a single  fatality  has  occurred  in  infants  vaccinated 
with  B.  C.  G.  In  some  earlier  publications,  he 
claimed  that  no  tuberculous  changes  were  pro- 
duced by  the  vaccination  of  guinea-pigs.  In  later 
publications,  however,  he  admits  that  tuberculous 
lesions  can  be  set  up,  but  he  adds  that  in  due  time 
the  lesions  heal  completely.  He  states  that  no 
matter  what  method  of  inoculation  was  used,  pro- 
gressive tuberculosis  was  never  produced  by  the 
living  B.  C.  G. 

On  the  other  hand,  a number  of  cases  bave 
been  reported  by  other  men  in  which  death  from 
tuberculosis  occurred  following  vaccination,  and 
the  deaths  have  been  attributed  to  infection  by 
the  B.  C.  G.  Petroff  reports  that  apparently  the 
bacilli  of  tuberculosis  may  assume  two  forms. 


In  one  form  they  are  comparatively  harmless, 
whereas  the  other  form  may  be  very  virulent. 
This  difference  may  account  for  the  unsatisfac- 
tory results  which  have  been  reported.  A vaccine 
made  from  what  was  supposed  to  be  the  harm- 
less tubercle  bacilli  would  have  an  unfortunate 
effect  on  the  subject  vaccinated  if  the  bacilli 
suddenly  changed  to  the  virulent  form. 

Kereszturi  and  Park,  in  reporting  upon  their 
experience  with  B.  C.  G.,  state  that  one  death 
occurred  in  a baby  whose  mother  died  of  miliary 
tuberculosis  soon  after  the  birth  of  the  child,  and 
it  was  thought  that  the  child  may  have  picked  up 
a blood-stream  infection  through  the  placenta. 

In  general  it  is  found  that  oral  B.  C.  G.  vacci- 
nation is  relatively  simple,  quite  harmless,  and 
gives  some  immunity.  Due  to  the  facts  that  the 
dosage  of  the  vaccine  by  the  oral  route  cannot 
be  controlled  very  well  and  that  the  oral  admin- 
istration is  good  only  in  the  newborn,  it  is  be- 
lieved that  the  subcutaneous  or  the  intracutaneous 
injection  of  the  B.  C.  G.  should  be  superior  to 
the  oral  method. 

Keeping  in  mind  the  merits  of  this  treatment 
and  recognizing  that  it  is  not  foolproof,  a safe 
course  should  be  followed  by  using  the  vaccine 
with  extreme  care  and  considering  that  indis- 
criminate use  of  the  B.  C.  G.  is  probably  not 
justifiable  at  the  present  time. 

W.  E.  Macpherson, 

Loma  Linda. 


University  of  California  Hospital  to  Adopt  Most 
Modern  X-Ray  Film  Storage. — In  order  to  further 
perfect  methods  of  storing  x-ray  film  and  to  make  its 
x-ray  rooms  and  storage  vaults  as  safe  and  as  mod- 
ern in  equipment  as  any  in  the  country,  the  Univer- 
sity of  California  Hospital  has  prepared  plans  for 
additions  and  changes  to  cost  $7500. 

In  making  known  this  program  recently,  Director 
Lionel  S.  Schmitt  stated  that  the  National  Board  of 
Fire  Underwriters  has  given  its  unqualified  approval 
of  the  plans,  and  that  they  have  been  submitted  to  the 
San  Francisco  fire  department  officials  as  well. 

The  University  Hospital  already  maintains  a sep- 
arate underground  vault  outside  of  the  hospital  build- 
ing proper,  the  effectiveness  of  which  was  proven 
during  the  fire  of  a few  months  ago.  But  the  addi- 
tional changes  will  not  only  add  further  safeguards  to 
this  vault,  but  will  make  it  impossible  for  fires  to 
occur  in  the  x-ray  viewing  room  as  was  the  case  this 
winter. 

First  of  all  the  concrete  walls  of  the  vault  will  be 
reinforced  with  additional  layers  of  fireproof  material, 
and  the  stored  films  will  be  placed  in  small  steel  con- 
tainers on  steel  racks.  Over  the  top  of  these  racks 
will  be  an  automatic  deluge  water  system  so  designed 
that  a sudden  rise  in  the  room  temperature,  about 
fifteen  degrees  in  a minute,  will  set  them  going  and 
promptly  flood  the  room. 

Double  fireproof  doors  will  be  installed,  one 
operated  by  an  automatic  check  and  the  other  con- 
nected with  the  sprinkler  system  in  such  a way  that 
simultaneous  to  the  starting  of  the  sprinklers,  the 
door,  if  not  already  closed,  is  thrust  shut. 

In  addition  to  these  changes  in  the  design  of  the 
vault  itself,  the  hospital  has  adopted  a noninfiammable 
film  for  all  future  x-ray  photography,  which  will  pre- 
vent ignition  of  film  in  viewing  machines.  Finally,  a 
limit  has  been  set  on  the  length  of  storage  of  inflam- 
mable film  now  being  kept  for  record.  Each  year  the 
oldest  films  will  be  sorted  out  and  thrown  away;  so 
that  soon,  even  within  the  fireproof  vault,  there  will 
be  no  inflammable  film  kept. — U.  C.  Clip  Sheet. 


Program 

The  Fifty-Ninth  Annual  Session 

of  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

To  be  held  at 

DEL  MONTE,  CALIFORNIA,  APRIL  28-MAY  1,  1930 

OFFICERS  AND  COMMITTEES,  1930 

GENERAL  OFFICERS 

Morton  R.  Gibbons,  San  Francisco,  President 
Lyell  C.  Kinney,  San  Diego,  President-Elect 
Edward  M.  Pallette,  Los  Angeles,  Speaker  of  House  of  Delegates 
John  H.  Graves,  San  Francisco,  Vice-Speaker  of  House  of  Delegates 
Emma  W.  Pope,  San  Francisco,  Secretary-Treasurer  and  Associate  Editor 
George  H.  Kress,  Los  Angeles,  Editor 
Hartley  F.  Peart,  San  Francisco,  General  Counsel 
Hubert  T.  Morrow,  Los  Angeles,  Associate  General  Counsel 


COUNCI  LORS 
First  District 

Mott  H.  Arnold,  San  Diego  (1932) 

Imperial,  Orange,  Riverside,  and  San  Diego  Counties 

Second  District 

William  Duffield,  Los  Angeles  (1930) 

Los  Angeles  County 

Third  District 

Gayle  G.  Moseley,  Redlands  (1931) 

Kern,  San  Bernardino,  San  Luis  Obispo,  Santa  Barbara 
and  Ventura  Counties 

Fourth  District 

Fred  R.  De  Lappe,  Modesto  (1932) 

Calaveras,  Fresno,  Inyo,  Kings,  Madera,  Mariposa, 
Merced,  Mono,  San  Joaquin,  Stanislaus,  Tulare 
and  Tuolumne  Counties 

Fifth  District 

Alfred  L.  Phillips,  Santa  Cruz  (1930) 

Monterey,  San  Benito,  San  Mateo,  Santa  Clara 
and  Santa  Cruz  Counties 

Sixth  District 

Walter  B.  Coffey,  San  Francisco  (1931) 

San  Francisco  County 

Seventh  District 

Oliver  D.  Hamlin,  Oakland  (1932) 

Alameda  and  Contra  Costa  Counties 

Eighth  District 

Junius  B.  Harris,  Sacramento  (1930) 

Alpine,  Amador,  Butte,  Colusa,  El  Dorado,  Glenn,  Lassen, 
Modoc,  Nevada,  Placer,  Plumas,  Sacramento,  Shasta, 
Sierra,  Sutter,  Tehama,  Yolo,  and  Yuba  Counties 

Ninth  District 

Henry  S.  Rogers,  Petaluma  (1931) 

Del  Norte,  Humboldt,  Lake,  Marin,  Mendocino,  Napa, 
Siskiyou,  Solano,  Sonoma,  and  Trinity  Counties 
Councilors-at  - Large 
George  G.  Hunter,  Los  Angeles  (1932) 

Ruggles  A.  Cushman,  Santa  Ana  (1930) 

George  H.  Kress,  Los  Angeles  (1931) 

Joseph  Catton,  San  Francisco  (1932) 

T.  Henshaw  Kelly,  San  Francisco  (1930) 

Robert  A.  Peers,  Colfax  (1931) 


DELEGATES  AND  ALTERNATES  TO  A.  M.  A. 


Delegates 
Dudley  Smith 
Oakland 
Albert  Soiland 
Los  Angeles 
Fitch  C.  E.  Mattison 
Pasadena 
Victor  Vecki 
San  Francisco 
Percy  T.  Magan 
Los  Angeles 
Junius  B.  Harris 
Sacramento 


(1930-1931) 

(1930-1931) 

(1930-1931) 

(1930) 

(1930) 

(1930) 


Alternates 

Joseph  Catton 
San  Francisco 
William  H.  Gilbert 
Los  Angeles 
James  F.  Percy 
Los  Angeles 
William  E.  Stevens 
San  Francisco 
Charles  D.  Lockwood 
Pasadena 
John  H. Shephard 
San  Jose 


STANDING  COMMITTEES 
Executive  Committee 


The  President,  the  President-Elect,  the  Speaker  of  the 
House  of  Delegates,  the  Secretary-Treasurer,  the  Editor, 
and  the  Chairman  of  the  Auditing  Committee.  (Com- 
mittee Chairman,  T.  Henshaw  Kelly;  Secretary,  Dr. 
Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego .1932 

William  Bowman  (Chairman),  Los  Angeles 1931 

George  H.  Kress,  Los  Angeles 1930 


Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach 1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals.  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles. .. 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands .....1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco .1932 

•William  T.  Mac  Arthur,  Los  Angeles 1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education  and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena... 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 

Committee  on  Medical  Defense 

George  G.  Reinle  (Chairman),  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Mott  H.  Arnold,  San  Diego 1930 

Committee  on  Membership  and  Organization 

Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks  (Chairman),  San  Francisco .1931 

Jesse  W.  Barnes,  Stockton 1930 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Charles  D.  Ball  (Chairman),  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz..... 1931 

Emmet  Rixford,  San  Francisco 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 1932 

Percy  T.  Magan  (Chairman),  Los  Angeles 1931 

Frederick  F-  Gundrum,  Sacramento ...1930 

The  Secretary ..  Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

Joseph  Catton,  San  Francisco 1930 

The  President - Ex-officio 

The  President-Elect - Ex-officio 

COMMITTEE  ON  SCIENTIFIC  PROGRAM 
Emma  W.  Pope,  Chairman 

Karl  L.  Schaupp  (1932)  Ernest  H.  Falconer  (1930) 

San  Francisco  San  Francisco 

Lemuel  P.  Adams  (1931)  Sumner  Everingham  (1930) 

Oakland  Oakland 

Robert  V.  Day  (1930)  Los  Angeles 


COMMITTEE  ON  ARRANGEMENTS 


T.  Henshaw  Kelly,  Chairman 


Joseph  Catton 
San  Francisco 
William  M.  Gratiot 
Monterey 
Garth  Parker 
Salinas 


William  H.  Bingaman 
Salinas 

Alfred  Phillips 
Santa  Cruz 
The  Secretary 
Ex-officio 


* Deceased. 


267 


268 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4- 


PKED  D.  WEIDMAN,  M.  D. 
Professor  of  Dermatology,  University  of 
Pennsylvania 


McKIM  MARRIOTT,  M.  D. 

Dean  and  Professor  of  Pediatrics,  Washington 
University,  St.  Louis 


A.  U.  DESJARDINS,  M.  D. 
Assistant  Professor  of  Radiology 
Mayo  Clinic 


GEORGE  M.  CURTIS,  M.  D. 
Associate  Professor  of  Surgery 
The  University  of  Chicago 


Guest  Speakers  at  the  59th  Annual  Session,  California  Medical  Association 


April,  1930 


PROGRAM — FIFTY-NINTH  ANNUAL  SESSION 


269 


1930  HOUSE  OF  DELEGATES 

Membership 


OFFICERS  (Ex-officio  Members) 

Morton  R.  Gibbons,  San  Francisco President 

Lyell  C.  Kinney,  San  Diego President-Elect 

Edward  M.  Pallette,  Los  Angeles 

Speaker  of  House  of  Delegates 

John  H.  Graves,  San  Francisco 

Vice-Speaker  of  House  of  Delegates 

Secretary-Treasurer  and  Editors 

Councilors 

Mott  H.  Arnold,  San  Diego  (1932) First  District 

William  Duffield,  Los  Angeles  (1930) Second  District 

Gayle  G.  Moseley,  Redlands  (1931) Third  District 

Fred  R.  De  Lappe,  Modesto  (1932)...  ..Fourth  District 

Alfred  L.  Phillips,  Santa  Cruz  (1930) Fifth  District 

Walter  B.  Coffey,  San  Francisco  (1931) Sixth  District 

Oliver  D.  Hamlin,  Oakland  (1932) Seventh  District 

Junius  B.  Harris,  Sacramento  (1930) Eighth  District 

Henry  S.  Rogers,  Petaluma  (1931) Ninth  District 

George  G.  Hunter,  Los  Angeles  (1932) At  Large 

Ruggles  A.  Cushman,  Santa  Ana  (1930)  At  Large 

George  H.  Kress,  Los  Angeles  (1931) At  Large 

Joseph  Catton,  San  Francisco  (1932) At  Large 

T.  Henshaw  Kelly,  San  Francisco  (1930).  At  Large 

Robert  A.  Peers,  Colfax  (1931) At  Large 


DELEGATES 


ALTERNATES 


DELEGATES 

L.  P.  Adams 
Chesley  Bush 
Daniel  Crosby 

C.  A.  Dukes 
E.  N.  Ewer 
R.  A.  Glenn 
Gertrude  Moore 
G.  G.  Reinle 

W.  H.  Irwin 

J.  P.  Schell 
U.  S.  Abbott 

D.  I.  Aller 
C.  O.  Mitchell 
C.  D.  Collins 

Etta  Lund 
Orris  Myers 


ALTERNATES 
Alameda  County  (9) 

C.  L.  Abbott 
F.  S.  Baxter 
W.  G.  Donald 
J.  A.  Dougherty 
W.  F.  Holcomb 

S.  A.  Jelte 

T.  C.  Lawson 
George  McClure 
Hobart  Rogers 

Butte  County  (1) 

J.  O.  Chiapella 
Contra  Costa  County  (1) 

J.  F.  Feldman 
Fresno  County  (3) 

A.  E.  Anderson 
W.  F.  Stein 
C.  M.  Vanderburgh 
Glenn  County  (1) 

Humboldt  County  (1) 

Charles  C.  Falk 


Eugene  Le  Baron 
F.  J.  Gundry 


G.  R.  Fortson 

Los  An 

Walter  Bayley 
W.  B.  Bowman 
Harry  V.  Brown 
Katherine  Close 
Foster  K.  Collins 
D.  M.  Ghrist 
F.  C.  E.  Mattison 
*W.  T.  McArthur 
James  F.  Percy 
F.  M.  Pottenger 

B.  O.  Raulston 
John  C.  Ruddock 
F.  B.  Settle 
Eleanor  C.  Seymour 
Leroy  B.  Sherry 

R.  G.  Taylor 
Packard  Thurber 

S.  M.  Alter 
John  V.  Barrow 
Walter  P.  Bliss 
R.  S.  Cummings 
Robert  V.  Day 
George  Dock 
Walter  L.  Huggins 
William  W.  Hutchinson 
Louis  Josephs 

W.  H.  Kiger 
Joseph  M.  King 
Percy  T.  Magan 
William  R.  Molony 

C.  E.  Phillips 
C.  W.  Rand 
Harlan  Shoemaker 
Henry  Snure 

C.  G.  Toland 
B.  Von  Wedelstaedt 

* Deceased. 


Imperial  County  (1) 

W.  W.  Apple 
Kern  County  (1) 

J.  M.  Kirby 

Lassen-Plumas  County  (1) 

Dan  Coll 


geles  County  (36) 
Ralph  Byrnes 
Montague  Cleeves 
R.  M.  Dodsworth 
Scott  D.  Gleeten 
Joseph  Goldstein 

G.  D.  Maner 
Wallace  J.  Miller 
E.  J.  Moffitt 
William  J.  Norris 
R.  E.  Ramsay 

A.  M.  Rogers 
W.  T.  Rothwell 
A.  J.  Scott 
C.  G.  Stadfleld 
Philip  Stephens 
W.  B.  Thompson 

H.  G.  Westphal 
R.  W.  Wilcox 
Harold  Witherbee 

I.  R.  Bancroft 
Fred  B.  Clarke 
Carl  R.  Howson 
John  C.  Irwin 
H.  G.  Levengood 
T.  C.  Lyster 

H.  G.  McNeil 

R.  P.  McReynolds 
A.  J.  Murrieta 
Thomas  C.  Myers 
John  P.  Nuttall 

S.  N.  Pierce 

J.  E.  Pottenger 
Albert  Soiland 
J.  K.  Swindt 
H.  B.  Tebbetts 
Neal  N.  Wood 


Marin  County  (1) 

Frank  M.  Cannon  John  H.  Kuser 

Mendocino  County  (1) 

Royal  Scudder  L.  K.  Van  Allen 


Merced  County  (1) 

J.  L.  Mudd 


H.  Kylberg 

Monterey  County  (1) 

W.  H.  Bingaman  C.  H.  Lowell 

Napa  County  (1) 

H.  R.  Coleman  George  I.  Dawson 

Orange  County  (2) 

Dexter  R.  Ball  George  M.  Tralle 

Harry  E.  Zaiser  William  S.  Wallace 

Placer  County  ( 1 ) 

C.  Conrad  Briner  Carl  P.  Jones 


Thomas  A.  Card 


Riverside  County  (1) 

William  R.  Dorr 


Sacramento  County  (3) 

W.  H.  Pope  W.  A.  Beattie 

Hans  F.  Schluter  G.  Parker  Dillon 

E.  W.  Beach  W.  K.  Lindsay 

San  Benito  County  (1) 

R.  L.  Hull  E.  E.  McKay 

San  Bernardino  County  (3) 

F.  F.  Abbott  S.  B.  Richards 

W.  F.  Pritchard  A.  T.  Gage 

San  Diego  County  (5) 

F.  L.  Macpherson  A.  J.  Thornton 

T.  O.  Burger  George  B.  Worthington 

C.  E.  Rees  L.  W.  Zochert 

B.  J.  O’Neill  E.  S.  Coburn 

W.  H.  Geistweit,  Jr.  L.  H.  Redelings 

San  Francisco  County  (19) 


Philip  H.  Arnot 
Elbridge  J.  Best 
Walter  W.  Boardman 
LeRoy  Brooks 
Harold  Brunn 
Edward  C.  Bull 
William  E.  Chamberlain 
Howard  W.  Fleming 
Henry  W.  Gibbons 
Alexander  S.  Keenan 
William  J.  Kerr 
Alson  R.  Kilgore 
Eugene  S.  Kilgore 
Langley  Porter 
George  K.  Rhodes 
Henry  A.  L.  Ryfkogel 
Karl  L.  Schaupp 
William  E.  Stevens 
John  H.  Woolsey 


J.  W.  Barnes 
B.  J.  Powell 


Edwin  L.  Bruck 
C.  Latimer  Callander 
William  R.  P.  Clark 
Elizabeth  A.  Davis 
Louise  B.  Deal 
William  Dock 
Randolph  G.  Flood 
Mary  E.  Glover 
Irving  S.  Ingber 
Albert  E.  Larsen 
Robert  C.  Martin 
Stanley  H.  Mentzer 
Lewis  Michelson 
Kaspar  Pischel 
I.  Walton  Thorne 
Edward  Topham 
Edward  B.  Towne 
William  C.  Voorsanger 
Rodney  A.  Yoell 
San  Joaquin  County  (2) 

R.  T.  McGurk 
C.  V.  Thompson 
San  Luis  Obispo  County  (1) 

Gifford  L.  Sobey  G.  J.  T'eass 

San  Mateo  County  (1) 

Edward  F.  Ziegelman  William  H.  Murphy 

Santa  Barbara  County  (2) 

Henry  J.  Ullmann  William  J.  Mellinger 

Hugh  F.  Freideli  William  H.  Eaton 

Santa  Clara  County  (3) 

Edwin  M.  Miller  C.  K.  Canelo 

A.  A.  Shufelt  H.  E.  Dahleen 

A.  H.  MacFarlane  J.  H.  Kirk 

Santa  Cruz  County  (1) 

L.  Liles  P.  T.  Phillips 

Shasta  County  (1) 

Ferdinand  Stabel  Earnest  Dozier 

Siskiyou  County  (1) 

C.  C.  Dickinson  Charles  Pius 

Solano  County  (1) 

Ream  S.  Leachman  J.  Edward  Hughes 

Sonoma  County  (1) 

J.  Walter  Seawell  Stewart  Z.  Peoples 

Stanislaus  County  (1) 

R.  E.  Maxwell 
Tehama  County  (1) 

Frank  L.  Doane 
T ulare  County  (1) 

H.  G.  Campbell 
Tuolumne  County  (1) 

William  L.  Hood 
Ventura  County  (1) 

Louis  W.  Achenbach  John  W.  Bardill 

Yolo-Colusa  County  (1) 

Fred  R.  Fairchild  J.  E.  Harbinson* 

Yuba-Sutter  County  (1) 

P.  B.  Hoffman  F.  W.  Didier 


J.  W.  Morgan 
Frank  ,T.  Bailey 
G.  B.  Furness 
Homer  D.  Rose 


270 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


HOUSE  OF  DELEGATES  MEETINGS 


FIRST  MEETING  PROGRAM 

Copper  Cup  Room,  Hotel  Del  Monte,  Monday, 

April  28,  8 p.  m. 

Open  to  Members  of  the  California  Medical  Association 

ORDER  OF  BUSINESS 

1.  Call  to  order. 

2.  Report  of  Credentials  Committee  and  roll  call. 

3.  Report  of  President  Morton  R.  Gibbons. 

4.  Appointment  of  the  two  Reference  Committees  and 

the  Credential  Committee  by  the  Speaker  of  the 
House  of  Delegates. 

5.  Report  of  the  Council,  Oliver  D.  Hamlin,  Chairman. 

6.  Report  of  the  Committee  on  Scientific  Program,  Emma 

W.  Pope,  Chairman. 

7.  Report  of  the  Auditing  Committee,  T.  Henshaw  Kelly, 

Chairman. 

8.  Report  of  the  Secretary,  Emma  W.  Pope. 

9.  Report  of  the  Editors,  George  H.  Kress,  Emma  W. 

Pope. 

10.  Report  of  the  General  Counsel,  Hartley  F.  Peart. 

11.  Unfinished  business. 

12.  New  business.  (Introduction  of  resolutions.) 

13.  Reading  and  adoption  of  minutes. 

Adjournment. 

SECOND  MEETING  PROGRAM 

Copper  Cup  Room,  Hotel  Del  Monte,  Wednesday, 
April  30,  8 p.  m. 

Open  to  Members  of  the  California  Medical  Association 

ORDER  OF  BUSINESS 

1.  Call  to  order. 

2.  Roll  call. 


3.  Announcement  of  the  place  of  session,  1931. 

4.  Election  of: 

(a)  President-elect. 

(b)  Speaker  of  House  of  Delegates. 

(c)  Vice-speaker  of  House  of  Delegates. 

(d)  Councilors. 

Second  District — Incumbent,  William  Duffield, 
Los  Angeles  (1930). 

Fifth  District — Incumbent,  Alfred  L.  Phillips, 
Santa  Cruz  (1930). 

Eighth  District — Incumbent,  Junius  B.  Harris, 
Sacramento  (1930). 

Councilors-at-Large — Incumbent: 

Ruggles  A.  Cushman,  Santa  Ana  (1930). 

T.  Henshaw  Kelly,  San  Francisco  (1930). 

(e)  Delegates  and  alternates  to  American  Medical 

Association  for  sessions,  1931-1932. 

Incumbents: 

Delegates 
Victor  Vecki 
San  Francisco 
Percy  T.  Magan 
Los  Angeles 
Junius  B.  Harris 
Sacramento 

(f)  Program  Committee: 

Incumbent — Robert  V.  Day,  Los  Angeles. 

5.  Report  of  Reference  Committee  on  Reports  of  Officers 

and  Standing  Committees. 

6.  Report  of  the  Reference  Committee  on  Resolutions 

and  New  Business. 

7.  Presentation  of  President. 

8.  Presentation  of  President-elect. 

9.  Reading  and  adoption  of  minutes. 

Adjournment. 


Alternates 
William  E.  Stevens 
San  Francisco 
Charles  D.  Lockwood 
Pasadena 

John  Hunt  Shephard 
San  Jose 


GENERAL  INFORMATION  * 


Registration  and  Information. — The  registration  and  in- 
formation desk  is  located  in  the  lobby,  Hotel  del  Monte. 
All  persons  attending  the  convention,  whether  members 
or  not,  are  requested  to  register  immediately  on  arrival. 
Beginning  Monday,  April  28,  registration  secretaries  will 
be  on  duty  daily  from  9 a.  m.  until  5 p.  m. 

Guests  and  Visitors. — All  guests  and  visitors  are  re- 
quested to  register.  All  general  meetings  and  scientific 
meetings  are  open  to  visitors  and  guests. 

Badges. — Four  kinds  of  badges  will  be  issued  by  the 
registration  bureau: 

1.  Members. — -Only  active,  associate,  retired  or  honor- 
ary members  of  the  California  Medical  Association  will  be 
issued  the  usual  membership  badge.  Members  must  show 
membership  cards  when  they  register. 

2.  Guest.— A special  badge  will  be  issued  to  all  fraternal 
delegates,  visiting  physicians,  wives  of  members,  and 
technical  specialists  who  are  attending  the  1930  session. 

3.  Delegates  and  Alternates. — The  usual  official  badge 
is  provided  for  this  purpose,  and  will  be  issued  only  to 
persons  authorized  to  wear  it. 

4.  Councilors. — An  official  badge  is  provided  for  all  offi- 
cers and  members  of  the  Council. 

Membership  Cards. — Every  member  in  good  standing  in 
the  California  Medical  Association  has  been  issued  an 
official  membership  card  for  1930.  Present  membership 
card  at  registration  desk. 

Suggestions  and  Constructive  Criticism. — The  officers 
and  committees  have  tried  to  do  everything  possible  to 
make  the  session  a success.  Suggestions  and  construc- 
tive criticism  calculated  to  make  future  sessions  more 
useful  will  be  welcomed  by  any  of  the  officers.  Com- 
plaints of  whatever  character  should  be  made  to  the 
registration  desk,  where  they  will  receive  attention. 

Social  Program. — The  social  program  is  in  the  hands  of 
the  Arrangements  Committee,  and  is  published  at  the 
end  of  this  program. 

Press  Representatives. — Accredited  press  representatives 
are  welcome,  and  they  will  be  accorded  every  possible 
courtesy. 

Publicity. — All  publicity  is  in  the  hands  of  a Publicity 
Committee.  It  is  requested  that  all  persons  having  matter 
of  “news”  value  report  it  to  this  committee.  It  is  par- 
ticularly requested  that  all  “news”  about  any  phase  of 
the  convention  be  given  out  through  the  official  com- 
mittee, and  in  no  other  way. 


* See  page  283  for  entertainment  program,  golf  tourna- 
ment, etc. 


Exhibits. — Only  advertisers  in  California  and  Western 
Medicine  are  permitted  to  exhibit  at  the  annual  session. 

Rules  Regarding  Papers  and  Discussions  at  the  State 
Meeting. — Upon  recommendation  of  the  Executive  Com- 
mittee, the  following  rules  regarding  papers  have  been 
adopted  by  the  Council: 

1.  All  papers  read  before  a section  of  an  annual  session 
are  the  property  of  California  and  Western  Medicine. 

2.  The  maximum  time  that  may  be  consumed  by  any 
paper  is  fifteen  minutes,  provided  that  not  to  exceed  ten 
minutes’  latitude  may  be  allowed  invited  guests  at  the 
discretion  of  the  presiding  chairman. 

3.  The  maximum  time  permitted  any  individual  to  dis- 
cuss a paper  is  four  minutes.  This  also  applies  to  the 
author  in  closing  his  discussion.  No  speaker  may  discuss 
more  than  once  any  one  subject. 

4.  A copy  of  each  and  every  paper  presented  at  the 
state  meeting  must  be  in  the  hands  of  the  chairman  or 
secretary  of  the  section  or  in  the  hands  of  the  general 
secretary  before  the  paper  is  presented. 

5.  All  papers  read  at  the  annual  meeting  shall  be  pub- 
lished in  full  in  California  and  Western  Medicine  as  soon 
after  the  meeting  as  space  will  permit.  At  the  option  of 
the  author  and  editor,  an  abstract  of  the  paper  of  about 
one  column  in  length  may  be  published  as  soon  as  possi- 
ble after  the  meeting  with  reprints  in  full  of  the  entire 
paper  (the  cost  of  setting  up  type  for  the  reprint  to  be 
borne  by  the  Association,  and  all  other  costs  to  be  borne 
by  the  author). 

6.  Articles  are  accepted  for  publication  on  condition 
that  they  are  contributed  solely  to  California  and  West- 
ern Medicine.  Authors  desiring  to  publish  their  papers 
elsewhere  than  in  the  journal  may  have  their  manu- 
scripts returned  to  them  upon  written  request  to  the 
state  secretary. 

7.  No  paper  will  be  accepted  by  the  General  Program 
Committee  nor  by  Section  Program  Committees  unless 
accompanied  by  a synopsis  of  not  to  exceed  fifty  words. 

8.  Papers  shall  not  be  “read  by  title.” 

9.  No  member  may  present  more  than  one  paper  at  any 
state  meeting,  provided  that  a member  may  be  a col- 
laborator on  more  than  one  paper,  if  these  papers  are 
presented  by  different  authors. 

10.  Failure  on  the  part  of  an  author  to  present  a paper 
precludes  acceptance  of  future  papers  from  such  author 
for  a period  of  two  years,  unless  the  author  explains  to 
the  satisfaction  of  the  Executive  Committee  his  inability 
to  fulfill  his  obligation. 


April,  1930 


PROGRAM — FIFTY-NINTH  ANNUAL  SESSION 


271 


LORRULI  RETHWILM 
Chairman  Anesthesiology 
Section 


SAMUEL  AYRES,  JR. 
Chairman  Dermatology  and 
Syphilology  Section 


BARTON  J.  POWELL 
Chairman  Eye,  Ear  Nose,  and 
Throat  Section 


WALTER  P.  BLISS 


CLARENCE  G.  TOLAND 


CHARLES  A.  DUKES 


Chairman  General  Medicine 
Section 


Chairman  General  Surgery 
Section 


Chairman  Industrial  Medicine 
and  Surgery  Section 


SCIENTIFIC  EXHIBIT 


A Scientific  Exhibit  of  gross  and  microscopic  specimens, 
illustrating  the  Mycoses,  will  be  demonstrated  in  the 
corridor  adjacent  to  the  Club  Room,  together  with 


roentgenologic  pictures  and  charts,  and  gross  specimens 
illustrating  various  interesting  phases  of  pathology. 
Exhibit  will  be  personally  demonstrated. 


General  Outline  of  Various  Meetings  and  Entertainment 

9-11:30  a.  m. 

11:30-1  p.  m. 

1-2:30  p.  m.  2:30-5  p.  m. 

£ 

Q. 

00 

Sunday 

Council,  Room  722,2  p.m. 

Council,  Room  722 

Monday 

Golf 

Del  Monte 
Links 

Golf 

General  Meeting 

Section  Meetings 
Council,  Room  722 

House  of  Delegates 
Copper  Cup 
Informal  Dance 
Auditorium 

T uesday 

Section 
Meetings. 
Council 
Room  722 

General  Meeting 

Pathology  Section 
Luncheon 

Golf  at  Del  Monte 
Seven  teen-mile 
Drive 

7 p.  m.  President’s 
Dinner  Dance 

Wednesday 

Section 

Meetings. 

Council 
Room  722 

General  Meeting 

Pathology  Section 
Luncheon 
Pediatric  Section 
Luncheon 

Golf  at  Pebble 
Beach  Links 

4 p.  m. 

Tea  for  Ladies 
Monterey  Peninsula 
Country  Club 

House  of  Delegates 
Copper  Cup 
Bridge  and 
Informal  Dance 

Thursday 

Section 

Meetings. 

Council 
Room  722 

272 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


THOMAS  G.  INMAN 
Chairman  Neuropsychiatry 
Section 


W.  T.  CUMMINS 
Chairman  Pathology  and 
Bacteriology  Section 


KARL  L.  SCHAUPP 
Chairman  Obstetrics  and 
Gynecology  Section 


MEETINGS.  DINNERS.  AND  LUNCHEONS 


Meetings  of  the  House  of  Delegates. — Monday  and 
Wednesday  evenings,  April  28  and  30,  at  8 p.  m.  in  Copper 
Cup  Room,  Hotel  Del  Monte. 

Council  Meetings — Room  722: 

First  meeting,  Sunday,  April  27,  2 p.  m. 

Second  meeting,  Sunday,  April  27,  8 p.  m. 

Third  meeting,  Monday,  2:30  p.  m. 

Fourth  meeting,  Tuesday,  9 a.  m. 

Fifth  meeting,  Wednesday,  9 a.  m. 

Sixth  meeting,  Thursday,  9 a.  m. 

General  Meetings. — The  public  is  invited  to  attend  all 
general  meetings: 

Monday,  1 to  2:30  p.  m. — Presidential  addresses,  Audi- 
torium. 

Tuesday,  11:30  a.  m.  to  1 p.  m. — Addresses,  by  invited 
guests,  Auditorium. 

Wednesday,  11:30  a.  m.  to  1 p.  m. — Addresses,  by  invited 
guests,  Auditorium. 

Organization  Meetings  of  All  Standing  Committees. — 

Members  of  all  Standing  Committees  should  meet  in  the 


Lounge  early  on  Thursday  morning  to  organize  for  the 
coming  year  by  the  election  of  a chairman  and  secretary, 
and  appointment  of  advisory  members— and  to  discuss 
plans  for  the  following  year’s  work. 

Dinners 

President’s  Dinner  Dance. — Tuesday  evening,  dining 
room  and  ballroom,  Hotel  Del  Monte,  7 p.  m.  Make  reser- 
vation at  Registration  Desk. 

Luncheons 

Pathology  Section  Luncheon. — Tuesday,  April  29,  Copper 
Cup  Room,  to  which  guests,  officers  of  the  California 
Medical  Association,  and  members  of  the  Section  on  Sur- 
gery are  invited.  Members  of  the  Section  on  Pathology 
are  requested  to  attend  the  luncheon  on  Wednesday, 
Copper  Cup  Room,  at  which  Dr.  Z.  E.  Bolin  will  present 
“Pathology  and  Legal  Medicine.” 

Pediatrics  Section  Luncheon. — Wednesday,  April  30, 
which  all  members  of  the  Section  are  requested  to  attend. 

Fraternity,  College,  and  Special  Luncheons. — Announce- 
ments of  any  such  will  be  placed  on  registration  desk 
bulletin  board. 


DIAGRAM  OF  SECTION  MEETINGS— FOUR-DAY  SESSION 


Auditorium 

Garden 

Room 

Club 

Room 

Copper 

Room 

Children’s 

Playroom 

“A” 

T ower 
Room 

Children's 

Playroom 

“R” 

Room  723 

April  28 
2:30-5:30 
p.  m. 

Medicine 

Surgery 

Pathology 

Pediatrics 

Eye,  Ear, 
Nose  and 
Throat 

Gynecology 

Derma- 

tology 

April  29 
9-11 :30 
a.  m. 

Medicine 

Surgery  and 
Pathology 
Union 
Meeting 
(Weidman) 

Industrial 

Medicine 

and 

Surgery 

Radiology 

Eye,  Ear, 
Nose  and 
Throat 

Urology 

Derma- 

tology 

Anesthesi- 

ology 

April  30 
9-11:30 
g.  m. 

Medicine  and 
Pediatrics 
Union  Meeting 
(Marriott) 

Neuro- 

psychiatry 

(Kempff) 

Pathology 

(Exhibit) 

Radiology 

Obstetrics 

Urology 

Anesthesi- 

ology 

May  1 
9-11:30 
a.  m. 

Medicine 

Surgery 

Neuropsy- 

chiatry 

Industrial 

Medicine 

and 

Surgery 

April,  1930 


PROGRAM — FIFTY-NINTH  ANNUAL  SESSION 


273 


GENERAL  MEETINGS 

All  General  Meetings  will  be  held  in  the  Auditorium 


FIRST  GENERAL  MEETING 
Monday,  April  28,  1 p.  m. 

1.  Invocation — Rev.  G.  M.  Cutting,  Pastor  of  Del 

Monte  Chapel. 

2.  President's  Annual  Address — Morton  R.  Gibbons, 

M.  D. 

SECOND  GENERAL  MEETING 
Tuesday,  April  29,  11:30  a.  m. 

1.  The  Value  of  Radiotherapy  in  Mediastinal  Tumors — 
A.  U.  Desjardins,  M.  D.,  Assistant  Professor  of 
Radiology,  Mayo  Clinic,  Rochester. 


2.  The  Clinical  Application  of  Recent  Studies  Concern- 
ing Chemical  Equilibrium  in  the  Body — McKim 
Marriott,  M.  D.,  Dean  and  Professor  of  Pedi- 
atrics, Washington  University,  St.  Louis. 

THIRD  GENERAL  MEETING 
Wednesday,  April  30,  11:30  a.  m. 

1.  Cretinism — George  M.  Curtis,  M.  D.,  Associate  Pro- 

fessor of  Surgery,  The  University  of  Chicago. 

2.  The  Yellowing  Dermatoses,  With  Special  Reference 

to  Xanthomas — Fred  D.  Weidman,  M.  D.,  Pro- 
fessor of  Dermatology,  University  of  Pennsyl- 
vania, Philadelphia. 


SECTION  MEETINGS 

See  Section  Index  Below 


ANESTHESIOLOGY  SECTION 

Lorruli  A.  Rethwilm,  M.  D.,  Chairman 
2217  Webster  Street,  San  Francisco 

William  W.  Hutchinson,  M.  D.,  Secretary 
1202  Wilshire  Medical  Building 
1930  Wilshire  Boulevard,  Los  Angeles 

First  Meeting — Room  723 
Tuesday,  April  29,  9 to  11:  30  a.  m. 

1.  Chairman’s  Address — Report  on  Use  of  Sodium- 

iso-amyl-ethyl-barbiturate — -Lorruli  A.  Rethwilm, 
M.  D.,  San  Francisco. 

2.  Chemical  Adjunct  to  Anesthesia  — Chauncey  D. 

Leake,  Ph.  D.,  University  of  California  Medical 
School,  San  Francisco. 

Pre-anesthesia  predicates  design  to  depress 
the  central  nervous  system  to  basic  level  for 
anesthesia.  Alkaloid  group,  the  coal  tar  anal- 
gesics, alcohol  derivatives  and  the  barbiturates. 
The  position  of  atropin  for  anesthetics  premedi- 
cate. Supporting  premedicate  affecting  general 
metabolism.  Rational  application  of  present 
knowledge. 

Discussion  opened  by  M.  L.  Tainter,  M.  D., 
San  Francisco. 

3.  Phenolphthalein  Excretion  After  Administration  of 

Sodium-iso- amyl- ethyl-barbiturate — Ludwig  A. 
Emge,  M.  D.,  2000  Van  Ness  Avenue,  San 
Francisco. 

This  paper  will  discuss  the  phenolphthalein 
excretion  in  operative  and  obstetrical  cases 
following  use  of  sodium-iso-amyl-ethyl-barbitu- 
rate  and  compare  it  to  similar  tests  in  operative 
cases  managed  with  scopolamin-morphin  and 
nitrous-oxid  anesthesia. 

4.  Tribrom ethanol  as  a Preoperative  Narcotic — Doro- 

thy A.  Wood,  M.  D.,  1390  Seventh  Avenue,  San 
Francisco. 

Description  of  the  drug;  calculation  of  the 
dosage;  technique  of  administration.  Safety  of 
its  use  as  a narcotic  contrasted  with  its  toxicity 
when  used  as  an  anesthetic.  Case  reports.  Re- 
action of  patients;  effect  upon  pulse,  blood 
pressure,  and  respiration;  recovery  of  patient. 
Amount  of  anesthetic  agent  apparently  dimin- 
ished when  tribromethanol  is  used  as  prelimi- 
nary medication. 

5.  Preoperative  Medication — Mary  E.  Botsford,  M.  D., 

807  Francisco  Street,  San  Francisco. 

Valuation  of  the  newer  drugs  for  preliminary 
medication.  Comparative  merits  of  the  barbi- 
turates and  avertin.  A discussion  of  the  anes- 
thetic properties  of  these  two  agents.  Their  use 
in  combination  with  spinal. 


Second  Meeting — Room  723 

Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  Modern  Controllable  Spinal  Anesthesia— Basic  Princi- 

ples Involved — Franklin  I.  Harris,  M.  D.,  916 
Four  Fifty  Sutter,  San  Francisco,  and  Edward 
H.  Bolze,  M.  D.,  Room  1219,  450  Sutter  Street, 
San  Francisco. 

• Review  of  development;  causes  of  former 
failures  and  fatalities.  Pharmacology  of  novo- 
cain; physiochemical  action.  Action  and  effect 
of  ephedrin;  necessity  of  Trendelenberg  posi- 
tion. Control  of  duration  and  height  of  anes- 
thesia. Simplified  technique  confirmed  by  two 
hundred  and  fifty  inductions.  (Lantern  slides.) 

Discussion  opened  by  Harry  W.  Martin, 
M.  D.,  Los  Angeles. 

2.  Circulatory  Responses  of  Ephedrin  and  Related 

Drugs — Modifications  by  Local  Anesthesia — M.  L. 
Tainter,  M.  D.,  Stanford  University  School  of 
Medicine,  San  Francisco. 

Cocain,  not  procain  and  butyn,  subcutaneously 
in  infiltration  anesthesia  doses,  profoundly 
modifies  circulatory  responses  to  epinephrin, 
ephedrin,  and  related  drugs.  Modifications  con- 
sist of  sensitization,  desensitization,  or  complete 
abolition  of  circulatory  response,  according  to 
drug  used.  Phenomena  important  in  systemic 
reactions  from  cocain,  and  in  treating  accidents 
of  local  anesthesia.  (Lantern  slides.) 

Discussion  opened  by  Chauncey  D.  Leake, 
Ph.  D.,  San  Francisco. 

3.  Infiltration  Anesthesia  in  Obstetrical  Surgery— 

Sterling  N.  Pierce,  M.  D.,  1200  South  Alvarado 
Street,  Los  Angeles. 

Inhalation  anesthesia  in  surgical  obstetrics 
has  certain  definite  disadvantages,  avoided  by 
the  use  of  local  anesthesia.  Certain  positive 
advantages  obtained  by  infiltration  method; 
striking  simplicity.  Conclusions  based  upon 
several  hundred  cases.  Author  believes  that  the 
results  in  these  cases  attest  to  the  adequacy  of 
the  method  for  obstetrical  anesthesia,  and  to  its 
safety. 

Discussion  opened  by  Lyle  G.  McNeile,  M.  D., 
Los  Angeles. 

4.  Business  meeting. 


Section  Index  Page 

Anesthesiology  273 

Dermatology  274 

Eye,  Ear,  Nose,  and  Throat ...274 

General  Medicine  275 

General  Surgery  -2 76 

Industrial  Surgery  278 

Neuropsychiatry  278 

Obstetrics  and  Gynecology 279 

Pathology  and  Bacteriology — 279 

Pediatrics  280 

Radiology  281 

Urology  282 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


27  • 


DERMATOLOGY  AND  SYPHILOLOGY 
SECTION 

Samuel  Ayres,  Jr.,  M.  D.,  Chairman 

517  Westlake  Professional  Building 

2007  Wilshire  Boulevard,  Los  Angeles 

George  F.  Koetter,  M.  D.,  Secretary 
812  Medical  Office  Building 

1136  West  Sixth  Street,  Los  Angeles 

First  Meeting — Children’s  Playroom  B 

Monday,  April  28,  2:30  to  5:  30  p.  m. 

1.  Chairman’s  Address — The  Kidney  Function  in  Pem- 

phigus— Samuel  Ayres,  Jr.,  M.  D.,  Los  Angeles. 

Phenolsulphonphthalein  excretion  when  given 
intramuscularly  and  intravenously,  urine  ex- 
amination, blood  chemistry.  Recent  ideas  con- 
cerning the  etiology  and  treatment  of  pemphi- 
gus. The  question  of  liver  involvement.  The 
significance  of  ’phthalein  excretion  in  relation 
to  arsenical  therapy. 

2.  Dermatological  Psychoses  — C.  Ray  Lounsberry, 

M.  D.,  1111  Medico-Dental  Building,  233  A 
Street,  San  Diego. 

Introduction.  Review  of  fundamentals  in 
classical  case  of  dermatitis,  welding  it  closely 
into  a psychotic  state.  Biographical  sketch 
from  birth  to  development  of  psychotic  derma- 
titis in  later  adolescent  period  of  life.  Etiology 
in  classical  case.  Diagnosis  and  treatment. 

Discussion  opened  by  Samuel  Ayres,  Jr., 
M.  D.,  Los  Angeles. 

3.  Dermatology  for  Nurses — Ernest  Dwight  Chipman, 

M.  D.,  501  Union  Square  Building,  350  Post 
Street,  San  Francisco. 

Lecturer  to  nurses  in  training  schools  con- 
fronted with  problem  of  teaching  students 
enough  to  satisfy  State  Board  requirements. 
Knowledge  of  purpura,  pemphigus,  and  pellagra 
necessary;  but  dermatological  dressing  seem- 
ingly not.  Teaching  of  nurses  should  have  for 
objective  making  of  good  nurse  rather  than 
poor  dermatologist.  Article  outlines  practical 
treatment  of  subject  with  hope  of  constructive 
discussion. 

Discussion  opened  by  George  Culver,  M.  D., 
San  Francisco. 

4.  Erythema  Induratum — Ernest  K.  Stratton,  M.  D., 

414  Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

Report  of  a case  associated  with  a chronic 
pneumonia  (the  location  of  which  is  probably 
the  site  of  an  old  tuberculosis);  tuberculous 
nodules  on  sclera,  as  well  as  a squamous  cell 
epithelioma  of  skin. 

Discussion  opened  by  Hiram  E.  Miller,  M.  D., 
San  Francisco. 

5.  Trichorrhexis  N odosa  as  a Clinical  Problem — Charles 

R.  Caskey,  M.  D.,  715  Wilshire  Medical  Build- 
ing, 1930  Wilshire  Boulevard,  Los  Angeles. 

Foreword.— Report  of  findings  in  few  cases 
to  stimulate  research.  Definition  of  trichor- 
rhexis nodosa,  trichoclasia,  and  trichoptilosis. 
Various  etiology  theories  — trophic,  neurotic, 
mechanical,  parasitic.  Case  reports.  Conclu- 
sions: findings  suggestive;  not  conclusive. 
Possibility  of  disease  being  caused  by  different 
but  closely  allied  organisms.  Plea  for  concerted 
research  into  this  and  other  causes  of  alopecia. 
(Lantern  slides.) 

Discussion  by  Stanley  O.  Chambers,  M.  D., 
Los  Angeles. 

Second  Meeting — Children’s  Playroom  B 

Tuesday,  April  29,  9 to  11:  30  a.  m. 

1.  Gastric  Analysis  in  Acne  Rosacea— N.  N.  Epstein, 
M.  D.,  Room  1304,  450  Sutter  Street,  San  Fran- 
cisco. 


Gastric  analysis  studies  have  been  made  on  a 
group  of  patients  with  acne  rosacea,  using  the 
alcohol  test-meal  and  the  histamine  method  of 
stimulating  gastric  secretion.  In  a large  num- 
ber of  these  cases  the  gastric  acidity  was  low. 
Clinical  improvement  followed  the  administra- 
tion of  hydrochloric  acid  and  pepsin. 

Discussion  opened  by  Garnett  Cheney,  M.  D., 
San  Francisco. 

2.  Syphilis  as  a Moral,  Economic  and  Teaching  Prob- 

lem— Stanley  O.  Chambers,  M.  D.,  1260  Roose- 
velt Building,  727  West  Seventh  Street,  Los 
Angeles. 

Modern  problems  in  syphilis  outlined.  At- 
tempt made  to  suggest  methods  for  preventive 
control.  These  phases  obviously  represent  more 
than  drug  values  in  the  control  of  syphilis. 
Teaching  of  modern  syphilology  to  layman 
offers  greater  efficiency  in  control  of  disease 
and  is  real  step  in  direction  of  eradication. 

Discussion  opened  by  Ernest  D.  Chipman, 
M.  D.,  San  Francisco. 

3.  Carotinemia — Hiram  E.  Miller,  M.  D.,  809  Fitz- 

hugh  Building,  384  Post  Street,  San  Francisco. 

Carotinemia  is  a yellowish  discoloration  of 
the  skin  seen  generally  on  the  face,  palms,  and 
soles,  but  may  cover  the  entire  body.  It  is  fre- 
quently associated  with  diabetes.  Differential 
diagnosis,  methods  of  testing  for  the  presence 
of  carotin,  clinical  significance  of  the  condition, 
etc.,  will  be  discussed. 

Discussion  opened  by  George  F.  Koetter, 
M.  D.,  Los  Angeles. 

4.  Statistical  Study  of  Three  T housand  Cases  of  Acne — 

Ruby  L.  Cunningham,  University  of  California 
Infirmary,  Berkeley,  and  C.  J.  Lunsford,  M.  D., 
3115  Webster  Street,  Oakland. 

Twelve  thousand  five  hundred  and  twenty- 
six  students  at  the  University  of  California  at 
Berkeley  showed  2978  had  acne.  Report  of  a 
statistical  study  of  these  2978,  using  3170  as 
controls.  Viewed  from  standpoints  of  age  dis- 
tribution, weight  correction,  complexion,  dis- 
tribution, lymph  glands,  menstrual  history,  and 
other  related  conditions,  such  as  foci  of  infec- 
tion, allergy,  constipation,  thyroid  gland,  oper- 
ations, etc. 

Discussion  opened  by  N.  N.  Epstein,  M.  D., 
San  Francisco. 

5.  Motion  Picture  Demonstration  of  Selected  Derma- 

tological Cases  From  Stanford  Medical  School 
Skin  Clinic — Harry  E.  Alderson,  M.  D.,  320 
Medico-Dental  Building,  490  Post  Street,  San 
Francisco. 

EYE,  EAR,  NOSE,  AND  THROAT  SECTION 

Barton  J.  Powell,  M.  D.,  Chairman 

510  Medico-Dental  Building,  Stockton 

Andrew  B.  Wessels,  M.  D.,  Secretary 
1305  Medico-Dental  Building 
233  A Street,  San  Diego 

First  Meeting — Children’s  Playroom  A 

Monday,  April  28,  2:30  to  5:30  p.  m. 

1.  Chairman’s  Address — Missed  Intra-Ocular  Foreign 

Bodies — Barton  J.  Powell,  M.  D.,  Stockton. 

Report  of  several  cases  of  missed  intra-ocular 
foreign  bodies  and  importance  of  systematic 
examination  of  all  eye  injuries,  regardless  of 
history,  with  x-ray,  ophthalmoscope,  magnet, 
and  localizing  apparatus  of  Dr.  William  M. 
Sweet. 

2.  The  Ocular  Findings  in  a Group  of  Unsclected  Dia- 

betics— H.  Claire  Shepardson,  M.  D.,  204  Fitz- 
hugh  Building,  384  Post  Street,  San  Francisco, 
and  Joseph  W.  Crawford,  M.  D.,  Room  1635, 
450  Sutter  Street,  San  Francisco. 

History  of  fifty  proved  diabetics  carefully 
worked  up,  both  as  to  the  extent  of  the  dia- 
betes, the  presence  or  absence  of  complicating 


April,  1930 


PROGRAM-  FIFTY-NINTH  ANNUAL  SESSION 


275 


diseases  as  arteriosclerosis  and  renal  disease, 
and  the  routine  studies  of  the  eyes  in  each. 

Discussion  opened  by  George  N.  Hosford, 
M.  D.,  San  Francisco. 

3.  The  Importance  of  a Correct  Diagnosis  in  Oper- 

ations on  the  Ocular  Muscles — Joseph  L.  McCool, 
M.  D.,  450  Sutter  Street,  San  Francisco. 

Convergent  squint  and  phorias  apparently 
result  of  faulty  coordination  of  converging  and 
diverging  muscles;  in  reality,  secondary  to 
vertical  abnormalities.  Knowledge  of  muscle 
affected  essential  in  surgical  treatment.  (Lan- 
tern slides  of  anatomy  and  physiology  of  eye 
muscles.) 

Shortening  of  underacting  muscle;  guarded 
tenotomy  or  recession  of  opponent  in  same  eye, 
or  associated  antagonist  in  fellow  eye. 

Discussion  opened  by  Roderic  O’Connor, 
M.  D.,  Oakland. 

4.  Personal  Convictions  Regarding  Cataract  Operations 

— Hans  Barkan,  M.  D.,  and  Otto  Barkan,  M.  D., 
921  Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

Methods  of  procedure  adopted  at  present  as 
worked  out  from  experience  with  several 
methods.  Reasons  for  methods  employed  and 
against  those  not  employed. 

Discussion  opened  by  Dwight  H.  Trowbridge, 
M..  D.,  Fresno. 

5.  Recurrent  Retinal  Hemorrhages — Theodore  C.  Lvster, 

M.  D.,  Wilshire  Medical  Building,  1930  'Wil- 
shire  Boulevard,  Los  Angeles. 

Recurrent  retinal  hemorrhages  in  young 
adults  seen  frequently.  After  trauma,  lues,  or 
probable  focal  cause  (other  than  pulmonary) 
are  excluded,  a relatively  large  group  probably 
tuberculous,  and  frequently  with  latent  involve- 
ment of  peribronchial  glands  remains.  Other 
signs  usually  absent.  Retinal  tuberculosis,  rare. 
Positive  evidence  secured  with  difficulty.  Prog- 
nosis guarded,  but  relatively  favorable,  depend- 
ing upon  the  duration  and  extent  of  involve- 
ment. Case  histories. 

Discussion  opened  by  Wallace  R.  Briggs, 
M.  D.,  Sacramento. 

Second  Meeting — Children’s  Playroom  A 
Tuesday,  April  29,  9 to  11:30  a.  m. 

1.  Management  and  Treatment  of  Otitis  Media — Clyde 

E.  Harner,  M.  D.,  923  Security  Building,  Long 
Beach. 

Keynote  of  treatment  should  be  conserva- 
tism, but  not  “hysterical”  conservatism.  Early 
incision  of  membrana  tympani  essential.  Light 
general  anesthesia  preferable.  Widespread  use 
of  phenolized  glycerin  only  measure  for  reliev- 
ing pain.  Careful  irrigation  preferable  to  “dry”' 
treatment.  Treatment  of  throat  and  naso- 
pharynx important.  Removal  of  adenoids  some- 
times necessary.  Oily  drops  in  nose  of  infants 
should  not  be  used  as  routine.  Conclusions  and 
summary. 

Discussion  opened  by  R.  C.  Martin,  M.  D., 
San  Francisco. 

2.  Low-Grade  Ethmoiditis  as  the  Cause  of  Certain  Eye 

Conditions  — Wallace  B.  Smith,  M.  D.,  812 
Medico-Dental  Building,  490  Post  Street,  San 
Francisco. 

Sinuses  in  general;  and  their  relation  to  focal 
infection  diseases  with  especial  reference  to  eye 
diseases.  Low-grade  ethmoid  infection  as  cause 
of  certain  cases  of  postbulbar  neuritis  with  cen- 
tral scotoma.  Literature.  Discussion  of  the 
several  theories  of  mode  of  origin.  Detailed 
report  of  the  nose  findings. 

Discussion  opened  by  Dohrmann  K.,  Pischel, 
M.  D.,  San  Francisco. 

3.  Carcinoma  of  the  Larynx — Simon  Jesberg,  M.  D., 

500  South  Lucas  Avenue,  Los  Angeles. 

The  incidence  of  carcinoma  of  the  larynx; 


the  management  and  the  duty  of  the  doctor  to 
his  patient  in  this  type  of  case. 

Discussion  opened  by  R.  S.  Tillotson,  M.  D., 
Woodland. 

4.  Visual  Disturbances  Associated  with  Influenza— 
Clifford  B.  Walker,  M.  D.,  410  Auditorium 
Building,  427  West  Fifth  Street,  Los  Angeles. 

Study  of  a group  of  cases  which  might  be 
classed  as  idiopathic  retrobulbar  neuritis  but 
which  really  have  a virus  infection  of  nasal 
origin,  sometimes  accompanied  by  . a variable 
degree  of  grippe,  or  even  encephalitic  symp- 
toms with  coryza  or  sinusitis  of  insignificant 
or  minor  degree.  Perimetric  studies  and  differ- 
entiation from  encephalitis  with  or  without 
lethargica,  sinusitis,  and  multiple  sclerosis,  oph- 
thalmoplegia without  migraine. 

Discussion  opened  by  M.  F.  Weymann. 
M.  D.,  Los  Angeles. 


GENERAL  MEDICINE  SECTION 

.Walter  P.  Bliss,  M.  D.,  Chairman 
407  Professional  Building 

65  North  Madison  Avenue,  Pasadena 

Ernest  H.  Falconer,  M.  D.,  Secretary 
316  Fitzhugh  Building 
384  Post  Street,  San  Francisco 

First  Meeting — Auditorium 

Monday,  April  28,  2:30  to  5:30  p.  m. 

1.  Heart  Rate  and  Size — Their  Importance  to  the  Phy- 

sician— William  Dock,  M.  D.,  Stanford  Hospi- 
tal, San  Francisco. 

Recent  studies  of  cardiac  output  and  velocity 
of  blood-flow  have  shifted  the  interest  from 
other  factors  in  connection  with  heart  failure, 
its  cause  and  its  treatment.  The  heart  volume 
and  rate  alone  are  significant  in  determining 
the  energy  spent  by  the  heart.  The  importance 
of  these  facts  in  the  diagnosis  and  treatment  of 
heart  conditions  is  discussed. 

Discussion  opened  by  A.  S.  Granger,  M.  D., 
Los  Angeles. 

2.  Eunuchoid  Syndromes— Elans  Lisser,  M.  D.,  208 

Fitzhugh  Building,  384  Post  Street,  San  Fran- 
cisco. 

Definition:  Distinguished  from  eunuchism; 
the  preadolescent  type  in  boys  and  girls;  the 
postadolescent  types  in  men  and  women;  sub- 
jective symptoms;  objective  physical  findings 
and  roentgenological  and  other  laboratory  find- 
ings. Prognosis  and  treatment.  Presentation 
of  typical  cases.  (Lantern  slides.) 

3.  Allergic  Toxemia  and  Migraines — Food  Allergy  a 

Cause  — Albert  H.  Rowe,  M.  D.,  242  Moss 
Avenue,  Oakland. 

Allergic  toxemia,  characterized  by  marked 
mental  confusion,  irritation,  nervousness,  lack 
of  initiative,  weakness  and  aching  of  the  body 
not  uncommonly  due  to  food  allergy.  Frequent 
in  patients  with  other  allergic  manifestations. 
Family  history  of  allergy  not  necessary  requi- 
site for  allergic  toxemia.  Report  of  migraine 
and  headaches  due  to  food  allergy  during  four 
years  in  private  practice. 

Discussion  opened  by  Walter  W.  Boardman, 
M.  D.,  San  Francisco. 

4.  Disturbances  of  Visual  Pathways  in  Temporal  Lobe 

Lesions — Harry  A.  Cave,  M.  D.,  San  Diego. 
(By  invitation.) 

This  paper  is'  based  upon  a study  of  a series 
of  four  cases  of  temporal  lobe  tumors  in  which 
the  neurological  findings  were  insufficient  to 
localize  the  neoplasm  accurately.  By  interrupt- 
ing the  visual  pathways  on  their  way  to  the 
occipital  cortex,  lesions  of  the  temporal  lobes 
produce  hemianopic  defects  in  the  visual  fields 
which  make  localization  of  the  tumors  possible. 

Discussion  opened  by  Howard  C.  Naffziger, 
M.  D.,  San  Francisco. 


276 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


5.  Giardiasis  in  Children — Sam  J.  McClendon,  M.  D., 
2001  Fourth  Street,  San  Diego. 

Report  based  upon  study  of  twenty-three 
cases  in  children.  No  definite  characteristic 
symptoms  ascribed  to  infection;  indefinite 
gastro-intestinal  symptoms,  urinary  disturb- 
ances, nervousness,  and  irritability  are  found 
in  varying  degrees.  Pathogenicity  of  flagellate 
proved  by  finding  of  giardia  in  stool  and  clear- 
ing up  of  symptoms  with  effective  treatment  by 
bismuth  salicylate,  treparsol  and  stovarsol,  with 
a nonirritating  diet. 

Discussion  opened  by  John  V.  Barrow,  M.  D., 
Los  Angeles. 

Second  Meeting — Auditorium 
Tuesday,  April  29,  9 to  11:30  a.  m. 

1.  Pulmonary  Tuberculosis  — Clinical  Classification — 

Sidney  J.  Shipman,  M.  D.,  Medico-Dental  Build- 
ing, 490  Post  Street,  San  Francisco. 

Older  classifications  based  largely  upon  ex- 
tent of  lesion  or  gross  anatomical  change  as  in 
Turban  classification  and  classification  of  the 
American  Sanatorium  Association,  which,  how- 
ever, attempted  to  unite  extent  of  lesion  with 
symptomatology  or  activity.  Most  valuable 
classification  based  upon  actual  pathology  as 
well  as  extent;  this  furnishes  valuable  informa- 
tion for  prognosis  or  treatment. 

Discussion  opened  by  Chesley  Bush,  M.  D., 
Livermore. 

2.  Hypochloremia— George  Morris  Curtis,  M.  D.,  Uni- 

versity of  Chicago.  (By  invitation.) 

3.  Arthritis — Rodney  F.  Atsatt,  M.  D.,  1421  State 

Street,  Santa  Barbara. 

The  treatment  of  arthritis  is  a problem  which 
general  medicine  must  supervise.  The  specialist 
should  not  be  allowed  to  overburden  the  pa- 
tient’s power  of  endurance.  Metabolic  disturb- 
ances are  the  keynote  in  many  cases,  but 
fatigue  is  an  important  etiological  factor. 
Proper  physiotherapy  alleviates  much  pain  and 
overcomes  many  deformities. 

Discussion  opened  by  William  J.  Kerr,  M.  D., 
San  Francisco. 

4.  Vndulant  Fever — Karl  F.  Meyer,  Ph.  D.,  Hooper 

Foundation  for  Medical  Research,  San  Fran- 
cisco. (By  invitation.) 

A critical  discussion  of  the  bacteriology  and 
epidemiology  of  undulant  fever  in  the  light  of 
recent  observations,  experimental  studies  and 
inquiries  made  in  California  and  abroad. 

Discussion  opened  by  John  Carroll  Ruddock, 
M.  D.,  Los  Angeles. 

5.  Late  Lues  Treated  with  a Single  Strain  of  Malaria — 

Analytical  Evaluation  of  Therapeutic  Results  in 
Four  Hundred  Cases — Ross  Moore,  M.  D.,  915 
Wilshire  Medical  Building,  1930Wilshire  Boule- 
vard, Los  Angeles. 

Late  lues  is  a new  biological  and  therapeutic 
division  of  the  clinical  course  of  syphilis.  This 
series  of  cases  is  separated  into  two  parts — late 
lues,  in  which  treatment  is  beneficial;  and 
terminal  lues,  in  which  treatment  is  nonbene- 
ficial,  the  object  being  to  create  a new  concept 
of  syphilis,  thereby  making  its  therapeusis 
more  accurate. 

Discussion  opened  by  H.  G.  Mehrtens,  M.  D., 
San  Francisco. 

Third  Meeting — Auditorium 

Union  Meeting  of  General  Medicine  and  Pediatrics 
Sections 

Wednesday,  April  30,  9 to  11:30  a.  m. 

Program  printed  under  second  meeting  of  Pedi- 
atrics Section.  See  page  281. 

Fourth  Meeting — Auditorium 
Thursday,  May  1,  9 to  11:30  a.  m. 

1.  A granulocytic  Angina  with  Apparent  Cure — George 
A.  Gray,  M.  D.,  209  St.  Claire  Building,  San 
Jose. 


A short  summary  of  this  unusual  group  of 
cases  with  a contribution  to  the  therapeutic 
problem  of  agranulocytosis.  A case  report  of 
an  apparent  cure  following  treatment  with 
large  doses  of  leukocytic  extract. 

Discussion  opened  by  Herbert  C.  Mofifitt, 
M.  D.,  San  Francisco. 

2.  Raynaud’s  Disease — William  J.  Kerr,  M.  D.,  Uni- 

versity of  California  Hospital,  San  Francisco. 

The  paper  will  take  up  recent  physiological 
studies  on  patients  with  varieties  of  Raynaud’s 
disease  which  indicate  the  disease  is  a local 
manifestation  of  the  failure  of  the  blood  vessels 
to  react  to  cold.  The  vasoconstrictor  influence 
is  of  little,  or  no,  importance.  Suggestions  for 
treatment  will  be  outlined. 

Discussion  opened  by  C.  Latimer  Callander, 
M.  D.,  San  Francisco. 

3.  Acute  Yellow  Atrophy  of  the  Liver — Verne  R. 

Mason,  M.  D.,  838  Pacific  Mutual  Building,  523 
West  Sixth  Street.  Los  Angeles. 

Report  of  twenty  cases  of  acute  hepatic  de- 
generation. Discussion  of  etiology  and  increas- 
ing incidence  of  the  disease.  Symptomatology 
of  hepatic  insufficiency.  Possibility  of  recovery 
from  mild  attacks. 

Discussion  opened  by  Fred  H.  Kruse,  M.  D., 
San  Francisco. 

4.  Some  Experiences  with  Fecal  Vaccines — William  H. 

Strietmann,  M.  D.,  Strad  Building,  230  Grand 
Avenue,  Oakland. 

Paper  deals  with  the  use  of  fecal  vaccines  for 
arthritis;  method  of  W.  B.  Wherry,  antigens 
from  anaerobic  and  partial  tension  organisms, 
also  aerobic.  Skin  tests  performed.  Interesting 
effects  noted  in  skin  lesions  associated  with 
arthritis.  Report  of  cases. 

5.  The  Business  of  Medicine — Rexwald  Brown,  M.  D., 

1421  State  Street,  Santa  Barbara. 

Hippocratic  Code  has  fashioned  mantle  of 
tradition.  Medicine  challenged  to  justify  posi- 
tion with  relation  to  programs  of  other  social 
forces.  Medicine  must  develop  statesman-like 
leadership.  Physicians  enmeshed  in  economic 
and  administrative  departments.  Medical  ser- 
vice expense  to  wealthy,  to  white-collar  class, 
and  to  indigents. 

Discussion  opened  by  William  Duffield,  M.D., 
Los  Angeles. 


GENERAL  SURGERY  SECTION 

Clarence  G.  Toland,  M.  D.,  Chairman 
902  Wilshire  Medical  Building 
1930  Wilshire  Boulevard,  Los  Angeles 
Sumner  Everincham,  M.  D.,  Secretary 
400  Twenty-Ninth  Street,  Oakland 
Clarence  E.  Rees,  M.  D.,  Assistant  Secretary 
2001  Fourth  Street,  San  Diego 

First  Meeting — Garden  Room 
Monday,  April  28,  2:30  to  5 p.  m. 

1.  Surgical  Correction  of  Cleft  Lip  and  Palate — Albert 

D.  Davis,  M.  D.,  1001  Howard  Building,  209 
Post  Street,  San  Francisco. 

Types.  Etiology.  Time  and  sequence  of 
operations.  Failures  and  their  prevention. 
Speech  training  and  orthodontia.  Lengthening 
the  palate.  (Lantern  slide  demonstration  of 
cases.) 

Discussion  by  E.  F.  Tholen,  M.  D.,  Los 
Angeles,  and  Emile  Holman,  M.  D.,  San  Fran- 
cisco. 

2.  The  Treatment  of  Bone  Tumors — Edwin  I.  Bartlett, 

M.  D.,  1020  Medico-Dental  Building,  490  Post 
Street,  San  Francisco. 

Reviews  the  types  of  treatment  employed  up 
to  the  present  time.  Cites  the  advances  made 
in  the  scientific  study  of  bone  tumors  during 
the  past  few  years.  Points  out  the  application 


April,  1930 


PROGRAM — FIFTY-NINTH  ANNUAL  SESSION 


277 


of  this  new  gained  knowledge  in  the  selection 
of  the  therapeutic  agent.  Discusses  the  prog- 
nosis. (Lantern  slides  of  selected  cases  and 
discussion  of  treatment  employed.) 

Discussion  opened  by  A.  U.  Desjardins,  M.D., 
and  Charles  Connors,  M.  D. 

3.  Factors  of  Healing  in  the  Repair  of  Intrapulmonary 

Abscesses  and  Persistent  Bronchial  Fistulae — 
Emile  Holman,  M.  D.,  Stanford  University 
Hospital,  San  Francisco. 

A discussion  of  the  physiological  processes 
underlying  the  repair  of  intrapulmonary  ab- 
scesses, and  the  retarding  effects  of  bronchial 
fistulae  upon  such  repair,  followed  by  a dis- 
cussion of  the  principles  governing  the  surgi- 
cal procedures  calculated  to  assist  in  the  repair 
of  intrapulmonary  abscesses  and  in  the  cure  of 
persistent  or  chronic  bronchial  fistulae  with 
presentation  of  illustrative  cases. 

Discussion  by  Harold  Brunn,  M.  D.,  San 
Francisco,  and  Fred  R.  Fairchild,  M.  D.,  Wood- 
land. 

4.  Diagnostic  Pneumothorax  in  Lung  Abscess  Cases — 

Harold  Brunn,  M.  D.,  1001  Fitzhugh  Building, 
384  Post  Street,  San  Francisco,  and  William  B. 
Faulkner,  Jr.,  M.  D.,  University  of  California 
Hospital,  San  Francisco. 

Management  of  patients  with  lung  abscesses 
has  been  decidedly  influenced  by  the  use  of 
diagnostic  pneumothorax.  A discussion  of  the 
technique  of  diagnostic  pneumothorax  and  the 
interpretation  of  diagnostic  pneumothorax  x-ray 
plates.  Report  of  six  cases  of  lung  abscesses 
wherein  diagnostic  pneumothorax  was  employed 
to  advantage  in  the  selection  of  rational  thera- 
peutic measures. 

Discussion  by  Sidney  Shipman,  M.  D.,  San 
Francisco,  and  Frank  S.  Dolley,  M.  D.,  Los 
Angeles. 

5.  Spastic  Contraction  Ring  as  a Cause  of  Postoperative 

Intestinal  Obstruction — -Hubbard  S.  Hoyt,  M.  D., 
Monterey. 

Report  of  a case  in  which  the  abdomen  was 
reopened  forty-eight  hours  after  a gastro- 
enterostomy had  been  performed,  because  of 
symptoms  of  obstruction.  Spastic  contraction 
ring  found  in  the  jejunum  at  the  distal  end  of 
the  anastomosis,  the  intestine  being  contracted 
to  a small  white  ring  approximately  three- 
eighths  of  an  inch  wide.  Summary  of  cases 
reported  in  the  literature.  Discussion  of  possi- 
ble causes.  Necessity  of  reopening  abdomen 
without  the  use  of  spasm-relaxing  anesthetics 
or  drugs  if  this  condition  is  to  be  detected. 

Discussion  by  J.  Homer  Woolsey,  M.  D.,  San 
Francisco,  and  Rexwald  Brown,  M.  D.,  Santa 
Barbara. 

Second  Meeting — Garden  Room 
Union  Meeting  of  Surgery  and  Pathology  Sections 

Tuesday,  April  29,  9 to  11:30  a.  m. 

Program  printed  under  second  meeting  of  Pa- 
thology and  Bacteriology  Section.  See  page  280. 

Third  Meeting — Garden  Room 
Thursday,  May  1,  9 to  11:30  a.  m. 

1.  Tubed  Pedicle  Graft  in  Reconstructive  Surgery — 
George  Warren  Pierce,  M.  D.,  720  Medico- 
Dental  Building,  490  Post  Street,  San  Fran- 
cisco. 

Advantages  of  tubed  pedicle  graft  and  prob- 
lems of  reconstruction  successfully  solved  with 
its  use.  Technique  of  making  pedicle  and  man- 


agement of  cases  through  various  stages  of 
transplantation.  Report  of  cases  showing  origi- 
nal defects  and  successive  stages  of  reconstruc- 
tion, of  nose,  ear,  and  fingers,  and  also  appli- 
cation of  the  pedicle  to  other  parts  of  the  body. 
Motion  picture. 

2.  Enemata  From  an  Anatomical  and  Physiological 

Standpoint — Silas  A.  Lewis,  M.  D.,  1023  Taft 
Building,  1680  North  Vine  Street,  Hollywood. 

Motion  picture  of  the  anatomy  of  colonic 
tract.  X-ray  films  used  to  illustrate  filling  of 
the  normal  colon  with  a barium  enema.  Com- 
parison with  films  of  chronic  enema  takers. 
Demonstration  made  of  the  amount  of  enema 
fluid  retained  after  defecation  and  where  and 
how  the  unexpelled  portion  is  pocketed  and 
retained.  The  paper  discusses  dangers  of  dila- 
tation of  the  colonic  tract  by  enemizing  surgi- 
cal cases  and  suggests  a method  of  restoring 
normal  bowel  function,  postoperative. 

Discussion  by  William  H.  Daniel,  M.  D.,  Los 
Angeles,  and  Charles  S.  James,  M.  D.,  Los 
Angeles. 

3.  Evidence  of  N onabsorbability  of  Glucose  Per  Rectum 

— -Bertnard  Smith,  M.  D.,  602  Wilshire  Medi- 
cal Building,  1930  Wilshire  Boulevard,  Los 
Angeles. 

Review  of  experimental  work.  Glucose  solu- 
tions of  different  concentrations  introduced  into 
the  colon  and  the  effects  noted  on  peripheral 
blood  sugar  and  on  respiratory  quotient.  Evi- 
dence that  glucose  introduced  in  five  per  cent 
solution  is  not  absorbed  from  the  colon.  Occa- 
sional evidence  in  clinical  observations  of  loss 
of  glucose  in  the  colon  from  bacterial  action. 
Possible  dangers  in  clinical  use  of  the  glucose 
per  rectum  method.  Increase  in  fluid  content 
in  colon  after  hypertonic  glucose  solutions  are 
given  by  rectal  drip  method. 

Discussion  by  Rea  Smith,  M.  D.,  Los  An- 
geles, and  Clarence  G.  Toland,  M.  D.,  Los 
Angeles. 

4.  Method  of  Pylorectomy  and  Gastro-Enterostomy  in 

One  Operation — Asa  Collins,  M.  D.,  Room  2100, 
450  Sutter  Street,  San  Francisco. 

When  necessary  to  perform  a gastro-enteros- 
tomy  and  pylorectomy  at  one  operation,  too 
much  time  is  consumed  in  most  methods  to 
make  it  safe.  Pylorectomy  can  be  done  by  a 
technique  used  for  the  past  fifteen  years  in  a 
comparatively  short  time  and  with  a low  mor- 
tality. Statistical  chart  of  ninety-four  cases 
with  end  results.  Technique  of  operation  with 
illustrations.  Slides  of  radiograms  immediately 
and  years  after  operation.  End  results.  Sum- 
mary. 

Discussion  by  Rodney  A.  Yoell,  M.  D.,  San 
Francisco,  and  Carl  L.  Hoag,  San  Francisco. 

5.  Internal  Ring  in  Oblique  Inguinal  Hernia — Albert  R. 

Dickson,  M.  D.,  604  California  Medical  Build- 
ing, 1401  South  Hope  Street,  Los  Angeles. 

Oblique  inguinal  hernia  is  the  result  of: 
(1)  Preformed  congenital  sac.  (2)  Enlargement 
of  the  internal  ring,  which  is  an  opening  in  the 
transversalis  or  endo-abdominal  fascia.  Dis- 
cussion of  structures  involved  with  technique 
of  anatomical  repair  of  the  internal  ring,  stress- 
ing fascial  closure  of  this  vitally  important 
structure.  Illustrated. 

Discussion  by  William  Kiskadden,  M.  D., 
Los  Angeles,  and  A.  D.  Davis,  M.  D.,  San 
Francisco. 


278 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


INDUSTRIAL  MEDICINE  AND  SURGERY 
SECTION 

Charles  A.  Dukes,  M.  D.,  Chairman 
601  Wakefield  Building 

426  Seventeenth  Street,  Oakland 
Edmund  J.  Morrissey,  M.  D.,  Secretary 
201  Medical  Building 

909  Hyde  Street,  San  Francisco 

First  Meeting — Club  Room 

Tuesday,  April  29,  9 to  11:30  a.  m. 

1.  Chairman’s  Address — Ethics — Charles  A.  Dukes, 

M.  D.,  Oakland. 

As  applied  to  industrial  medical  practice, 
ethics  is  common  sense  in  dealing  with  patient, 
industry,  and  industrial  representative.  Some 
of  the  difficulties  in  dealing  with  the  insurance 
company  representatives.  Many  of  the  large 
industries  have  medical  departments  in  charge 
of  medical  representatives,  conducted  on  ethical 
lines.  Is  there  any  difference  in  ethics?  Is  it 
not  only  a more  complicated  application  of 
right? 

2.  Lead  Poisoning — Ernest  H.  Falconer,  M.  D.,  316 

Fitzhugh  Building,  384  Post  Street,  San  Fran- 
cisco. 

Analysis  of  one  hundred  cases  of  lead  intoxi- 
cation occurring  in  industry,  with  special  refer- 
ence to:  (1)  Criteria  necessary  for  diagnosis. 
(2)  Length  of  disability.  (3)  Treatment. 

3.  The  Treatment  of  Acute  Head  Injuries — Edmund  J. 

Morrissey,  M.  D.,  201  Medical  Building,  909 
Hyde  Street,  San  Francisco. 

In  the  treatment  of  head  injuries  it  is  of  prime 
importance  to  determine  the  extent  of  the  brain 
lesion.  This  is  manifested  by  positive  clinical 
findings  and  evidence  of  increased  intracranial 
pressure.  It  is  essential  likewise  to  distinguish 
whether  the  pressure  is  a result  of  brain  edema 
or  extracerebral  hemorrhage. 

Discussion  opened  by  E.  B.  Towne,  M.  D., 
San  Francisco. 

4.  Femoral  Condylitis — Merrill  C.  Mensor,  M.  D.,  1038 

Medico-Dental  Building,  490  Post  Street,  San 
Francisco. 

Reporting  two  cases  having  localized  inflam- 
matory process  of  the  condyle  of  the  femur, 
characteristic  roentgenological  appearances  and 
clinical  findings.  The  literature  does  not  reveal 
any  previous  report  of  a similar  syndrome.  The 
importance  of  differentiating  this  from  trauma 
is  essential  from  an  industrial  aspect. 

Discussion  opened  by  James  T.  Watkins, 
M.  D.,  San  Francisco. 

Second  Meeting — Tower  Room 

Thursday,  May  1,  9 to  11:30  a.  m. 

1.  Fracture  Dislocation  of  the  Cervical  Spine — H.  W. 

Spiers,  M.  D.,  614  Westlake  Professional  Build- 
ing, 2007  Wilshire  Boulevard,  Los  Angeles. 

An  efficient  method  of  reduction  and  reten- 
tion. A discussion  of  the  problems  and  the 
cardinal  principles  of  the  treatment  of  fractures 
as  related  to  them.  Case  histories  and  x-ray 
films.  A description  of  the  method  and  a five- 
minute  motion  picture  demonstration. 

Discussion  opened  by  Maynard  C.  Harding, 
M.  D.,  San  Diego. 

2.  Difficult  Fractures — W.  C.  Adams,  M.  D.,  802  Medi- 

cal Building,  1904  Franklin  Street,  Oakland. 

Showing  difficult  fractures  of  various  bones 
with  complications.  Handling  of  fractures  in 
case  of  complications.  Methods  of  reduction 
and  appliances.  (Lantern  slides.) 

Discussion  opened  by  E.  W.  Cleary,  M.  D., 
San  Francisco. 

3.  Bumper  Fractures — N.  Austin  Cary,  M.  D.,  2939 

Summit  Street,  Oakland. 

A series  of  fractures  in  patients  struck  by 
automobile  bumpers.  Nature  of  the  fracture. 
Method  of  treatment.  End  results  in  fifty-five 
cases. 

Discussion  opened  by  Leonard  Barnard, 
M.  D.,  Oakland. 


NEUROPSYCHIATRY  SECTION 

Thomas  G.  Inman,  M.  D.,  Chairman 
2000  Van  Ness  Avenue,  San  Francisco 

Henry  G.  Mehrtens,  M.  D.,  Secretary 
Stanford  Hospital,  San  Francisco 

First  Meeting — Garden  Room 

Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  The  Significance  of  Postural  Tensions  for  Normal 

and  Abnormal  Human  Behavior — Edward  J. 
Kempff,  M.  D.,  44  Butterfly  Lane,  Santa  Bar- 
bara. 

Physiology  of  postural  tensions  in  striped 
and  unstriped  neuromuscular  segments.  The 
proprioceptive  stream  and  affective  streams  in 
association  with  the  exteroceptive  streams  mak- 
ing most  of  the  stream  of  mentation.  Man’s 
method  of  controlling  the  effect  of  environ- 
mental stimuli,  particularly  personal  relations, 
upon  himself.  Man’s  method  of  controlling  the 
inner  streams  of  feeling  and  sensation  in  order 
to  control  himself  in  relation  to  his  environ- 
ment. Particular  application  of  these  principles 
to  the  functional  neuroses  and  psychoses. 

2.  Business  Meeting. 

Second  Meeting — Copper  Cup  Room 
Thursday,  May  1,  9 to  11:30  a.  m. 

1.  The  Constitutional  Psychopathic  Inferior  Personal- 

ity— A Medico-Legal  Problem — Thomas  J.  Orbi- 
son,  M.  D.  616  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

The  constitutional  psychopathic  inferior  pos- 
sesses inherent  and  implicit  factors  inimical  to 
society.  Graphs.  Data  to  show  unmistakable 
hereditary  element.  Stress  character  building 
in  childhood  and  youth  by  disciplinary  methods 
to  form  beneficent  acquired  characteristics. 
Emphasis  upon  duty  and  right  of  state  to  take 
cognizance  of  this  menace  since  the  patient  is 
often  committable. 

2.  Brain  Lesions  with  Homolateral  Signs  of  Pyramidal 

Tract  Involvement — I.  Leon  Meyers,  M.  D.,  1417 
Wilshire  Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Lesions  of  the  cerebellum  may  give  rise  to 
spastic  reflexes  and  a Babinski  sign  on  the  side 
of  the  lesion  instead  of  the  opposite  side.  This 
condition  occasionally  noted  in  lesions  of  the 
cerebrum.  The  rarity  of  such  instances,  with 
report  of  cases.  Stress  importance  of  securing 
data  other  than  those  resulting  from  damage  to 
pyramidal  tracts,  in  determining  the  laterality 
of  the  lesion. 

3.  A Clinical  Consideration  of  Epilepsy — Influence  of 

Calcium  and  IVater  Metabolism  Upon  Seizures — 
Helen  H.  Detrick,  M.  D.,  2055  California  Street, 
San  Francisco. 

Lines  along  which  control  of  epileptic  seiz- 
ures has  been  attempted  in  past.  Effects  of 
fasting,  ketogenic  diet,  and  dehydration  upon 
mineral  metabolism  of  body.  Clinical  applica- 
tion of  principles  with  special  relation  to  thera- 
peutic effects  of  a balanced  salt-water  regimen. 
Effect  on  convulsions,  personality  and  general 
health  of  patient. 

4.  Sodium  Chlorid  and  IVater  Metabolism  in  the  Con- 

vulsive States  — Frederick  Proescher,  M.  D., 
Agnew. 

This  paper  deals  with  the  sodium  chlorid  and 
water  metabolism  in  the  convulsive  states  under 
rigid  experimental  conditions.  The  diagnostic 
significance  of  the  sodium  chlorid  retention  and 
its  relation  to  seizures  will  be  discussed. 


April,  1930 


PROGRAM — FIFTY-NINTH  ANNUAL  SESSION 


279 


OBSTETRICS  AND  GYNECOLOGY  SECTION 

Karl  L.  Schaupp,  M.  D.,  Chairman 
835  Medico-Dental  Building 
490  Post  Street,  San  Francisco 

Clarence  A.  De  Puy,  M.  D.,  Secretary 
Strad  Building,  230  Grand  Avenue,  Oakland 

First  Meeting — Tower  Room 
Monday,  April  28,  2:30  to  5:30  p.  m. 

1.  Gonorrhea  in  the  Female — Albert  V.  Pettit,  M.  D., 

2000  Van  Ness  Avenue,  San  Francisco. 

Incidence  in  western  cities;  handling  of  in- 
fectious cases.  Internal  and  external  pathology 
of  acute  and  so-called  chronic  gonorrheal  in- 
fections. Criticism  of  methods  of  treatment. 
Operative  and  nonoperative  treatments. 

Description  and  criticism  of  newer  methods; 
hyperpyrexia  induced  by  foreign  protein,  hydro- 
therapy and  diathermy. 

Problem  facing  gynecologists  in  treatment  of 
gonorrhea,  from  economic  and  social  aspects. 
Case  reports. 

2.  Nonspecific  Vaginal  Infection — Donald  A.  Dallas, 

M.  D.,  530  Medico-Dental  Building,  490  Post 
Street,  San  Francisco. 

Description  of  the  various  types  of  non- 
gonorrheal  cervicitis  and  vaginitis  as  seen  and 
studied  in  the  Stanford  University  Women’s 
Clinic,  with  appropriate  methods  of  treatment 
for  each  form. 

3.  Pelvic  Endometriosis — Alice  Maxwell,  M.  D.,  Uni- 

versity of  California  Hospital,  Fourth  and  Par- 
nassus Avenues,  San  Francisco. 

The  importance  of  aberrant  Mullerian  tissue 
is  apparent  from  the  numerous  reports  appear- 
ing on  pelvic  endometriosis.  The  discussion 
will  be  concerned  with  theories  of  its  etiology. 
The  variation  and  severity  of  the  symptoms 
depend  upon  the  invasiveness  of  the  aberrant 
endometrium  and  the  resulting  peritonitis  and 
fixation  of  the  involved  structures.  A diagnosis 
of  the  lesions  and  treatment  of  the  condition 
will  be  presented. 

Second  Meeting — Children’s  Playroom  A 
Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  Chairman's  Address — Resuscitation  of  the  Newborn 

— Karl  L.  Schaupp,  M.  D.,  San  Francisco. 

2.  Conduct  of  Normal  Labor — John  Vruwink,  M.  D., 

709  Medical  Office  Building,  1136  West  Sixth 
Street,  Los  Angeles. 

Definition  of  normal  labor.  Objective  in  the 
management  of  normal  labor.  Role  of  anal- 
gesia and  anesthesia.  Value  and  detriment  of 
certain  medical  and  surgical  aids.  Review  of 
cases  without  analgesia,  and  with  Gwathmey  or 
twilight  sleep.  Suggestions  in  the  management 
of  the  third  stage  and  the  immediate  care  of 
the  nursing  child. 

3.  Conduct  of  Occiput  Posterior  Position — T.  Floyd 

Bell,  M.  D.,  400  Twenty-Ninth  Street,  Oakland. 

Study  based  on  histories  of  occiput  posterior 
position  at  the  University  of  California  Hos- 
pital. Internal  rotation  is  considered  in  detail 
in  relation  to  poor  pains,  parity,  poor  flexion, 
and  in  spontaneous  deliveries.  Interference  in 
delivery  with  forceps  and  other  means  has  been 
studied.  Maternal  and  fetal  deaths  tabulated. 
Treatment  is  considered  as  to  means  of  rota- 
tion, the  use  of  anesthesia  in  long  labors,  and 
the  type  of  delivery. 


4.  Birth  Injuries  — Louis  I.  Breitstein,  M.  D.,  416 
Union  Square  Building,  350  Post  Street,  San 
Francisco. 

Plea  for  “better  obstetrics”;  better  instruc- 
tion of  undergraduates;  better  diagnosis;  befter 
management  in  contracted  pelves,  and  better 
technique  in  operative  procedures.  Danger  in 
use  of  forceps  and  also  in  prolongation  of  ex- 
pectant policy.  Need  for  closer  cooperation 
with  pediatrician  and  neurosurgeon.  Motion 
picture  of  birth  injuries. 


PATHOLOGY  AND  BACTERIOLOGY 
SECTION* 

W.  T.  Cummins,  M.  D.,  Chairman 
Southern  Pacific  Hospital,  San  Francisco 
George  D.  Maner,  M.  D.,  Secretary 
Wilshire  Medical  Building 
1930  Wilshire  Boulevard,  Los  Angeles 

First  Meeting — Club  Room 
Monday,  April  28,  2:30  to  5:30  p.  m. 

1.  Chairman’s  Address — W.  T.  Cummins,  M.  D.,  San 

Francisco. 

2.  The  Clinical  Significance  of  Erythrocytic  Measure- 

ments— A New,  Simple  Method  of  Determining — 
Garnett  Cheney,  M.  D.,  703  Shreve  Building, 
210  Post  Street,  San  Francisco. 

History  of  red  cell  measurements.  Laborious 
methods  employed.  Simplicity  and  accuracy  of 
Eve’s  “halometer”  for  measuring  average, 
mean  diameters  noted.  Normal  average  sizes. 
Disorders  in  which  measurements  are  of  great, 
of  considerable,  and  of  doubtful  value.  The 
facility  of  Eve’s  method  necessitates  a wider 
clinical  knowledge  of  subject.  (Illustrated.) 

3.  Some  of  the  Factors  Governing  Tumor  Susceptibility 

— C.  L.  Connor,  M.  D.,  University  of  California 
Medical  School,  San  Francisco.  (By  invitation.) 

This  is  a summary  of  work  on  hereditary  and 
racial  susceptibility  and  immunity  as  studied  by 
others,  and  a resume  of  personal  work  on  the 
effect  of  sex  glands,  and  other  glands,  wffiich 
may  in  some  manner  regulate  the  growth  of 
tumors.  (Illustrated.) 

4.  The  Flagellate , Trichomonas  Hominis;  Pathogenicity 

in  the  Rabbit,  with  Report  of  a Human  Fatality — 
Franklin  R.  Nuzum,  M.  D.,  Albert  H.  Elliott, 
M.  D.,  and  Blanche  V.  Priest,  A.  B.  (By  invi- 
tation.) Cottage  Hospital,  Santa  Barbara. 

The  literature  is  summarized  regarding  the 
geographical  distribution  and  incidence  of 
Trichomonas  hominis  infestation.  The  sympto- 
matology, pathogenicity,  and  results  of  animal 
experimentation  are  discussed.  A series  of  in- 
oculation experiments  in  rabbits  are  reported.in 
detail.  An  instance  of  infestation  in  man,  with 
complete  necropsy  examination  is  given. 

Luncheon  Notices 

Luncheon  on  Tuesday  in  Copper  Cup  Room,  to 
which  guests,  officers  of  the  California  Medical  Asso- 
ciation, and  members  of  the  Section  on  Surgery  are 
invited. 

Members  of  the  Section  on  Pathology  are  requested 
to  attend  the  luncheon  on  Wednesday  in  Copper  Cup 
Room,  at  which  Dr.  Z.  E.  Bolin  will  present  “Pathol- 
ogy and  Legal  Medicine.” 

Scientific  Exhibit 

A scientific  exhibit  of  gross  and  microscopic  speci- 
mens, illustrating  the  Mycoses,  will  be  demonstrated 
in  the  corridor  adjacent  to  the  Club  Room,  together 
with  roentgenologic  pictures  and  charts,  and  other 
gross  specimens  illustrating  various  interesting  phases 
of  pathology.  Exhibit  will  be  personally  demonstrated. 


280 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


5.  Case  Reports  of  Mycotic  Diseases  (Illustrated) : 

Coccidioidal  Meningitis — A.  H.  Zeiler,  M.  D., 
Los  Angeles. 

Blastomycosis— V.  L.  Andrews,  M.  D.,  Holly- 
wood. 

Actinomycosis— H.  A.  Thompson,  M.  D.,  San 
Diego,  and  S.  P.  Strange,  M.  D.,  San  Fran- 
cisco. 

Sporotrichosis  and  Streptothricosis — H.  S. 

Sumerlin,  M.  D.,  San  Diego. 

Aspergillosis  — Newton  Evans,  M.  D.,  South 
Pasadena. 

Torular  Meningitis — B.  Frank  Sturdivant,  M.D.. 
Pasadena. 

Unusual  Fungous  Septicemia  — O.  I.  Cutler. 
M.  D.,  Loma  Linda. 

Histoplasmosis — J.  F.  Kessel,  Ph.  D.,  and  Ralph 
Crumrine,  M.  D.,  Los  Angeles.  (By  invi- 
tation.) 

Second  Meeting — Garden  Room 
Union  Meeting  with  the  Surgery  Section 
Tuesday,  April  29,  9 to  11:30  a.  m. 

1.  The  Deep  Mycoses  in  Their  Surgical  Aspects— Role 

of  Laboratory  Diagnosis — Fred  D.  Weidman, 
M.  D.,  University  of  Pennsylvania,  Philadel- 
phia. (By  invitation.) 

2.  Symposium  on  Coccidioidal  Granuloma: 

Internal  Medicine— Herbert  C.  Moffitt,  M.  D., 
San  Francisco. 

Surgery — Emmet  Rixford,  M.  D.,  San  Fran- 
cisco. 

Pathology  and  Bacteriology — William  Ophuls, 
M.  D.,  San  Francisco. 

Dermatology — Douglass  W.  Montgomery,  M.  D., 
San  Francisco. 

Roentgenology  (Illustrated) — William  B.  Bow- 
man, M.  D.,  Los  Angeles. 

Discussion  by  Howard  Morrow,  M.  D.,  San 
Francisco,  and  Karl  F.  Meyer,  Ph.  D.,  San 
Francisco. 

Third  Meeting — Club  Room 
Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  The  Experimental  Production  of  Arteriosclerosis — 

Richard  D.  Evans,  M.  D.,  Cottage  Hospital, 
Santa  Barbara. 

Arteriosclerosis  is  one  of  the  oldest  of  patho- 
logical conditions  and  is  the  most  important 
change  in  the  degenerative  diseases  which  are 
becoming  increasingly  prevalent.  The  types  of 
sclerosis  are  described  and  the  experimental 
work  done  on  their  etiology  is  summarized. 
Histological  preparations  will  be  demonstrated. 
(Illustrated.) 

2.  Tularemia  in  Cattle  and  Sheep — J.  C.  Geiger,  M.  D., 

Hooper  Foundation  for  Medical  Research,  San 
Francisco. 

Tularemia  is  primarily  a disease  of  wild  rab- 
bits. Man  becomes  infected  secondarily,  the 
mode  of  transmission  being  from  rodents 
through  the  bite  of  an  infected  fly,  tick,  or  per- 
haps mosquito,  or  by  contamination  of  cutane- 
ous or  conjunctival  surfaces.  The  geographic 
and  animal  distribution  of  the  disease  must  be 
very  wide.  Tularemic  investigations  in  cattle 
and  sheep,  and  their  possible  relationship  to 
human  beings,  are  fully  discussed. 

3.  Histologic  Diagnosis  of  Tumors  of  the  Glioma  Group 

— Cyril  B.  Courville,  M.D.,  Los  Angeles  County 
General  Hospital,  1100  Mission  Road,  Los  An- 
geles, and  L.  J.  Adelstein,  M.  D.,  Los  Angeles. 
(By  invitation.) 

The  histologic  diagnosis  of  gliomas  is  pre- 
sented from  the  standpoint  of  the  general  pa- 
thologist, with  the  use  primarily  of  routine 


staining  methods.  The  interpretation  of  the 
histologic  picture,  thus  presented,  is  facilitated 
by  the  use  of  specific  metallic  methods.  Pa- 
thologists, and  others  interested  in  intracranial 
pathology,  should  acquaint  themselves  with  a 
few,  definite,  characteristic  histologic  aspects 
of  the  common  gliomas.  (Illustrated.) 

4.  The  Colloidal  Benzoin  Test  of  Spinal  Fluid  and  Its 
Clinical  Value — W.  R.  Dodson,  M.  D.,  Los  An- 
geles County  General  Hospital,  1100  Mission 
Road,  Los  Angeles.  (By  invitation.) 

In  which  the  constancy  of  the  benzoin  re- 
action is  studied  in  purulent  meningitis,  syphi- 
lis of  the  central  nervous  system  and  meninges, 
tuberculous  meningitis,  poliomyelitis,  encepha- 
litis and  a miscellaneous  group,  comprising 
one  thousand  cases  verified  by  clinical  and 
laboratory  findings  and  in  part  by  autopsy. 


PEDIATRICS  SECTION 

Guy  L.  Bliss,  M.  D.,  Chairman 

1723  East  First  Street,  Long  Beach 

Donald  K.  Woods,  M.  D.,  Secretary 

Fifth  and  Laurel  Streets,  San  Diego 

First  Meeting — Copper  Cup  Room 

Monday,  April  28,  2:30  to  5:30  p.  m. 

1.  Chairman’s  Address  — Problem  Parents  — Guy  L. 

Bliss,  M.  D.,  Long  Beach. 

The  new  development  of  applied  psychology 
is  of  great  assistance  to  modern  pediatrics.  The 
education  of  parents  by  classes  in  the  public 
schools  and  also  by  mental  hygiene  societies  is 
of  great  assistance.  Foster  homes  for  problem 
children  while  the  parents  are  being  educated 
are  of  great  assistance. 

2.  Pneumonia  at  the  Los  Angeles  General  Hospital — 

Review  and  Discussion  of  Cases  During  the  Past 
Few  Years — E.  E.  Moody,  M.  D.,  722  Westlake 
Professional  Building,  2007  Wilshire  Boulevard, 
Los  Angeles. 

New  methods  of  treatment  or  new  scientific 
data  are  not  the  scope  of  this  paper.  Pneumonia 
service  in  children  in  Los  Angeles  General 
Hospital  is  perhaps  the  largest  in  the  state. 
The  Mexican  population  furnishes  a large  part 
of  the  cases.  Pneumonia  classified.  The  pneu- 
monia of  last  year  showed  an  unusual  inci- 
dence of  influenza.  Low  death  rate  of  our 

service.  Open-air  treatment  for  lobar  cases. 

Discussion  by  William  Happ,  M.  D.,  Los  An- 
geles, and  S.  J.  McClendon,  M.  D.,  San  Diego. 

3.  The  Duration  of  Breast  Feeding  in  One  Thousand 

Cases  of  American  IV ell  Babies — E.  J.  Lamb, 
M.  D.,  1515  State  Street,  Santa  Barbara. 

Review  of  literature  in  comparison  with  simi- 
lar studies.  Synopsis:  Character  of  labor,  birth 
weight,  etc.  Duration  of  breast  feeding  esti- 
mated in  per  cent  for  months.  Causes  for 

weaning  baby  from  breast.  Artificial  feedings 
substituted  for  breast  milk. 

Discussion  opened  by  J.  B.  Manning,  M.  D., 
Santa  Barbara. 

4.  Blood  Transfusions  in  Children — Phillip  Rothman, 

M.  D.,  925  Pacific  Mutual  Building,  523  West 
Sixth  Street,  Los  Angeles. 

The  present  status  of  blood  transfusions  in 
pediatrics  is  discussed.  The  merits  of  the  pro- 
cedure in  the  treatment  of  anemias,  sepsis, 

pneumonia,  and  malnutrition  are  reviewed  and 
illustrated  with  case  reports.  The  causes  of  re- 
actions, technique  of  administering  blood,  and 
essentials  for  proper  matching  are  emphasized. 

Discussion  by  E.  P.  Cook,  M.  D.,  San  Jose, 
and  W.  W.  Belford,  M.  D.,  San  Diego. 


April,  1930 


PROGRAM — FIFTY-NINTII  ANNUAL  SESSION 


281 


S.  Hilum  Tuberculosis  in  Children — Joseph  C.  Savage, 
M.  D.,  Wilshire  Medical  Building,  1930  Wil- 
shire  Boulevard,  Los  Angeles. 

Hilum  tuberculosis  in  children  frequently 
overlooked.  Necessity  for  more  careful  check- 
ing of  children’s  chests  in  suspicious  cases. 

The  value  of  the  x-ray.  Emphasis  on  the 
need  of  prolonged  care. 

Observation  and  rechecking  of  these  cases. 
Discussion  opened  by  Lloyd  B.  Dickey,  M.  D., 
San  Francisco. 

Second  Meeting — Auditorium 
Union  Meeting  of  General  Medicine  With 
Pediatrics  Section 

Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  The  Role  Played  by  Infection  in  the  Disorders  in 

Infants  and  Children — McKim  Marriott,  M.  D., 
Washington  University  School  of  Medicine,  St. 
Louis.  (By  invitation.) 

2.  Colic  in  the  Second  Trimester  of  Infancy — A.  J. 

Scott,  Jr.,  M.  D.,  900  California  Medical  Build- 
ing, 1401  South  Hope  Street,  Los  Angeles. 

Colic  in  the  second  three  months  of  infancy 
is  not  common.  Etiological  factors  to  be  con- 
sidered are:  indigestion;  angioneurotic  edema; 
cerebral  birth  injuries;  congenital  anomalies  as 
Meckel’s  diverticulum  with  volvulus,  intussus- 
ception; pyuria  and  renal  colic;  the  neurotic 
child  with  nervous  parents;  inflammatory  dis- 
eases of  the  ear;  strangulated  hernia. 

Discussion  opened  by  Langley  Porter,  M.  D., 
San  Francisco. 

3.  Abdominal  Allergy  in  Infancy — Henry  E.  Stafford, 

M.  D.,  242  Moss  Avenue,  Oakland. 

Colic  with  or  without  vomiting  often  can  best 
be  treated  when  considered  as  an  allergic  mani- 
festation. Illustrative  cases  and  practical  points 
in  treatment  are  to  be  discussed. 

Discussion  by  E.  S.  Babcock,  M.  D.,  Sacra- 
mento, and  A.  H.  Rowe,  M.  D.,  Oakland. 

4.  Congenital  Heart  Disease — Hobart  Rogers,  M.  D., 

Summit  Medical  Building,  400  Twenty-ninth 
Street,  Oakland. 

A fifteen-minute  film  of  sixteen  millimeters 
size,  showing  different  phases  of  congenital 
heart  disease.  Discussion  of  the  different  points 
brought  out  by  the  film  as  it  is  run. 

Discussion  opened  by  William  J.  Kerr,  M.  D., 
San  Francisco. 


RADIOLOGY  SECTION* 

Irving  S.  Ingber,  M.  D.,  Chairman 
321  Medico-Dental  Building 
490  Post  Street,  San  Francisco 

William  H.  Sargent,  M.  D.,  Secretary 
Franklin  Building,  1624  Franklin  Street,  Oakland 

First  Day — Copper  Cup  Room 
Tuesday,  April  29,  8:30  to  11:30  a.  m. 

Business  Session 

1.  Chairman’s  Address. 

2.  Radiation  Treatment  of  Carcinoma  of  the  Respira- 

tory Tract — Orville  N.  Meland,  M.  D.,  1407 
South  Hope  Street,  Los  Angeles. 

Malignancy  of  the  respiratory  tract  is  usually 
of  the  inoperable  type.  The  exception  to  the 
rule  is  intrinsic  carcinoma  of  the  larynx.  Carci- 
noma of  the  bronchial  tree  is  benefited  by 
x-radiation,  and  if  it  is  discovered  early  by 
bronchoscopic  examination,  implantation  of 
radium  needles  or  radon  seeds  will  retard  the 
progress  of  the  disease.  Report  of  cases. 

Discussion  opened  by  Edward  W.  Chamber- 
lain,  M.  D.,  San  Diego. 

* Discussion  must  be  limited  to  five  minutes  and  gen- 
eral discussion  on  case  reports. 


3.  Multiple  Myeloma  With  a Case  Report  — Lloyd 

Bryan,  M.  D.,  and  Joseph  Levitin,  M.  D.,  Room 
1124,  450  Sutter  Street,  San  Francisco. 

Lantern  slide  demonstration,  showing  effects 
of  therapy  on  the  tumor. 

4.  The  Effect  of  X-Ray  on  Tissue — Henry  J.  Ullmann, 

M.  D.,  1520  Chapala  Street,  Santa  Barbara. 

Methods  for  determining  the  time  after  radia- 
tion when  the  greatest  effect  occurs,  at  least 
for  a certain  definite  portion  of  the  effect. 

Discussion  opened  by  A.  U.  Desjardins, 
M.  D.,  Mayo  Clinic,  Rochester,  Minnesota. 

5.  Therapeutic  Irradiation  of  the  Ovaries — Alfred  C. 

Siefert,  M.  D.,  Merritt  Hospital,  Oakland. 

The  ovary,  exclusive  of  reproductive  function, 
occupies  a dominant  position  in  female  organ- 
ism in  youth  and  maturity,  in  health  and  dis- 
ease. Its  periodic  activity  affects  remote  organs, 
normal  or  pathological. 

Therapeutic  irradiation  and  modification  of 
ablation  of  function  discussed;  radiation  treat- 
ment of  benign  gynecological  diseases,  and  of 
extragenital  affections  of  the  female  organism. 

Discussion  opened  by  William  H.  Sargent, 
M.  D.,  Oakland. 

6.  Radiosensitiveness  of  Lymphocytes  and  Its  Signifi- 

cance in  Radiotherapy — A.  U.  Desjardins,  M.  D., 
Mayo  Clinic,  Rochester,  Minnesota.  (By  invi- 
tation.) 

Second  Day — Copper  Cup  Room 
Wednesday,  April  30,  8:30  to  11:30  a.  m. 

1.  X-Ray  Diagnosis  of  Lung  Pathology — Frank  R.  Ruff, 

M.  D.,  Burnett  Sanitarium,  Fresno. 

This  article  covers  many  lung  conditions, 
with  lantern  slides  to  show  the  different  dis- 
eases such  as  syphilis  of  the  lung,  Hodgkin’s 
disease,  abscesses,  dermoid  cysts,  malignancies, 
unresolved  pneumonia,  pneumothoraces,  em- 
pyema, etc.,  with  a short  discussion  of  each  as 
to  the  differential  diagnosis. 

Discussion  by  Rollo  G.  Karshner,  M.  D.,  Los 
Angeles. 

2.  A Case  Simulating  Thoracic  Stomach — James  B. 

Bullitt,  M.  D.,  303  Medico-Dental  Building,  San 
Jose. 

3.  Diverticula  of  the  Stomach — With  the  Report  of 

Three  Cases — M.  J.  Geyman,  M.D.,  1520  Cha- 
pala Street,  Santa  Barbara. 

4.  Chylo-Thorax — R.  G.  Van  Nuys,  M.  D.,  Franklin 

Building,  1624  Franklin  Street,  Oakland. 

Report  of  one  case  with  brief  resume  of 
literature.  These  cases  are  rare  and  interesting. 
This  case  presents  some  unusual  features. 

5.  Ewing’s  Tumor — Kenneth  S.  Davis,  M.  D.,  St. 

Vincent’s  Hospital,  Los  Angeles. 

6.  High  Milliamperage  Technique — John  D.  Lawson, 

M.  D.,  Woodland  Clinic,  Woodland. 

Report  of  five  years’  experimentations  with 
a technique  using  milliamperage  varying  from 
100  to  250.  Comparison  of  efficiency  and  econ- 
omy of  this  contrasted  with  lower  milliamper- 
age method. 

7.  The  Value  of  the  X-Ray  in  the  Diagnosis  of  Tracheo- 

bronchial and  Pulmonary  Tuberculosis — M.  L. 
Pindell,  M.  D.,  678  South  Ferris  Avenue,  Los 
Angeles. 

Ten-year  contract  program.  Physical  find- 
ings versus  x-ray  findings.  Conclusions. 


282 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


UROLOGY  SECTION 

Charles  P.  Mathe,  M.  D.,  Chairman 
Room  1831,  450  Sutter  Street,  San  Francisco 

Harry  W.  Martin,  M.  D.,  Secretary 
1010  Quinby  Building 
650  South  Grand  Ave.,  Los  Angeles 

First  Meeting — Tower  Room 
Tuesday,  April  29,  9 to  11:30  a.  m. 

1.  Chairman’s  Address — Charles  P.  Mathe,  M.  D., 

San  Francisco. 

2.  End  Results  in  Perineal  Prostatectomy  by  the  Closed 

Method — A.  Elmer  Belt,  M.  D.,  722  Pacific 
Mutual  Building,  523  West  Sixth  Street,  Los 
Angeles. 

This  paper  deals  with  the  results  in  a group 
of  perineal  prostatectomies  done  by  the  closed 
method.  The  technique  is  resumed  with  modi- 
fication used  by  the  author.  The  comparison 
with  the  classical  or  open  method  bears  upon 
the  length  of  hospitalization,  of  wound  healing, 
functional  results  together  with  changes  in  the 
postoperative  care. 

Discussion  opened  by  George  G.  Reinle, 
M.  D.,  Oakland. 

3.  Radical  Prostato-Seminal  Vesiculectomy  for  Benign 

Hyperplasia  with  Infection — Frank  Hinman, 
M.  D,.  603  Fitzhugh  Building,  384  Post  Street, 
San  Francisco. 

Reason  for  operation.  Technical  steps  of  the 
first  operation,  illustrated  with  lantern  slides. 
Report  of  cases;  pathological  findings;  results, 
urination,  sexual  power. 

Discussion  opened  by  Leo  Buerger,  M.  D., 
Los  Angeles. 

4.  The  Obstructing  Prostate  and  Its  Surgical  Treatment 

— Nathan  Hale,  M.  D.,  418  Medico-Dental 

Building,  1127  Eleventh  Street,  Sacramento. 

The  author’s  results  based  on  six  years’’  rec- 
ords in  one  hospital.  An  attempt  to  record  the 
end  results  of  recognized  operative  procedures 
under  ordinary  conditions  and  usual  hospital 
care. 

Discussion  opened  by  Wilbur  Parker,  M.  D., 
Los  Angeles. 

5.  Clinical  Manifestations  of  Bladder  Tumors — Louis 

Clive  Jacobs,  M.  D.,  Room  1410,  450  Sutter 
Street,  San  Francisco,  and  Abelson  Epsteen, 
M.  D.,  870  Market  Street,  San  Francisco. 

A study  of  bladder  tumors  based  upon  a 
review  of  one  hundred  cases  at  Mount  Zion 
Hospital,  San  Francisco.  Special  emphasis  is 
placed  upon  frequency  of  occurrence;  methods 
of  diagnosis;  necessity  of  complete  cystoscopic 
investigation;  value  of  roentgenology,  including 
cystography;  and  biopsic  findings.  An  evalua- 
tion of  surgical  diathermy  is  detailed. 

Discussion  opened  by  George  D.  Stilson, 
M.  D.,  Long  Beach. 

6.  The  Treatment  of  Acute  Prostatitis — Burnett  Wright, 

M.  D.,  1137  Roosevelt  Building,  727  West  Sev- 
enth Street,  Los  Angeles. 

A convenient  and  efficient  method  is  described. 
An  apparatus  that  permits  of  continuous 
rectal  irrigation  with  solutions  of  a constant, 
controllable  temperature  for  long  periods  of 
time,  will  be  illustrated  by  lantern  slides. 

Discussion  opened  by  Edward  W.  Beach, 
M.  D.,  Sacramento. 


7.  Demonstration  of  a New  Cystoscopic  Instrument — 
Herbert  A.  Rosenkranz,  M.  D.,  1024  Story 
Building,  610  South  Broadway,  Los  Angeles. 

Demonstration  of  a device  to  prevent  drag- 
ging out  or  displacement  of  renal  catheters  dur- 
ing withdrawal  of  the  cystoscopic  sheath. 

Second  Meeting — Tower  Room 

Wednesday,  April  30,  9 to  11:30  a.  m. 

1.  Business  Meeting. 

2.  Nephroptosis — Diagnosis  and  Treatment:  Review  of 

Case  Histories  and  X-Rays — J.  J.  Crane,  M.  D., 
514  Westlake  Professional  Building,  2007  Wil- 
shire  Boulevard,  Los  Angeles. 

Diagnosis  is  based  on:  (a)  Symptoms  which 
are  quite  uniform  for  all  cases.  ( b ) Physical 
examination.  ( c ) Kidney  studies,  pyelograms 
taken  in  supine  and  upright  positions  to  show 
degree  of  ptosis,  dilatation  of  calices  and  pelvis 
as  well  as  kinking  of  ureters.  Reproduction  of 
pain  by  pyelogram,  etc. 

Treatment:  (a)  Nonsurgical.  ( b ) Surgical: 
Methods. 

Discussion  opened  by  William  E.  Stevens, 
M.  D.,  San  Francisco. 

3.  Ureteral  Pain  Persisting  After  Nephrectomy,  Re- 

lieved by  Ureterectomy — Lewis  Michelson,  M.  D., 
434  Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

Erroneous  idea  that  pain  cannot  be  present 
in  ureter  after  removal  of  kidney.  Discussion 
as  to  cause  of  pain.  Pathological  findings  and 
report  of  cases. 

Discussion  opened  by  B.  H.  Hager,  M.  D., 
Los  Angeles. 

4.  Pathology  of  Kidney  and  Ureter  in  Calculus  Dis- 

ease— Leo  Buerger,  M.  D.,  Wilshire  Medical 
Building,  1930  Wilshire  Boulevard,  Los  Angeles. 

Salient  features  of  pathological  alterations 
induced  by  infection  and  calculus  disease,  an- 
alyzed with  a view  to  improve  methods  for 
conservation  of  reno-ureteral  tract. 

5.  Management  of  Stag-Horn  Stones  in  Unilateral  Kid- 

neys— James  R.  Dillon,  M.  D.,  301  Medico- 
Dental  Building,  490  Post  Street,  San  Fran- 
cisco. 

Introduction — Discussion  of  operative  tech- 
nique which  will  cause  a minimum  of  destruc- 
tion of  kidney  tissue  and  of  function.  Presen- 
tation of  cases.  Summary.  (Lantern  slides.) 

Discussion  of  Doctor  Buerger’s  and  Doctor 
Dillon’s  papers  by  J.  C.  Negley,  M.  D.,  Los 
Angeles,  and  Paul  A.  Ferrier,  Pasadena. 

6.  Horseshoe  Kidney — With  Report  of  a Case  in  Which 

Partial  Resection  was  Performed — A.  J.  Scholl, 
M.  D.,  721  Pacific  Mutual  Building,  523  West 
Sixth  Street,  Los  Angeles. 

A short  review  of  the  anatomy  of  horseshoe 
kidneys  is  given,  together  with  a discussion  of 
the  surgical  approach  in  the  treatment  of  vari- 
ous pathological  conditions.  A case  is  reported 
of  resection  of  one-half  of  a horseshoe  kidney. 

Discussion  by  Edwin  F.  Chamberlain,  M.  D., 
San  Diego. 

7.  Ureteral  Reflux  in  the  Human  Being — H.  A.  R. 

Kreutzmann,  M.  D.,  2000  Van  Ness  Avenue, 
San  Francisco. 

A summary  of  the  various  factors  which 
cause  ureteral  reflux,  with  a discussion  of  its 
occurrence  in  normal  people. 

Discussion  opened  by  Franklin  Farman, 
M.  D.,  Los  Angeles. 


April,  1930 


PROCRAM — FIFTY-NINTH  ANNUAL  SESSION 


283 


HOTEL  DEL  MONTE— HEADQUARTERS 


ENTERTAINMENT  PROGRAM 


GOLF 

GOLF  COMMITTEE 


Elbridge  J.  Best,  Chairman San  Francisco 

John  Crossan Los  Angeles 

Orrin  Cook Sacramento 

Harry  Alderson San  Francisco 

Clarence  G.  Toland Los  Angeles 


For  those  who  enjoy  golf,  the  Monterey  Peninsula 
offers  abundant  opportunity  for  recreation.  It  will  be 
possible  to  play  each  day  while  attending  the  meeting. 

On  Sunday,  April  27,  there  will  be  no  medical 
tournament,  but  it  will  be  possible,  for  those  who 
wish,  to  play  one  of  several  courses. 

Monday,  the  28th,  in  the  morning,  there  will  be  a 
special  tournament  on  the  Del  Monte  links. 

Tuesday  afternoon,  the  regular  tournament  will  be 
held  to  decide  the  championship  of  the  Association. 
There  will  also  be  a number  of  attractive  prizes  so 


arranged  as  to  give  every  player  an  equal  chance 
to  win. 

Wednesday  afternoon  will  be  devoted  to  a tourna- 
ment on  the  Pebble  Beach  links  and  some  novel 
features  will  be  introduced. 

All  competition  will  be  based  upon  medal  play, 
according  to  the  U.  S.  G.  A.  rules.  Failure  to  putt 
out  on  any  hole  disqualifies. 

In  view  of  the  fact  that  the  North  and  South  Medi- 
cal Golf  Associations  have  decided  not  to  hold  their 
annual  tournament  this  year  because  of  the  possibility 
that  such  a tournament  might  detract  from  the  medi- 
cal meeting,  the  number  of  contestants  for  the  above 
tournaments  will  probably  be  large.  It  is  therefore 
strongly  urged  that  all  players  watch  for  detailed 
announcements  and  be  on  the  first  tee  early  in  order 
that  every  one  may  complete  his  round  in  good  time. 


PROGRAM  FOR  WOMAN’S  AUXILIARY 


STATE  AUXILIARY  OFFICERS 

Mrs.  H.  S.  Rogers,  Petaluma. President 

Mrs.  W.  H.  Geistweit,  San  Diego First  Vice-President 

Mrs.  John  Hunt  Shephard,  San  Jose 

Second  Vice-President 

Mrs.  R.  A.  Cushman,  Santa  Ana  Secretary-Treasurer 

Business  Meetings 

On  Tuesday,  April  29,  at  10  a.  m.  a meeting  of  the 
Woman’s  Auxiliary  of  the  California  Medical  Asso- 
ciation will  be  held  in  the  Lounge  adjoining  the  main 
dining  room.  All  members  of  county  and  state  auxili- 
aries and  all  visiting  women  eligible  to  membership 
are  invited  to  attend. 

On  Wednesday,  April  30,  at  10  a.  m.,  a second  meet- 
ing of  the  Woman’s  Auxiliary  of  the  California  Medi- 
cal Association  will  be  held  in  the  Lounge.  Dr. 
Morton  R.  Gibbons,  president  of  the  California  Medi- 
cal Association,  and  Dr.  William  Duffield,  councilor 
of  Los  Angeles,  will  address  this  meeting.  All  mem- 
bers of  the  auxiliary  and  all  visiting  women,  eligible 
to  membership,  are  earnestly  requested  to  attend. 

Entertainment 
Seventeen-Mile  Drive 

Tuesday  afternoon,  April  29,  has  been  devoted  to 
the  enjoyment  of  the  famous  Seventeen-Mile  Drive. 
All  women  guests  are  invited.  Will  those  who  have 
extra  space  in  their  cars  furnish  this  information  to 


the  registration  desk  that  all  available  space  may  be 
used.  The  Chamber  of  Commerce  and  Arrange- 
ments Committee  will  endeavor  to  provide  trans- 
portation for  those  who  cannot  be  so  accommodated. 

Tea  to  President' s Wife 

In  honor  of  Mrs.  Morton  R.  Gibbons,  a tea  will  be 
held  at  the  Monterey  Peninsula  Country  Club  on 
Wednesday  afternoon  at  four  o’clock.  Those  who 
desire  to  attend  will  please  secure  tickets  at  the  regis- 
tration desk.  Early  reservation  for  all  events  is  ear- 
nestly requested.  Members  who  have  available  space 
in  their  cars  should  furnish  this  information  at  the 
time  of  purchasing  tickets. 

Call  to  Breakfast  Conferences 

The  board  of  directors  of  the  Woman’s  Auxiliary, 
consisting  of  the  president,  first  and  second  vice-presi- 
dents, secretary-treasurer  of  the  State  Auxiliary,  and 
the  presidents  and  secretaries  of  each  County  Auxili- 
ary will  meet  at  nine  o’clock  breakfasts  for  informal 
conferences  on  Monday  the  28,  Tuesday  the  29th,  and 
Wednesday  the  30th. 

Luncheons 

A luncheon  table  for  members  will  be  set  apart  in 
the  main  dining  room,  to  which  all  members  of  the 
auxiliary  are  invited  on  Wednesday  at  one  o’clock. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION 


MORTON  R.  GIBBONS President 

LTELL  C.  KINNEY President-Elect 

EMMA  W.  POPE Secretary 


OFFICIAL  NOTICE 

SOUTHERN  PACIFIC  TRAIN  SCHEDULE 
TO  DEL  MONTE 

Leave  San  Francisco 8:00  a.  m.  3:00  p.  m.  6:15  p.  m. 

Arrive  at  Del  Monte 11:46  a.m.  6:20  p.m.  9:56  p.m. 

* * * 

Leave  Los  Angeles 8:00  a.m.  8:15  p.m. 

Arrive  at  Del  Monte 8:20  p.  m.  8:07  a.  m. 

* * * 

Round  trip  rates  to  Del  Monte: 

From  San  Francisco $ 6.00 

From  Los  Angeles 18.50 

* * * 

Driving  from  South:  Go  to  Salinas,  turn  left  and  drive 
straight  to  Del  Monte. 

Driving  from  North:  Go  to  Salinas  and  on  through 
town  direct  to  Del  Monte.  Do  not  make  Los  Angeles  turn. 

* * * 

For  hotel  rates  and  information,  see  page  126  of  the 
February  issue  of  California  and  Western  Medicine. 


COUNCIL  MINUTES 

Minutes  of  the  One  Hundred  and  Eighty-Sixth 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Eighty-Seventh 
Meeting  of  the  Council  of  the  California  Medical 
A ssociation,  January  18,  1930 

Held  at  the  home  of  Dr.  George  H.  Kress, 
Uplifters’  Ranch,  Santa  Monica  Canyon,  Los  Angeles, 
Saturday,  September  28,  1929,  at  11  a.  m. 

Present. — Doctors  Gibbons,  Kinney,  Pallette,  Ar- 
nold, Duffield,  Moseley,  DeLappe,  Phillips,  Coffey, 
Hamlin,  Harris,  Rogers,  Hunter,  Cushman,  Kress, 


Catton,  Kelly,  Peers,  Pope,  and  General  Counsel 
Peart. 

Absent. — None. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Minutes  of  the  Council. — The  chairman  stated 
that  the  minutes  of  the  181st,  182nd,  183rd,  184th  and 
185th  meetings  of  the  Council  had  been  mailed  to  all 
members  of  the  Council,  and  if  there  were  no  objec- 
tions, he  would  entertain  a motion  for  their  approval 
without  further  reading. 

Action  by  the  Council. — On  motion  of  Duffield,  sec- 
onded by  Kelly,  and  unanimously  carried,  the  follow- 
ing resolution  was  adopted: 

Resolved,  That  the  minutes  of  the  181st,  182nd, 
183rd,  184th  and  185th  meetings  of  the  Council  as 
mailed  to  all  members,  be  approved. 

Doctor  Kress  then  stated  that  he  believed  it  was 
advisable  at  each  annual  session  to  present  the  min- 
utes of  the  previous  day  for  approval  in  order  that 
Council  minutes  might  receive  earlier  publication  in 
the  journal. 

Action  by  the  Council. — On  motion  of  Kress,  duly 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  at  annual  meetings,  the  minutes  of 
the  previous  day’s  meeting  be  taken  up  for  approval 
at  the  next  meeting  of  the  Council. 

3.  Minutes  of  the  Executive  Committee. — The 
chairman  stated  that  the  minutes  of  the  113th  and 
114th  meetings  of  the  Executive  Committee  had  been 
mailed  to  all  members  of  the  Council  and  if  there 
were  no  objections,  he  would  entertain  a motion  for 
their  approval  without  further  reading. 

Doctor  Kress  asked  that  minute  4 of  the  114th 
meeting  on  “Standing  Committees”  be  changed  to 
read  “Letter  from  Doctor  Kress  suggesting  that  by 
mutual  agreement  councilors  who  are  serving  on 
standing  committees  and  who  would  be  elected  for 

three-year  terms,  re- 
sign at  the  organiza- 
tion meeting  of  the 
Council  each  year.” 
This  would  provide  for 
a reshifting  of  coun- 
cilors to  different 
standing  committees 
to  fit  in  with  the 
wishes  of  different 
councilors  in  case  they 
bad  an  especial  inter- 
est in  the  work  of 
some  one  committee. 

Doctor  Kress  asked 
that  a change  be  made 
in  the  introductory 
sentence  to  minute  28 
on  “Wine  Tonics”; 
but  waived  his  request 
for  change,  after  dis- 
cussion. 


Colton  Hall 


Doctor  Kress  stated 
that  the  motion  of 
furnishing  bound  vol- 
umes of  the  journal, 
minute  32,  was  made 
by  Doctor  Pallette, 
duly  seconded.  Such 
change  in  the  minutes 
was  authorized. 


284 


April,  1930 


STATE  MEDICAL  ASSOCIATIONS 


285 


Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Kinney,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  minutes  of  the  113th  and  114th 
meetings  of  the  Executive  Committee,  as  amended, 
be  approved. 

4.  Offices  of  the  Association. — The  secretary-treas- 
urer reported  that  pursuant  to  action  of  the  Council, 
the  offices  of  the  Association  had  been  removed  to 
rooms  2004  to  2007,  Four-Fifty  Sutter  Street,  on  the 
25th  of  September. 

Action  by  the  Council.— On  motion  duly  made  and 
seconded  and  unanimously  carried,  the  following  res- 
olution was  adopted: 

Resolved,  That  the  offices  of  this  Association  be  and 
the  same  are  hereby  fixed  and  located  at  rooms  2004 
to  2007,  Four-Fifty  Sutter  Street,  San  Francisco, 
notice  thereof  having  been  sent  by  mail  to  all  officers 
of  the  Association,  section  officers,  all  county  secre- 
taries; and  to  all  members  by  publication  in  the  official 
notices  in  the  October  issue  of  the  journal. 

5.  Committee  on  History  of  the  California  Medical 
Association. — Letter  from  Dr.  Emmet  Rixford  asking 
if  any  action  had  been  taken  at  the  last  annual  meeting 
in  re  the  Committee  on  the  History  of  the  California 
Medical  Association  was  presented.  It  was  stated  that 
the  formation  of  the  standing  committees  provided 
for  in  the  new  constitution  had  automatically  dis- 
solved all  special  committees  existing  under  the  pre- 
vious constitution.  Doctor  Rixford’s  letter  stated  that 
he  had  still  on  hand  a check  for  $100  which  had  been 
allowed  his  committee  for  clerical  help  and  postage. 
It  was  decided  that  the  $100  should  be  returned  to 
the  secretary-treasurer  for  deposit  in  the  general  funds 
of  the  Association  and  that  Doctor  Rixford  be  asked 
to  submit  a statement  of  any  expenses  incurred. 
Doctor  Kress  stated  that  the  work  of  the  Historical 
Committee  would  now  be  taken  over  by  the  Com- 
mittee on  History  and  Obituaries. 

6.  Committee  on  Medical  Defense. — Letter  from 
Doctor  Trowbridge  expressing  regret  at  his  inability 
to  serve  on  the  Committee  on  Medical  Defense  was 
read. 

Action  by  the  Council. — On  motion  of  Harris,  sec- 
onded by  Kelly,  and  unanimously  carried,  it  was 

Resolved,  That  the  resignation  of  Dr.  Dwight 
Trowbridge  be  accepted  with  regret,  and  that  Dr. 
James  L.  Maupin,  Sr.,  be  appointed  a member  of  the 
Committee  on  Medical  Defense,  to  fill  the  unexpired 
term  of  Doctor  Trowbridge. 

Letter  from  Dr.  Mott  H.  Arnold  submitting  his 
resignation  as  a member  of  the  Committee  on  Medical 
Defense  was  read. 

After  discussion,  Doctor  Arnold  decided  to  with- 
draw his  resignation  and  remain  on  the  committee. 
The  membership  of  the  committee  was  then  stated  to 
be  Doctors  Mott  Arnold,  George  Reinle,  J.  L.  Maupin. 

7.  Standing  Committees. — Doctor  Kress  stated  that 
it  had  been  decided  to  place  a councilor  on  each 
standing  committee  so  that  he  could  act  as  a liaison 
officer  between  the  Council  and  the  committee  and 
that  it  might  be  well  if  all  councilors  serving  on 
standing  committees  resigned  at  the  reorganization 
meeting  of  the  Council  each  year  since  such  resig- 
nations would  provide  for  any  adjustment  of  member- 
ship on  the  committee  which  might  be  advisable. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Gibbons,  and  unanimously  carried,  it  was 

Resolved,  That  it  be  the  sense  of  the  Council  that  at 
the  reorganization  meeting  of  the  Council  each  year, 
the  councilors  who  are  on  standing  committees  shall 
submit  their  resignations  on  such  committees  and  the 
Council  shall  proceed  to  readjust  the  councilor  rep- 
resentation on  the  standing  committees  as  would 
seem  to  the  best  interests  of  the  Association,  by 
mutual  consent. 

Doctor  Rogers  stated  that  it  might  be  desirable  for 
the  Council  to  name  the  chairmen  of  standing  com- 
mittees since  at  present  the  councilor  was  instructed 
to  call  the  committee  together  for  organization  and 
election  of  a chairman  and  since  his  vote  decided  the 


chairmanship,  it  was  liable  to  cause  hard  feelings. 
No  action  taken. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Duffield,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  By  the  Council  of  the  California  Medical 
Association,  that  a form  letter  such  as  is  appended 
to  this  resolution  shall  be  sent  to  each  memlber  of 
every  standing  committee  within  two  weeks  after  the 
annual  session  of  the  Association;  and  be  it  further 

Resolved,  That  if  the  members  of  a standing  com- 
mittee do  not  of  themselves  organize  and  notify  the 
central  office  of  the  Association  of  such  organization 
within  a period  of  two  months  after  the  annual  session 
of  the  Association,  then  the  Executive  Committee 
shall  have  the  power  to  nominate  a chairman  and 
secretary  of  such  standing  committee.  The  secretary 
of  the  Association  shall  send  such  nominations  to  each 
member  of  each  such  committee  with  a reply  blank 
asking  each  such  member  to  register  his  vote,  so  that 
each  such  committee  shall  be  properly  organized,  and 
be  able  to  take  up  its  work  for  the  Association. 

Form  Letter 

To  the  Members  of  the  Standing  Committee  on 

Names  (3) 

Dear  Doctors: 

The  Constitution  and  By-Laws  of  the  California 
Medical  Association  (see  Chapter  V,  Section  V)  pro- 
vides that  each  standing  committee  shall  elect  its  own 
chairman  and  secretary. 

It  is  important  that  this  be  done  if  the  committee 
is  to  properly  function. 

Recognizing  that  such  organization  may  sometimes 
be  overlooked  by  members  of  the  standing  commit- 
tees, the  enclosed  resolution  bearing  on  the  subject 
has  been  passed  by  the  Council. 

In  accordance  therewith  the  members  of  this  com- 
mittee are  herewith  notified  that  the  Executive  Com- 
mittee of  the  California  Medical  Association  has 
nominated  as  chairman  of  your  committee,  Doctor 
, and  as  secretary,  Doctor  

Unless  a majority  vote  is  cast  against  such  nomina- 
tions these  officers  will  be  requested  to  act  in  such 
capacity  until  at  some  subsequent  meeting  of  your 
standing  committee  the  members  ratify  the  above  or 
make  other  selections  for  chairmanship  and  secretary- 
ship. 

Trusting  this  will  be  acceptable,  we  are 

The  Executive  Committee. 


By 


Secretary-Treasurer. 

8.  Radio  Broadcasting. — The  secretary  read  a letter 
from  the  San  Francisco  County  Society  enclosing 
letter  from  a doctor  relative  to  broadcasting  the 
American  Medical  Association  health  material  over 
KFRC.  It  was  stated  that  the  Air  Health  Institute  of 
Oakland  broadcasting  over  KGO  was  desirous  of 
having  the  Association  approve  its  broadcasting. 
Doctor  Cushman  stated  that  broadcasting  was  being 
carried  on  in  Orange  County  under  the  auspices  of 
the  county  society.  General  discussion  was  then  en- 
tered into  and  it  was  stated  that  if  the  Association 
approved  the  broadcasting  of  one  concern  it  would 
immediately  be  swamped  with  requests  for  approval 
from  all  sources  and  the  amount  of  work  involved 
would  be  so  great  that  it  would  be  much  more  satis- 
factory to  prepare  and  broadcast  our  own  programs. 
If  this  were  done,  the  Association  could  answer  all 
requests  for  approval  with  the  statement  that  we  did 
our  own  broadcasting  and  therefore  did  not  approve 
any  other  broadcasting  programs. 

Doctor  Kelly  stated  that  he  had  investigated  the 
matter  of  broadcasting  and  had  obtained  the  follow- 
ing figures: 

Before  6 p.  m.,  $50  for  fifteen  minutes  hookup  of 
KFRC,  San  Francisco,  and  KHJ,  Los  Angeles. 

Before  6 p.  m.,  $25  for  fifteen  minutes  hookup  of 
KFRC,  San  Francisco,  only. 

After  6 p.  m.,  $40  for  fifteen  minutes  hookup  of 
KFRC,  San  Francisco,  only.  Los  Angeles,  KHJ, 
will  not  allow  lectures  of  any  kind  after  6 p.  m. 


286 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


It  was  stated  that  fifteen  minutes  would  be  ample 
time  to  present  a paper  on  a subject  of  interest  to  the 
public.  These  papers  could  be  prepared  by  an  author- 
ity on  the  subject  to  be  presented,  and  read  by  any- 
one having  a good  knowledge  of  medical  terms  and  a 
satisfactory  voice  for  delivery  before  the  microphone. 
Doctor  Kelly  stated  that  he  had  not  investigated 
whether  or  not  there  would  be  further  expense 
involved  in  delivering  the  programs.  It  was  felt  that 
it  would  be  advisable  to  omit  the  names  of  the  doctors 
who  prepared  the  papers  and  merely  state  that  the 
talks  were  prepared  by  a prominent  member  of  the 
California  Medical  Association  who  is  considered  to 
have  a special  knowledge  of  the  subject. 

Action  by  the  Council.— On  motion  of  Kress,  sec- 
onded by  Kinney,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  Executive  Committee  be  re- 
quested to  investigate  the  matter  further,  with  power 
to  act;  provided  that  it  does  not  engage  in  any  con- 
tract for  longer  than  one  year  or  at  a greater  expense 
than  $3000;  with  the  understanding  that  any  radio 
broadcasting  shall  be  absolutely  impersonal  without 
the  use  of  any  names  of  individuals. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  DeLappe,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  Council  of  the  California  Med- 
ical Association  refer  to  the  Executive  Committee  for 
investigation  any  medical  broadcasting  by  members 
of  the  medical  profession  with  instructions  to  call  to 
the  attention  of  such  medical  broadcasters  defections 
in  methods  of  broadcasting  if  it  seem  desirable;  and 
make  a report  to  the  Council  in  due  time. 

Doctor  Moseley  stated  that  since  we  had  decided 
to  answer  all  requests  for  approval  with  the  state- 
ment that  the  Association  did  not  approve  any  broad- 
casting but  its  own,  he  did  not  see  that  any  further 
action  was  necessary. 

9.  First  Aid  and  Minor  Medical  Care  (Committee 
on  Public  Health  and  Instruction). — Doctor  Rogers 
stated  that  the  Committee  on  Public  Health  and 
Instruction  had  not  been  organized  early  enough  to 
submit  a report  on  the  question  of  the  growing  tend- 
ency of  physical  instructors  to  give  first  aid  and 
minor  medical  care  to  students,  but  that  in  answer  to 
his  personal  investigations  he  had  received  the  reply 
that  the  men  who  take  up  physical  instruction  are  not 
physicians  and  unless  physicians  can  be  encouraged 
to  go  into  this  type  of  work  the  question  will  undoubt- 
edly always  be  present.  Doctor  Kress  called  attention 
to  correspondence  regarding  the  Department  of 
Health  and  Physical  Education.  Doctor  Rogers  stated 
that  he  had  received  this  correspondence  and  it  would 
be  referred  to  the  chairman  of  the  Committee  on 
Public  Health  and  Instruction. 

10.  Mexican  Medical  Men. — Doctor  Kress  stated 
that  Mr.  C.  N.  Thomas,  who  was  desirous  of  having 
some  of  the  medical  men  from  Mexico  as  guests  of 
the  Association  during  next  spring  had  been  to  visit 
him  but  that  the  plan  was  very  indefinite  and  from 
conversation  with  other  persons  who  knew  the  Mexi- 
can situation  and  from  the  results  of  the  attempt  of 
the  American  Medical  Association  along  this  line  it 
appeared  impractical.  No  action  taken. 

11.  Committee  on  Medical  Economics. — Letter  from 
Dr.  John  H.  Graves,  chairman  of  the  Committee 
on  Medical  Economics,  stating  that  at  present  the 
committee  was  gathering  information  on  the  cost  of 
sickness,  was  read. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Gibbons,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  report  of  the  Committee  on 
Medical  Economics  be  accepted. 

12.  Incorporation  of  the  Association. — The  secre- 
tary-treasurer reported  that  a second  letter  on  incor- 
poration had  been  mailed  to  members  who  had  not 
yet  cast  their  ballots  and  that  only  800  votes  were 
needed  to  make  the  necessary  two-thirds  vote.  It  was 


felt  that  the  full  quota  of  votes  would  be  received 
from  this  second  canvass,  but  in  the  event  that  the 
ballots  were  slow  in  coming  in  the  Executive  Com- 
mittee could  take  the  matter  in  hand.  It  was  sug- 
gested that  the  names  of  members  who  had  not  yet 
cast  their  ballot  be  sent  to  some  of  the  different 
county  societies. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Coffey,  and  unanimously  carried,  it  was 

Resolved,  That  the  Executive  Committee  be  em- 
powered to  take  such  action  as  is  necessary  to 
expedite  the  acquiring  of  the  necessary  two-thirds 
ballot. 

13.  Narcotics. — Letter  from  the  Bureau  of  Legal 
Medicine  and  Legislation  submitting  a proposed  Uni- 
form State  Narcotic  Act,  was  presented.  No  action 
taken. 

Correspondence  from  Dr.  William  Cole  and  the 
Board  of  Medical  Examiners  regarding  the  possibil- 
ity of  having  druggists  communicate  with  doctors 
before  filling  prescriptions  for  narcotics,  to  eliminate 
the  possibility  of  forgery  of  doctors’  names,  was  read. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  DeLappe,  and  unanimously  carried,  the 
following  resolution  w.as  adopted: 

Resolved,  That  the  correspondence  be  filed. 

14.  Woman’s  Auxiliary. — Correspondence  from  Mrs. 
R.  A.  Cushman,  secretary  of  the  Woman’s  Auxiliary, 
asking  that  a change  be  made  in  the  rules  governing 
the  Woman’s  Auxiliary  which  would  permit  widows 
of  physicians  to  become  members,  was  presented.  It 
was  stated  that  the  Executive  Committee  recom- 
mended such  change. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Peers,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  recommendation  of  the  Execu- 
tive Committee  be  approved. 

Letter  from  Mrs.  Henry  S.  Rogers,  president  of 
the  Auxiliary,  asking  that  some  work  be  given  the 
Auxiliary,  was  read.  It  was  pointed  out  that  the 
County  Auxiliaries  had  to  be  organized  through  the 
county  medical  societies  and  in  many  cases  a lack 
of  interest  was  shown  by  the  county  societies.  It  was 
felt  that  the  county  societies  should  be  urged  to 
cooperate  with  the  Auxiliary.  Doctor  Gibbons  stated 
that  since  the  formation  of  the  Auxiliary  was  an 
obligation  of  the  state  society,  it  might  be  well  to 
select  topics  such  as  are  used  by  the  American  Med- 
ical Association  and  furnish  them  to  the  various 
Auxiliaries. 

Action  by  the  Council.— On  motion  duly  made  and 
seconded,  and  unanimously  carried,  the  following 
resolution  was  adopted: 

Resolved,  That  the  Council  authorize  a subscription 
to  the  official  publication  of  the  Woman’s  Auxiliary 
of  the  American  Medical  Association  for  each  county 
society;  such  copy  to  be  sent  to  the  secretary  of  the 
county  medical  society  with  instructions  to  forward 
the  same  letter  to  the  secretary  of  the  county  unit  of 
the  Woman’s  Auxiliary. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Duffield,  and  unanimously  carried,  it  was 

Resolved,  That  the  general  supervision  of  the 
Woman’s  Auxiliary  be  referred  to  the  Committee 
on  Associated  and  Affiliated  Societies. 

Doctor  Kinney  suggested  that  the  editor  be  asked 
to  put  a note  in  the  editorial  column  regarding  the 
matter. 

15.  Cooperative  Diagnostic  Laboratories. — Corre- 
spondence from  Dr.  Olin  West  regarding  the 
Cooperative  Diagnostic  Laboratories  of  Los  Angeles 
was  presented.  Discussion  was  then  had  of  the  ethics 
of  members  interested  in  such  a laboratory.  It  was 
stated  that  investigations  and  reports  had  been  made 
by  committees  of  the  Los  Angeles  County  Medical 
Association.  It  was  felt  that  the  question  of  ethics 
involved  was  primarily  one  for  the  county  society  to 
solve  in  this  case  but  that  inasmuch  as  the  problem 
involved  was  one  that  would  probably  be  coming  up 
in  other  communities,  it  would  be  well  to  study 
the  case. 


April,  1930 


STATE  MEDICAL  ASSOCIATIONS 


287 


Action  by  t lie  Council. — On  motion  of  Catton,  sec- 
onded by  Gibbons,  the  following  resolution  was 
adopted: 

Resolved,  That  inasmuch  as  this  is  an  involved 
problem,  the  whole  matter  be  referred  to  the  Com- 
mittee on  Hospitals,  Dispensaries  and  Clinics,  for 
report  back  to  the  Council. 

16.  Herzstein  Bequest. — The  secretary-treasurer  in- 
formed the  Council  that  $941  interest  from  the  Herz- 
stein Bequest  Fund  had  been  credited  to  the  account 
of  the  Association;  this  fund  to  be  used  for  the  sup- 
pression of  quackery. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Kress,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Whereas,  By  the  will  of  Dr.  Morris  Herzstein 
a Trust  Fund  in  the  sum  of  $20,000  was  established 
with  the  Wells  Fargo  Bank  and  Union  Trust  Com- 
pany, the  income  of  which  is  to  be  used  by  this 
Association  for  suppression  of  quackery  in  the  prac- 
tice of  medicine,  and 

Whereas,  In  the  opinion  of  the  Council  of  the 
California  Medical  Association,  one  of  the  most 
effective  methods  of  suppressing  quackery  is  to  spread 
and  disseminate  the  true  facts  of  scientific  medicine, 
and 

Whereas,  The  Council  has  at  its  meeting  on  Sep- 
tember 28,  1929,  authorized  and  directed  the  Executive 
Committee  to  establish  a radio  broadcasting  service 
if  it  so  decides;  now  therefore  be  it 

Resolved,  That  in  the  event  that  the  Executive 
Committee  determines  to  establish  such  radio  broad- 
casting service,  that  the  accumulated  and  accruing 
interest  from  the  Herzstein  Bequest  be  used  to  defray 
to  the  extent  thereof,  the  cost  of  such  service;  and 
be  it  further 

Resolved,  That  apDropriate  mention  be  made  of  the 
contribution  of  this  bequest  to  said  work  in  each 
announcement. 

It  was  suggested  that  it  might  be  well  in  broad- 
casting to  mention  that  part  of  the  funds  for  broad- 
casting were  from  the  bequest;  or  call  the  broadcast 
the  California  Medical  Association  Herzstein  Hour. 

17.  Retired  Members. — Letter  from  the  San  Diego 
County  Society  requesting  that  Dr.  R.  Lorini  be 
granted  retired  membership  in  the  Association,  was 
read. 

Action  by  the  Council. — On  motion  of  Harris, 
seconded  by  Kress,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  Doctor  R.  Lorini  of  San  Diego  be 
granted  retired  membership  in  the  California  Medical 
Association  on  account  of  retirement  from  active 
practice. 

Letter  from  the  San  Bernardino  County  Society 
requesting  that  Dr.  W.  H.  Craig  of  Upland  be 
granted  retired  membership  in  the  Association,  was 
read. 

Action  by  the  Council. — On  motion  of  Kinney, 
seconded  by  DeLappe,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  Dr.  W.  H.  Craig  of  Upland,  San 
Bernardino  County,  be  granted  retired  membership 
in  the  California  Medical  Association  on  account  of 
retirement  from  active  practice. 

It  was  decided  that  the  list  of  doctors  holding 
affiliate  membership  under  the  former  Constitution 
should  be  submitted  for  approval  or  rejection  as 
retired  members. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Kelly,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  question  of  status  of  affiliate 
members  under  the  previous  Constitution  be  referred 
to  the  Executive  Committee  with  power  to  act. 

18.  Protex  Company. — Correspondence  regarding 
the  Protex  Company  was  presented  and  it  was  felt 
that  the  action  of  the  Executive  Committee  covered 
the  situation  and  no  further  action  was  necessary. 

19.  Secretary  of  Surgical  Section. — Letter  from  Dr. 
Dexter  Richards  stating  that  he  would  be  unable  to 
continue  as  secretary  of  the  Northern  Division  of  the 


Surgical  Section  on  account  of  absence  and  illness 
was  presented.  Letter  from  Doctor  'Poland,  chair- 
man of  the  Surgical  Section,  stated  that  in  accord- 
ance with  Doctor  Richards’  suggestion,  he  recom- 
mended that  the  Council  appoint  Dr.  Sumner  Evering- 
ham  to  act  as  secretary  of  the  Northern  Division,  was 
also  presented. 

Action  by  the  Council. — On  motion  of  Kinney, 
seconded  by  DeLappe,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  Dr.  Sumner  Everingham  be  ap- 
pointed Northern  secretary  of  the  Surgical  Section 
to  fill  the  unexpired  term  of  Dr.  Dexter  Richards. 

20.  Ownership  of  Papers. — In  accordance  with  the 
request  of  the  Executive  Committee  the  following 
form  was  submitted  which  will  be  signed  by  each 
applicant  for  space  on  an  annual  program,  stating 
that  all  papers  shall  be  the  property  of  the  Associa- 
tion and  shall  not  be  published  elsewhere  unless  re- 
leased in  writing  by  the  Committee  on  Publications: 

(Note.  By  ruling  of  the  Council,  this  blank,  which 
incorporates  provisions  of  Constitution  and  By-Laws, 
must  be  signed  by  all  members  who  submit  papers 
at  an  annual  session.)  Place Date 

I hereby  agree  that  my  paper,  entitled  -,  which 

has  been  accepted  by  the  section  officers  for  presen- 
tation before  section  of  the  (year)  annual 

session,  is  the  property  of  the  California  Medical 
Association  for  exclusive  publication  in  California 
and  Western  Medicine,  the  official  journal  of  the  Cali- 
fornia Medical  Association  (if  approved  for  publica- 
tion therein  by  the  editors),  and  that  the  original 
manuscript  thereof  shall  be  delivered  to  the  secretary 
of  said  section  immediately  after  it  has  been  read, 
and  by  him  transmitted  promptly  to  the  Association 
secretary  at  the  office  of  the  Association. 

I understand  and  agree  that  my  above  article  shall 
be  published  in  California  and  Western  Medicine 
only  unless  released  in  writing  through  the  Commit- 
tee on  Publications  of  the  California  Medical  Associa- 
tion voluntarily  or  in  response  to  a written  request 
from  me  in  which  I state  why  such  release  is  desired. 

Signed  

Address  

A member  of  the  County  Medical  Society,  a 

component  unit  of  the  California  Medical  Association. 

21.  Paper  of  Doctor  Voorsanger. — Page  proof  of 
paper  of  Dr.  William  Voorsanger  was  presented  to 
the  Council,  in  which  four  pages  of  tables  were 
included. 

Action  by  the  Council. — On  motion  of  DeLappe, 
seconded  by  Harris,  and  unanimously  carried,  it  was 

Resolved,  That  the  tables  be  not  published  in  the 
journal  but  that  a footnote  be  inserted  stating  that 
the  tables  appear  in  the  reprint  of  the  article. 

22.  Association  Letterheads. — The  secretary-treas- 
urer presented  a sample  letterhead  for  the  Associa- 
tion. It  was  the  sense  of  the  Council  that  the  editors 
be  given  full  authority  to  determine  the  type  of  paper 
to  be  used  by  the  Association.  Letterhead  as  sub- 
mitted was  approved  by  the  editors. 

23.  Insurance  on  Furniture. — The  question  of  re- 
newing the  policy  for  insurance  covering  furniture 
of  the  Association  was  discussed  and  on  motion  of 
Moseley,  seconded  by  Harris,  and  unanimously  car- 
ried, the  following  resolution  was  adopted: 

Resolved,  That  the  furniture  be  insured  for  the  full 
insurable  value. 

24.  Bond  for  Secretary. — It  was  pointed  out  that 
the  new  Constitution  provided  for  the  bonding  of  the 
secretary. 

Action  by  the  Council. — On  motion  duly  made, 
seconded  and  unanimously  carried,  the  following  res- 
olution was  adopted: 

Resolved,  That  the  secretary-treasurer  be  placed 
under  surety  company  bond  in  the  sum  of  $5000  cov- 
ering the  faithful  performance  of  her  duties. 

25.  Right  to  Doctorate. — Correspondence  from  Dr. 
A.  W.  Meyer  regarding  the  right  of  a doctor  holding 
an  M.  D.  degree  from  an  accredited  school  who  is  not 


288 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


licensed  in  California  to  use  the  letters  “M.  D.”  after 
his  name,  was  presented.  Section  17  of  the  Medical 
Practice  Act  was  discussed.  Doctor  Kress  stated  that 
he  had  prepared  an  editorial  on  the  subject  which 
would  be  sent  to  all  councilors  together  with  a copy 
of  Doctor  Meyer’s  correspondence,  at  which  time 
they  could  make  any  comments  they  desired. 

26.  Colon  Machine. — Doctor  Kelly  stated  that  the 
management  of  the  Four-Fifty  Sutter  Building  was 
anxious  to  keep  any  questionable  tenants  from  the 
building  and  had  asked  if  a tenant  handling  a colon 
flushing  machine  would  be  considered  objectionable. 
The  Council  stated  that  it  had  no  reaction  to  the 
question. 

27.  Date  and  Place  of  Spring  Council  Meeting. — 

After  discussion,  the  date  of  the  next  meeting  of  the 
Council  was  set  as  Saturday,  January  18,  1930,  at  the 
offices  of  the  Association  at  San  Francisco. 

28.  Noon  Adjournment. — At  this  point  the  Council 
adjourned  for  luncheon. 

29.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman;  all  members  of  the  Council  who 
attended  the  morning  session  being  present  except 
Dr.  Mott  H.  Arnold. 

30.  Medical  Practice  Act  and  Basic  Science  Act. — 

Discussion  was  had  on  the  revision  of  the  Medical 
Practice  Act  and  the  advisability  of  initiating  a basic 
science  act.  Mr.  Peart  pointed  out  the  necessity  of 
protecting  the  M.  D.  degree. 

Action  by  the  Council. — On  motion  duly  made, 
seconded  and  unanimously  carried,  the  following  res- 
olution was  adopted: 

Resolved,  That  the  Council  appoint  a special  coun- 
cil committee  to  study  and  bring  in  a prompt  report 
concerning  a possible  revision  of  the  California  Med- 
ical Practice  Act,  and  a basic  science  law;  that  said 
committee  be  constituted  as  follows:  the  president, 
the  president-elect,  the  secretary,  the  editor,  the 
chairman  of  the  Council,  the  chairman  of  the  Execu- 
tive Committee,  one  councilor,  the  general  counsel, 
three  members  of  the  Committee  on  Public  Policy  of 
the  California  Medical  Association,  the  deans  of  the 
medical  schools  of  the  University  of  California,  Stan- 
ford, the  College  of  Medical  Evangelists  and  the 
University  of  Southern  California,  the  president  and 
the  secretary  of  the  Board  of  Medical  Examiners, 
Doctor  Molony,  and  Doctor  Gundrum  of  the  State 
Board  of  Health.  The  chairman  of  the  Council  to 
appoint  one  member  as  chairman  of  the  entire  com- 
mittee and  three  sub-chairmen,  one  from  the  sub- 
group south  of  the  Tehachapi,  one  from  the  Bay 
region  and  one  from  the  members  not  included  in  the 
two  preceding  groups.  Each  group  or  sub-committee 
to  meet  as  soon  as  possible  to  study  these  matters 
and  to  formulate  its  recommendations,  the  same  to 
be  submitted  at  a session  of  the  entire  committee  to  be 
held  on  call  early  in  January.  The  entire  committee 
then  to  meet  and  formulate  a report  to  be  submitted 
at  the  spring  session  of  the  Council  of  the  California 
Medical  Association. 

The  committee  was  then  stated  to  be  as  follows: 

Bay  Region — Morton  R.  Gibbons,  group  chairman; 
Oliver  D.  Hamlin,  T.  Henshaw  Kelly,  Emma  W. 
Pope,  Walter  B.  Coffey,  Joseph  Catton,  Langley 
Porter,  William  Ophuls. 

Los  Angeles — George  H.  Kress,  general  chairman; 
Lyell  C.  Kinney,  William  Duffield,  Percy  T.  Magan, 
group  chairman;  William  Cutter,  William  Molony. 

At  Large — Junius  Harris,  group  chairman;  Percy 
Phillips,  Charles  Pinkham,  Frederick  Gundrum. 

31.  Medical  Care. — Dr.  Walter  B.  Coffey  stated  that 
at  the  last  annual  meeting  he  had  been  appointed  by 
the  Council  to  devise  a plan  for  the  care  of  sick 
individuals  of  limited  incomes.  Doctor  Coffey  then 
presented  a written  outline  of  his  plan  for  the  care 
of  individuals  having  an  income  of  $2500  or  less, 
together  with  a letter  from  his  personal  attorney 
(Doctor  Coffey  having  been  unable  to  see  General 
Counsel  Peart),  stating  that  he  had  hurriedly  glanced 
over  the  plan  and  believed  it  was  legally  feasible. 
Doctor  Coffey  stated  that  his  plan  was  presented 


merely  as  a working  basis  and  that  it  might  be  pos- 
sible to  devise  a better  mode  of  procedure,  but  that 
it  was  his  belief  that  some  such  plan  was  feasible  and 
workable. 

Doctor  Cushman  spoke  of  the  work  of  the  Medical 
Economics  Committee  on  the  study  of  the  cost  of 
medical  care.  After  discussion,  it  was  felt  that  Doctor 
Coffey’s  committee  and  the  Medical  Economics  Com- 
mittee should  confer. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Kelly,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  plan  of  Doctor  Coffey  for  the 
medical  care  of  individuals  having  incomes  of  $2500 
or  less  yearly  be  referred  to  the  Executive  Commit- 
tee for  study  and  that  the  Committee  on  Medical 
Economics  be  called  into  consultation  with  the 
Executive  Committee  and  the  legal  aspects  of  the 
plan  worked  out. 

Doctor  Coffey’s  written  outline  of  his  plan  with 
the  memorandum  from  his  personal  attorney  was  then 
ordered  mimeographed  and  a copy  thereof,  with  copy 
of  the  original  notes  on  the  plan  by  Doctor  Kress 
was  ordered  sent  to  all  councilors  and  to  the  members 
of  the  Committee  on  Medical  Economics. 

32.  Resolution  of  Appreciation. — Action  by  the 
Council.— On  motion  of  Moseley,  seconded  by  Kelly, 
and  unanimously  carried,  the  following  resolution  was 
adopted: 

Resolved,  That  this  Council  express  its  appreciation 
to  Doctor  and  Mrs.  Kress  for  their  generous  hos- 
pitality. 

33.  Adjournment.— There  being  no  further  busi- 
ness, the  meeting  adjourned. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 


COMPONENT  COUNTY  SOCIETIES 

CONTRA  COSTA  COUNTY 

One  of  the  most  successful  and  the  best  attended 
regular  meetings  for  many  years  was  held  by  the 
Contra  Costa  County  Medical  Society  at  Richmond 
on  March  11,  1930. 

The  meeting  was  opened  by  Dr.  J.  W.  Bumgarner, 
president  of  the  society,  who  introduced  Dr.  H.  J. 
Templeton  of  Oakland.  The  speaker  gave  a complete 
presentation  on  “Ringworm  Infection  of  the  Feet,” 
discussing  incidence,  secondary  infection,  types,  and 
therapy.  The  recent  work  done  at  the  University  of 
California  on  this  most  common  condition  was  re- 
viewed by  the  speaker.  The  importance  of  ringworm 
of  the  feet  in  public  health  was  stressed.  The  resist- 
ance of  this  condition  to  all  forms  of  therapy  and  the 
results  to  be  expected  from  each  form  were  depicted 
in  a clear  manner.  It  is  important  to  individualize  the 
treatment  of  these  cases.  The  efficiency  of  various 
antiseptics  was  discussed  in  detail. 

The  second  paper  of  the  evening  was  presented  by 
Dr.  O.  H.  Garrison,  also  of  Oakland.  His  topic  was 
on  “Newer  Concepts  in  the  Treatment  of  Diabetes 
Mellitus.”  A complete,  concise  and  practical  review 
of  diabetes  was  given.  After  a brief  outline  of  its 
nature,  pathology,  incidence,  and  symptomatology, 
the  speaker  offered  practical  points  in  determining  the 
threshold  of  carbohydrate  tolerance.  Insulin  is  indi- 
cated in  any  diabetic  who  cannot  remain  sugar-free 
on  an  adequate  diet.  The  three  common  views  on 
what  constitutes  an  adequate  diet  were  explained. 
The  method  of  estimating  the  daily  insulin  dosage 
and  the  color  reactions  of  the  Benedict  test  on  the 
urine  were  described. 

The  simplification  of  the  two  subjects,  in  spite  of 
their  thorough  presentation  by  Doctors  Templeton 
and  Garrison,  was  greatly  enjoyed  by  their  audience. 
Lengthy  discussions  of  each  paper  proved  highly 
instructive. 

The  regular  business  followed  the  scientific  pro- 
gram. Dr.  I.  O.  Church  of  Martinez,  county  health 
physician,  was  unanimously  voted  a member  of  the 


April,  1930 


STATE  MEDICAL  ASSOCIATIONS 


289 


society.  The  application  of  Dr.  Clara  H.  Spalding  of 
Richmond,  a former  member  of  the  society,  was  ac- 
knowledged and  referred  to  the  board  of  censors,  as 
usual.  Mrs.  J.  W.  Bumgarner,  wife  of  our  president, 
sent  acknowledgment  of  congratulations  and  flowers 
forwarded  on  the  birth  of  a daughter.  The  death  of 
Dr.  Joseph  T.  Breneman  of  El  Cerrito  on  March  9 
was  officially  reported.  The  late  doctor  was  the  oldest 
practitioner  in  the  county  and  a founder  of  the  society. 
A floral  tribute  and  a letter  of  condolence  to  the 
widow  of  Doctor  Brenneman  were  authorized. 

A list  of  orders  to  be  followed  by  Metropolitan 
nurses  called  to  visit  the  sick  of  the  company  before 
the  arrival  of  a physician,  and  to  be  used  on  their 
first  visit  only,  was  approved  by  the  society  after 
thorough  discussion. 

J.  L.  Beard  and  I.  O.  Church,  both  of  Martinez, 
were  appointed  to  arrange  the  program  of  the  next 
meeting  to  be  held  in  their  city  in  April. 

The  Woman’s  Auxiliary  held  their  meeting  in  Rich- 
mond on  the  same  date,  and  were  guests  of  the 
society  at  dinner  following  the  meetings. 

L.  H.  Fraser,  Secretary. 

* 

FRESNO  COUNTY 

The  Fresno  County  Medical  Society  held  its  regu- 
lar meeting  at  the  University  Sequoia  Club  March  4, 
at  8 p.  m.  Forty  members  were  present. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

Dr.  A.  E.  Anderson  was  appointed  chairman  of  a 
special  committee  to  investigate  the  question  of  hospi- 
talization of  patients  of  moderate  means. 

Report  was  made  at  a special  meeting  held  March  7. 

After  general  discussion  by  the  members  of  the 
society  the  matter  was  laid  on  the  table. 

Dr.  John  Hudley  Scudder  of  Oakland  read  a very 
interesting  paper  on  “Errors  in  Diagnosis  of  Appendi- 
citis.” He  reviewed  the  different  causes  for  surgical 
failures.  j.  M.  Frawley,  Secretary. 

& 

NAPA  COUNTY 

The  regular  monthly  meeting  of  the  Napa  County 
Medical  Society  was  held  Wednesday,  March  5,  at 
6:30  p.  m.  at  the  Napa  State  Hospital.  Dr.  C.  E. 
Sisson,  medical  superintendent,  acted  as  host  and 
provided  a most  appetizing  dinner,  which  preceded 
the  business  session.  Dr.  George  I.  Dawson,  presi- 
dent, opened  the  meeting. 

The  minutes  of  the  previous  meeting  were  read  and 
approved.  Communications  were  read. 

It  was  moved,  seconded  and  carried,  that  the  Napa 
County  Medical  Society  adhere  rigidly  to  the  fee 
schedule  of  the  State  Compensation  Insurance  Fund 
as  applied  to  x-ray  pictures,  and  that  the  secretary 
should  so  notify  certain  insurance  companies  who  are 
attempting  to  lower  the  rate. 

The  formation  of  a woman’s  auxiliary  was  dis- 
cussed, and  the  wives  of  members  will  be  invited  to 
attend  the  next  regular  meeting  of  the  society. 

The  business  meeting  having  adjourned,  the  staff 
of  the  Napa  State  Hospital  presented  a number  of 
typical  mental  cases. 

Dr.  C.  E.  Nixon,  pathologist,  presented  several  in- 
teresting postmostem  specimens. 

Members  present  were:  C.  H.  Bulson,  H.  R.  Col- 
man,  George  I.  Dawson,  E.  F.  Donnelly,  A.  E. 
Chappie,  I.  E.  Charlesworth,  C.  A.  Gregory,  C.  A. 
Johnson,  Lena  Miller,  A.  K.  McGrath,  A.  McLish, 
C.  E.  Nelson,  R.  S.  Northrop,  G.  W.  Ogden,  J.  Rob- 
ertson, O.  Rockwell,  J.  B.  Rogers,  C.  E.  Sisson, 
H.  W.  Vollmer,  L.  Welti,  and  George  J.  Wood. 

Visitors  present  were:  Dr.  C.  E.  Nixon,  Dr.  Toller, 
Dr.  Williams,  Mr.  Owen  Murray,  supervisor  Napa 
State  Hospital;  Mrs.  Harvey,  superintendent  Victory 
Hospital,  Napa;  Mrs.  M.  Davis,  matron  Napa  State 
Hospital;  and  Miss  Rose  Offutt,  social  service  worker 

C.  A.  Johnson,  Secretary. 


ORANGE  COUNTY 

The  regular  monthly  meeting  of  the  Orange  County 
Medical  Association  was  held  at  St.  Ann’s  Inn,  Santa 
Ana,  on  March  11,  the  date  having  been  postponed 
one  week  due  to  the  invitation  of  the  society  to  hear 
Doctors  Coffey  and  Humber’s  lecture  at  San  Diego 
on  cancer. 

Forty-five  members  were  present  and  a sumptuous'' 
turkey  dinner  was  served  promptly  at  7 o’clock.  Our 
guests  of  honor  were  Doctors  LeRoy  Crummer  of 
Los  Angeles,  Lyell  C.  Kinney,  president-elect  of  the 
California  Medical  Association,  and  Mott  T.  Arnold, 
councilor  of  the  first  district. 

Between  courses  the  following  business  of  the 
society  was  transacted: 

1.  The  minutes  of  the  last  three  meetings  were  read 
and  approved. 

2.  A report  on  the  Barlow  medical  library  and  radio 
broadcasting  was  made  by  Dr.  M.  W.  Hollingsworth. 
It  was  suggested  that  the  society  take  out  a patron 
membership  in  the  Barlow  library  for  this  year  only, 
costing  $25.  It  was  voted  on  and  carried.  The  ques- 
tion as  to  the  weekly  radio  talks  over  our  local  broad- 
casting station  was  then  discussed,  the  cost  of  $9  for 
fifteen  minutes  weekly  to  be  paid  by  the  Madden 
Pharmacy  of  Santa  Ana.  On  referring  this  to  the 
membership  it  was  carried  by  one  vote. 

3.  The  reading  of  Dr.  H.  F.  Gramlich’s  application 
for  membership  was  heard  for  the  first  time.  The 
second  readings  of  Doctors  H.  MacVicker  Smith,. 
Robert  S.  Wade,  and  E.  D.  Kilbourne  were  heard  by 
the  society  and  voted  on.  All  three  were  taken  into 
membership  of  the  association. 

4.  The  question  as  to  expenses  for  the  Woman’s 
Auxiliary  during  the  meeting  of  the  Southern  Cali- 
fornia Medical  Association  in  Santa  Ana  in  April  was 
discussed.  It  was  moved  and  carried  that  the  society 
allow  $25  for  the  Auxiliary  for  this  occasion. 

5.  A report  of  the  proposed  Southern  California 
meeting  was  given  by  Dr.  M.  W.  Hollingsworth,  pro- 
gram chairman.  Plans  for  this  meeting  by  his  com- 
mittee and  the  Woman’s  Auxiliary  were  given  in 
detail.  The  question  as  to  whether  our  regular  April 
meeting  should  be  postponed  on  account  of  the  South- 
ern California  meeting  was  discussed,  but  by  vote  it 
was  decided  to  hold  our  regular  April  meeting  as 
usual. 

Dr.  Lyell  C.  Kinney  was  then  introduced  to  the 
members,  and  gave  a very  interesting  talk  on  the 
State  Association,  stressing  three  proposed  objectives 
at  this  time,  namely:  (a)  Incorporation.  ( b ) Basic 
Science  Law.  (c)  Medical  service  to  those  of  small 
salaries. 

Dr.  Mott  H.  Arnold,  councilor  of  the  first  district, 
was  introduced  and  gave  a short  talk. 

Dr.  LeRoy  Crummer  of  Los  Angeles  gave  the  prin- 
cipal address  of  the  evening  on  “Angina  Pectoris.” 
It  was  a very  interesting  discussion  of  the  subject 
and  was  very  capably  handled  by  the  speaker,  who 
gave  many  of  his  personal  opinions  and  experiences 
on  this  type  of  heart  disease. 

At  the  end  of  this  paper  Doctor  Cushman  moved 
that  a vote  of  thanks  be  extended  Doctors  Crummer, 
Kinney,  and  Arnold  for  their  effort  in  making  this 
meeting  a very  decided  success.  It  was  unanimously 
carried. 

On  motion  the  meeting  adjourned. 

Harry  G.  Huffman,  Secretary. 

PLACER  COUNTY 

The  Placer  County  Medical  Society  held  its  monthly 
meeting  Saturday  evening,  March  15,  in  Auburn, 
President  Max  Dunievitz  presiding. 

There  were  present  the  following  members  and 
visitors : 

Members — Doctors  Dunievitz,  Durand,  Woodbridge, 
C.  E.  Lewis,  Myers,  William  Miller,  Thoren,  Mackay, 
L.  C.  Barnes,  Monica  Stoy  Briner,  Fay,  Rooney,  and 
Peers.  Visitors — Doctors  Morton  R.  Gibbons,  presi- 
dent of  the  California  Medical  Association;  L.  E. 


290 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


Jones  of  Roseville,  and  H.  M.  Kanner,  C.  B.  Jones, 
J.  L.  Fanning,  G.  A.  Foster,  E.  W.  Beach  and  O.  S. 
Cook  of  Sacramento. 

Dr.  Louis  E.  Jones  of  Roseville  was  elected  to 
membership,  subject  to  the  approval  of  the  state 
office. 

The  guest  of  honor  was  Dr.  Morton  R.  Gibbons, 
who  addressed  the  society  on  matters  pertaining  to 
industrial  accident  work  and  other  subjects  of  in- 
terest to  the  profession.  Doctor  Gibbons  explained 
the  main  features  of  the  Workman's  Compensation, 
Insurance  and  Safety  Act,  stressing  the  rights  of  the 
insured  and  those  of  the  members  of  the  profession. 
Doctor  Gibbons  discussed  at  length  many  of  the  sub- 
jects now  before  the  profession  and  which  are  being 
carefully  studied  by  the  Council,  including  the  Basic 
Science  Law,  social  insurance,  other  forms  of  health 
insurance,  our  state  journal,  the  finances  of  the  state 
society,  and  the  subject  of  dues. 

At  the  close  of  Doctor  Gibbons’  address  these  mat- 
ters were  very  fully  discussed  by  all  members  present, 
and  many  questions  were  asked  by  the  members  and 
answered  by  Doctor  Gibbons. 

Doctor  Mackay  discussed  the  recent  appointment 
by  the  Board  of  Supervisors  of  a milk  inspector  for 
Placer  County.  It  was  the  opinion  of  the  majority  of 
the  members  present  that  the  action  of  the  board 
should  be  upheld. 

Doctor  Rooney  spoke  briefly  regarding  legislation 
relating  to  the  prescribing  of  narcotics  and  alcohol 
by  members  of  the  profession,  condemning  the  pres- 
ent tendency  to  restrict  physicians  in  their  profes- 
sional work. 

Before  adjournment  Doctor  Dunievitz  stated  that 
the  next  meeting  would  be  held  in  Grass  Valley  on 
a date  to  be  announced  later.  He  reported  that  the 
speakers  of  the  Grass  Valley  meeting  would  be  former 
Nevada  County  residents  now  practicing  in  San 
Francisco.  Robert  A.  Peers,  Secretary. 

(C 

SACRAMENTO  COUNTY 

The  first  regular  meeting  of  the  Sacramento  So- 
ciety for  Medical  Improvement  for  the  year  1930  was 
called  to  order  by  the  president,  Dr.  Gustave  Wilson, 
in  the  Senator  Hotel  on  January  21.  Fifty-three  doc- 
tors were  present. 

The  minutes  of  the  November  1929  meeting  were 
read  and  approved. 

Dr.  F.  Gundrum  reported  the  interesting  case  of  a 
woman  who  had  had  a mitral  stenosis  for  twenty-five 
years  and  who  suddenly  developed  an  auricular  flutter 
following  exertion.  Digitalis  had  no  effect,  but  quini- 
din  in  small  doses,  one  grain  three  times  a day,  in- 
creasing by  one  grain  daily,  changed  the  flutter  to  a 
fibrillation.  A few  days  later  she  developed  a sudden 
pain  in  the  abdomen,  with  numbness,  tingling,  and 
cyanosis  of  both  feet.  Thrombosis  at  the  bifurcation 
of  the  aorta,  which  this  patient  had,  is  a rare  condition. 

There  being  no  further  cases  reported,  the  paper 
of  the  evening  was  delivered  by  Dr.  Alfred  C.  Reed, 
professor  of  tropical  medicine  at  the  University  of 
California  Medical  School.  The  subject  was  “Some 
Medical  Problems  of  the  Orient.”  Doctor  Reed  had 
recently  traveled  through  Egypt,  Syria,  Persia,  India, 
the  Federated  Malay  States,  and  China,  studying  the 
diseases  peculiar  to  these  countries,  noting  their  epi- 
demiology, pathology,  and  treatment.  The  diseases 
specially  mentioned  were  amebiasis,  leprosy,  Bill- 
roth’s disease,  bacillary  dysentery,  rabies,  and  sun- 
stroke. The  paper  was  illustrated  by  lantern  slides 
from  the  pictures  Doctor  Reed  had  taken,  which  made 
the  talk  very  interesting.  Appreciation  of  the  paper 
was  voiced  by  Doctors  Gundrum  and  Johnson. 

The  application  for  membership  from  Dr.  Lloyd  C. 
Austin  was  read.  This  being  the  first  reading  no 
action  was  taken.  Doctor  Fanning’s  transfer  was  also 
read. 

Doctor  Sampson  announced  the  staff  meetings  at 
the  Sacramento  Hospital  on  the  fourth  Tuesday  each 
month.  Members  were  urged  to  attend. 


Doctor  Hall  asked  the  doctors  to  report  all  cases 
of  pneumonia. 

It  was  moved  and  seconded  that  the  secretary  be 
instructed  to  inquire  about  reservations  for  delegates 
and  alternates  from  this  society  to  the  annual  con- 
vention of  the  California  Medical  Association  at  Del 
Monte.  Motion  carried. 

There  being  no  further  business  the  meeting  ad- 
journed. Frank  Warne  Lee,  Secretary. 

* 

SAN  BERNARDINO  COUNTY 

The  meeting  of  the  San  Bernardino  County  Medi- 
cal Society  was  held  at  the  County  Hospital  in  San 
Bernardino,  March  4.  The  meeting  was  called  to 
order  at  8:10  p.  m. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

The  secretary  spoke  briefly  concerning  the  present 
status  of  the  Coffey-Humber  treatment  of  cancer. 

The  program  of  the  evening  was  then  entered  upon: 

The  Neurological  Aspect  of  Relief  of  Pain  in  the 
Various  Parts  of  the  body — Mark  Albert  Glaser  of 
Los  Angeles.  Illustrated  by  lantern  slides.  Dis- 
cussion opened  by  W.  A.  George  of  Loma  Linda. 

The  Medical  Aspect  of  Pain — Samuel  D.  Ingham  of 
Los  Angeles.  Discussion  opened  by  C.  L.  Emmons 
of  Ontario. 

Luncheon  at  10:30  o’clock. 

* * * 

Owing  to  the  changes  in  the  new  constitution  the 
delegates  and  alternates  are  now  elected  for  two 
years,  one-half  being  elected  each  alternate  year. 
This  necessitates  the  following  changes:  Dr.  W.  F. 
Pritchard  and  Dr.  A.  T.  Gage  for  1930;  Dr.  F.  F. 
Abbott  and  Dr.  S.  B.  Richard  for  1930-31. 

A letter  from  Doctor  Stivers  was  read  concerning 
a talk  on  speech  defect  to  be  given  before  the  medical 
society.  As  it  is  impossible  to  reconcile  conflicting 
dates  this  program  will  have  to  be  postponed. 

The  following  milk  commission  has  been  appointed 
by  the  President  for  the  current  year:  Dr.  K.  L.  Dole 
of  Redlands,  Dr.  C.  I.  Emmons  of  Ontario,  Dr.  C.  F. 
Whitmer  of  Colton,  Dr.  W.  A.  Taltaval  of  Redlands, 
Dr.  J.  W.  Whitsett  of  Redlands,  and  Dr.  W.  W. 
Fenton  of  San  Bernardino. 

Meeting  adjourned  at  1 :30  o’clock. 

E.  J.  Eytinge,  Secretary. 

# 

SAN  JOAQUIN  COUNTY 

The  stated  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  Thursday  evening  at  eight 
o’clock,  March  6,  in  the  Medico-Dental  Club,  242 
North  Sutter  Street,  Stockton.  This  was  a joint  meet- 
ing at  which  the  Seventh  District  Dental  Society  were 
guests. 

The  meeting  was  called  to  order  by  Dr.  H.  E. 
Kaplan,  president.  The  minutes  of  the  previous  meet- 
ings were  read  and  approved. 

Doctor  Kaplan  introduced  Dr.  Nathan  Sinai,  who 
addressed  the  society  on  the  subject  of  “Medical 
Trends.” 

The  speaker  described  the  effect  on  the  public  of 
the  great  number  of  articles  relative  to  medical  care 
in  current  publications.  The  effect  of  these  articles 
is  to  build  up,  on  a very  flimsy  basis  of  facts,  a dan- 
gerous public  opinion  as  to  methods  for  correcting 
any  defects  that  may  exist  in  medical  care. 

Evidences  of  dissatisfaction  with  our  system  of 
medical  care  are  to  be  seen  among  the  groups  supply- 
ing service  as  well  as  the  public  which  receives  it. 
Each  group  seems  to  have  its  particular  cause  or 
causes  for  complaint,  most  of  the  complaints  having 
an  economic  basis. 

Apparently  the  widespread  dissatisfaction  points  to 
inevitable  changes  in  our  system  of  medical  care,  and 


April,  1930 


STATE  MEDICAL  ASSOCIATIONS 


291 


these  changes  may  take  either  an  evolutionary  or 
revolutionary  course. 

The  Committee  on  the  Cost  of  Medical  Care  was 
organized  to  carry  on  a comprehensive  study  of  our 
system  of  medical  care  so  that  any  changes  which 
might  seem  necessary,  as  a result  of  study,  may  be 
brought  about  in  an  orderly  and  unemotional  manner. 
The  committee  stresses  the  fact  that  no  preconceived 
opinions  concerning  the  future  of  medical  care  are 
held.  The  committee  further  asks  that  any  opinions 
or  plans  for  correcting  any  conclusions  regarding 
alleged  defects  in  our  present  system  should  be  held 
in  reservation  until  its  studies  have  been  completed. 

The  committee  proposes  to  make  complete  studies 
of  medical  facilities  in  San  Joaquin  County.  The 
study  is  to  be  made  through  questionnaires,  inter- 
views, and  analyses  of  whatever  data  are  available. 

From  like  studies  to  be  made  in  other  parts  of  the 
country  and  from  over  twenty  additional  studies  of 
medical  care  the  committee  hopes  to  arrive  at  some 
solution  of  the  problem,  to  the  end  that  all  of  the 
people,  regardless  of  their  means,  may  secure  ade- 
quate and  scientific  medical  care. 

The  discussion  was  opened  by  Doctors  Dewey  R. 
Powell,  J.  F.  Doughty,  and  J.  J.  Sippy  for  the  medical 
men,  and  by  Doctors  Jerry  O’Brien  and  H.  J.  Mc- 
Gilvray  for  the  dentists.  The  paper  was  further  freely 
discussed  by  Doctors  McGurk,  Chapman,  Looser, 
Thompson,  S.  H.  Hall,  Walker,  D’Amico,  Foard,  and 
Dooley. 

The  president  appointed  the  following  special  com- 
mittee, cooperating  with  the  Committee  on  Cost  of 
Medical  Care:  Doctors  Dewey  R.  Powell  (chairman), 
McGurk,  Chapman,  Barnes,  Sippy,  Doughty,  and 
C.  V.  Thompson. 

Doctor  Barnes  presented  the  matter  of  the  Porter 
Narcotic  Bill,  now  pending  before  Congress,  and 
moved  that  the  secretary  be  instructed  to  send  tele- 
grams to  each  representative  and  senator  at  Wash- 
ington protesting  the  passage  of  this  bill.  Motion  was 
duly  seconded  and  carried. 

The  meeting  was  attended  by  members  from  the 
medical  society  and  dental  society  both.  Those  pres- 
ent were:  Dr.  Nathan  Sinai,  Dr.  F.  R.  Prince, 
president  of  the  dental  society;  and  eighteen  other 
dentists  as  guests.  Medical  members  present  were: 
Doctors  S.  R.  Arthur,  Blackmun,  Broaddus,  Chapman, 
Conzelmann,  Doughty,  Dozier,  Davison,  Foard,  Frost, 
Gallegos,  Goodman,  Hammond,  Kaplan,  Looser,  Mc- 
Coskey,  McGurk,  McNeil,  Marnell,  Owens,  Peterson, 
Pinney,  D.  R.  Powell,  Rohrbacher,  Sanderson,  Shel- 
don, Sippy,  Margaret  Smyth,  C.  V.  Thompson,  Vischi, 
and  Walker. 

There  being  no  further  business,  the  meeting  ad- 
journed for  refreshments  and  social  hour. 

C.  A.  Broaddus,  Secretary. 


TULARE  COUNTY 

The  regular  monthly  meeting  of  the  Tulare  County 
Medical  Society  was  held  Sunday  evening,  Febru- 
ary 23,  at  Motley’s  Cafe.  The  meeting  was  called 
to  order  by  Dr.  FI.  G.  Campbell,  president,  at  eight 
o’clock.  Minutes  of  the  previous  meeting  were  read 
and  approved. 

The  following  were  unanimously  admitted  to  mem- 
bership: R.  C.  Hill,  George  B.  Dewees,  and  K.  F. 
Weiss. 

Members  present :Doctors  C.  C.  Bond,  Groesback, 
A.  Bond,  Brigham,  Campbell,  Tourtillott,  Lipson, 
Gilbert,  Zumwalt,  Seligman,  Weiss,  Hill,  Dewees,  and 
Ginsburg. 

Dr.  J.  C.  Geiger  of  Hooper  Foundation,  University 
of  California,  gave  a very  interesting  address  on 
“Cerebrospinal  Fever  on  the  Pacific  Coast.”  The 
address  was  illustrated  with  lantern  slides. 

A vote  of  appreciation  was  expressed  by  the  society 
to  Doctor  Geiger  for  his  address. 

There  being  no  other  business  the  meeting  closed 
at  9:30  o’clock.  S_  s Ginsburg,  Secretary. 


VENTURA  COUNTY 

The  March  meeting  of  the  Ventura  County  Medical 
Society  was  held  March  11  at  the  clinic  of  Ventura 
County  Hospital. 

Vice-president  W.  S.  Clark  opened  the  meeting. 
The  members  present  were:  Doctors  Coffey,  Jones, 
Patton,  Welsh,  D.  G.  Clark,  Felberbaum,  Schultz, 
Bardill,  Yoakum,  Achenbach,  Shore,  Homer,  Smolt. 

Doctors  W.  H.  Leake  and  Claude  Davison  of  Los 
Angeles  were  present  at  guests.  The  minutes  were 
nead  and  after  a correction  of  the  roll,  striking  out 
the  name  Johnson,  were  approved. 

Letters  were  read  from  the  University  of  California 
Medical  School,  and  the  Committee  on  Associated 
Societies  of  the  State  Association. 

Doctor  Welsh  inquired  about  a uniform  fee  sched- 
ule for  the  county.  Discussion  developed  the  opinion 
that  there  is  no  such  schedule  in  force  at  present  and 
that  none  is  desired. 

The  business  meeting  was  then  closed  and  Doctor 
Clark  introduced  the  speaker  of  the  evening,  Dr. 
William  H.  Leake.  Doctor  Leake  is  a senior  attend- 
ing physician  at  Los  Angeles  County  General  Hospi- 
tal and  is  connected  with  the  medical  school  of  the 
University  of  Southern  California.  His  subject  was 
“Cardiac  Symptoms  in  Thyrotoxicosis.” 

Doctor  Leake  emphasized  the  fact  that  abnormal 
cardiac  rhythm  is  not  in  itself  a contraindication  to 
thyroidectomy.  He  also  described  in  detail  the  pre- 
operative preparation  of  goiter  cases,  especially  the 
use  of  Lugol’s  solution  and  digitalis.  The  use  of 
quinidin  in  correcting  persistent  arrhythmia  after 
operation  was  also  well  set  forth.  In  conclusion  three 
case  histories  of  interest  were  read  and  commented 
upon.  Doctor  Leake  then  answered  questions  upon 
hyperthyroidism  in  general. 

Dr.  R.  M.  Jones  was  appointed  by  Doctor  Clark  to 
arrange  the  program  for  the  April  meeting  and  the 
members  adjourned.  CharL£S  a.  Smolt>  Secretary. 


■ YOLO-COLUSA  COUNTY 

A regular  meeting  of  the  Yolo-Colusa  Medical 
Society  was  held  at  Davis  on  March  5. 

G.  H.  Hart  and  H.  H.  Cole  of  the  Division  of  Ani- 
mal Husbandry  of  the  College  of  Agriculture  pre- 
sented a paper  on  their  studies  with  the  sex-maturing 
hormone  of  the  pituitary  gland  (anterior  hypophysis). 
This  consisted  in  a discussion  of  the  research  work 
that  has  been  going  on  during  the  last  few  years  on 
the  anterior  hypophysis  hormone  and  also  folliculin 
or  estrin,  a second  hormone  affecting  the  genital  tract, 
probably  produced  in  the  Graafian  follicle. 

The  work  had  been  done  on  blood  samples  of  preg- 
nant mares  and  urine  of  pregnant  women.  De- 
monstrations were  also  made  on  immature  white  rats 
which  had  been  brought  to  sexual  maturity  by  the 
injection  of  blood  and  urine  from  cases  in  various 
stages  of  pregnancy.  It  showed  this  to  be  a very 
satisfactory  biological  test  for  the  diagnosis  of  preg- 
nancy in  the  early  stages  in  both  humans  and  animals. 

Microprojection  apparatus  was  used  to  demonstrate 
the  changes  taking  place  in  the  ovaries  of  the  rats. 
These  showed  changes  from  the  enlargement  of  a 
single  follicle  to  very  extensive  changes  in  many 
follicles,  including  ovulation,  with  a demonstration 
of  the  ova  in  the  oviduct,  depending  on  the  concen- 
tration of  the  hormones  in  the  blood  or  the  variations 
in  the  size  of  the  dose  from  the  same  sample  of  blood 
from  mares.  The  evidence  presented  showed  that  in 
all  probability  the  effect  of  the  anterior  hypophyseal 
hormone  was  to  produce  development  of  one  or  more 
Graafian  follicles  which  in  turn  probably  produce 
folliculin  which  caused  the  changes  in  the  uterus  and 
vagina. 

A demonstration  was  also  made  of  the  character- 
istic cell  picture  from  vaginal  smears  in  rats  at  vari- 
ous stages  of  the  cycle. 

In  working  with  spayed  mature  and  immature  rats, 
as  compared  to  nonspaved  immature  rats,  it  was 


292 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


shown  that  a considerably  larger  dose  of  serum  (thirty 
cubic  centimeters)  was  required  to  demonstrate  the 
presence  of  folliculin  in  spayed  rats,  whereas  a single 
injection  of  one  cubic  centimeter  of  the  same  serum 
into  unspayed  immature  rats  produced  the  character- 
istic hypophyseal  hormone  changes  in  the  ovary. 

The  studies  showed  a varying  concentration  of  the 
hormone  in  the  blood  of  a pregnant  mare,  its  first 
appearance  being  demonstrated  from  thirty-seven  to 
forty-two  days  after  pregnancy,  as  compared  to  a 
much  earlier  appearance  in  pregnant  women.  This 
was  followed  in  the  mare  by  a rapid  increase  in  the 
concentration  between  the  forty-fifth  and  eightieth 
days,  followed  by  a gradual  decline  to  the  one  hun- 
dred and  eightieth  day,  when  the  ovaries  of  the  in- 
jected rats  were  again  comparable  in  size  to  the 
controls. 

There  was  also  a discussion  of  the  application  of 
this  knowledge  to  clinical  medicine  and  to  animal 
husbandry. 

An  article  on  this  work  will  soon  appear  in  the 
American  Journal  of  Physiology. 

The  meeting  then  adjourned  to  inspect  the  new 
Animal  Science  Building.  The  several  different  cham- 
bers for  the  estimation  of  the  basal  metabolism  of 
insects  and  animals  of  all  sizes  were  shown  and 
explained. 

Expressions  of  appreciation  to  Doctor  Hart  and  his 
confreres  and  thanks  for  their  time  and  efforts  were 

then  given.  W E Bates,  Secretary-Treasurer. 


YUBA-SUTTER  COUNTY 

A meeting  of  the  Yuba-Sutter  Medical  Society  was 
held  on  February  11  last,  and  Dr.  Hans  Lisser  of 
San  Francisco  gave  a very  delightful  and  instructive 
lecture  on  endocrines,  etc.  The  lecture  was  illustrated 
by  lantern  slides,  and  all  statistical  facts  were  brought 
out  clearly.  There  was  a full  attendance  of  the 
society,  and  a vote  of  thanks  was  extended  to  Doctor 
Lisser  for  his  lecture  and  his  coming  to  our  meeting. 

* * * 

At  the  meeting  of  the  society  on  March  11,  Dr. 
P.  B.  Hoffman  was  elected  as  delegate  and  Dr.  F.  W. 
Didier  as  alternate  to  the  California  Medical  Associa- 
tion House  of  Delegates. 

The  meeting  was  held  in  the  Marysville  Hotel  and 
was  well  attended. 

The  speaker  of  the  evening  was  Dr.  Albert  Rowe 
of  Oakland.  His  subject,  “Food  Allergy — Its  Control 
by  Elimination  Diets,”  was  well  appreciated.  The 
subject  was  a little  different  from  the  better  under- 
stood specialties,  and  a vote  of  thanks  and  due  ap- 
preciation was  given  to  Doctor  Rowe. 

The  subject  was  one  more  or  less  observed  but 
never  taken  into  the  deep  consideration  it  should  have 
had;  and  the  enlightenment  caused  by  Doctor  Rowe’s 
lecture  will  make  amateur  allergists  out  of  all  of  us. 

F.  W.  Didier. 

CHANGES  IN  MEMBERSHIP 
New  Members 

Alameda  County — Benjamin  Warren  Black. 

Fresno — Everett  Morris,  Harry  A.  Randel. 

Imperial  County — -Augustus  Hunter  Foster. 

Los  Angeles  County — Robert  Janies  Bowman,  Edward 
E.  Hethcock,  John  Ernest  Jackson,  Israel  Klein, 
Elbert  B.  Liddell,  Guy  Oliver  McKeehan,  Clarence 
Eugene  Schuetz,  Milton  J.  Tobias,  Earl  Willson 
Wells. 

Marin  County — R.  Martha  Allen. 

Monterey  County — Raymond  J.  Cluen,  Sydney  H. 
Smith. 

Napa  County — John  Robertson. 

Orange  County — Ralph  Carr  Green,  Samuel  J. 
Walker,  Murray  Bates. 


Riverside  County — William  E.  Gardner,  Jesse  N. 
Roe,  Harry  C.  Reynolds,  Herman  John  Wickman. 

San  Francisco  County — Horace  Gray,  Frank  Bernard 
Hand,  Chauncey  D.  Leake,  Charles  F.  Sanborn, 
Abraham  Blackburn  Sirbu. 

San  Luis  Obispo  County — Charles  E.  Brown,  Daniel 
H.  Craig. 

Santa  Clara  County — Bertha  Stuart  Dyment. 

Yolo-Colusa  County — E.  Haskins  Gray,  Oscar  C. 
Railsbach,  Rulon  S.  Tillotson. 

Transferred  Members 

Otis  A.  Sharpe,  from  San  Francisco  to  San  Mateo 
County. 

Louis  O.  Wallace,  from  Sonoma  to  New  Hamp- 
shire. 

Charles  H.  Lewis,  from  Los  Angeles  to  San  Fran- 
cisco County. 

Hobart  P.  Shattuck,  from  Los  Angeles  to  Arizona. 

Jay  Jacobs,  from  Lassen-Plumas  to  San  Francisco 
County. 

Herbert  Q.  Willis,  from  San  Joaquin  to  Orange 
County. 

Clement  E.  Counter,  from  San  Bernardino  to 
Orange  County. 

George  Franklin  Shiels,  from  San  Francisco  to  San 
Mateo  County. 

Henrietta  Frederickson,  from  Los  Angeles  to 

Sonoma  County.  -c  . 

J Resignations 

San  Francisco  County — Charles  E.  Taylor,  William 
L.  Rogers,  Enrique  M.  Aldana,  Paul  S.  Barrett, 
William  L.  Blanck,  Paul  G.  Capps,  Victor  d’Ercole, 
Henry  L.  Holzberg,  Thor  Lude,  Madeline  M.  Manuel, 
J.  Edward  Neville,  Maurice  W.  O’Connell,  Eva  C. 
Reid,  Max  Salomon,  W.  Francis  B.  Wakefield, 
Conrad  Weil. 

Los  Angeles  County — Kawor  Iseri. 

Deaths 

Beckwith,  Ward  M.  Died  January  15,  1930,  age 
73  years.  Graduate  of  Columbia  University  College  of 
Physicians  and  Surgeons,  New  York,  1889.  Licensed 
in  California  1891.  Doctor  Beckwith  was  a member 
of  the  Alameda  County  Medical  Society,  the  Cali- 
fornia Medical  Association,  and  the  American  Medical 
Association. 

De  Loss,  Herbert.  Died  December  27,  1929,  age 
70  years.  Graduate  of  Rush  Medical  College,  Chicago, 
1888.  Licensed  in  California,  1892.  Doctor  De  Loss 
was  a member  of  the  Alameda  County  Medical  So- 
ciety, the  California  Medical  Association,  and  the 
American  Medical  Association. 

Leavitt,  Edgar  Irving.  Died  March  7,  1930,  age 

41  years.  Graduate  of  Cooper  Medical  College,  San 
Francisco,  1910.  Licensed  in  California,  1910.  Doctor 
Leavitt  was  a member  of  the  San  Francisco  County 
Medical  Society,  the  California  Medical  Association, 
and  a Fellow  of  the  American  Medical  Association. 

McArthur,  William  Taylor.  Died  March  11,  1930, 
age  64  years.  Graduate  of  University  of  Toronto 
Faculty  of  Medicine,  Ontario,  1895.  Licensed  in  Cali- 
fornia, 1895.  Doctor  McArthur  was  a member  of  the 
Los  Angeles  County  Medical  Association,  the  Cali- 
fornia Medical  Association,  and  the  American  Medical 
Association. 

McClish,  Clark  Loring.  Died  February  17,  1930, 
age  55  years.  Graduate  of  University  of  California 
Medical  School,  Berkeley,  1904.  Licensed  in  Cali- 
fornia, 1904.  Doctor  McClish  was  a member  of  the 
Los  Angeles  County  Medical  Association,  the  Cali- 
fornia Medical  Association,  and  the  American  Medical 
Association. 

Miller,  Allan  Percy.  Died  February  20,  1930,  age 
50  years.  Graduate  of  McGill  University  Faculty  of 
Medicine,  Montreal,  1905.  Licensed  in  California, 
1909.  Doctor  Miller  was  a member  of  the  Los  An- 
geles County  Medical  Association,  the  California 


April,  1930 


STATE  MEDICAL  ASSOCIATIONS 


293 


Medical  Association,  and  the  American  Medical 
Association. 

Owens,  William  Dunlop.  Died  February  13,  1930, 
age  51  years.  Graduate  of  Georgetown  University 
School  of  Medicine,  Washington,  D.  C.,  1901.  Li- 
censed in  California,  1920.  Doctor  Owens  was  a 
member  of  the  San  Diego  County  Medical  Society, 
the  California  Medical  Association,  and  the  American 
Medical  Association. 

Rubin,  Joseph  Salem.  Died  January  18,  1930,  age 
30  years.  Graduate  of  University  of  California  Medi- 
cal School,  Berkeley,  1926.  Licensed  in  California, 
1926.  Doctor  Rubin  was  a member  of  the  Los  An- 
geles County  Medical  Association,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 


OBITUARIES 


William  Taylor  McArthur 
1866-1930 


William  Taylor  McArthur  has  gone  from  us — - 
capable  surgeon,  orator  of  native  wit,  devoted  worker 
for  organized  medicine,  and  beloved  physician  and 
loyal  friend. 

Born  sixty-three  years  ago  of  sturdy  Scotch  parent- 
age in  Ontario,  Canada,  in  an  environment  of  sim- 
plicity, sincerity  and  earnestness,  he  grew  to  man- 
hood with  these  attributes  dominating  his  life.  There 
were  no  great  libraries  in  the  woods  of  Canada  when 
he  was  a youth,  but  there  was  Burns  and  Scott  and 
Shakespeare  and  the  Bible,  and  these  few  classics 
were  so  well  mastered  in  youth  that  excerpts  from 
the  memories  of  that  reading  were  a never  failing 
source  of  pleasure  to  his  audiences — public  or  private. 

Doctor  McArthur  graduated  from  the  Owen  Sound 
Collegiate  Institute  in  1891  and  from  the  medical 
department  of  the  University  of  Toronto  in  1895. 
Following  his  graduation  he  located  in  Los  Angeles  in 
1895,  and  remained  there  with  the  exception  of  time 
for  postgraduate  study  in  London  and  in  Edinburgh, 
from  the  university  of  which  latter  city  he  received 
the  degree  of  F.  R.  C.  S.  In  1901  he  resumed  practice 
in  Los  Angeles  until  his  death  on  March  11,  1930. 

From  1907  to  1911  he  was  Professor  of  Surgical 
Anatomy  in  the  University  of  Southern  California. 


He  was  a lecturer  on  artistic  anatomy  in  the  Los  An- 
geles School  of  Art  and  Design.  For  many  years 
he  was  an  attending  surgeon  at  the  Los  Angeles 
General  Hospital.  He  was  a member  of  many  clubs, 
civic  and  social  organizations,  his  attendance  at  any 
being  always  hailed  with  pleasure  by  his  fellows. 

But  it  was  in  organized  medicine  that  Doctor  Mc- 
Arthur took  the  greatest  interest  and  perhaps  his 
greatest  satisfaction  so  far  as  civic  or  public  life  was 
concerned.  He  knew  the  need  of  organization  and  he 
believed  in  its  future.  For  more  than  twenty  years 
there  was  no  time  when  the  name  of  W.  T.  McArthur 
did  not  appear  in  the  councils  of  the  county,  state  or 
district  medical  organizations. 

He  served  as  a councilor  of  the  Los  Angeles  County 
Medical  Association  for  many  years  and  was  a mem- 
ber of  its  board  of  trustees  from  the  organization 
of  that  body  until  his  death.  After  having  served  as 
councilor  of  the  State  Association  for  many  terms,  he 
was  elected  president  of  the  California  Medical  Asso- 
ciation for  1926-1 927. 

Doctor  McArthur’s  usefulness  in  these  important 
positions  was  due  to  his  mental  poise  and  judicial 
mind.  He  gathered  facts  and  viewed  them  from  all 
angles,  and  his  final  decision  was  always  deliberate 
and  judicial.  Nobody  questioned  his  sincerity;  none 
doubted  his  honesty.  With  him  patience  worked  the 
perfect  work.  No  matter  how  serious  or  how  im- 
portant the  matter,  Doctor  McArthur  could  always 
see  a humorous  side  that  brought  a laugh  or  a smile 
at  some  solemn  stage  of  the  proceeding.  In  private 
conversation  and  in  public  address  he  was  noted  for 
his  wit,  but  it  was  ever  wit  without  a sting. 

In  1904  Doctor  McArthur  was  married  to  Alary  D. 
Smith  of  York,  Pennsylvania,  who  survives  him.  The 
McArthur  home  has  been  known  fur  its  hospitality 
to  the  medical  profession.  Airs.  McArthur  has  sym- 
pathetically cooperated  with  her  husband’s  work  in  a 
most  devoted  manner.  Four  children  were  born: 
Alary,  Elizabeth  (Airs.  Henry  Duque  of  Cambridge, 
Alass.),  William  T.  Jr.,  and  Duncan.  Four  brothers 
survive:  The  Honorable  Robert  T.  AlcArthur  of 
Aloorfield,  Ontario;  James  McArthur  of  Ontario, 
Dr.  Peter  R.  McArthur  and  Dr.  Duncan  D.  McArthur 
of  Los  Angeles. 

In  his  professional  life  Doctor  McArthur  was  indi- 
vidualistic. His  patients  were  his  people.  He  was  a 
“doctor  of  the  old  school — ”a  “Weelum  McClure”  of 
AlcLaren’s  “Bonnie  Briar  Bush.”  Indeed,  James  Main 
Dixon  and  others  referred  to  him  always  as  “Weelum.” 
What  finer  tribute  could  be  paid  a physician?  Who 
could  crave  one  higher! 

Now  is  the  stately  column  broke, 

The  beacon  light  is  quenched  with  smoke, 

The  trumpet’s  silver  sound  is  still, 

The  warder  silent  on  the  hill. 


Joseph  Truesdale  Breneman 
1849-1930 

In  the  death  of  Doctor  Breneman  the  Contra  Costa 
Society  has  lost  one  of  its  oldest  and  most  loved  and 
respected  members. 

Doctor  Breneman  practiced  for  fifty  of  the  eighty- 
one  years  of  his  useful  life,  thirty-eight  of  these  active 
years  being  spent  in  California. 

He  was  born  on  a farm  in  Hancock,  Ohio,  on 
January  23,  1849  and,  following  the  usual  prelimi- 
nary public  school  education,  he  received  his  medical 
degree  from  the  University  of  Iowa  in  1879.  Two  of 
his  classmates  survive  him;  one,  Dr.  P.  K.  Waters 
of  Watsonville  visited  him  during  his  last  illness. 

Doctor  Breneman  was  respected  by  his  fellow  phy- 
sicians and  especially  by  the  members  of  the  Contra 
Costa  County  Society  for  his  strict  adherence  to  the 
ethics  of  medicine;  for  his  keen  mind,  and  his  con- 
stant interest  in  the  progress  of  medicine  and  the 
world. 


294 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


THE  WOMAN’S  AUXILIARY  OF  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION* 


CONTRA  COSTA  COUNTY 

The  second  meeting  of  the  Woman’s  Auxiliary  to 
the  Contra  Costa  Medical  Society  was  held  Tuesday 
evening,  March  11,  at  the  Richmond  Conservatory  of 
Music,  906  McDonald  Avenue,  Richmond. 

The  meeting  was  called  to  order  by  Mrs.  J.  M. 
McCullough,  president. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted. 

The  president  appointed  the  following  chairmen: 

Membership — Mrs.  H.  L.  Carpenter  (telephone, 
Richmond),  Mrs.  P.  C.  Campbell  (telephone,  Mar- 
tinez), and  Mrs.  I.  O.  Church. 

Entertainment— Mrs.  W.  E.  Cunningham. 

Philanthropy — Mrs.  A.  H.  Beede. 

Education — Mrs.  N.  L.  Fernandez. 

Mrs.  I.  O.  Church  was  appointed  chairman  of 
arrangements  for  the  next  meeting. 

The  possible  activities  of  the  auxiliary  were  dis- 
cussed. 

There  being  no  further  business  the  meeting  was 
adjourned.  Helen  Weil,  Secretary. 

fC 

LOS  ANGELES  COUNTY 

The  first  regular  meeting  of  the  Woman’s  Auxili- 
ary of  the  Los  Angeles  County  Medical  Association 
was  held  on  Thursday  afternoon,  February  20,  in  the 
assembly  hall  of  the  Friday  Morning  Club  building, 
Mrs.  James  F.  Percy,  president,  presiding.  Mrs. 
Martin  G.  Carter,  secretary-treasurer,  read  the  min- 
utes of  the  former  gathering. 

Mrs.  Nell  Lockwood  Josephs  added  to  the  pleasure 
of  the  occasion  with  several  songs,  after  which  the 
president,  with  her  usual  grace,  introduced  the  speaker 
of  the  afternoon,  Dr.  Percy  T.  Magan.  In  effect, 
Doctor  Magan  summarized  the  function  of  the 
Woman’s  Auxiliary  as  that  of  helping  the  physician 
to  do  the  important  things  that  he  is  unable  to  do 
himself  because  of  the  stress  of  his  vocation.  The 
conscientious  doctor  spends  all  his  time  in  studying 
the  problems  of  how  he  can  prolong  life,  preserve 
health,  prevent  suffering,  and  thus  adds  to  human 
happiness,  which  is  so  tremendous  a problem  that 
the  doctor  has  little  time  for  anything  else. 

And  yet  there  are  important  problems  that  con- 
front the  doctor  quite  as  much  as  any  other  person — 
problems  that  concern  his  own  profession  directly. 
Social  problems  and  situations,  things  political,  reli- 
gious activities  that  form  the  warp  and  woof  of  our 
civilization.  And  it  is  in  these  very  things  that  the 
Woman’s  Auxiliary — the  wives,  sisters,  and  daughters 
of  the  physician,  who  know  and  appreciate  his  needs 
more  than  others  in  the  community — can  be  helpful. 

The  consummation  of  this  combination  should  mean 
everything  to  the  welfare  of  the  community  as  well 
as  to  the  welfare  of  the  physicians  in  the  community. 
For,  after  all,  their  aims  and  objects  and  ambitions 
are  the  same. 

The  regular  meetings  of  the  Woman’s  Auxiliary 
will  be  held  on  the  third  Thursday  of  every  second 
month,  the  next  meeting  being  on  April  17  in  the 
assembly  hall  of  the  Friday  Morning  Club  building. 

Cora  Young  Williams, 

Publicity  Chairman. 

* As  county  auxiliaries  to  the  Woman’s  Auxiliary  of  the 
California  Medical  Association  are  formed,  the  names  of 
officers  should  be  forwarded  to  the  state  secretary-treas- 
urer, Mrs.  R.  A.  Cushman,  632  North  Broadway,  Santa 
Ana,  and  to  the  California  Medical  Association  office. 
Room  2004,  450  Sutter  Street,  San  Francisco.  Brief  re- 
ports of  county  auxiliary  meetings  will  be  welcomed  for 
publication  in  this  column.  See  advertising  page  6 of 
each  issue  for  state  and  county  officers. 


Executive  Board  Meeting  of  the  Woman’s  Auxiliary 
of  the  Los  Angeles  County  Medical  Association.— 

Mrs.  James  F.  Percy  called  the  meeting  to  order  at 
1:40  p.  m.  February  20  at  940  South  Figueroa  Street. 

Mesdames  Carter,  Percy,  and  von  Wedelstaeldt 
were  present. 

Moved,  seconded,  and  carried  that  bills  amounting 
to  $102.95  be  approved  as  paid. 

After  a general  discussion  of  plans  for  future  meet- 
ings, there  being  no  further  business  to  come  before 
the  board,  the  meeting  adjourned  after  having  ap- 
proved the  above  minutes. 

* * * 


Regular  Meeting  of  the  Woman’s  Auxiliary  of  the 
Los  Angeles  Medical  Association. — Mrs.  James  F. 
Percy  called  the  meeting  to  order  at  2:45  p.  m.  Feb- 
ruary 27  at  940  South  Figueroa  Street. 

The  minutes  of  the  organization  meeting  on  De- 
cember 27,  1929,  were  read  and  approved. 

The  standing  rules  of  the  auxiliary,  as  adopted  by 
the  Executive  Committee,  were  read  by  the  secretary. 

After  the  president’s  announcements,  Mrs.  Nell 
Lockwood  Josephs  sang. 

Dr.  Percy  W.  Magan,  the  speaker  of  the  afternoon, 
chose  for  his  subject  “The  Hand  That  Holds  the 
Doctor’s  Heart  Is  the  Hand  That  Moulds  the  Heal- 
ing Art.’’’ 

After  the  meeting  adjourned,  tea  was  served  and  a 
social  hour  enjoyed. 


The  following  signed  as  additional  charter  members 


MESDAMES 

Samuel  M.  Alter 
E.  W.  Ames 
Harry  E.  Anderson 
Howard  Andrews 
Arthur  J.  Annis 
Edward  D.  Anthony 
Francis  L.  Anton 
Edwin  V.  Askey 
John  M.  Askey 
Thomas  C.  Austin 

Robt.  V.  Baker 
R.  W.  Baker 
A.  J.  Balkins 
H.  O.  Barnes 
LI.  D.  Barnard 
Roger  W.  Barnes 
Samuel  G.  Bay 
Horace  R.  Beck 
Ben  M.  Behr 
Elmer  A.  Belt 
Chas.  L.  Bennett 
Curtis  Bland 
Peter  H.  Blong 
A.  E.  Boland 
Vincent  Bonfiglio 
Oliver  P.  Bourbon 
W.  A.  Boyce 
Walter  H.  Boyd 
H.  B.  Breitman 
A.  Brockway 
Page  Brown 
Chas.  E.  Browning 
Harry  E.  Bryant 
Richard  O.  Bullis 
James  H.  Burgan 
Lloyd  A.  Burrows 
Frank  Byington 

Clayton  C.  Campbell 
John  Carling 
J.  K.  Carson 
Miss  Kingsetta  Carson 
William  F.  Carver 
Chas.  R.  Caskey 
R.  W.  Cavell 
Rafe  B.  Chaffin 
Ben  H.  Chamberlain 
H.  H.  Chamberlin 
H.  L.  Charles 
Raymond  E.  Chase 
A.  C.  Christensen 
Fred  B.  Clark 
R.  M.  Clark 
Harry  W.  Coffin 
George  L.  Cole 
A.  B.  Cooke 
John  C.  Copeland 
Carl  C.  Cowin 
Jay  J.  Crane 
Lawrence  L.  Craven 
Leonard  E.  Croft 
J.  Carl  Cummings 


R.  A.  Davis 
Claude  E.  Davison 
Robert  V.  Day 
James  R.  Dean 
Richard  Dewey 
Ed.  W.  Dougherty 
Paul  S.  Dougherty 
C.  O.  Driver 
R.  M.  Dunsmoor 

Earl  Eames 
Philip  J.  Edson 
H.  D.  Edwards 
Jos.  T.  Edwards 
Newton  G.  Evans 
P.  B.  Exelby 

Roy  E.  Fallas 
Franklin  G.  Farman 
R.  M.  Farnham 
James  J.  Farrell 
W.  Max  Fearon 
Louie  Felger 
P.  Ashley  Foster 
Julius  Frankl 
H.  J.  Friesen 
J.  Frank  Friesen 
Chas.  E.  Futch 

C.  R.  Gailmard 
Peter  A.  Gallant 
W.  Morton  Gardner 
Donald  B.  Garstang 
Albert  C.  Germann 

O.  E.  Ghrist 
Dozier  H.  Gibbs 
Jacques  S.  Gilbert 
Mark  A.  Glasser 
Scott  D.  Gleeten 
Leon  D.  Godshall 
Jos.  Goldstein 
Oscar  Goodley 

A.  Gottlieb 
Ben  E.  Grant 
James  Green 

L.  H.  Greenbaum 
Sutton  H.  Groff 
Robert  E.  Grogan 
Lowrie  Grow 

Clemen  Hamer 
Clyde  E.  Harner 
Trustin  M.  Hart 

P.  F.  Haskell 

R.  F.  Hastreiter 
Ed.  W.  Hayes 
John  R.  Haynes 
Atlas  T.  Hembree 
Francis  C.  Hertzog 
O.  C.  Hester 
Daniel  L.  High 

M.  R.  Hill 

R.  M.  Hippaeh 
W.  W.  Holley 
John  H.  Hooval 
Arthur  D.  Houghton 


April,  1930 


state  medical  associations 


295 


John  A.  Jackson 
Robert  J.  James 
Joseph  J.  Jelineck 
Simon  Jesberg 
Russell  A.  Jewett 
Elmer  H.  Johnson 
Archie  A.  Jones 

D.  N.  Jones 
I.  H.  Jones 

I.  W.  Jones 
Louis  Josephs 
Herbert  Judson 

Julius  Kahn 
Benjamin  Katz 
Louis  A.  Kempff 
Raymond  W.  Kelso 
Norman  J.  Kilborne 
William  P.  Kroener 

J.  Mark  Lacey 
Wyant  La  Mont 
Eric  E.  Larson 
William  O.  Leach 
William  H.  Leake 
Lawrence  E.  Lepper 
Silas  A.  Lewis 

C.  A.  Lindquist 
Harry  C.  L.  Lindsay 
J.  L.  Linn 
Henry  H.  Lissner 
Fred  Loring 

Charles  Le  Roy  Lowman 
James  B.  Luckie 
Le  Val  Lund 

Granville  MacGowan 
Ernest  MacLeod 
William  P.  McCool 
John  L.  McDaniels 
Ralph  W.  McKebby 
A.  E.  Mack 
George  E.  Malsbary 
George  D.  Maner 
M.  Lee  Martin 

E.  Signe  Maxson 
E.  M.  Miller 
Harry  A.  Miller 
Miss  Verda  C.  Miller 
Hyman  Miller 

I/.  L.  Miner 
Oliver  M.  Moore 
Ross  Moore 
R.  J.  Morrison 
H.  J.  Movius 
H.  Wallace  Murray 

Arthur  N.  Nelson 

Robert  E.  O’Connor 
Thomas  J.  Orbison 
Frank  M.  Otto 
G.  R.  Owen 

P.  G.  H.  Pahl 
Wilbur  B.  Parker 
George  Parrish 
Harold  E.  Peterson 
Charles  E.  Phillips 
M.  L.  Pindell 
J.  E.  Pottinger 
Bonnie  L.  Pritchett 

Paul  A.  Quaintance 

R.  E.  Ramsay 
Howard  F.  Rand 
Rankin  S.  Reiff 
Louis  Reinard 
Sidney  M.  Reiser 
Oscar  Reiss 
Lewis  D.  Remington 


Francis  C.  Renfrew 
Louis  G.  Reynolds 
Fredrick  A.  Rhodes 
John  H.  Rindlaub 
Frank  O.  Ringnell 
F.  W.  Rinkenberger 
Clinton  Roath 
Aaron  Rosanoff 
Eric  A.  Royston 
E.  H.  Ruediger 

Ralph  William  Schaeffer 
George  F.  Schenck 
Phillip  E.  Schmidt 
Moses  Scholtz 
Arnold  Scholtz 
LeRoy  O.  Schultz 
Edwin  G.  Schultz 
Raymond  L.  Schultz 

D.  Z.  Schwartz 

A.  J.  Scott,  Jr. 

Paul  K.  Sellew 
Francis  B.  Settle 
Charles  L.  Sexton 
James  H.  Seymour 

B.  H.  Sherman 
Leroy  B.  Sherry 
Charles  Shickle 
O.  F.  Shipman 
Harlan  Shoemaker 
Leon  Shulman 
John  R.  Silverthorn 
J.  Morris  Slemons 
Orville  J.  Sloan 

E.  P.  Smart 
Mark  H.  Smith 
Myrtle  M.  Smith 
Grant  G.  Speer 
H.  Waldo  Spiers 
Karl  P.  Stadlinger 
Morris  Stark 
George  M.  Stevens 

C.  G.  Stivers 
Lionel  A.  B.  Street 
Charles  T.  Sturgeon 
C.  N.  Suttner 

Miss  M.  D.  Suttner 
C.  F.  Swanson 
Louise  D.  Sweet 
William  A.  Swim 

L.  E.  Thayer 
Roy  E.  Thomas 
George  Thomason 
C.  E.  Thompson 
Raymond  C.  Thompson 
Vernon  P.  Thompson 
Milton  Tobias 
Clarence  Toland 
J.  V.  Trainer 
Leslie  D.  Trott 
Florence  Turnquist 

J.  E.  Vallee 

Richard  H.  Van  Denburg 

Dean  Q.  Waddell 
Mary  E.  Walker 
Ruth  S.  Ward 
J.  W.  Warren 
Leigh  F.  Watson 
John  C.  Webster 
Alfred  Hi.  Weitkamp 
S.  H.  Welch 
Walter  F.  Wessels 
Henry  G.  Westphal 
Norman  H.  Williams 
William  W.  Worster 
Clifford  A.  Wright 
George  A.  Wright 

A.  H.  Zeiler 


Ella  R.  Carter  (Mrs.  Martin  G.  Carter), 

Secretary. 

ORANGE  COUNTY 

The  Orange  County  Auxiliary  held  its  third  meet- 
ing at  Mrs.  Cushman’s  home  on  March  4,  with  the 
state  and  county  secretaries  assisting  the  hostesses. 
Dr.  K.  H.  Sutherland,  head  of  the  County  Health  De- 
partment spoke  on  the  subject  of  “County  Health 
Administration.” 

A committee  on  entertainment  was  appointed  to 
arrange  a program  for  the  entertainment  of  the 
women  relatives  of  physicians  who  attend  the  South- 
ern California  medical  convention  to  be  held  in  Santa 
Ana  April  4 and  5. 

After  the  formal  program,  tea  and  coffee  were 
served  and  an  hour  of  sociability  was  enjoyed.  There 
were  twenty-eight  members  present. 


The  organization  meets  once  each  month,  and  it  is 
planned  to  hold  the  meetings  in  private  homes,  the 
members  feeling  that  in  this  way  a spirit  of  mutual 
friendliness  is  engendered.  The  next  meeting  will  be 
held  with  Mrs.  F.  H.  Patterson. 

Mrs.  Dexter  A.  Ball,  Secretary. 


SAN  BERNARDINO  COUNTY 


The  meeting  of  the  Woman’s  Auxiliary  of  the  San 
Bernardino  County  Medical  Society  was  called  by  the 
president. 

The  secretary  read  the  minutes  of  the  previous 
meeting. 

The  treasurer’s  report  was  read  and  accepted. 

Letters  from  Mrs.  Jean  F.  Rogers,  state  president, 
Mrs.  R.  A.  Cushman,  state  secretary,  and  from  the 
Committee  on  Associated  Societies  of  the  California 
Medical  Association  were  read  by  the  secretary. 

Mrs.  Emmons  suggested  that  notices  of  meetings 
be  sent  to  the  State  Association  with  the  notices  of 
the  county  medical  society  if  agreeable  to  the  county 
society  secretary. 

Motion  was  made  by  Mrs.  Walter  Pritchard  that 
the  delegates  to  the  state  meeting  remain  as  elected 
at  the  last  meeting. 

Dr.  Belle  Wood-Comstock  of  Los  Angeles  gave  an 
informal  talk  on  the  work  accomplished  by  organized 
medical  women  of  Los  Angeles.  Their  aim  is  to  edu- 
cate women  whose  lack  of  fundamental  knowledge  of 
anatomy  and  physiology  make  them  an  easy  subject 
for  quacks.  During  the  six  years  that  the  medical 
women  have  had  charge  of  the  public  health  section 
of  the  women’s  clubs  remarkable  progress  has  been 
made  in  health  education  of  woman,  prejudices  re- 
moved, and  interest  awakened  among  a very  large 
group. 

Dr.  Wood-Comstock  pointed  out  that  the  Woman’s 
Auxiliary  might  follow  a similar  line  of  work  in  con- 
nection with  the  various  women’s  clubs. 


We  were  then  entertained  by  three  delightful  and 
amusing  readings  by  Priscilla  Gage. 

The  meeting  adjourned.  After  a social  half-hour 
members  of  the  auxiliary  joined  the  doctors  at  the 
hospital  for  refreshments,  which  were  presided  over 
by  the  hostesses,  Mrs.  Richard,  Mrs.  Tisinger,  and 
Mrs.  Mulvane.  Ethel  E.  Curtiss, 

Secretary. 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY.  701  Medical  Arts  Building, 

Salt  Lake  City Associate  Editor  for  Utah 


COMPONENT  COUNTY  SOCIETIES 

CARBON  COUNTY 

One  of  the  outstanding  events  of  the  past  month  in 
medical  circles  was  the  meeting  and  banquet  of  the 
Carbon  County  Medical  Society  held  at  the  Rotesserie 
Inn,  Price,  February  25.  A general  invitation  to  the 
members  of  all  other  county  societies  was  extended 
by  mail,  and  was  responded  to  to  a large  extent. 

The  scientific  program  was  given  by  Doctors 
Howard  Fleming  and  George  Pierce,  both  of  San 
Francisco,  California. 

Doctor  Fleming’s  paper  was  on  the  “Treatment  of 
Head  Injuries,”  and  Doctor  Pierce’s  paper  was  on 
“Treatment  of  Hand  Injuries.”  Both  were  illustrated 
with  lantern  slides. 

The  banquet  was  a fitting  accompaniment  to  an 
excellent  program,  and  the  entire  occasion  was  en- 


296 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


joyed  by  all  those  present.  In  a sense,  it  was  a get- 
together  meeting  and,  therefore,  doubly  enjoyable. 
Salt  Lake  County  Society  came  down  in  a special  car 
and  returned  the  next  morning. 

* 

SALT  LAKE  COUNTY 

A report  of  the  committee  regarding  a communica- 
tion from  the  Salt  Lake  General  Hospital  asking  for 
the  sentiment  of  this  society  in  respect  to  professional 
cards  being  allowed  in  the  year  book  of  this  institu- 
tion was  made.  It  was  the  sense  of  the  committee 
that  names  of  the  doctors  who  would  contribute  to 
the  magazine  fund  be  printed  in  one  page  of  the  ad- 
vertising section  of  that  magazine.  J.  P.  Kerby 
moved  that  the  report  be  accepted.  Seconded  and 
carried. 

The  report  of  the  board  of  censors  on  the  applica- 
tion of  J.  M.  Schaffer  was  to  the  effect  that  the  appli- 
cant be  notified  to  apply  to  the  nearest  component 
society  of  the  Utah  State  Medical  Association. 

The  applications  of  Maurice  Gordon  and  J.  R. 
Wherritt  were  read  and  given  to  the  board  of  censors 
for  investigation. 

The  applications  of  Mildred  Nelson  and  Orin 
Ogilvie  were  favorably  reported  upon  by  the  board 
of  censors,  and  both  were  unanimously  elected  mem- 
bers of  the  society. 

F.  M.  McHugh  took  the  chair  and  announced  that 
on  February  24  there  would  be  a dinner  meeting  at 
the  Newhouse  Hotel  at  7 p.  m. 

The  meeting  was  adjourned  at  10  p.  m. 

* * * 

The  Salt  Lake  County  Medical  Society  held  a ban- 
quet at  the  Newhouse  Hotel  on  Monday,  February  24. 

The  meeting  was  called  to  order  at  7 p.  m.  Fifty- 
three  members  and  six  visitors  were  present. 

The  program  was  as  follows: 

The  Problems  and  Principles  of  Reconstructive 
Surgery — George  Pierce,  San  Francisco,  California. 

Peptic  Intracranial  Complications — Howard  Flem- 
ing, San  Francisco,  California. 

At  the  close  of  the  scientific  program,  President 
M.  M.  Nielson  announced  that  on  the  following  eve- 
ning Doctors  Pierce  and  Fleming  would  talk  before 
the  Carbon  County  Medical  Society  at  Price.  A spe- 
cial car  would  leave  the  Denver  and  Rio  Grande  sta- 
tion at  7:30  a.  m.  for  Price,  and  would  return  at  10:30 
the  following  morning.  Members  of  the  society  were 
urged  to  join  the  excursion  to  the  Carbon  County 
Medical  Society  meeting. 

The  meeting  adjourned  at  10  p.  m. 

Barnet  E.  Bonar,  Secretary. 

* 

UTAH  COUNTY 

On  February  12  the  Utah  County  Medical  Society 
held  a meeting.  George  A.  Cochran  of  Salt  Lake 
City  was  the  speaker.  The  subject  Doctor  Cochran 
spoke  on  was  “Diagnosis  of  Heart  Lesions  and  the 
value  of  the  Electrocardiogram  in  Same.” 

A series  of  electrocardiographs  of  the  normal  and 
pathological  hearts  was  shown  by  lantern,  and  ex- 
planations of  the  same  were  given  by  Doctor  Cochran. 

Mr.  Corsaw  of  the  Pioneer  Service  Company  took 
a short  time  to  sketch  the  history  and  methods  of 
attacks,  and  position  of  his  company  in  the  field  of 
collecting  accounts. 

The  second  meeting  of  the  County  Medical  Society 
was  held  February  26.  Dr.  L.  Oaks  was  the  speaker. 
He  spoke  on  the  subject,  “Review  of  Clinical  and 
Therapeutic  Features  of  the  Ear,  Nose,  and  Throat 
Practice  of  Interest  to  the  General  Practitioner.” 

A motion  was  passed  to  appoint  a committee  to 
investigate  proposed  legislation  in  Congress  to  fur- 
ther control  and  hamper  the  medicinal  use  of  nar- 
cotics, and  if  justified  by  the  findings  to  wire  the 
senators  on  the  question.  j L Aird>  Secretary. 


WEBER  COUNTY 

At  the  regular  county  society  meeting  held  the  eve- 
ning of  February  26,  Dr.  G.  W.  Pierce  of  San  Fran- 
cisco, California,  addressed  the  Weber  society  on  the 
subject  of  “Reconstructive  Surgery.”  The  lecture  was 
illustrated  with  lantern  slides,  and  was  greatly  en- 
joyed by  the  members  present. 

Dr.  Clark  Rich  writes  from  Vienna,  Austria,  that 
he  is  greatly  enjoying  his  postgraduate  work  in  that 
city. 

Dr.  M.  J.  Seidner  intends  to  sail  for  Europe  the 
forepart  of  April  for  a few  months  of  postgraduate 

"0r*v'  Conrad  H.  Jensen,  Secretary. 


UTAH  NEWS 

The  Holy  Cross  Hospital  Clinical  Society  held  its 
February  meeting  at  the  hospital  the  night  of  Feb- 
ruary 17.  The  following  papers  were  presented: 

Volkman’s  Contracture,  L.  N.  Ossman.  Osteo- 
myelitis of  the  Vertebra,  L.  F.  Hummer.  Report  of 
Meningitis,  Doctor  Walker.  Death  from  Tonsillec- 
tomy, F.  B.  Bailey. 

* * * 

The  recent  meetings  of  the  Academy  of  Medicine 
which  meets  each  Thursday  have  presented  the  fol- 
lowing programs  on  the  specified  dates: 

February  13 — Arteriovenous  Aneurysm,  Dr.  George 
Middleton.  Spastic  Colitis,  X-Ray  Diagnosis  and 
Treatment,  Dr.  R.  Tyndale.  Differential  Diagnosis 
of  Chest  Conditions,  Doctor  Jellison. 

February  20 — Review  of  Wilkie’s  Article  on  Ab- 
dominal Surgery,  Dr.  L.  A.  Stevenson.  Review  of 
American  College  of  Physicians  Meeting  in  Minne- 
apolis, Dr.  La  Barge. 

March  6 — Cardiac  Neurosis  and  Irritable  Heart, 
Doctor  Viko.  Spastic  Colitis,  Doctor  Sugden. 


Natural  Gas  Leakage  Easily  Detected  by  Odorizing 
with  Ethyl  Mercaptan. — The  detection  of  leakage  is 
a recognized  problem  in  the  safe  and  economic  distri- 
bution and  use  of  natural  gas.  That  type  of  fuel  gas 
is  practically  odorless  and  therefore  lacking  in  the 
property  of  indicating  significant  leakage  by  the  sense 
of  smell,  the  most  valuable  and  widely  used  means 
of  apprising  gas  employees  and  consumers  of  leaks 
of  the  more  odorous  types  of  fuel  gases.  Physically 
and  chemically  operated  detecting  devices  have  been 
developed  and  are  of  assistance  in  making  organized 
leak  surveys  and  in  investigating  suspected  leakage, 
but  none  of  these  meets  the  necessity  of  spontaneously 
indicating  the  location  of  leakage  at  the  time  of 
occurrence. 

The  United  States  Bureau  of  Mines,  at  its  Pitts- 
burgh Experiment  Station,  has  been  interested  in  the 
detection  of  leakage  of  fuel  gases  for  a number  of 
years,  and  particularly  the  leakage  of  types  of  gas 
that  do  not  possess  indicating  or  warning  properties 
as  odor  or  irritation.  In  view  of  this  interest  and  also 
the  recognized  value  of  the  odor  for  detecting  leakage 
of  the  more  odorous  types  of  gases,  the  bureau 
studied  the  possibilities  of  adding  small  amounts  of 
highly  odorous  substances  to  odorless  types  of  fuel 
gas,  as  blue  water  gas  and  natural  gas,  for  the  purpose 
of  imparting  an  odor  to  the  gas  that  would  be  readily 
perceptible  and  thereby  serve  as  a means  of  detection. 

The  results  of  the  previous  studies  indicated  that 
ethyl  mercaptan  was  a very  promising  odorizing  sub- 
stance for  natural  gas.  This  has  recently  been  sub- 
stantiated by  tests  made  in  distributing  systems  of 
the  Union  Gas  and  Electric  Company.  The  ethyl 
mercaptan  was  found  to  travel  through  the  lines  with 
the  gas  and,  due  to  its  powerful  odor,  was  not  only 
efficacious  in  giving  warning  of  leaks  in  consumers' 
house  piping,  but  made  apparent  underground  leaks 
in  distributing  and  service  lines.  In  some  cases  leaks 
in  the  distributing  systems  and  service  lines  were 
detected  by  persons  walking  or  riding  along  the 
street. — United  States  Department  of  Health. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  department  are 
grouped:  News;  Medical  Economics;  Correspondence;  Department  of  Public  Health;  California  Board  of  Medical 
Examiners;  and  Twenty-Five  Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 

. ..  - 

NEWS 


Doctor  Lokrantz  Receives  High  Decoration  From 
the  King  of  Sweden. — Dr.  Sven  Lokrantz,  medical 
director  of  Los  Angeles  city  schools,  has  received  a 
very  high  decoration  from  the  King  of  Sweden  on 
account  of  his  health  work  for  the  children  of  Cali- 
fornia and  in  a lesser  degree  for  the  children  of 
Sweden.  The  decoration  is  Knighthood  of  the  Royal 
Order  of  Vasa,  first  class,  which  has  been  given  out 
to  only  a very  few  men  in  this  country. 

Doctor  Lokrantz,  who  is  now  an  American,  came 
to  the  United  States  as  a young  man  at  the  age  of 
eighteen.  He  was  born  in  Stockholm,  Sweden.  Some 
time  ago  Doctor  Lokrantz  was  partly  instrumental 
in  sending  an  ambulatory  clinic  to  the  needy  children 
of  northern  Sweden.  This  clinic  is  now  going  from 
school  to  school  caring  for  the  pupils’  eyes,  ears,  nose, 
throat,  and  teeth.  Similar  clinics  were  invented  by 
Doctor  Lokrantz  for  Los  Angeles  children,  and  many 
thousands  of  children  have  been  aided  here. 

The  Los  Angeles  School  Health  Department  is 
rated  as  the  leading  department  of  its  kind  in  the 
United  States. 

Mr.  G.  W.  Olson,  superintendent  of  the  Cali- 
fornia Hospital,  had  been  officially  requested  by  the 
Swedish  Embassy  to  present  this  decoration  to  Doctor 
Lokrantz. — Bulletin  of  the  Los  Angeles  County  Medical 
Association,  March  6,  1930. 

Metabolic  Clinic  at  Carmel. — Dr.  R.  A.  Kocher, 
director  of  the  Grace  Deere  Velie  Metabolic  Clinic 
now  being  completed  in  Carniel,  states  that  he  hopes 
to  have  the  clinic  open  by  the  time  the  Annual  Meet- 
ing is  held  at  Del  Monte.  In  any  event  if  not  open, 
it  will  be  ready  for  the  members  to  visit  and  they  will 
be  shown  through  gladly. 


Lane  Medical  Lectures,  May  5-9,  1930. — Charles  R. 
Stockard.  M.  D.,  Ph.  D.,  Sc.  D.,  Professor  of  Anatomy 
at  Cornell  University  Medical  School,  New  York  City, 
will  deliver  the  Lane  Medical  Lectures  for  the  year 
1930  at  the  Stanford  University  Medical  School,  San 
Francisco,  California,  on  the  following  dates: 

May  5. — Medical  and  Biological  Aspects  of  Consti- 
tution. 

May  6. — Germinal  Constitution. 

May  7. — Developmental  Constitution. 

May  8. — The  Interplay  of  Inheritance  and  Environ- 
ment in  Constitution. 

May  9. — Postnatal  Reactions  and  Periodic  Changes 
in  Constitution. 

Doctor  Stockard  will  also  give  a lecture  at  Stanford 
University  on  Wednesday,  May  7,  at  4:15  p.  m.,  on 
“Structural  Types  in  Animals  and  Men.” 


Doctor  Rixford  Honored. — On  March  27.  cere- 
monies were  held  honoring  Dr.  Emmet  Rixford,  who 
became  emeritus  professor  of  surgery  in  Stanford 
University  Medical  School. 

Surgeons  of  the  colloquium  of  the  Stanford  School 
met  at  a luncheon  on  that  day,  when  the  new  title  was 
conferred. 

Doctor  Rixford  served  for  several  decades  on  the 
school  staff. 


San  Francisco  Pathological  Society. — The  regular 
meeting  of  the  San  Francisco  Pathological  Society 
was  held  on  Monday,  March  3,  in  the  auditorium  of 
St.  Mary’s  Hospital,  Hayes  and  Stanyan  streets,  at 
8 p.  m.  The  following  program  was  presented: 

Carcinoma  of  Gall  Bladder — E.  M.  Smith. 

Sarcoma  of  Male  Breast — W.  M.  Dillon  (by  invita- 
tion). 

Four  Cases  of  Primary  Lung  Carcinoma,  Chondro- 
sarcoma of  the  Heart — F.  Proescher. 

Chronic  Coccidioidal  Dermatitis — H.  E.  Miller. 

Chorionic  Epithelioma — D.  S.  Pulford. 

Multiple  Myeloma — W.  T.  Cummins. 

Members  who  have  not  paid  their  dues  for  1929 
(which  is  the  sum  of  one  dollar)  are  requested  to  for- 
ward them  to  the  secretary.  The  dues  for  1930  are 
now  payable. 


Meeting  of  Southern  California  Medical  Associa- 
tion.— The  eighty-second  semiannual  meeting  was 
held  in  the  Knights  of  Pythias  Hall  in  Santa  Ana  on 
Friday  and  Saturday,  April  4 and  5. 

In  addition  to  articles  by  well-known  southern 
Californians,  papers  were  presented  by  distinguished 
guests  from  other  sections. 

Dr.  Alfred  W.  Adson,  chief  of  the  department  of 
neurological  surgery  at  the  Mayo  Clinic,  spoke  on 
“Indications  for  Sympathectomy.” 

Dr.  William  Dock  of  San  Francisco  reported  the 
results  of  his  latest  studies  on  digitalis. 

Dr.  J.  Herman  Wylie,  chief  of  the  medical  depart- 
ment of  the  Taylor  Memorial  Hospital  at  Paotingfu, 
China,  spoke  on  “Western  Medicine  in  China.” 


California  District  of  the  American  Association  of 
Hospital  Social  Workers. — The  organization  of  the 
California  District  of  the  American  Association  of 
Hospital  Social  Workers  has  recently  been  completed 
and  the  following  officers  elected:  Evelyn  Phelps, 
chairman  (Pacific  Branch,  American  Red  Cross); 
Marguerite  Spiers,  vice-chairman  (Berkeley  Health 
Center);  Florence  Swan,  secretary  (Baby  Hospital, 
Oakland);  Mrs.  Beulah  Spunn,  treasurer  (Alameda 
County  Health  Center). 

The  California  district  consists  of  two  groups  which 
center  about  San  Francisco  and  the  bay  region  and 
Los  Angeles  County  and  San  Diego.  The  district 
officers  will  rotate  north  and  south  yearly.  Miss  Alice 
Kratka,  Pasadena  Dispensary,  is  chairman  of  the 
southern  group. 

The  preliminary  work  of  organizing  was  accom- 
plished through  the  efforts  of  the  California  Associa- 
tion of  Medical  Social  Workers  with  its  branches 
in  both  northern  and  southern  California  and  through 
a group  of  medical  social  workers  in  Alameda  County 
hospitals  and  health  centers  and  the  hospital  workers 
of  the  American  Red  Cross  at  Letterman  General 
Hospital,  San  Francisco,  and  United  States  Naval 
Hospital,  Mare  Island.  The  last  named  groups  had 
been  meeting  with  some  degree  of  regularity  for  a 
year  and  had  been  greatly  assisted  by  a medical 
advisory  committee  consisting  of  the  following  phy- 
sicians: Dr.  B.  W.  Black,  superintendent.  Highland 
Hospital,  Oakland,  California;  Dr.  William  Dock, 
Stanford  University  Hospital;  Dr.  Edward  Glaser, 
State  Health  Department;  Dr.  Frank  Kelly,  Berkeley 
Health  Center  and  University  of  California;  Dr.  Wil- 
liam P.  Lucas,  University  of  California  Hospital, 
Dr.  Ralph  Seem,  superintendent,  Stanford  University 

297 


298 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


Hospital;  Dr.  William  Shepard,  Welfare  Department, 
Western  Division,  Metropolitan  Life  Insurance  Com- 
pany. 

It  is  the  aim  of  the  California  district  to  help  pro- 
mote higher  standards  of  social  case  work  with 
patients,  to  encourage  training  facilities,  and  through 
contact  with  other  districts  in  the  United  States  to 
keep  in  touch  with  recent  developments  in  technique. 

The  first  hospitals  in  this  country  to  recognize  the 
need  of  hospital  social  service  were  Johns  Hopkins 
Hospital  and  the  Massachusetts  General  Hospital,  the 
latter  of  which  will  this  year  celebrate  the  twenty-fifth 
anniversary  of  its  establishment.  In  1920  the  Ameri- 
can Association  of  Hospital  Social  Workers  first  came 
into  existence.  It  has  twelve  districts  and  maintains 
both  an  executive  and  an  educational  secretary.  Dur- 
ing the  past  few  years  much  work  has  been  done  in 
planning  courses  of  training  for  medical  social  work- 
ers in  connection  with  universities  and  affiliated  hos- 
pitals, the  most  recent  of  which  are  the  University 
of  Chicago,  Tulane  University  in  New  Orleans  and 
Western  Reserve  in  Cleveland.  Two  general  meet- 
ings are  held  annually,  one  with  the  National  Confer- 
ence of  Social  Work  and  the  other  with  the  American 
Hospital  Association.  The  California  District  will 
meet  on  May  16  at  Santa  Barbara  as  a kindred  group 
of  the  California  Conference  on  Social  Work. 


CORRESPONDENCE 


Subject  of  Following  Letter:  A Woman’s  Medical 
College  in  China,  and  Its  Needs 

The  Hackett  Medical  College  for  Women  (the  only 
one  in  China),  located  in  Canton,  a city  of  a million 
and  a half,  was  established  thirty  years  ago  by  Dr. 
Mary  Fulton.  Since  then  it  has  graduated  162  phy- 
sicians, many  of  whom  have  become  brilliant  sur- 
geons. The  college  and  hospital  (120  beds)  have  been 
provided,  as  need  arose,  by  philanthropic  Americans. 
Between  2000  and  2500  patients  are  annually  cared 
for  in  the  hospital.  Over  10,000  are  treated  annually 
in  the  dispensary  and  between  20,000  and  25,000  out- 
patients are  visited  each  year.  In  the  Nurses’  Train- 
ing School  the  course  is  three  and  one-half  years. 
The  medical  college  requires  seven  years.  Two 
preparatory  years  are  devoted  to  botany,  zoology, 
biology,  physics,  mathematics,  and  history  of  the 
medical  sciences.  Then  four  years  of  regular  college 
work  and,  finally,  an  intern  year.  Both  college  and 
hospital  are  self-supporting,  and  yet  fully  one-half 
the  patients  treated  are  given  free  service,  because  of 
their  poverty. 

The  unrest  in  China  during  recent  years  has  in- 
creased the  demand  for  service  and,  at  the  same  time, 
has  reduced  the  income  of  the  college.  The  organiza- 
tion has  been  unable  to  purchase  many  of  the  really 
essential  items  of  equipment.  For  instance,  an  x-ray 
machine  is  very  much  needed.  Doctors  Leung  Ngai 
Man  and  Miriam  Bell  (the  former,  professor  of  gyne- 
cology, the  latter,  of  pediatrics)  are  doing  special 
work  in  this  country. 

They  wish  to  appeal  to  physicians  to  contribute 
equipment  which,  for  one  or  another  reason,  they  are 
no  longer  using;  and  which  is  in  good  mechanical 
condition  and  worth  the  cost  of  transportation  to 
China.  Among  equipment  most  needed  might  be 
mentioned:  An  x-ray  machine;  a fluoroscopic  screen 
for  same.  Electric  otoscopes.  Electric  refrigerator 
for  preserving  biologicals  in  the  tropics.  Electric 
operating  lamp,  shadowless.  Sphygmograph  and/or 
polygraph.  Sphygmomanometers,  and  many  other 
pieces.  If  any  reader  is  willing  to  assist  so  notable 
a work,  please  correspond  with  Dr.  Miriam  Bell,  1264 
N.  Twenty-third  Street,  Philadelphia,  Pennsylvania, 
or  with  Dr.  John  C.  King,  990  Atchison  Street,  Pasa- 
dena, California.  T 

John  C.  King. 

(Editor’s  Note:  Dr.  John  C.  King  was  president  of  the 
California  Medical  Association  in  1910.) 


CLIPPINGS  FROM  THE  LAY 
PRESS 


__  The  following  clippings  deal  with  the  Los  Angeles 
County  General  Hospital.*  The  first  clipping  is  an 
excerpt  from  an  article  entitled  “Supervisors  Settle 
Row  Over  Hospital,”  printed  in  the  Los  Angeles 
Examiner  of  March  4,  1930: 

“Friction  between  members  of  the  Board  of  Super- 
visors over  the  cost  of  the  new  acute  unit  of  the  General 
Hospital,  now  under  construction,  came  to  a head  yes- 
terday. . . . 

“.  . . Upon  the  suggestion  of  Supervisor  Frank  L. 
Shaw,  seconded  by  Fred  T.  Beatty,  the  supervisors  unani- 
mously agreed  to  continue  the  employment  of  the  Allied 
Architects  with  the  proviso  that  Supervisor  Graves  and 
County  Architect  Karl  Muck  attend  all  the  deliberations 
of  the  architects  &nd  join  in  their  discussions. 

“It  was  also  voted  that  the  Allied  Architects,  who  drew 
the  original  plan,  should  not  ‘plan  a hospital  for  indigent 
poor  that  would  be  better  and  more  perfectly  appointed 
than  the  Biltmore  or  the  Ambassador  hotels.  . . .’ 

“.  . . Supervisor  Beatty  stated  that  the  board  has  in- 
vested $792,967  in  the  Allied  Architects  and  that  they 
should  be  permitted  to  finish  the  work  they  began.  He 
proposed,  however,  that  Supervisor  Graves  and  the 
county  architect  should  have  a voice  and  vote  in  all  the 
deliberations  of  the  Allied  Architects.  The  supervisors 
also  went  on  record  to  have  the  architects  file  with  the 
board  all  changes  and  estimates  of  cost.” 

* * * 

The  following  is  an  excerpt  from  an  editorial  (com- 
pare it  with  the  last  paragraph  in  the  previous  item) 
entitled  “General  Hospital  Costs,”  printed  in  the  Los 
Angeles  Times  of  March  2,  1930: 

",  . . The  incident  has  served  one  good  purpose  in 
bringing  to  public  attention  the  desirability  of  such 
expert  and  disinterested  services  as  are  being  given  the 
General  Hospital  project  by  the  board  of  architects.  . . . 
The  county  is  exceedingly  fortunate  to  have  these  men 
on  the  General  Hospital  job  and  the  Supervisors  should 
keep  them  there  till  the  last  brushful  of  paint  is  applied 
to  the  completed  structure.” 

* * * 

The  following  is  an  excerpt  from  an  article  entitled 
“Board  Battles  Over  Hospital,”  printed  in  the  Los 
Angeles  Times  of  March  4,  1930: 

“.  . . The  hospital  situation  first  came  to  public  atten- 
tion two  weeks  ago  when  Supervisor  Graves,  chairman  of 
the  Building  Committee,  pointed  out  that  under  the 
then-existing  specifications  the  estimate  for  the  com- 
pleted building  had  risen  from  an  original  $11,000,000  to 
$16,000,000.  . . . 

“.  . . 'We  have  already  paid  the  architects  more  than 
$600,000,’  said  Supervisor  Shaw,  who  added  that  if  the 
unit  were  built  according  to  present  specifications,  it 
would  be  ‘the  finest  hospital  in  the  United  States.’  He 
pointed  out,  however,  that  economy  is  more  to  be  desired 
than  the  ‘finest  hospital  in  the  United  States,’  and  de- 


* See  also  editorial  on  Construction  Costs  of  Los  An- 
geles County  General  Hospital  in  this  issue  of  the  Cali- 
fornia and  Western  Medicine. 


The  new  unit  of  the  Los  Angeles  County  General 
Hospital.  The  photograph  from  which  this  cut  was  made 
was  taken  on  December  26,  1929. 


April,  1930 


MISCELLANY 


299 


dared  that  the  ultimate  cost  cannot  be  brought  within 
the  original  estimate  except  by  entirely  rewriting  the 
specifications  for  all  the  work  remaining  to  be  done.  . . . 

. . Supervisor  Graves  who,  as  chairman  of  the  build- 
ing committee,  is  the  Supervisors’  official  representative 
in  the  construction  of  the  hospital  unit,  replied  that  he 
had  'lost  faith  in  the  Allied  Architects.' 

“ 'Six  months  ago  they  started  rewriting  specifications,’ 
Graves  continued.  'I  objected  and  since  then  I have  not 
been  invited  to  their  meetings,  nor  have  I been  advised 
when  they  were  meeting.'.  . . . 

* * * 

The  following  excerpt  is  from  an  article  entitled 
“Hospital  May  Cost  Extra  Millions”  from  the  Los 
Angeles  Record  of  February  20,  1930: 

“.  . . Here  are  some  of  the  'extravagant  refinements’ 
which  Supervisors  Graves  and  Shaw  say  must  go: 

"More  than  5000  metal  doors,  to  cost  more  than  $700,000. 
Birch  doors  will  do  quite  as  well,  it  is  claimed,  and  will 
cost  $35,  instead  of  more  than  $100  apiece. 

“ 'Stainless  steel’  for  the  bottom  rail  of  the  door 
frames,  the  last  word  in  exquisite  equipment. 

“One  million  three  hundred  thousand  dollars  worth  of 
‘albarene,’  an  acid-resisting  soapstone  which  it  is  pro- 
posed to  use  not  only  in  the  laboratories,  but  on  the  roofs 
and  stair  treads  and,  in  a few  instances,  in  the  ceiling 
This  item  could  be  cut  to  at  least  $200,000,  the  two 
belligerent  supervisors  now  think. 

“Fancy  metal  work,  marble  and  tile.  . . . 

“.  . . Supervisor  Graves  has  charge  of  the  county’s 
building  operations.  Supervisor  Shaw,  who  has  charge  of 
operating  the  hospital,  says  he  wants  to  cut  the  cost  of 
building  so  that  he  can  keep  the  ‘overhead’  of  operating 
down. 

“ 'I  can  do  a lot  of  things  for  the  poor  of  Los  Angeles 
County,’  he  said,  ‘with  the  interest  on  $6,000,000. 

“ ‘With  the  lower  cost  we  can  give  the  patients  the 
same  comforts  and  the  same  service  that  we  can  with 
the  higher.’ 

"The  new  hospital,  with  its  2400  beds,  will  be  completed 
and  ready  for  use  December  31,  1932,  according  to  present 
plans.  It  is  being  paid  for  out  of  tax  levies. 

“Down  to  date  the  architects  have  received  in  fees  on 
the  big  building  $631,219.19,  6%  per  cent  of  the  cost.  Five 
per  cent  of  the  cost  is  paid  for  plans  and  specifications 
and  1%  per  cent  for  supervision. 

"And  the  county  pays  for  the  blueprinting  and  the 
printing  of  the  specifications." 


Anent  the  cancer  discussion  which  in  the  last  few 
weeks  has  been  given  so  much  publicity  in  the  lay 
press,  an  Associated  Press  dispatch  in  the  Los  An- 
geles Times  of  March  21  states  as  follows: 

"Plans  for  leading  American  cancer  experts  to  investi- 
gate the  new  cancer  extract  at  San  Francisco  were 
announced  tonight  to  the  Academy  of  Medicine  of  North- 
ern New  Jersey. 

“To  inform  the  public  quickly  is  the  purpose  Dr 
Joseph  Colt  Bloodgood  of  Johns  Hopkins  University  told 
the  physicians.  At  the  same  time  he  appealed  for  ‘some 
authoritative  body  of  cancer  students  and  scientists  to 
deal  with  eancern  cures  announced  by  the  daily  press  so 
frequently  and  in  such  an  optimistic  way  that  it  reaches 
thousands  of  people  dying  of  cancer  and  raises  false 
hopes  of  a cure.’ 

Discoverers  Invite 

"The  invitation  to  investigate,  he  said,  came  from 
Doctors  Coffey  and  Humber,  discoverers  of  the  San 
Francisco  serum. 

" 'William  W.  Buffum,  general  manager  of  the  Chemical 
Foundation,  has  already  offered  financial  aid  for  such  a 
commission,’  Doctor  Bloodgood  said.  It  is  hoped  that 
other  foundations  interested  in  cancer  and  cancer  re- 
search institutions  will  offer  sufficient  funds  to  allow 
representatives  to  go  to  California  and  make  this  in- 
vestigation. 

Publicity  Deplored 

“ ‘To  one  who  has  given  education  of  the  public  con- 
tinuous study  for  almost  twenty  years,  this  recent  pub- 
licity of  a cancer  cure  that  is  as  yet  not  a cure,  raises 
the  hope  that  ultimately  we  may  obtain  the  same  results 
through  the  press  with  correct  information,  and  that  we 
may  influence  the  readers  who  have  not  the  disease  but 
need  the  protection  of  correct  information,  just  as  pro- 
foundly as  we  can  influence  those  dying  of  the  disease. 

" ‘Publicity  through  the  press  and  radio  with  correct 
information  has  as  yet  never  been  tested  to  the  limit. 
That  is  the  next  thing  to  do  in  this  country.’  ” 


The  following  clipping  reports  the  appointment  of 
a committee  of  medical  men  by  Doctor  Bloodgood  of 
Johns  Hopkins  University  to  investigate  the  Coffey- 
Humber  suprarenal  extract.  The  committee  was  ap- 
pointed at  the  request  of  Doctors  Coffey  and  Humber. 


The  clipping  is  an  Associated  Press  dispatch  taken 
from  the  Los  Angeles  Times  of  March  22,  and  is  as 
follows : 

“Several  distinguished  American  medical  men  were 
named  today  on  a commission  to  go  quickly  to  San  Fran- 
cisco to  investigate  the  Coffey-Humber  cancer  experi- 
ment. 

"Included  are:  United  States  Surgeon-General  Cum- 
mings, Dr.  Charles  Mayo,  Dr.  Morris  Fishbein,  editor  of 
the  Journal  of  the  American  Medical  Association;  Dr. 
Francis  Carter  Wood  of  Columbia  University;  Dr.  Clar- 
ence Cook  Little,  Dr.  James  Ewing  of  Cornell,  Dr.  Gideon 
W ells  of  the  University  of  Chicago,  and  Dr.  Joseph  Colt 
Bloodgood  of  Johns  Hopkins.  The  commission  has  a num- 
ber of  leading-  cancer  experts. 

"The  invitation  was  telegraphed  from  a train  at 
Liberal,  Kansas,  by  Doctors  Coffey  and  Humber,  who  are 
returning  to  San  Francisco  after  testifying  before  a 
Senate  committee  about  their  cancer  treatment. 

Expenses  To  Be  Paid 

"The  urge  for  speed  was  issued  by  Doctor  Bloodgood 
who  said  that  yesterday  alone  he  was  personally  asked  by 
sixty  cancer  sufferers  whether  they  should  go  to  San 
h lanciseo  and  ask  the  westerners  to  experiment  upon 
them.  These  requests  came  to  Bloodgood  from  as  far 
as  Guatemala. 

"The  telegram  named  Doctor  Bloodgood  to  select  the 
members  of  the  commission.  It  was  addressed  to  General 
Manager  William  W.  Buffum  of  the  Chemical  Foundation, 
to  whom  Doctor  Bloodgood  assigned  charge  of  arrange- 
ments. The  foundation  has  offered  to  pay  expenses 
Doctor  Buffum  said  those  invited  will  be  consulted  about 
setting  the  earliest  possible  date. 

In  a statement  Doctor  Bloodgood  said: 

Bloodgood  Statement 

An  extract  from  the  adrenal  gland  is  being  experi- 
mentally employed  by  Doctors  Coffey  and  Humber  in  me 
treatment  of  hopeless  cancer.  The  adrenal  gland  lies 
above  the  kidney  and  is  one  of  the  glands  of  internal 
secretion. 

The  claim  that  it  relieves  pain  is  no  evidence  of  the 
curative  value,  because  many  other  sera,  extracts  and 
other  forms  of  treatment  have  temporarily  relieved  pain 
but  never  accomplished  a cure. 

The  claim  that  this  adrenal  extract  produces  central 
necrosis  (bieaking  down  of  cells)  in  the  cancer  is  also 
not  an  evidence  of  its  curative  value;  because  this 
necrosis  takes  place  spontaneously  in  all  cancer  and  has 
been  observed  to  take  place  after  many  forms  of  treat- 
ment. 

“ ‘At  the  present  time  cancer  students  throughout  the 
world  agree  that  there  are  but  two  forms  of  treatment 
that  have  ever  accomplished  permanent  cures;  complete 
removal  of  the  cancer  tumor  by  operation,  or  irradiation 
by  x-ray  and  radium,  with  or  without  operation. 


The  good  and  bad  effects  of  alcohol  were  formerly 
subjects  of  intense  discussion  by  members  of  the 
medical  profession.  The  opposite  sides  in  the  argu- 
ments usually  held  to  their  same  viewpoints  at  the 
end  of  their  discussions.  Now,  in  connection  with  the 
Eighteenth  Amendment,  we  are  getting  an  indirect 
lay  opinion  concerning  alcohol  through  the  straw 
votes  of  the  Literary  Digest.  The  Los  Angeles  Evening 
Herald  of  March  20,  printed  the  following  figures: 


votes  i or  repeal  of  prohibition  continue  to  lead  in 
Literai-y  Digest's  " — 


State — 

California  

Connecticut 
District  of  Columbia 

Georgia  

Illinois  

Indiana  

Iowa  

Kansas  

Michigan  

Minnesota  

Missouri  ... 

Nebraska  

New  Jersey  

New  York  

North  Dakota  .. 

Ohio  

Oregon  

Pennsylvania  .... 
South  Dakota 

Washington  

Wisconsin  


nation-wide  poll. 

Figures 

for  the 

straw  vole 

; are  as 

follows: 

For 

For 

For 

Enforcement 

Modification  Repeal 

Total 

..  16,709 

19,377 

20,847 

56,933 

. 1,196 

2,495 

4,507 

8,198 

a 1,022 

1,326 

2,227 

4,575 

..  2,529 

2,054 

2,024 

6,607 

..  19,502 

26,225 

37,657 

83,384 

..  12,355 

8.S42 

8,271 

29.46S 

..  12,960 

9,181 

8,362 

30,503 

. 11,968 

4,721 

3,343 

20,032 

..  8,047 

7,792 

9,314 

25,153 

11,625 

11,518 

13,858 

37,001 

..  13,101 

11,648 

18,211 

42,960 

..  5,051 

3,291 

2,683 

11,025 

..  6,745 

12,968 

19,543 

39,256 

..  24,296 

54,917 

84,128 

163,341 

..  1,160 

1,085 

1,179 

3,424 

..  22,387 

23,424 

23,231 

69,042 

..  3,555 

2,779 

1,996 

8,330 

1,906 

3,064 

5,750 

10,720 

. 1,370 

1,118 

916 

3,404 

..  6,103 

5,975 

5,094 

17,172 

..  8,322 

10,341 

14,744 

33,407 

191,909 

224,141 

287,885 

703,935 

300 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vo!.  XXXII,  No.  4 


TWENTY-FIVE  YEARS  AGO* 


EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  4,  April  1905 

From  some  editorial  notes : 

. . . Thank  God! — With  the  deepest  and  most  pro- 
found reverence,  one  may  well  say,  Thank  God!  The 
legislature  has  adjourned  sine  die!  Fortunately  no 
harm  has  been  done  so  far  as  the  relations  of  the  phy- 
sician to  the  public  are  concerned,  and  the  standards 
required  for  eligibility  to  practice  medicine  within  the 
state  remain  unchanged.  The  more  than  dangerous 
antivaccination  bill,  which  was  passed  by  both  houses, 
was  vetoed  by  the  Governor,  of  course.  Assembly 
Bill  No.  267,  which  amended  the  present  medical  law 
practically  out  of  existence.  . . . 

. . . Assembly  Bill  No.  1164,  which  amended  the 
same  law  in  the  section  defining  the  practice  of  medi- 
cine in  such  a way  as  to  permit  any  pharmacist  to 
practice  medicine  or  surgery,  was,  on  the  same  day, 
refused  passage  by  a vote  of  13  to  34.  The  two  bills 
representing  the  very  acme  of  superlative  legislative 
asininity,  the  bills  creating  a board  of  examiners  of 
“naturopathy”  (?),  died  on  the  file.  . . . 

. . . For  all  of  these  things  let  us  be  thankful,  and 
for  that  we  do  not  have  to  be  watchful  for  another 
two  years,  let  us  unite  in  saying,  Thank  God!  The 
legislature  has  adjourned!  But  what  an  ironical  com- 
mentary on  the  venality  of  the  men  we  elect  to  frame 
our  laws! 

. . . The  Panama  Canal  Commission. — Dr.  C.  A.  L. 
Reed  of  Cincinnati  has  recently  returned  from  his 
trip  of  inspection  to  the  “Canal  Zone”  and  has  sub- 
mitted his  report,  which  appears  in  full  in  The  Jour- 
nal of  the  American  Medical  Association , March  11, 
1905.  . . . 

...  It  was  not  so  much  the  Chagres  River  that 
defeated  the  French  company  in  its  efforts,  as  it  was 
the  little  mosquito,  carrying  yellow  fever  and  estivo- 
autumnal  malaria  from  victim  to  victim.  In  Cuba, 
Colonel  Gorgas  has  shown  what  he  can  do  to  put  to 
rout  these  pests  if  he  is  given  a free  hand.  To  trammel 
and  tie  down  such  a man  when  the  issue  is  one  of 
thousands  of  lives  and  millions  on  millions  of  dol- 
lars— not  to  speak  of  the  reputation  of  a country  and 
its  president.  . . . 

. . . By  all  means,  Mr.  Roosevelt,  do  away  with 
your  foolish  “commission,”  and  let  the  men  who  have 
the  brains  and  the  ability  dig  the  ditch.  . . . 

. . . Have  IV e IV on  the  Fight? — The  journal  takes 
considerable  pleasure  in  publishing,  on  page  103,  the 
full  statement  of  a newly  organized  “Council  on 
Pharmacy  and  Chemistry”  of  the  American  Medical 
Association.  . . . 

. . . Of  course  the  very  idea  that  the  criticisms  pub- 
lished in  your  journal  may  have  had  anything  to  do 
with  this  latest  action  of  the  trustees  of  the  American 
Medical  Association  is  not  to  be  found  in  the  edi- 
torial; that  would  be  a degree  of  broadmindedness 
hardly  to  be  expected,  under  the  circumstances;  the 
child  seldom  kisses  the  hand  that  spanks  it.  . . . 

...  In  a letter  from  a friend  in  New  York,  very 
recently  received,  appeared  the  following  sentences, 
which  we  beg  permission  to  quote:  “I  do  not  know 
how  far  you  are  acquainted  with  what  is  going  on 
below  the  surface  in  the  American  Medical  Associa- 
tion. I am  myself  not  in  a position  to  get  very  much 
information,  but  I know  enough  to  be  able  to  tell 
you  positively  that  you  are  not  going  to  win  in  your 
fight  for  the  purification  of  the  advertising  pages  of 
The  Journal  of  the  American  Medical  A ssociation — for 
the  good  and  sufficient  reason  that  you  have  won  it 
already!  . . . 


* This  column  aims  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


From  an  article  on  “Report  on  an  Epidemic  of  Diph- 
theria’’ by  Ray  Lyman  Wilbur , M.  D.,  Stanford  Uni- 
versity: 

It  is  my  aim  to  present  to  you  in  this  paper  a brief 
report  on  forty-three  cases  of  diphtheria  that  recently 
came  under  my  observation,  and  also  to  outline  the 
methods  used  to  prevent  the  spread  of  the  disease, 
particularly  by  the  prophylactic  injection  of  antitoxin. 


From  an  article  on  “Postoperative  Ventral  Hernia — 
Its  Causes  and  Prevention”  by  C.  George  Bull,  M.D., 
A lame  da: 

That  hernia  of  the  abdominal  wall  may  follow  celi- 
otomy is  too  well  known  to  require  more  than  a bare 
statement.  Its  frequency  varying  from  one  per  cent 
in  clean  cases  to  between  20  and  25  per  cent  in  septic 
cases  is  very  suggestive.  Let  us  first,  however,  ex- 
amine into  its  more  frequent  causes  and  we  shall  then 
be  in  a better  position  to  determine  how  to  pre- 
vent it.  . . . 


From  medical  society  reports: 

Alameda  County. — The  program  arranged  for  the 
evening  consisted  of  a symposium  on  infant  feeding, 
as  follows:  “Breast  Feeding,”  Dr.  Dudley  Smith; 
“Home  Modification  of  Cow’s  Milk,”  Dr.  Charles 
A.  Dukes;  “Proprietary  Foods,”  Dr.  Hubert  N. 
Rowell.  . . . 

San  Francisco  County.— The  regular  meeting  for  the 
month  of  March  was  held  in  the  parlors  of  the  Y.  M. 
C.  A.  on  the  14th,  the  meeting  being  called  to  order 
by  the  president,  Dr.  Emmet  Rixford.  Dr.  Herbert  C. 
Moffitt  read  a paper  on  “Clinical  Observations  in 
Nerve  Syphilis,”  which  was  discussed  by  Doctors 
Montgomery,  Power,  and  others.  Dr.  William  Fitch 
Cheney  read  a paper  on  “Tubercular  Meningitis  with 
Report  of  Three  Cases,”  which  was  generally  dis- 
cussed. . . . 

San  Joaquin  Valley  Aledical  Society. — . . . Dr.  Mc- 
Clelland of  Los  Banos  sent  a splendid  paper  the  sub- 
ject of  which  was:  “Old-Fashioned  Remedies,”  in 
which  he  urged  the  profession  to  be  better  students 
of  the  materia  rnedica,  and  to  formulate  their  own 
prescriptions  rather  than  to  use  so  many  ready-made 
and  proprietary  mixtures,  said  to  contain  this  or  that 
and  to  cure  a number  of  different  diseases.  It  was 
greatly  enjoyed  by  all  and  freely  discussed.  . . . 


From  an  article  on  “Alcoholics",  by  Charles  Anderson, 
M.  D.,  Santa  Barbara: 

The  discussion  of  the  use  of  alcohol  in  medicine 
is  so  complicated  by  the  contention  of  the  warring 
elements,  vested  interests  on  one  side  and  the  religio- 
politico-ethical  opinions  on  the  other,  that  it  is  almost 
a dangerous  proceeding  to  attack  the  question;  for 
one  side  or  the  other  is  almost  sure  to  raise  the  cry 
of  interest,  or  the  charge  that  the  party  has  been  in- 
fluenced by  unworthy  motives.  Unfortunately  the 
same  state  of  affairs  seems  to  have  arisen  within  the 
medical  profession  as  exists  without,  if  the  discussions 
in  some  of  the  journals  are  to  be  taken  as  an  index. 
The  organization  of  medical  temperance  societies 
shows  that  at  least  one  side  has  taken  a decided  stand 
on  a subject  that,  scientifically,  is  still  sub  judice. 

What  we  want  in  the  consideration  of  this  subject 
are  facts,  scientifically  determined  facts,  not  argu- 
ments. The  latter,  most  unfortunately,  are  what  we 
have  most  of  on  both  sides  of  the  question.  . . . 


From  an  article  on  “Uncinariasis,  <with  Report  of  Seven 
Cases”  by  Herbert  Gunn,  M.D.,  San  Francisco: 

Uncinariasis  or  ankylostomiasis,  known  as  hook- 
worm disease,  Egyptian  chlorosis,  brickburners’  an- 
emia, miners’  anemia,  tunnel  disease,  etc.,  until  re- 
cently believed  to  be  endemic  only  in  tropical  coun- 
tries, is  now  known  to  be  widely  distributed  through- 
out Germany,  France,  northern  Italy,  southern  United 
States,  South  America,  etc.  . . . 


April,  1930 


MISCELLANY 


301 


DEPARTMENT  OF  PUBLIC 
HEALTH 


By  W.  M.  Dickie,  Director 

Rabies  Becomes  More  Extensive. — The  control  of 
rabies  in  California  becomes  an  increasingly  greater 
problem  each  year.  Totals  of  nearly  800  cases  in  ani- 
mals have  occurred  in  each  of  the  past  two  years, 
and  up  to  February  8 of  the  present  year  a total  of 
ninety-four  cases  of  rabies  in  animals  has  been 
reported  within  the  state.  The  numbers  of  cases  of 
this  disease  reported  in  California  by  years,  since  1920 
are  as  follows: 

1920 176 

1921.  124 

1922  559 

1923  1092 

1924  502 

1925  353 

1926  375 

1927  376 

192S 791 

1929  786 

1930  to  February  8 94 

This  makes  a total  of  5228  cases  reported  in  Califor- 
nia during  the  past  ten  years.  More  than  75  per  cent 
of  these  cases  have  been  reported  in  the  southern  part 
of  the  state,  but  during  the  past  few  years  the  disease 
has  been  increasingly  prevalent  in  northern  counties. 
So  far  this  year,  cases  have  been  reported  in  Fresno, 
Kern,  Kings,  Los  Angeles,  Napa,  Riverside,  Sacra- 
mento, San  Diego,  San  Joaquin,  Stanislaus,  Tulare 
and  Yuba  counties.  In  some  counties,  where  a few 
years  ago  intensive  action  was  taken  in  the  control 
of  stray  dogs,  rabies  had  been  almost  eliminated. 

The  numbers  of  human  deaths  from  rabies  occur- 
ring in  California  since  1920  are  as  follows: 


1920  4 

1921  5 

1922  4 

1923.. 11 

1924  5 

1925  1 

1926  5 

1927  1 

1928  3 

1929  2 


It  is  unfortunate  that  these  human  deaths  have 
occurred,  for  they  might,  all  of  them,  have  been  pre- 
vented if  the  disease  in  animals  had  been  placed  under 
control.  The  remedy  lies  in  the  control  of  the  dog 
population,  chiefly  in  the  control  of  stray  dogs.  Rabies 
seldom  occurs  in  dogs  that  are  properly  housed  and 
cared  for,  unless  they  come  in  contact  with  stray 
animals  which  are  infected  with  the  disease. 

While  nearly  all  cases  of  rabies  occur  in  dogs, 
cases  have  been  found  in  California  during  the  past 
ten  years  in  cats,  cows,  horses,  coyotes,  goats,  hogs, 
sheep,  skunks,  mules  and  foxes. 

Persons  who  have  been  bitten  by  rabid  animals  are 
in  great  danger  of  contracting  the  disease.  Bites  upon 
the  face  near  the  large  nerve  centers  are  particularly 
dangerous.  Wounds  from  dog  bites  should  be  cau- 
terized, only,  with  concentrated  (fuming)  nitric  acid. 
No  other  known  agent  is  of  any  value  whatsoever  in 
cauterizing  such  wounds.  The  Pasteur  treatment  is 
preventive  only,  and  in  order  to  be  effective  its  admin- 
istration must  be  started  early.  Human  beings  who 
develop  any  symptoms  of  rabies  do  not  recover. 
There  is  no  record  of  anyone  who  ever  contracted 
the  disease  having  escaped  with  his  life. 

The  first  symptom  of  rabies  in  dogs  is  a change  in 
disposition.  Dogs  which  are  normally  good-natured 
become  savage,  and  dogs  which  are  normally  savage 
generally  become  strangely  docile.  There  is  a change 
in  the  tone  of  the  animal’s  voice.  There  follows  a 
paralysis  of  the  muscles  of  the  throat  which  causes 
the  animal  to  attempt  to  use  the  paralyzed  muscles. 
This  produces  the  tendency  to  bite,  and  it  is  during 
this  stage  that  the  disease  is  most  readily  transmitted. 
In  the  final  stage  of  rabies,  there  is  a complete  paraly- 


sis of  the  hind  legs,  the  animal  being  unable  to  run 
without  falling. 

It  is  not  always  necessary  that  an  individual  must 
be  bitten  by  a rabid  dog  in  order  to  contract  rabies. 
Many  individuals  have  contracted  the  disease  through 
handling  sick  animals,  the  infective  agent  gaining 
entrance  through  cuts  or  wounds  in  the  skin.  Because 
rabies  is  100  per  cent  fatal  in  human  beings,  and 
because  it  produces  one  of  the  most  agonizing  dis- 
eases that  is  known,  its  control  is  of  the  utmost  im- 
portance. As  an  economic  measure  in  the  prevention 
of  losses  to  stock  growers  its  control  is  also  highly 
important.  

Investigations  of  Public  Health  Problems. — While 
the  disease  known  as  Rocky  Mountain  spotted  fever 
is  no  longer  the  deadly  menace  that  it  used  to  be, 
thanks  to  the  protective  vaccine  devised  by  workers 
of  the  Public  Health  Service,  there  is  evidence  that 
the  area  of  its  distribution  is  considerably  wider  than 
was  formerly  supposed.  The  opening  up  of  the 
country  may  also  be  expected  to  increase,  at  least 
temporarily,  the  exposure  of  persons  to  this  disease. 
By  analogy  with  other  diseases,  however,  the  ulti- 
mate reduction  and  virtual  disappearance  of  this  con- 
dition may  be  expected  as  a result  of  the  intensive 
occupation  of  the  land  by  an  increased  population. 
In  the  meantime,  there  is  abundant  opportunity  for 
continued  study  in  this  field,  since  no  means  have  as 
yet  been  discovered  for  eradicating  the  disease  among 
the  small  animals  which  constitute  the  natural  reser- 
voirs of  the  infection,  and  since  laboratory  studies 
of  the  reputed  cause  of  the  disease  have  thus  far 
failed  to  show  conclusive  results.  The  manufacture 
and  distribution  of  the  preventive  vaccine  developed 
by  the  Public  Health  Service  have  been  continued 
and  increased.  Vaccine  sufficient  to  vaccinate  5000 
persons  has  been  dispensed,  but  the  results  following 
its  use,  while  excellent,  have  not  been  completely 

assembled. 

For  the  first  time  in  a number  of  years  a definite 
increase  of  malaria  has  been  observed  in  certain 

areas.  This  phenomenon  has  increased  interest  in  the 
malaria  problem,  and  studies  are  under  way  to  deter- 
mine its  cause  and  to  devise  means  for  combating  it. 
The  use  of  Paris  green  for  the  control  of  malaria- 
carrying mosquitoes  has  been  shown  to  have  much 

wider  application  than  was  formerly  supposed.  Much 
work  has  been  done  on  the  application  of  this  sub- 
stance to  breeding  areas  by  means  of  inexpensive 
power  handblowers  to  be  used  either  from  boats  or 
from  the  shore  in  connection  with  portable  equipment 
which  would  come  within  the  means  of  almost  any 
community.  Gratifying  progress  has  been  made  in 
the  study  of  larvicides  and  new  remedies  for  malaria. 
A trial  of  these  various  methods  of  malaria  control 
will  be  made  during  the  year  on  a county-wide  scale 
in  two  widely  separated  counties. 

The  studies  of  the  salt  marsh  mosquito  problem 
have  been  completed.  The  report  under  preparation 
will  be  comprehensive  and  will  include  descriptions 
of  the  various  kinds  of  breeding  places  of  these  mos- 
quitoes; an  enumeration  of  their  species,  habits  and 
distribution;  an  estimate  of  the  extent  of  the  problem 
and  various  means  of  control  which  have  been  found 
effective  in  various  places  and  under  different  cir- 
cumstances. 

There  occurred  during  the  past  year  a number  of 
serious  epidemics  of  meningococcus  meningitis  (cere- 
brospinal meningitis).  Observations  of  the  specific 
serum  used  in  the  treatment  of  this  disease  showed 
that  the  results  were  unequal  or  irregular,  and  a vig- 
orous attempt  is  being  made  to  improve  the  thera- 
peutic efficiency  of  this  serum.  This  is  an  extensive 
undertaking  since  strains  of  meningococci  must  be 
selected  from  various  epidemics  and  studied  as  to 
their  pathogenic  and  immunizing  properties. 


302 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 


By  C.  B.  Pinkham,  M.  D. 

Secretary  of  the  Board 

In  this  issue  in  this  column  are  given  some  excerpts 
from  the  1929  annual  report  of  the  state  medical 
examining  board.* 

Written  Examinations 

The  high  percentage  of  examinees  that  passed  dur- 
ing the  year  1929  is  a practical  demonstration  of  the 
high  standard  of  present-day  medical  education.  The 
percentage  of  failures  among  graduates  of  extra  state 
schools  was  not  so  high  as  the  prior  year.  Again  our 
three  active  California  medical  schools  have  made  a 
perfect  score  in  the  written  examinations.  A 1918 
graduate  of  the  College  of  Physicians  and  Surgeons 
of  San  Francisco,  which  closed  the  same  year,  failed. 


Recapitulation,  1929,  Examination  Results 


Physicians 

and  Surgeons 

Per 

Per 

cent 

cent 

Passed  Failed  Total 

passed 

failed 

College  of  Medical  Evangel- 

ists  

. 53 

0 53 

100 

0 

Stanford  University  

45 

0 45 

100 

0 

University  of  California 

40 

0 40 

100 

0 

College  of  Physicians  and 

Surgeons,  San  Francisco. 

0 

1 1 

0 

100 

Extra  state  

7159 

17  176 

90  + 

9— 

Totals  

297 

18  315 

94  + 

5— 

t Grades  of  three  applicants 

raised  by 

Review 

Com- 

mittee.  * * * 

Medical  Colleges  Represented 
The  following  table  lists  the  medical  colleges  that 
sent  written  examinees  before  the  board,  the  year 
each  applicant  graduated  from  said  medical  college, 
and  whether  passed  or  failed: 

Year  of 

School  graduation  Passed  Failed  Total 


Boston  University  

1928 

1 

0 

1 

College  of  Medical  Evangelists 

1927 

1 

0 

1 

1928 

3 

0 

3 

College  of  Physicians  and  Surgeons, 

1929 

49 

0 

49 

Boston  

College  of  Physicians  and  Surgeons, 

1916 

0 

1 

1 

San  Francisco  

Columbia  University  College  of 

1918 

0 

1 

1 

Physicians  and  Surgeons 

Creighton  University  School  of 

1928 

1 

0 

1 

Medicine  

1928 

3 

0 

3 

Dalhousie  University  Faculty  of 

1929 

6 

3 

9 

Medicine  

George  Washington  University  Medi- 

1927 

1 

0 

1 

cal  School  

1929 

1 

0 

1 

Harvard  University  Medical  School.. 

1924 

1 

0 

1 

1925 

1 

0 

1 

1926 

1 

0 

1 

1927 

1 

0 

1 

1928 

2 

0 

2 

Howard  University  School  of  Medi- 

1929 

1 

0 

1 

cine  

Indiana  University  School  of  Medi- 

1921 

0 

1 

1 

cine  

Indiana  University  School  of  Medi- 

1924 

0 

1 

1 

cine  

1924 

1 

0 

1 

Jefferson  Medical  College 

1928 

1 

0 

1 

Johns  Hopkins  University  School  of 

1929 

1 

u 

1 

Medicine  

1923 

I 

0 

1 

Laval  University  Faculty  of  Medi- 

1928 

2 

0 

2 

cine  

Loyola  University  School  of  Medi- 

1912 

0 

1 

1 

cine  

1928 

l 

0 

1 

Marquette  University  School  of 

1929 

2 

0 

2 

Medicine  

McGill  University  Faculty  of  Medi- 

1929 

i 

0 

1 

cine  

1920 

i 

0 

1 

1926 

i 

0 

1 

1928 

i 

0 

1 

National  University  of  Athens, 

1929 

i 

0 

1 

Greece  

National  University  of  Mexico,  Fac- 

1923 

i 

0 

1 

ulty  of  Medicine 

1914 

i 

0 

1 

1918 

i 

0 

1 

1924 

0 

1 

1 

* See  also  editorial  in  this  issue  concerning  annual 
report  of  the  state  medical  examining  board. 


Year  of 

School  graduation  Passed  Failed  Total 

Northwestern  University  Medical 


School  

1 

0 

1 

1927 

2 

0 

2 

1929 

10 

0 

10 

Ohio  State  University  College 

of 

Medicine  

1926 

1 

0 

1 

Queen’s  University  Faculty 

of 

Medicine  

1915 

0 

1 

1 

Royal  University  of  Siena 

1928 

1 

0 

1 

Rush  Medical  College 

1903 

1 

0 

1 

1920 

1 

0 

1 

1925 

1 

0 

1 

1927 

1 

0 

1 

1928 

3 

0 

3 

1929 

13 

0 

13 

St.  Louis  College  of  Physicians  and 

Surgeons  

1923 

1 

0 

1 

St.  Louis  University  School 

of 

Medicine  

1928 

2 

0 

2 

1929 

5 

0 

5 

Stanford  University  School  of  Medi- 

cine  

1928 

3 

0 

3 

1929 

42 

0 

42 

Trinity  Medical  College  (Toronto)....  1904 

1 

0 

1 

Tufts  College  Medical  School 

1927 

1 

0 

1 

Tulane  L'niversity  of  Louisiana 

School  of  Medicine 

1925 

1 

0 

1 

1929 

4 

0 

4 

University  of  Arkansas 

1927 

1 

0 

1 

University  of  Bonn  Faculty 

of 

Medicine  

1923 

1 

0 

1 

University  of  Buffalo 

1928 

1 

0 

1 

University  of  California  Medical 

School  

1928 

2 

0 

2 

1929 

38 

0 

38 

University  of  Carolina,  Prague, 

Czech 

1921 

0 

1 

1 

University  of  Cincinnati  College 

of 

Medicine  

1929 

2 

0 

2 

University  of  Colorado  School 

of 

Medicine  

1928 

4 

0 

4 

1929 

1 

0 

1 

University  of  Glasgow  Faculty 

of 

Medicine  

1890 

0 

1 

1 

University  of  Gottingen,  Germany  ...  1922 

1 

0 

1 

University  of  Guadalajara,  Mexico  ...  1918 

1 

0 

1 

1922 

0 

1 

1 

1928 

0 

1 

1 

University  of  Illinois  College 

of 

Medicine  

1922 

1 

0 

1 

1924 

1 

0 

1 

1927 

1 

0 

1 

1928 

4 

0 

4 

1929 

6 

0 

6 

University  of  Iowa 

1928 

3 

2 

5 

University  of  Louisville  School 

of 

Medicine  

1927 

1 

0 

1 

1928 

2 

0 

2 

University  of  Manitoba  Faculty 

of 

Medicine  

1916 

1 

0 

1 

University  of  Maryland  School 

of 

Medicine  

1928 

1 

0 

1 

University  of  Michigan  Medical 

School  

1927 

1 

0 

1 

1928 

2 

0 

2 

University  of  Minnesota  Medical 

School  

1928 

1 

0 

1 

1929 

1 

0 

1 

University  of  Nebraska  College 

of 

Medicine  

1928 

1 

0 

1 

1929 

4 

0 

4 

University  of  Oklahoma  School 

of 

Medicine  

1928 

3 

0 

3 

University  of  Oregon  Medical  School  1927 

1 

0 

1 

1928 

3 

0 

3 

1929 

4 

0 

4 

University  of  Pennsylvania 

1929 

1 

0 

1 

University  of  Pittsburgh  School 

of 

Medicine  

1927 

1 

0 

1 

1928 

1 

0 

1 

University  of  Tennessee  College 

of 

Medicine  

1929 

1 

0 

1 

University  of  Tomsk,  Siberia 

1911 

1 

0 

1 

University  of  Toronto  Faculty 

of 

Medicine  

1928 

1 

0 

1 

1929 

1 

0 

1 

University  of  Vermont  College 

of 

Medicine  

1928 

1 

0 

1 

University  of  Vienna  Faculty 

of 

Medicine  

1923 

0 

1 

1 

University  of  Wisconsin  Medical 

School  

1928 

2 

0 

2 

1929 

1 

0 

1 

Vanderbilt  University  School 

of 

Medicine  

1928 

1 

0 

1 

Washington  University  School 

of 

Medicine  

1928 

2 

0 

2 

1929 

2 

0 

2 

Western  Reserve  University  School 

of  Medicine  

1928 

1 

0 

1 

Woman’s  Medical  College 

1927 

1 

0 

1 

Yale  University  School  of  Medi- 

cine  

1926 

1 

0 

1 

Totals  298  16  314 


April,  1930 


MISCELLANY 


303 


Source  of  Reciprocity  Licentiate 
The  greater  number  of  reciprocity  certificates  in 
1929  were  issued  to  applicants  from  Illinois,  and  Ohio 
shared  second  place  with  Missouri,  while  New  York, 
which  headed  the  list  in  1928,  ranked  fourth,  sharing 
honors  with  Iowa  and  Minnesota. 


Tabulation  by  States 


State 

1928 

1929 

State 

1928 

1929 

Alabama 

0 

10 

Nebraska  

16 

9 

Alaska  .... 

0 

0 

Nevada  

0 

2 

Arizona  

0 

4 

New  Hampshire 

0 

0 

Arkansas  

0 

0 

New  Jersey  

0 

1 

Colorado  

8 

11 

New  Mexico  

0 

1 

Connecticut 

0 

1 

New  York  

27 

13 

Delaware 

1 

0 

North  Carolina 

1 

2 

District  of 

North  Dakota  

3 

4 

Columbia 

1 

1 

Ohio  

9 

16 

Florida  

1 

3 

4 

2 

Georgia  

3 

2 

Oregon  . 

6 

11 

Hawaii 

2 

0 

Pennsylvania  

9 

6 

Idaho  

. 8 

2 

Philippine  Islands 

0 

0 

Illinois  

19 

26 

Rhode  Island  

1 

0 

Indiana  

8 

5 

South  Carolina  ... 

0 

0 

Iowa  

6 

13 

South  Dakota  

2 

4 

Kansas  

4 

6 

1 

6 

Kentucky 

2 

1 

Texas  

6 

4 

Louisiana 

2 

3 

Utah  

8 

6 

Maine  

1 

0 

Vermont  

0 

1 

Maryland 

. 6 

11 

1 

1 

Massachusetts 

..  2 

3 

Washington 

. 5 

7 

Michigan  

. 10 

14 

West  Virginia 

0 

0 

Minnesota 

15 

13 

Wisconsin  

4 

6 

Mississippi  

0 

0 

Wyoming 

. 1 

1 

13 

Montana  

..  3 

3 

Totals  

.221 

241 

* * * 

Hearings 

Charges  of  unprofessional  conduct  under  the  pro- 
visions of  Section  14  of  the  Medical  Practice  Act 
have  been  filed  against  thirty  licentiates  during  the 
year  just  closed,  a decrease  of  six  from  the  number 
of  hearings  held  during  the  prior  year. 

It  is  indeed  disheartening  when  after  weeks  of 
earnest  endeavor  in  securing  evidence,  after  hours  of 
patient  listening  to  the  testimony  submitted  and 
thereafter  determining  the  respondent  guilty  of  hav- 
ing obtained  a California  license  by  fraud,  to  have 
some  court  set  aside  the  finding  of  the  board,  not 
because  of  the  evidence,  but  because  of  some  techni- 
cality wherein  a complaint  was  faulty,  losing  sight  of 
the  important  issue,  namely,  fraud  in  obtaining  a Cali- 
fornia license.  Two  such  cases,  one  for  seven  years, 
another  for  five,  have  blocked  the  California  board  in 
revoking  licenses  convincingly  shown  to  have  been 
obtained  by  fraud.  Injunction,  pending  in  one  case 
for  practically  two  years,  stops  the  board  from  openly 
acting  on  the  sworn  testimony  of  two  confessed  deal- 
ers in  fraudulent  credentials,  both  of  whom  testified — 
one  that  as  an  official  examiner  of  the  State  of  Mis- 
souri he  had  made  out  a false  certificate  of  alleged 
examination  which  mentioned  that  the  individual 
named  therein  had  been  examined  for  three  days, 
whereas  said  examiner  testified  under  oath  to  the 
California  board  he  had  not  seen  the  examinee.  He 
further  stated  he  had  sold  this  educational  certificate 
with  other  fraudulent  credentials  to  our  other  witness. 
Our  second  witness  testified  he  had  procured  said 
certificate  from  the  witness  first  mentioned  and  in 
turn  had  sold  it  to  the  individual  who  used  it  as  an 
important  part  of  his  credentials  to  obtain  a Cali- 
fornia license.  ’Tis  a sad  commentary  on  modern 
justice  that,  with  such  evidence  of  fraud,  the  courts 
so  tie  the  hands  of  the  Board  of  Medical  Examiners 
that  a license  obtained  by  fraud  cannot  be  revoked. 
Here  again  the  Diploma  Mill  Bill  offers  a ray  of  hope, 
and  we  trust  that,  though  our  efforts  to  revoke  a 
license  obtained  by  fraud  are  in  vain,  we  have  a trump 
card  through  prosecution  on  a felony  complaint. 

As  noted  in  prior  reports,  narcotic  violators  com- 
prise the  largest  group  of  those  charged  with  un- 
professional conduct,  although  less  in  number  than 
the  year  1928: 


(a)  Narcotic  10 

(b)  Illegal  operation  (alleged)  9 

(c)  Habitual  Intemperance  3 

(d)  Miscellaneous  s 

Total  30 


The  judgments  rendered  by  the  board  during  the 
year  just  closed  are  classified  as  follows: 

Guilty — Revoked  8 

Guilty — Probation  7 

Guilty — Penalty  suspended  2 

Dismissed  4 

Deferred  to  February,  1930 9 

Total  30 


Department  of  Professional  and  Vocational  Stand- 
ards, Board  of  Medical  Examiners. — Results  of  the 
written  examination  for  physician  and  surgeon  certifi- 
cate held  in  Los  Angeles  Februarv  4 to  6,  inclusive, 
1930: 


School 


Passed  Year  of 

Graduation 


College  of  Medical  Evangelists (1929) 

Creighton  University  School  of  Medicine  ..(1929) 

Harvard  University  Medical  School (1928) 

Long  Island  College  Hospital (1929) 

Northwestern  University  Medical  School.. (1927) 
Northwestern  University  Medical  School. (1929) 
Northwestern  University  Medical  School..(1929) 

Rush  Medical  College (1921) 

Rush  Medical  College (1923) 

Rush  Medical  College (1929) 

Rush  Medical  College (1929) 

Rush  Medical  College (1929) 


St.  Louis  University  School  of  Medicine.  (1929) 
St.  Louis  University  School  of  Medicine..  (1929) 
St.  Louis  University  School  of  Medicine  . (1929) 
St.  Louis  University  School  of  Medicine  . (1929) 

Tulane  University  School  of  Medicine (1928) 

Tulane  University  School  of  Medicine (1929) 

Tufts  College  Medical  School (1929) 

University  and  Bellevue  Hospital  Medi- 
cal College  ....(1927) 

University  of  Colorado  School  of  Medi- 
cine   (1924) 

University  of  Colorado  School  of  Medi- 
cine   ....(1929) 

University  of  Colorado  School  of  Medi- 
cine   ...(1929) 

University  of  Colorado  School  of  Medi- 
cine   (1929) 

University  of  Colorado  School  of  Medi- 
cine   (1929) 

University  of  Colorado  School  of  Medi- 
cine   . (1929) 

University  of  Illinois  College  of  Medicine.  (1929) 
University  of  Illinois  College  of  Medicine.. (1929) 
University  of  Iowa  Medical  Department.. (1928) 
University  of  Kansas  School  of  Medicine..(1929) 


University  of  London (1926) 

University  of  Louisville  School  of  Medi- 
cine   (1929) 

University  of  Minnesota  Medical  School. .(1927) 

University  of  Nebraska  College  of  Medi- 
cine   (1928) 

University  of  Oklahoma  School  of  Medi- 
cine   (1929) 

University  of  Oklahoma  School  of  Medi- 
cine   (1929) 

University  of  Oregon  Medical  School ..(1929) 

University  of  Rochester  School  of  Medi- 
cine   (1929) 

Stanford  University  Medical  School... (1929) 

Washington  University  Medical  School 

(St.  Louis)  (1929) 

Washington  University  Medical  School 

(St.  Louis)  (1929) 

Western  Reserve  University  School  of 

Medicine  (1929) 

Woman’s  Medical  College  of  Pennsyl- 
vania   (1929) 


Per 

Cent 

86 

81  1/9 

85 

90  2/9 
87  4/9 
83  7/9 

82  3/9 

81  4/9 
87  2/9 
75  7/9 

82 

81  6/9 
80  8/9 

82  5/9 

79 

82  5/9 

83  7/9 

86  2/9 

80  8/9 

82  6/9 
77  5/9 
92  2/9 

83 

90  1/9 
89  1/9 

81  8/9 
83  8/9 
85  1/9 
79  1/9 
84.5 
85 

83  5/9 
86.3 


81  1/9 

82  4/9 

83  6/9 

88  1/9 

91  1/9 

80  1/9 

85  3/9 
82  8/9 

81 

89  8/9 


Failed 


Charles  University  of  Prague (1921)  72  4/9 

College  of  Physicians  and  Surgeons, 

Boston  (1916)  65  8/9 

Creighton  University  School  of  Medicine.. (1929)  73  3/9 

University  of  Guadalajara  (Mexico) (1921)  64  6/9 

University  of  Guadalajara  (Mexico) (1923)  69 

University  of  Illinois  College  of  Medicine..(1924)  74  4/9 


News  Items,  April,  1930 

Recent  reports  relate  that  a narcotic  prescription 
made  out  for  Ralph  Conley  and  signed  P.  H.  Sweet, 
M.  D.,  was  recently  presented  at  the  Roscoe  Drug 
Store,  Roscoe,  and  paid  for  with  a $10  check  by  a 
party  posing  as  Ralph  Conley,  who  received  $8.25  in 
change,  the  check  later  being  returned  by  the  West 
Los  Angeles  branch  of  the  Bank  of  Italy,  on  which  it 
was  drawn,  marked  “No  account  at  this  branch.” 


Giuseppe  Accardo,  announcing  himself  as  a spe- 
cialist for  sprains,  dislocation  and  rheumatism  of  the 


304 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  4 


spine,  on  February  24  pleaded  guilty  in  the  city  of 
Los  Angeles  to  a charge  of  violation  of  the  Medical 
Practice  Act  and  was  given  a suspended  sentence  of 
a $200  fine  or  twenty  days  in  the  city  jail. 


According  to  reports,  L.  Allison,  practicing  what 
he  calls  “Weltmer-Craig  System  of  Magnetic  Heal- 
ing” at  120  North  Orange  Street,  Glendale,  on 
March  1 pleaded  guilty  to  a charge  of  violation  of 
the  Medical  Practice  Act  and  paid  a fine  of  $100,  sen- 
tence being  suspended  for  two  years  on  condition  of 
no  further  violation  of  the  Medical  Practice  Act. 


Heated  words  flew  at  the  concluding  session  of  the 
State  Board  of  Medical  Examiners’  three-day  meet- 
ing at  Foresters  Hall,  1329  South  Hope  Street,  yester- 
day as  a result  of  a legal  fight  over  the  case  of  Dr. 
Francis  J.  Bold,  Whittier,  charged  with  having  per- 
formed an  illegal  operation.  Attorney  William  T. 
Kendrick,  Sr.,  appearing  for  his  son,  who  had  ob- 
tained a writ  of  prohibition  halting  the  board’s  hear- 
ing of  charges,  set  off  the  verbal  fireworks  when  he 
attempted  to  explain  the  defense  procedure.  The 
board  members  contended  that  it  had  been  stipulated 
they  were  to  be  notified  when  the  petition  for  the 
writ  was  presented  in  court,  but  they  asserted  they 
had  not  been  so  notified.  Prosecutor  Richard  Lyman 
scored  the  defense  for  what  he  described  as  a “flagrant 
breach  of  faith.”  Attorney  Kendrick  originally  ob- 
tained a writ  of  prohibition  in  Superior  Judge  Wil- 
son’s court.  The  judge  dissolved  the  writ  at  a hear- 
ing yesterday,  to  which  all  the  members  of  the  board 
had  been  subpoenaed,  but  gave  the  defense  leave  to 
amend.  Another  writ  was  obtained  in  the  court  of 
Superior  Judge  Wood,  returnable  next  Tuesday  be- 
fore Superior  Judge  Gates  . . . (Los  Angeles  Times, 
February  7,  1930).  

According  to  reports,  A.  S.  Clayton,  advertising  as 
an  “electric  needle  specialist,  removing  superfluous 
hairs,  warts,  moles  permanently  removed  ...”  re- 
cently pleaded  guilty  in  Ventura  on  a charge  of  viola- 
tion of  the  Medical  Practice  Act  and  was  sentenced 
to  pay  a fine  of  $100,  sentence  being  suspended. 


According  to  reports,  Lucy  V.  Craig  of  Montrose 
on  March  1 pleaded  guilty  to  a charge  of  violation  of 
the  Medical  Practice  Act  and  was  sentenced  to  pay 
a fine  of  $100,  suspended  for  two  years  on  condition 
of  no  further  violation,  it  being  stated  that  she  was 
engaged  in  practicing  the  Weltmer-Craig  system  of 
magnetic  suggestive  therapeutics  and  held  a diploma 
“evidently  issued  by  her  and  her  husband  to  herself, 
the  same  being  signed  A.  L.  Craig,  president,  and 
L.  V.  Craig,  secretary.  That  it  was  her  intention  to 
issue  these  diplomas  in  Glendale  is  indicated  by  the 
fact  that  she  had  in  her  place  of  business  diplomas 
in  blank,  already  signed  by  her  husband  and  sealed, 
ready  to  fill  out  for  anyone  who  wanted  one.  . . . ” 


Answering  a recent  attack  on  the  policy  of  the 
state  in  regulating  professions  and  vocations  and  per- 
mitting members  to  remove  from  practice  those  under 
their  jurisdiction,  which  appeared  in  a newspaper  pub- 
lished in  Chico  by  one  of  our  legislators,  the  San 
Francisco  Recorder  of  Monday,  February  10.  1930, 
takes  up  the  cudgels  for  the  licensing  boards,  relating 
that  in  the  original  article  the  author  “fails  to  state 
that  in  every  instance  persons  disciplined  or  denied 
the  right  to  continue  in  practice,  have  the  right  to 
appeal  to  the  courts  for  a review  of  the  action  of  the 
disciplining  body;  nor  does  he  point  out  that  no  civil 
remedy  in  the  form  of  an  action  for  damages  for  mal- 
practice has  been  taken  away  from  the  people  by 
these  regulatory  statutes.  As  a matter  of  fact,  the 
public  is  far  better  protected  today  than  it  has  ever 
been  against  crooks,  charlatans,  and  incompetents, 
for  now  such  persons  in  regulated  professions  and 
vocations  may  be  removed  from  their  opportunity  to 
do  further  damage  to  those  who  entrust  themselves 
or  their  affairs  to  their  hands.” 


Police  reports  that  Maurice  E.  Eisenbach  has  been 
arrested  in  Jacksonville,  Florida,  with  stolen  medical 
credentials  of  Dr.  Joseph  H.  Marks  of  Los  Angeles 
in  his  possession,  were  announced  today  by  Dr. 
Charles  B.  Pinkham,  secretary  of  the  Board  of  Medi- 
cal Examiners.  Doctor  Marks,  seeking  a California 
state  license,  informed  state  board  officials  last  week 
that  his  medical  diploma  and  credentials,  as  well  as 
his  United  States  Army  Medical  Corps  commission 
were  stolen  in  January  while  he  was  serving  as  an 
intern  in  a St.  Louis  hospital.  He  said  he  suspected 
Eisenbach,  a fellow  intern  (San  Francisco  Examiner, 
March  13,  1930).  The  documents  reported  by  Doctor 
Marks  as  having  been  taken  from  him  were  a 1928 
medical  diploma  from  the  St.  Louis  University  Medi- 
cal School,  a 1928  Missouri  state  license  (No.  20158), 
a 1928  United  States  Army  Medical  Corps  commis- 
sion, a certification  of  internship  at  the  Jewish  Hospi- 
tal, a Carthage  (Missouri)  High  School  diploma,  a 
Zeta  Beta  Tau  fraternity  certificate,  and  a 1928  St. 
Louis  LTniversity  class  picture. 


According  to  reports,  P.  S.  George  was  on  Feb- 
ruary 7.  in  the  city  of  Los  Angeles,  adjudged  guilty 
of  violation  of  the  Medical  Practice  Act  and  sentenced 
to  pay  a fine  of  $100,  sentence  suspended  on  condition 
of  no  further  violation. 


The  name  of  Robert  Griffin,  “physiotherapist  and 
x-ray  specialist,”  was  listed  at  police  headquarters 
today.  He  was  arrested  in  his  downtown  office,  747 
South  Hill  Street,  accused  of  violating  the  State 
Poison  Act,  by  possession  of  two  complete  narcotic 
hypodermic  outfits.  The  arrested  man  was  listed  as 
general  manager  and  director  of  Health  Studios,  Ltd. 
(Los  Angeles  Record,  February  18,  1930.) 


Petition  for  writ  of  review  by  Dr.  Fred  B.  Tap- 
ley  to  compel  the  State  Board  of  Medical  Examiners 
to  restore  his  license,  was  taken  under  submission 
yesterday  by  Superior  Judge  Walter  Perry  Johnson. 
The  license  of  Doctor  Tapley,  Marysville,  was  re- 
voked last  July  when  Doctor  Tapley  was  accused  of 
performing  two  illegal  operations  (San  Francisco 
Examiner,  January  16,  1930). 


A ninety  day  jail  term  was  hung  over  the  head 
of  Dr.  J.  M.  Threadgill,  Westwood  physician,  yester- 
day, by  Municipal  Judge  Wilbur  C.  Curtis,  to  remind 
him  to  report  treatment  of  gunshot  wounds  hereafter 
to  police.  The  doctor  pleaded  guilty  yesterday,  say- 
ing he  innocently  had  violated  the  law  when  he 
secretly  treated  a bullet  wound  in  the  head  of  Theo- 
dore Jerke,  asserted  bandit  (Los  Angeles  Illustrated 
Mews,  December  27,  1929). 

Dr.  H.  G.  Throop,  drugless  physician  with  offices 
at  109  North  Bright  Avenue,  was  found  not  guilty 
of  practicing  as  a chiropractor.  . . . On  another  charge, 
one  of  advertising  as  a chiropractor,  he  was  found 
guilt}’  and  sentenced  to  pay  a fine  of  $50,  which  he 
paid  (Whittier  News,  December  3,  1929). 


The  County  Grand  Jury  last  night  began  investi- 
gation into  charges  against  several  hospital  and  health 
associations.  Eight  complaints  are  on  file.  The  com- 
plaints allege  the  associations  sold  hospital  or  medical 
service  to  members,  but  when  ailing  members  sought 
treatment  it  was  either  postponed  or  refused  outright 
(San  Francisco  press  dispatch,  printed  in  the  Sacra- 
mento Bee,  January  22,  1930). 


T.  Wah  Hing,  well-known  Sacramento  . . . Chinese 
herb  specialist,  yesterday  was  charged  with  practic- 
ing without  a license  in  a complaint  issued  by  the 
district  attorney’s  office  and  filed  with  Justice  of  the 
Peace  Silas  Orr  of  North  Sacramento.  The  complaint 
was  issued  following  an  objection  filed  by  members 
of  the  State  Board  of  Medical  Examiners  . . . (Sacra- 
mento Union,  January  28.  1930).  (Previous  entries, 
December  1925,  January  1926,  and  January  1927.) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


THE  NEW  VOGUE  IN  DOCTORS’  EQUIPMENT 


By  ALLISON 


We  are  distributors  of  the  distinctive  ALLISON  line  of  treatment  room,  consultation  office 
and  reception  room  furniture.  Let  us  help  you  in  planning  your  new  office,  or  in  refurnishing 
your  old  suite.  May  we  send  catalog?  Free  on  request. 


TRAVERS  SURGICAL  CO. 

Physicians’  and  Hospital  Supplies 

FRESNO  SAN  FRANCISCO 

933  Van  Ness  429  Sutter  Street 

CALIFORNIA’S  LEADING  SURGICAL  SUPPLY  HOUSE 


dnuisa 


A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER. 

Looks  like  a dress  silk  stocking.  A new  German 
invention.  Gives  compression  when  drawn  up  at 
the  top.  Tightness  regulated  in  direct  relation  to 
vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treatment  of  varicose  veins 
and  swollen  limbs.  Neat  and  comfortable. 

Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 


PRICES 

Length  as  illustrated $ 7.00 

Half  thigh  length 9.00 

Full  length  10.00 


In  ordering  give  patient’s 
calf  measurement. 


SOLD  AND  FITTED  BY 


323  W.  6TH  STREET 


LOS  ANGELES,  CALIF. 


Phone  MUtual  8081 


34 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


• • • powerful  and 
rapid  in  action.  Kills 
bacteria  almost 
instantly. 


Valuable  in  the  treatment 
of  all  open  wounds,  abra- 
sions, and  infections  of  the 
mucous  membranes 


12  FLUID  OUNCES 


‘■'QUO*.  HCXYLRE50BCIN0US.  S A 

GENERAL  ANTISEPTIC 
STABLE.  NON-TOXIC. 


|XYLRESORC« 
SOLUTION  S.T.31 


> WHICH!  RETAINS  ITS  ACWJ 

S'JO^HEN  applied  TO  TISSU- 

JSFACES  AN  n nESTR0’5, 


AND  Dt=>‘ 

TJJTOGENIC  bacteri 


i rc  c B AC  i _(-u. 

v rST  ^AN  15  SECONDS  CQ 


• • • especially  suggested, at 
this  time  of  the  year,  as  a 
nasal  spray,  mouth  wash 
and  gargle. 


SHARP  & DOHME 

BALTIMORE 

NEW  YORK  CHICAGO  NEW  ORLEANS  ST.  LOUIS  ATLANTA 

PHILADELPHIA  KANSAS  CITY  SAN  FRANCISCO  BOSTON  DALLAS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  31) 

and  Humber  have,  like  those  of  most  investigations, 
been  exaggerated  in  current  reports. — Jour.  A.  M.  A., 
February  1,  1930,  p.  343. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the 
Food,  Drug,  and  Insecticide  Administration  of  the 
United  States  Department  of  Agriculture  which  en- 
forces the  Federal  Food  and  Drugs  Act:  Lunge 
Heala  (Norwich  Pharmacal  Company)  consisting 
essentially  of  compounds  of  ammonium,  calcium, 
sodium,  potassium  and  phosphorus,  with  chlorids,  tar, 
traces  of  menthol  and  chloroform  and  extracts  of 
plant  drugs,  including  wild  cherry,  together  with 
alcohol,  sugar  and  aromatic  substances.  Armistead’s 
Ague  Tonic  (W.  M.  Akin  Medicine  Company),  con- 
sisting essentially  of  quinin  sulphate,  extract  of  plant 
drugs,  sugar,  alcohol  and  water,  flavored  with  cinna- 
mon. Merle’s  Cod-liver  Oil  Tablets  (Devore  Manu- 
facturing Company),  containing  metallic  iron,  zinc 
compounds,  phosphids,  berberin,  strychnin,  and  a 
small  amount  of  fish  oil.  Laxative  Anti-Gripine  (Anti- 
Gripine  Company),  consisting  essentially  of  acetan- 
ilid  (215.8  grains  per  ounce),  sodium  salts,  carbonates, 
red  pepper,  podophyllin,  aconite  alkaloids  and  ex- 
tracts of  plant  drugs,  including  a laxative.  Arkadin, 
consisting  essentially  of  creosote,  menthol,  benzoate 
of  soda,  quaiacol,  phenol,  mydriatic  alkaloids,  sugar, 
alcohol,  and  water.  Cod-Liver  Oil  Compound  Tablets 
(Morgenstern  Company)  containing  iron  and  zinc 
compounds,  strychnin,  extracts  of  plant  drugs  includ- 
ing ginger,  and  a laxative  drug  with  a trace  of  fish 
oil.  Broncil  (Modern  Products  Company),  consist- 
ing essentially  of  ammonium  chlorid,  menthol,  tolu 
balsam,  oil  of  eucalyptus,  extracts  of  plant  drugs,  in- 
cluding wild  cherry,  tartar  emetic,  sugar,  and  alcohol. 

(Continued  on  Next  Page) 


Suggest  this 
Pure  Fruit  Juice, 
so  rich  in 
Food  Values 

Young  and  old  relish  the  delicious  mel- 
low taste  of  ’49  Brand  California  Grape 
Juice.  For  general  diet  and  hospital  use  ’49 
Grape  Juice  is  unsurpassed  because  of  its 
high  percentage  of  natural  invert  sugar, 
valuable  mineral  salts,  and  stimulating  laxa- 
tive properties. 

An  exclusively  controlled  process  is  respon- 
sible for  the  fresh,  lasting  purity  of  ’49  Brand. 

All  the  natural  goodness  of  selected,  mature 
grapes  is  brought  to  you  in  ’49.  Nothing — 
not  even  sugar — is  added  to  the  pure  juice. 


Physicians,  dietitians 
or  hospitals  interested 
in  learning  more  about 
’49  Brand  California 
Grape  Juice,  either 
Red  or  White,  may 
write  to 


VITA-FRUIT  PRODUCTS  INC. 

RUSS  BLDG.,  SAN  FRANCISCO 

GRAPE  JUICE  PLANT  AT  LODI 

PARROTT  6c  CO. 

SALES  REPRESENTATIVES 

SAN  FRANCISCO  LOS  ANGELES  PORTLAND 

SEATTLE  TACOMA  SPOKANE 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


36 


Rainier  Pure  Grain  Alcohol 

USP 


The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRAIN  ONLY 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 


RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calif. 


As  a General  Antiseptic 

in  place  of 

TINCTURE  OF  IODINE 
T ry 

Mercurochrome  - 220  Soluble 

( Dibrom-oxymercuri- fluorescein.) 

2%  Solution 

It  stains,  it  penetrates,  and  it 
furnishes  a deposit  of  the  germ- 
icidal agent  in  the  desired  field. 

It  does  not  burn,  irritate  or  injure 
tissue  in  any  way. 

Hynson,  Westcott  & Dunning 

Baltimore,  Maryland 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 

Jarabe  Compuesto  Cocillana  Tropical  (American 
Tropical  Remedy  Company),  consisting  essentially 
of  an  extract  of  a plant  drug,  menthol,  alcohol,  sugar, 
and  water.  McK  & R Cold  and  Grippe  Tablets 
(McKesson  and  Robbins,  Inc.),  containing  acetanilid, 
cinchonidin,  hydrobromid,  camphor,  aloin,  and  a laxa- 
tive plant  drug  extractive.  Amber-O-Latum  (Amber- 
O-Latum  Company),  consisting  essentially  of  an  oint- 
ment with  a lanolin  and  petrolatum  base,  containing 
oil  of  wintergreen,  oil  of  mustard,  camphor,  and 
eucalyptus.  Griperol  (Gabriel  J.  Fajardo),  consisting 
essentially  of  ammonium,  hypophosphites,  chlorids, 
cod-liver  oil  extract,  menthol,  tar,  and  other  pine 
products,  alcohol,  sugar,  and  water.  Mack’s  Cold 
Capsules  (S.  Pfeiffer  Manufacturing  Company),  con- 
taining acetanilid,  quinin,  sodium  and  potassium  com- 
pounds, bromids,  methyl  salicylate,  and  aloin.  La 
Flugo  Cold  Tablets  (Lincoln  Pharmacal  Company), 
containing  calcium  and  sodium  salts,  sulphates,  cam- 
phor, oleoresin  of  capsicum,  traces  of  the  alkaloids  of 
ipecac  and  aconite,  and  extracts  of  plant  drugs.  B.  B. 
Headache  Powders  (Bostwich  Bros.),  containing  3.3 
grains  of  acetanilid,  each,  with  aspirin,  potassium 
bromid  and  caffein.  Mintol  Vapocream,  an  ointment 
with  a petrolatum  base,  containing  carbolic  acid,  for- 
maldehyd,  peppermint  and  eucalyptus  oil,  camphor 
and  menthol.  Ru-Bon  No.  1 (Ru-Bon  Chemical  Com- 
pany) consisting  essentially  of  chrysarobin,  ether, 
alcohol,  and  water.  Ru-Bon  No.  2 (Ru-Bon  Chemical 
Company),  consisting  essentially  of  chrysarobin,  sali- 
cylic acid,  resorcin,  glycerin,  volatile  oils,  alcohol,  and 
water.  Ru-Bon  No.  3 (Ru-Bon  Chemical  Company), 
containing  resorcin,  salicylic  acid,  chrysarobin,  vola- 
tile oils,  glycerin,  alcohol,  and  water. — Jour.  A.  M.  A., 
February  1,  1930,  p.  357. 

(Continued  on  Page  38) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


Reid 

Bros. 

Factory  at 
Irvington, 
California 


OFFICES 

n 91  Drumm  Street  San  Francisco,  Calif, 

‘•v  Phone  DOuglas  1381 

1417  Fourth  Avenue,  Seattle,  Washington 


One  of 
America’s 
Leading  Hos- 
pital Supply 
Houses 


Manufacturers  of  " Porcello ” 
Aseptic  Steel  Furniture 


The  Larkin  House. — In  1832  Thomas  O.  Larkin 
came  to  Monterey.  He  opened  a wholesale  and  retail 
store,  and  became  the  first  and  only  United  States 
Consul  to  California.  Larkin  performed  stellar  ser- 
vice toward  bringing  California  under  the  American 
flag.  The  large  adobe  home  he  built  almost  a hundred 
years  ago  is  a point  of  great  interest  to  visitors,  and 
is  still  occupied  by  a descendant  of  the  builder. 


Sherman’s  Headquarters.  — Next  to  the  Larkin 
house  is  another  adobe  built  by  Larkin  in  1834.  Here 
was  headquartered  William  Tecumseh  Sherman  when 
he  was  stationed  at  Monterey.  At  that  time  the 
man — who  was  later  to  be  a famous  Civil  War 
general — was  a lieutenant.  General  Halleck  was  head- 
quartered at  the  same  place.  Sherman,  as  a youth 
in  Monterey,  figured  in  one  of  Monterey’s  wistful 
legends. 

Young  Sherman  was  enamored  of  “the  most  beauti- 
ful senorita  of  the  town.”  When  he  was  ordered  East 
he  called  to  take  his  farewell.  He  was  wearing  a 
“cloth  of  gold”  rose  wrhich  the  two  of  them  rever- 
ently planted.  Sherman  declared  that  when  the  rose 
bloomed  he  would  return  for  the  senorita.  Years 
rolled  by.  The  rose  grew  and  enveloped  the  senorita’s 
doorway  and  wall  with  blossoming  branches.  Into 
old  age  waited  the  faithful  senorita,  but  Sherman 
never  returned.  Recently  Sherman  Rose  House  was 
removed  to  make  way  for  a modern  bank  building. 
It  is  being  restored  in  another  part  of  the  city. 


House  of  the  Four  Winds,  Monterey. — This  ram- 
bling old  structure  was  the  first  in  this  community 
to  boast  a weather  vane.  Thus  it  received  its  name. 
Also  built  by  Larkin,  the  House  of  the  Four  Winds 
was  the  first  Hall  of  Records  of  the  state.  It  is  now 
used  as  a club  building  by  the  Monterey  Woman’s 
Civic  Club. 


Tycos  Surgical  Unit 

For  Blood  Pressure  Determina- 
tion in  the  Operating  Room 

For  the  convenience  of  anaesthetists  and 
surgeons,  who  are  finding  that  accurate 
blood  pressure  readings  are  invaluable 
during  anaesthesia  and  surgery,  we  have 
designed  this  Tycos  Surgical  Unit. 

It  consists  of  a large  easy  reading  type 
Tycos  Sphygmomanometer  and  a uni- 
versal clamp.  The  clamp  enables  the 
Sphygmomanometer  to  be  adjusted  to 
any  position  convenient  for  the  anaes- 
thetist and  out  of  the  way  of  the  sur- 
geons and  assistants.  The  adjustments 
can  be  made  instantly,  but  once  made 
the  instrument  is  firm  as  the  table  itself. 

If  it  is  inconvenient  to  have  the  instru- 
ment attached  to  the  table,  the  clamp 
will  accommodate  it  to  the  anaesthesia 
equipment  or  instrument  stand. 

Modern  trends  make  it  extremely  impor- 
tant for  hospitals  to  include  the  Tycos 
Surgical  Unit  in  their  operating  room 
equipment. 

Your  dealer  can  supply  you  with  this 
equipment.  Complete  unit  $52.50. 
Clamp  only  $15.00.  Write  today  for 
additional  information. 

Taylor  Instrument  Companies 

ROCHESTER,  N.  Y.,  U.  S.  A. 

CANADIAN  PLANT  MANUFACTURING  DISTRIBUTORS 
TYCOS  BUILDING  IN  GREAT  BRITAIN 

TORONTO  SHORT  & MASON.  LTD.,  LONDON 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


38 


Analyzed  and  Certified  Products 

NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 
INTRAMUSCULAR  MEDICATIONS 
PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


CERTIFIED 


WALTER/ 

TLRGICAL  €0. 


Headquarters  for 

Physicians,  Surgeons  and  Hospital  Supplies 

FINEST  QUALITY  CHROME  AND  NICKEL 
INSTRUMENTS  ALWAYS  ON  HAND 


Modern  Office  Equipment 

All  the  Leading  Makes  in 

White  Enamel  and  Finished  Wood 


Also 

DRESSINGS,  TONGUE  BLADES,  ENAMELWARE, 
GLASSWARE,  RUBBER  GOODS,  ETC. 


NEW  FEATURES 

BARD-PARKER’S  NEW  BLADE  NO.  24 
KOMPAK  MODEL  BAUMANOMETER 


We  trill  send  you  circulars  on  request.  Send  to  our 
San  Francisco  Office: 

521  Sutter  Street 
Phone  DOUGLAS  4017 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  36) 

Ceanothyn  Not  Acceptable  for  New  and  Nonofficial 
Remedies.— In  1926  the  Council  on  Pharmacy  and 
Chemistry  found  Ceanothyn  (Flint,  Eaton  & Co.) 
unacceptable  for  New  and  Nonofficial  Remedies  be- 
cause its  composition  was  uncertain,  because  no  tests 
were  furnished  to  control  its  uniformity  and  identity, 
and  because  no  satisfactory  evidence  for  its  thera- 
peutic value  had  been  submitted.  Later  the  firm  re- 
quested reconsideration  of  the  product,  submitting  as 
evidence  reports  of  experimental  and  clinical  studies 
carried  out  with  Ceanothyn.  The  firm  also  submitted 
new  advertising  in  which  it  is  stated  that  each  lot  is 
physiologically  tested  and  that  this  insures  a uniform 
product;  but  no  acceptable  evidence  to  support  this 
claim  was  furnished.  A “blind  test”  made  for  the 
Council  gave  no  satisfactory  evidence  that  Ceanothyn 
changes  the  clotting  time  of  the  blood.  In  considera- 
tion of  the  unestablished  and  therefore  unwarranted 
therapeutic  claims  for  Ceanothyn,  and  in  further  con- 
sideration of  the  inconclusive  character  of  the  avail- 
able evidence  for  the  drug’s  value  as  a coagulant,  the 
Council  confirmed  its  decision  holding  the  product 
unacceptable  for  New  and  Nonofficial  Remedies. — 
Jour.  A.  M.  A.,  February  8,  1930,  p.  410. 

Vigantol  Not  Acceptable  for  New  and  Nonofficial 
Remedies. — When  reports  of  experimental  clinical 
studies  made  it  apparent  that  irradiated  ergosterol 
preparations  would  be  offered  for  therapeutic  use,  the 
Council  on  Pharmacy  and  Chemistry  undertook  to 
select  a name  for  this  vitamin  D bearing  product. 
The  Council  did  this  so  that  products  of  this  kind 
might  be  marketed  under  a single  name  and  thus  the 
confusion  avoided  which  inevitably  results  when  the 
same  product  is  marketed  under  a multiplicity  of 
names.  The  Council  adopted  “Viosterol”  as  the  New 
(Continued  on  Page  41) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


39 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 
NEW  YORK,  NEW  YORK 

FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  haring  an  addict  problem  is 
invited  to  write  for  " Hospital  Treatment  for 
Alcohol  and  Drug  Addiction.** 


FRANK  F.  WEDEKIND  CO. 

SURGICAL  SUPPLY  CENTER 
First  Floor,  Medical  Building 
Opposite  St.  Francis  Hospital 
BUSH  AND  HYDE  STREETS 

Telephone  GRaystone  9210 

Main  Store  and  Fitting  Rooms 
2004-06  SUTTER  STREET  WEST  6322 

Corsets  . . Surgical  Appliances  . . Storm  Binders 
Orthopedic  Appliances  . . Elastic  Hosiery  . . Trusses 
California  Manufacturing  Agents  for 

The  "Storm  Binder”  and  Abdominal  Supporter 
(Patented) 


Missions  at  Monterey  and  Carmel — On  June  3,  1770, 
Father  Serra  founded  the  San  Carlos  Mission  of 
Monterey.  But  little  later  it  was  removed  to  the 
Carmel  Valley,  about  six  miles  distant.  Now  it  is 
called  Carmel  Mission.  Father  Serra  and  fifteen 
governors  of  the  early  territory  are  buried  in  this 
consecrated  church.  It  is  the  most  famous  of  all 
Franciscan  Missions,  and  is  visited  by  thousands  of 
tourists  annually.  Here  was  completed,  in  1924,  the 
monumental  sarcophagus  to  Father  Junipero  Serra, 
one  of  the  masterpieces  of  western  sculpture,  the 
creation  of  Jo  J Mora  of  Pebble  Beach. 

The  Church  of  San  Carlos  de  Monterey  was  erected 
in  1794,  and  was  known  as  the  Royal  Chapel.  Here 
worshiped  the  representatives  of  the  King  of  Spain. 
It  is  an  interesting  old  structure.  The  transept  and 
present  main  altar  were  erected  in  1858. 


Sloat  Monument. — There  is  one  monument  outside 
of  Washington,  D.  C.,  partially  financed  by  Congress, 
in  commemoration  of  an  officer’s  deeds.  That  single 
monument  stands  on  the  Monterey  Peninsula.  Con- 
gress appropriated  $10,000  toward  this  memorial, 
which  honors  the  man  who  took  possession  of  Cali- 
fornia for  the  United  States  in  1846.  On  a hill  in  the 
Federal  reservation  it  rests,  with  a granite  base  built 
of  contributed  blocks  from  thirty-five  California  coun- 
ties, cities,  and  interested  organizations. 


Old  Pacific  Building. — This  old  adobe,  Scott  and 
Main  streets,  Monterey,  was  built  in  1847  by  Thomas 
O.  Larkin.  The  upper  story  was  used  as  a boarding 
house  for  sailors.  The  first  floor  served  as  court- 
house, jail,  and  storehouse.  All  windows,  above  and 
below,  were  iron-barred  to  protect  the  inmates  against 
Indians  and  marauders.  In  the  old  Mexican  days  the 
back  yard,  surrounded  by  a high  adobe  wall,  was  used 
for  bear  and  bull  fights.  In  1866  the  property  came 
into  the  possession  of  the  Jacks  family. 


_ SAVE  MONEY  ON  — 

YOUR  X-RAY  SUPPLIES 


We  Save  You  from  10%  to  25% 

GET  OUR  PRICE  LIST  AND  DISCOUNTS 


Insures  finest  radiographs  on  heavy  parts,  such  as 
kidney,  spine,  gall-bladder  or  heads. 

Curved  top  style — up  to  17  x 17  size  cassettes $250.00 

Flat  top  style  for  11  x 14  size 175.00 

Flat  top  style  for  14  x 17  size 260.00 

X-RAY  FILM — Buck  Silver  Brand  or  Eastman  Super- 
speed Duplitized  Film.  Heavy  discounts  on  carton 
quantities.  Buck,  Eastman  and  Justrite  Dental  Films. 
BARIUM  SULPHATE — for  stomach  work,  purest 
grade.  Also  BARI-SUSP  MEAL.  Low  Prices. 
DEVELOPING  TANKS  — 4,  5 & 6 compartment 
soapstone,  EBONITE  2 14,  5 & 10  gallon  sizes. 
Enamel  Steel  and  Hard  Rubber  Tanks. 
COOLIDGE  X-RAY  TUBES— 7 styles.  Gas  Tubes. 
INTENSIFYING  SCREENS  & CASSETTES  for 
reducing  exposures.  Special  low  prices. 

JONES  BASAL  METABOLISM  UNITS, 
Most  accurate,  reliable,  portable — $235.00. 

If  you  have  a machine  GcO.  fW.  Brady  & Co. 
have  us  put  your  name  781  s.  western  Ave. 

on  our  mailing  list.  Chicago 


Illinois 


40 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


FINANCING  THE  DOCTOR’S  PATIENTS 

A Definite  Payment  Plan 

CASH  for  the  Doctor  CREDIT  for  the  Patient 

HUNDREDS  OF  SATISFIED  DOCTORS 
THOUSANDS  OF  SATISFIED  PATIENTS 

We  Collect  Annually  Over  $200,000 

No  Investment  No  Entrance  Fee 

Medico-Dental  Finance  Corporation 

Suite  410 — 450  Sutter  Street  San  Francisco,  Calif. 

Medico-Dental  Finance  Corporation  of  Oakland 

909  Financial  Center  Building  Oakland,  Calif. 


FOR 

SALE 


Beautifully 
situated 
in  the 

Sierra  Nevada 
Foothills 


This  desirable  convalescent  home  and  grounds  covering  65  acres,  conveniently  located  on  the  highway  three 
miles  from  Colfax.  In  center  of  locality  noted  for  climate  beneficial  to  tuberculous  patients. 

Will  accommodate  25  people — good  water  supply — garden — small  orchard.  All  in  first  class  condition. 

Was  built  for  and  occupied  by  Standard  Oil  Company  of  California  as  a sanatorium  for  the  tuberculous. 

For  further  information  write  H.  S.  THOMSON,  M.  D.,  225  Bush  Street,  San  Francisco 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


41 


CALSO  WATER 

PALATABLE  ALKALINE  SPARKLING 

Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Galso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Galso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Los  Angeles 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  38) 

and  Nonofficial  Remedies  name  for  irradiated  ergo- 
sterol  and  the  name  “Viosterol  in  oil  100  D”  to  desig- 
nate a preparation  containing  the  substance  dissolved 
in  oil  and  having  one  hundred  times  the  vitamin  D 
potency  of  a standard  cod-liver  oil.  Four  firms  have 
made  their  products  acceptable  under  the  Council 
name  for  inclusion  in  New  and  Nonofficial  Remedies. 
The  Winthrop  Chemical  Company  is  offering  to  phy- 
sicians of  the  United  States  a brand  of  viosterol  in 
oil  100  D under  the  proprietary  name  “Vigantol.” 
The  Council  declared  “Vigantol”  unacceptable  for 
New  and  Nonofficial  Remedies  because  the  applica- 
tion of  a proprietary  name  to  a preparation  of  irradi- 
ated ergosterol  is  contrary  to  the  best  interest  of  the 
medical  profession  and  of  the  public.— Jour.  A.  M.  A., 
February  8,  1930,  p.  410. 

The  Twenty-Fifth  Anniversary  of  the  Council  on 
Pharmacy  and  Chemistry. — At  a meeting  held  Febru- 
ary 3,  1905,  the  board  of  trustees  of  the  American 
Medical  Association  created  an  advisory  board  to  be 
known  as  the  Council  on  Pharmacy  and  Chemistry. 
The  organization  of  this  Council  was  perfected  on 
February  11,  1905.  Thus  the  Council  on  Pharmacy 
and  Chemistry  passes  the  twenty-fifth  year  of  its 
organization  and  continues,  in  a second  quarter  cen- 
tury, one  of  the  most  notable  works  for  scientific 
medicine  ever  accomplished  by  any  organized  group. 
It  is  significant  that  several  of  the  original  members 
of  the  body  have  maintained  their  connection  since 
its  inception  and  that  the  secretary,  W.  A.  Puckner, 
has  rendered  continuous  service  as  a full-time  officer 
for  the  body  from  the  first.  The  Council  could  not 
have  achieved  what  it  has,  without  the  support  of  the 
medical  profession  of  our  country.  Thus,  with  the 
establishment  of  the  Council,  the  advertising  of  me- 
(Continued  on  Page  43) 


^ OW ...  A World  Mart 
of  Surgical  Supplies 
Brought  to  You  . . . 
...IN  LOS  ANGELES 

For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 

Send  (or  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 

KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


This  Feeding  Calculator 
Makes  the  Computation  of  Klim  Formulae 
Simple  and  Accurate 


AS  a result  of  extensive  tests  in  feeding  large  numbers 
of  cases,  the  Klim  Formulary  pictured  herewith 
has  been  arranged. 

♦ 

This  infant-feeding  calculator  is  designed  to  make 
the  computation  of  Klim  formulae  in  average  cases  as 
simple  and  accurate  as  possible.  At  a glance  it  makes 
available  the  most  approved  combinations  of  Klim, 
water  and  carbohydrate  together  with  frequency  of 
feedings. 


The  Klim  Formulary  will  be  sent  to  you  on  request. 
You  will  find  it  saves  time  and  effort  in  constructing 
Klim  formulae.  Klim  in  itself  is  not  a formula  or 
special  infant  food.  It  is  simply  pure,  fresh  milk  pow- 
dered. The  spray  process  used  in  drying  Klim  so 
breaks  up  the  curd  as  to  render  the  product  more 
digestible  than  fluid  milk. 

Literature  and  samples  including  spe- 
cial feeding  calculator  sent  on  request. 

Merrell- Soule  Co.,  Inc.,  350  Madison  Ave.,  New  York 


(Recognizing 
the  importance 
of  ecien  tific 
control,  all  con- 
tact with  the 
laity  is  predi- 
cated on  the 
policy  that 
KLIM  and  its 
allied  products 
be  used  in  in- 
fant feeding 
only  according 
to  a physician’s 
formula.) 


Merrell-Soule  Powdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 


B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 

Training  School  for 
Nurses 

U 

For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  41) 

dicinal  preparations  in  The  Journal  of  the  American 
Medical  Association  was  limited  to  those  products  that 
had  been  passed  by  the  Council.  The  same  rule  has 
applied  to  the  other  publications  of  the  association, 
and  finally  every  state  medical  journal,  except  those 
of  Illinois  and  New  York,  followed  this  lead.  A con- 
siderable number  of  journals  not  controlled  by  medi- 
cal societies  also  give  their  support  to  the  Council’s 
work.  The  medical  profession  must  support  the  Coun- 
cil or  its  work  will  be  futile.  The  members  of  the 
Council  serve  without  remuneration  and  The  Journal 
of  the  American  Medical  Association  tenders  to  them 
the  thanks  and  appreciation  of  the  profession  that 
they  have  so  well  served. — Jour.  A.  M.  A.,  February  8, 
1930,  p.  413. 

Vitamin  D in  Tuberculosis. — A recent  investigation 
of  the  role  of  vitamin  D in  the  management  of  tuber- 
(Continued  on  Next  Page) 


Creating  Joy 

Qreate  joy  for  yourself  a?id  others 
by  sending  flowers 


224-226  Grant  Avenue 
Telephone:  SUtter  6200 
SAN  FRANCISCO 


44 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Banning  Sanatorium 

Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
Treatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


Dr.  Pollard’s  High  Tension  Stethoscope 


Postpaid  Price  $6.00 


A SCOPE  with  which  you 
can  hear  the  heart  sounds 
through  an  overcoat,  coat  and 
vest,  and  with  which  you  can 
easily  hear  the  fetal  heart 
sound.  The  regulation  bin- 
aurals  are  furnished  with  this 
stethoscope. 

TRY  IT  a week;  if  not  sat- 
isfied, return  and  your  money 
will  be  cheerfully  refunded. 


JOHN  D.  POLLARD,  M.  D. 

3603  Flournoy  Street  Chicago,  111. 


NICHOL/'  POWDER 


Get  this  Nasal  Powder- 

J FREE/ 

We  want  every  physician  to 
try  Nichols  Nasal  Syphon 
Powder-lls  new  and  unusual- 
ly fine  for  use  with  the  Nichols 
Nasal  Syphon  - or  wherever 
nasal  cleansing  is  indicated, 

NICHOL/ 

NAyAL  ^YPHON.INC. 

159  East  54,hSt.-’  N.Y.C. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Preceding  Page) 
culosis  indicated  that  the  administration  of  viosterol 
did  not  produce  any  detectable  acceleration  of  the 
healing  process.  These  observations  suggest  that  such 
value  as  cod-liver  oil  possesses  in  tuberculosis  does 
not  depend  on  its  relatively  high  concentration  of 
vitamin  D.  These  studies  emphasize  the  fact  that 
cod-liver  oil  possesses  more  than  one  claim  to  nutri- 
tive value,  for  it  is  even  richer  in  vitamin  A than  in 
the  antirachitic  factor.  In  spite  of  the  enormous  anti- 
rachitic potency  of  viosterol,  this  material  is  by  no 
means  to  be  regarded  as  therapeutically  equivalent 
to  cod-liver  oil. — Jour.  A.  M.  A.,  February  8,  1930, 
p.  414. 

The  Committee  on  Foods. — More  than  a hundred 
products,  representing  the  products  of  numerous 
manufacturers,  have  been  submitted  to  the  committee, 
in  addition  to  several  national  advertising  campaigns 
by  cooperative  marketing  organizations.  This  co- 
operation is  welcomed  by  the  committee,  but  obvi- 
ously has  thrown  a great  burden  of  work  on  the 
committee  at  the  start.  Manufacturers  have  greeted 
with  acclaim  the  permission  to  use  on  packages  and 
in  advertising  the  seal  of  the  committee.  Whereas 
less  food  is  eaten,  so  far  as  concerns  caloric  or  energy 
value,  foods  have  been  greatly  modified  to  improve 
palatability  and  to  provide  what  are  recognized  as 
necessary  ingredients  in  the  form  of  vitamins  and 
mineral  salts.  It  is  the  hope  of  the  committee  that 
its  efforts  will  give  stability  to  a rapidly  growing  in- 
dustry and  prevent  the  sinking  of  the  modern  food 
market  in  a morass  of  hokum  such  as  engulfed  the 
drug  industry  in  its  developing  stages. — Jour.  A.  M.  A., 
February  8,  1930,  p.  415. 

Vigantol  Not  Accepted. — “Viosterol’'  is  the  name 
adopted  by  the  Council  on  Pharmacy  and  Chemistry 
(Continued  on  Page  46) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


5Dlathetmu. 

fot  aenetatina.  Aeat  wilAiji  t/e  tissues 


Anything  short  of  major  calibre 
in  a diathermy  machine  will 
prove  disappointing.  TheVictor 
Vario  Frequency  Diathermy 
Apparatus  is  designed  and  built 
to  meet  every  requirement.  It 
has,  first,  the  necessary  capacity 
to  create  the  desired  physio- 
logical effects  within  the 
heaviest  part  of  the  body; 
secondly,  a refinement  of  control 
and  selectivity  unprecedented 
in  high  frequency  apparatus. 


ABUNDANT  evidence  of  an  in- 
creasing  use  of  diathermy  in 
therapeutics  is  offered  through  a 
perusal  of  the  outstanding  period- 
icals in  the  medical  library. 

The  widely  varying  applications 
of  this  form  of  heat,  indicates 
also  that  almost  every  physician, 
whether  in  general  or  specialized 
practice,  will  find  this  energy  of 
inestimable  value  in  some  condi- 
tions met  with  almost  daily.  Many 
of  these  clinical  reports  cite  un- 
usually stubborn  conditions,  of  long 
standing,  which  have  yielded  to 
intelligent  use  of  diathermy,  with 
results  gratifying  to  physician  and 
patient  alike. 


When  heat  is  desired  within  the 
tissues,  regardless  of  how  deep 
seated  the  pathology  may  be,  noth- 
ing known  to  medical  science  can 
create  heat  within  the  affected  part 
so  quickly  and  directly  and  con- 
veniently, as  a correctly  designed 
diathermy  machine. 

If  you  are  interested  in  investi- 
gating this  subject  through  the 
opinions  of  recognized  medical 
authorities,  we  will  be  glad  to  send 
you,  without  obligation,  the  book- 
let “Indications  for  Diathermy,” 
containing  abstracts  and  digests 
from  recent  literature  on  the  sub- 
ject, and  arranged  by  specialty. 


SAN  FRANCISCO:  Four-fifty  Sutter 
LOS  ANGELES:  Medico-Dental  Building 


GENERAL  ® ELECTRIC 


X-RAY  CORPORATION 


2012  Jackson  Boulevard 


FORMERLY  VICTOR 


Chicago,  111.,  U.  S.  A. 


X-RAY  CORPORATION 


Join  us  in  the  General  Electric  Hour,  broadcast  every  Saturday 
at  9 d.  m..  E.  S.  T..  on  a nation-wide  N.  B.  C.  network 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


4.6 


DIATHERMY 


GALVANIC 


SINE  WAVE 


X-RAY 


Dewar  & Hare  Electric  Co* 


386  Seventeenth  Street 


Oakland,  California 


THE  "THERMOTAX” 

A high  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 


THE  "ELECTROTAX” 

A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 

Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


San  Francisco  Home  for 
Incurables,  Aged  and  Sick 

2750  Geary  Street,  N.  E.  corner  Wood  Street 
Telephone  WEst  5700 

A non-profit  institution  for  the  service  of  persons  of 
limited  means.  Two  large  courts  with  gardens ; 
solariums,  roof  garden  and  sun  room. 

Day  and  night  nursing  care— ^Staff  Physician  in  at- 
tendance— Private  Physician  if  desired. 

Convalescent  patients  received. 

No  mental,  alcoholic  or  contagious  cases  accepted. 
Formal  application  required  before  admission. 

DR.  GEO.  W.  COX 
(Johns  Hopkins)  Attending  Physician 
MISS  MARY  A.  TAUTPHAUS,  R.N.,  Superintendent 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  44) 

for  irradiated  ergosterol,  and  “viosterol  in  oil  100  D” 
for  a solution  in  vegetable  oil  having  one  hundred 
times  the  antirachitic  potency  of  a standard  cod-liver 
oil.  All  of  the  firms  licensed  by  the  University  of 
Wisconsin  Foundation  to  prepare  this  preparation 
have  agreed  to  cooperate  with  the  Council  on  Phar- 
macy and  Chemistry,  by  using  this  name,  except  the 
Winthrop  Chemical  Company.  The  Winthrop  Chemi- 
cal Company  has  determined  to  call  its  product 
“Vigantol,”  notwithstanding  the  fact  that  the  Council 
has  declared  that  the  application  of  such  a proprietary 
name  is  contrary  to  the  best  interests  of  the  medical 
profession  and  the  public.  The  medical  profession 
must  support  the  Council  in  this  type  of  work  if  the 
Council’s  efforts  are  to  be  effective. — Jour.  A.  M.  A., 
February  8,  1930,  p.  415. 


Misbranded  Pharmaceuticals. — During  1929  Notices 
of  Judgment  were  issued  by  the  Food,  Drug  and 
Insecticide  Administration  of  the  United  States  De- 
partment of  Agriculture  against  the  following  phar- 
maceutical products  that  were  found  adulterated  or 
misbranded — or  both— under  the  Food  and  Drugs 
Act:  Spirits  of  Nitre  (W.  H.  Crawford  Company, 
Baltimore,  Maryland);  Damiana  Herb  (S.  B.  Penick 
& Company,  Inc.,  New  York  City);  Combination 
Tablets  (P.  H.  Mallen  Company,  Chicago);  Alter- 
ative Tablets  (P.  H.  Mallen  Company,  Chicago); 
Pituitary  Extract  (Pharmacal  Products  Company, 
Inc.,  Easton,  Maryland);  Phenolphthalein  Compound 
Tablets  (P.  H.  Mallen  Company,  Chicago). — Jour. 
A.  M.  A.,  February  8,  1930,  p.  428. 

EfeDroN  Hart  Nasal  Jelly. — EfeDroN  Hart  Nasal 
Jelly  is  another  one  of  the  ever  increasing  ephedrin 
proprietaries.  The  preparation  is  made  by  the  Hart 
(Continued  on  Page  48) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


THE  SAFE  MILK 


MADE  FROM  „nnu 

w&IOR  Quality  milk  FROM 
part  ofthe  butter  fat 
has  been  removed  and  then  orih> 
by  the  'Oust’'  process. 

<Mf&TICULarly  SUITABLE  FOR  n6 

FANT  and  convalescent  FE£D 

APPROXIMATE  AMTTS1S- 
butter  fat  12% 
milk  sugar  ow° 
protein  32% 

SALTS  7«/o 
MOISTURE  3% 


Contains  all 
the 

Vitamins 
U nim- 
paired 


Not  poor  hygienic  con 
ditions  nor  poor  ventila 
tion — but  poor  diet  is  the  main 
factor  in  promoting  the  incidence 
of  malnutrition;  tuberculosis;  anemia 
etc.  Milk  must  be  free  from  pa  th  ogenic 
bacteria  and  be  digestible  to  be  beneficial! 

DRY  CO  is  well  tolerated  by  the  most  delicate 
stomach;  has  a high  fat  metabolism;  gives  immediate 
relief  from  digestive  disturbances  ana  increases  the 
weight.  The  protein  of  DRYCO  is  97  per  cent  assimilable. 

SEND  FOR  SAMPLES  AND  CLINICAL  DATA 

THE  DRY  MILK  COMPANY,  Inc.,  15  Park  Row,  New  York,  N.YJ 


y 


48 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 

FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  i Excellent  Cuisine 

DR.  MAX  ROTHSCHILD  DR.  HARRY  C.  WARREN 

Medical  Director  Asst.  Medical  Director 


Rates  and  Prospectus  on  Request 


San  Francisco  Office 
384  Post  Street 
Phone  DAVENPORT  4466 


Address:  BELMONT,  CALIF. 
Phone  BELMONT  100 
(3  Trunk  Lines) 


No.  611 — 16"  Physician’s  Bag,  in  Black  or 
Brown,  Price  $13.00 

Bischoff’s  Surgical  House 

THE  HOUSE  OF  SERVICE 

427  20th  Street,  Elks  Bldg.,  Oakland,  Calif. 

Branch,  68  So.  1st,  San  Jose,  Calif. 

A COMPLETE  LINE  OF  PHYSICIAN’S, 
HOSPITAL  AND  SICKROOM  SUPPLIES 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  46) 

Drug  Corporation,  Miami,  Florida.  According  to  the 
label  the  formula  is:  Ephedrine  hydrochloride  Gr.  1; 
Chlorbutanol  Gr.  2^4;  Sodium  Chloride  Gr.  2^4;  Men- 
thol Gr.  3;  Phenol  Gr.  2;  Oil  of  Cinnamon  Gr.  0.08; 
Jelly  base  q.  s.  ad  drachms  5.  The  preparation  has 
not  been  accepted  for  New  and  Nonofficial  Remedies. 
While  physicians’  samples  of  this  product  have  been 
liberally  distributed,  the  carton  is  one  which  seem- 
ingly is  addressed  to  the  public  as  well.  — Jour. 
A.M.A.,  February  8,  1930,  p.  430. 

Farastan  Not  Acceptable  for  New  and  Nonofficial 
Remedies. — The  Council  on  Pharmacy  and  Chemistry 
reports  that  Farastan  is  the  name  under  which  the 
Farastan  Company,  Philadelphia,  markets  a prepara- 
tion of  iodin  and  cinchophen  claimed  to  be  mono- 
iodo-cinchophen.  The  preparation  is  recommended 
for  use  in  “Arthritis  . . . Rheumatoid  and  Neuritic 
conditions.”  The  Council  reports  that  there  is  no  evi- 
dence that  the  routine  use  of  cinchophen  and  iodid 
in  fixed  proportions  (or  in  any  proportions)  is  desir- 
able or  rational.  Usually,  the  conditions  that  require 
cinchophen  do  not  require  the  simultaneous  adminis- 
tration of  the  iodids,  and  vice  versa,  and  that  it  ap- 
pears particularly  undesirable  and  even  dangerous  to 
encourage  the  routine  prescribing  of  cinchophen, 
which  should  be  used  only  for  short  periods,  with  an 
iodid  compound,  which  must  be  continued  over  long 
periods.  The  Council  declared  Farastan  unacceptable 
for  New* and  Nonofficial  Remedies  because  it  is  an 
irrational  preparation  marketed  with  unwarranted 
therapeutic  claims. — Jour.  A.  M.  A.,  February  IS,  1930, 
p.  484. 

Antistreptococcus  Serum  Omitted  From  New  and 
Nonofficial  Remedies. — The  Council  on  Pharmacy  and 
Chemistry  reports  that  for  some  years  it  has  been 
questioning  the  value  of  antistreptococcus  serum 

(Continued  on  Page  52) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


Announcing 
The  new 

AUDIPHONE 

This  hearing  device  is  equipped  with  a small 
inconspicuous  earpiece  and  a powerful  light- 
weight battery  which  can  be  easily  concealed. 

The  Audiphone  was  developed  in  the  Bell 
Telephone  Laboratories,  and  is  manufactured 
by  the  Western  Electric  Company — a strong 
guarantee  of  its  reliability. 

Full  details  or  demonstration  upon  request 

■ 


W.  D.  FENNIMORE  . . A.  «.  FENNIMORE 


177-181  Post  Street  San  Francisco 


The  Custom  House. — To  most  people,  the  old  Cus- 
tom House  in  Monterey  is  the  most  interesting  build- 
ing on  the  Pacific  Coast.  In  the  earliest  days  it  was 
not  only  used  for  conduct  of  royal  business,  but  it 
was  a social  center  for  Spanish  aristocrats.  Here 
beneath  the  Spanish  flag,  pressing  matters  of  state 
were  settled,  and  gala  balls  were  held.  The  upper 
end  was  built  in  1814  by  the  Spaniards.  The  center 
section  was  built  by  the  Mexicans  when  they  had 
wrested  independence  from  Spain.  In  1846  Commo- 
dore Sloat  raised  an  American  flag  over  the  building, 
and  the  lower  end  of  the  Custom  House  was  built 
by  the  Americans.  First  Spanish,  then  Mexican,  then 
United  States  property,  the  Custom  House  is  now 
owned  by  the  State  of  California.  It  is  an  adobe 
structure,  and  in  good  preservation. 


Colton  Hall. — Here  was  the  cradle  of  the  western 
empire:  the  first  capitol  of  California.  Commodore 
Stockton,  who  succeeded  Commodore  Sloat,  ap- 
pointed Reverend  Walter  Colton  the  alcalde  of  Mon- 
terey. Colton  had  been  chaplain  of  the  historic  frigate 
Congress.  Later  Colton  was  elected  alcalde  by  the 
people.  Ambitious  for  a state  house,  he  set  about 
raising  funds  with  typical  fervor.  Subscriptions,  court 
fines,  prison  labor,  gambling  levies — all  did  their 
share  toward  rearing  Colton  Hall.  Here  in  Septem- 
ber, 1849  met  the  first  constitutional  convention  of 
California.  The  city  of  Monterey  now  uses  this 
ancient  structure — which  is  in  excellent  condition- — as 
a City  Hall. 


Point  Pinos  Lighthouse. — Point  Pinos  was  named 
by  Vizcaino  when  he  named  Monterey  in  1602.  On 
this  headland,  about  two  miles  west  of  Pacific  Grove, 
is  one  of  the  oldest  lighthouses  of  the  Pacific  Coast. 
Built  about  the  time  of  the  gold  rush,  it  has  long 
been  a beacon  of  safety  to  countless  mariners. 


Would  you  buy 

an  automobile  which  has  no 
local  station  to  give  you  service? 

Professional 

Liability 

Insurance 

must  be  backed  by  a universal 
and  permanent  organization  of 
local  agents  and  claim  investi- 
gators to  assure  complete  and 
satisfactory  protection  in  time 
of  trouble. 

Over  $68,000,000  We  insure  only 

in  Resources  ethical  practitioners 


UNITED  STATES  FIDELITY 
AND  GUARANTY  COMPANY 

BALTIMORE,  MARYLAND 

BRANCH  OFFICES 

340  Pine  Street,  San  Francisco,  Calif. 

1404  Franklin  Street,  Oakland,  Calif. 

724  South  Spring  Street,  Los  Angeles,  Calif. 

602  San  Diego  Trust  8C  Savings  Building 
San  Diego,  Calif. 

Continental  Nat’I  Bank  Bldg.,  Salt  Lake  City,  Utah 


50 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Doctor!  Have  You  a 
Collection  Problem? 


Our  bookkeeper  fails 
to  find  your  account 
settled  on  our  books. 
Please  help  him  out. 


pAST  DUE! 

i)#"'  This  Account  has  no  doubt  escaped 
your  notice.  Will  you  please  favor  us  with 
a remittance  by  return  mail  and  oblige? 


THIS  ACCOUNT 

IS  PAST  DUE. 
PLEASE  REMIT. 


Regarding  Your  Past-Due  Account 

Our  records  show  that  several  statements  and  re- 
minders have  been  sent  you  regarding  the  enclosed 
statement. 

If  your  circumstances  have  made  it  impossible  for 
you  to  pay  the  amount  due,  kindly  write  us  promptly 
to  that  effect.  Our  office  will  then  endeavor  to  extend 
all  possible  courtesies. 

You  appreciate,  we  are  sure,  that  physicians,  like 
other  citizens,  must  pay  their  bills  promptly.  They 
can  only  do  so,  however,  when  their  own  clients  in 
turn  pay  them  promptly  for  such  professional  services 
as  may  have  been  rendered. 

A check  to  cover  your  account,  which  is  now  con- 
siderably overdue,  will  be  appreciated. 


Final  Notice 

In  practically  all  businesses  the  custom  which  is 
generally  followed  with  overdue  accounts  is  to  send 
such  to  a collecting  agency. 

Our  bookkeeper  has  nothing  in  the  records  of  the 
office  to  show  when  you  intend  to  pay  the  enclosed 
account.  Perhaps  the  previous  statements  and  remind- 
ers may  have  been  overlooked  or  ignored. 

Following  the  rule  of  this  office,  this  overdue  account 
will  be  sent  to  the  collecting  agency  within  ten  days 
if  arrangements  for  its  settlement  are  not  made  prior 
to  that  time. 

This  collection  bureau  method  is  disagreeable  to  us ; 
and  we  believe,  also  to  you.  By  promptly  sending  your 
check  all  this  can  be  avoided. 

When  an  account  is  sent  to  the  collecting  agency 
that  organization  takes  full  charge  of  it  thereafter. 


"The  doctor  who  does  not  collect  a goodly 
proportion  of  the  fees  he  has  earned,  is  more 
than  apt  to  be  faced  with  a column  in  the 
red;  and  no  man  can  do  justice  to  himself 
in  his  profession  and  give  expression  to  his 
best  work,  and  capacity  under  such  a handi- 
cap. . . . This  system  creates  a minimum  of 
antagonism  among  delinquent  patients  in  its 
results 

Reprinted  from  “California  and  Western 
Medicine,”  September,  1927. 


These  collection  stickers  and  notices  are 
now  stocked  by  us  and  the  numerous  repeat 
orders  speak  well  for  the  effective  manner 
in  which  they  have  stimulated  the  collection 
of  dormant  accounts. 

The  prices  quoted  below  are  for  the  com- 
plete series  — three  gum  stickers  and  two 
notices,  as  reproduced  in  this  ad.  The  price 
includes  postage: 


250. 

500 

1000. 


4 6.75 
_ 9.00 

_ 13.50 


We  shall  be  pleased  to  quote  you  on  any 
other  piece  of  printed  matter  for  which  you 
may  be  in  the  market. 


The  JAMES  H.  BARRY  COMPANY 


1 1 22-24  MISSION  STREET 
SAN  FRANCISCO,  CALIFORNIA 
[Telephone  MArket  7900  ] 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5t 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  275  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newly  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


RESENTING 


Syringe 


LOCAL, 
REGIONAL 
AND  SPINAL 
ANAESTHESIA 
-by 

. Dr.  William 

R.  Meeker 


The  Meeker  Syringe,  of  10  cc.  capacity, 
features  special  glass  barrel,  eccentric  tip, 
and  bayonet-lock  attachment  ....  $4.50 

Circular  showing  flexible  stainless 
steel  Meeker  needles,  on  request 


yvb 

Compromise 


Often  the  quality  of  the  supplies  you  buy 
can  be  determined  only  by  usage.  For  in- 
stance, two  instruments  may  "look”  alike. 
Yet  under  the  polish  one  may  be  cast  iron, 
the  other  hand-tooled  steel. 


Since  1844  Sharp  & Smith  has  maintained 
a policy  of  "No  compromise  with  Quality.” 
This  is  one  of  the  reasons  you  order  your 
instruments  and  supplies  from  the  SandS 
catalog  with  the  assurance  of  complete  satis- 
faction. 


General  Hospital  and  Surgical  Supplies 

65  East  Lake  Street  Chicago,  111. 


52 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Experienced  Technicians  in  Clinical  Laboratory 
and  Physiotherapy  Departments.  Electrocardio- 
graphic and  Basal  Metabolic  determinations  made. 


The 

Santa  Barbara  Clinic 

1421  State  Street 

SANTA  BARBARA,  CALIFORNIA 

General  Surgery 

Rexwald  Brown,  M.  D. 

Irving  Wills,  M.  D. 

Internal  Medicine 

Hilmar  O.  Koefod,  M.  D. 

H.  E.  Henderson,  M.  D. 

Wm.  M.  Moffat,  M.  D. 

Neville  T.  Ussher,  M.  D. 
Obstetrics  and  Gynecology 

Benjamin  Bakewell,  M.  D. 
Lawrence  F.  Eder,  M.  D. 
Diseases  of  Children 

Howard  L.  Eder,  M.  D. 

Ear,  Nose  and  Throat 

H.  J.  Profant,  M.  D. 

Wm.  R.  Hunt,  M.  D. 

U rology 

Irving  Wills,  M.  D. 

Orthopedics 

Rodney  F.  Atsatt,  M.  D. 

Eye 

F.  J.  Hombach,  M.  D. 
Roentgenology 

M.  J.  Geyman,  M.  D.,  Consultant 


ST.  JOSEPH’S  HOSPITAL 


SAN  FRANCISCO, 
CALIFORNIA 


Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


Health  First 

SPRING  WATER 

Delivered 

to  Offices  and  Homes 
Entire  Bay  District 

Purity  Spring  Water  Co. 

2050  Kearny  Street 
San  Francisco 
Phone  DAvenport  2197 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  48) 

preparations.  In  1928  the  Council  decided  that  unless 
new  and  favorable  evidence  became  available,  all 
streptococcus  serum  preparations  would  be  omitted 
from  New  and  Nonofficial  Remedies  with  the  close  of 
1929.  Since  no  such  new  evidence  has  become  avail- 
able, the  Council  has  omitted  all  antistreptococcus 
serum  preparations  as  follows:  Antistreptococcic 
Serum  (Gilliland  Laboratories,  Inc.);  Antistrepto- 
coccic Serum,  Polyvalent  (Lederle  Antitoxin  Labora- 
tories); Antistreptococcic  Serum  (Eli  Lilly  & Co.); 
Antistreptococcic  Serum,  Purified  and  Concentrated 
(Lilly);  Antistreptococcic  Serum,  Polyvalent  (H.  K. 
Mulford  Co.);  Antistreptococcic  Serum  (National 
Drug  Co.);  Antistreptococcic  Serum  (Parke,  Davis 
& Co.);  Antistreptococcic  Serum  (Squibb). — Jour. 
A.  M.  A.,  February  15,  1930,  p.  484. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 


Los  Angeles  Office 
WILSHIRE  MEDICAL  BLDG. 
1930  Wilshire  Blvd. 


For  particulars  address: 

POTTENGER  SANATORIUM 

Monrovia,  California 


Udga  Stomach  Treatment. — The  formula  of  Udga 
is,  apparently,  secret — at  least  none  of  the  advertis- 
ing matter  and  follow-up  letters  give  it.  The  Udga 
Medicine  Company,  which  puts  up  this  preparation, 
was  formerly  known  as  the  Phungen  Laboratories. 
The  preparation  is  advertised  as  a mail-order  treat- 
ment for  stomach  ulcer,  gastritis,  and  dyspepsia. 
From  tests  made  in  the  American  Medical  Associa- 
tion Chemical  Laboratory  it  appears  that  the  prepara- 
tion is  similar  in  composition  to  the  Pfunder  Stomach 
Tablets  which  were  found  to  contain  bismuth  sub- 
nitrate, magnesium  oxid,  and  sodium  carbonate. — 
Jour.  A.  M.  A.,  February  15,  1930,  p.  504. 


A Thoroughly  Equipped 


PHYSICAL  THERAPY 

LABORATORY 

Available  to  patients  under  prescription  of 
licensed  physicians. 

DELMER  J.  FRAZIER 


The  Coffey-Humber  Cancer  Treatment. — The  pub- 
licity given  through  Hearst  newspapers  primarily,  to 
the  Coffey-Humber  cancer  treatment  has  brought 
about  the  very  type  of  injury  to  scientific  research 
that  was  predicted.  Regardless  of  the  fact  that  Drs. 
Coffey  and  Humber  have  made  it  clear  that  their 
work  is  purely  experimental  and  that  they  do  not 
claim  to  have  developed  a cancer  cure,  the  great  trek 
of  cancer  sufferers  across  the  continent  has  begun 
and  physicians  everywhere  are  besought  by  their 
patients  to  procure  this  remedy. — Jour.  A.  M.  A.,  Feb- 
ruary 22,  1930,  p.  562. 

Viosterol  or  Irradiation. — If  rickets  is  the  disorder 
that  is  to  be  cured  or  averted,  both  cod-liver  oil  and 
irradiated  ergosterol,  the  latter  now  available  as  vio- 
sterol in  oil  100  D,  act  as  specifics;  so  that  irradi- 
ation with  artificial  light  sources  is  not  essential 
though  its  effectiveness  to  accomplish  the  same  ends 
deserves  emphasis.  Viosterol  also  serves  to  promote 
the  proper  metabolism  of  calcium  and  phosphorus  in 
other  disorders.  On  the  other  hand,  irradiation  with 
ultra-violet  rays  doubtless  produces  a variety  of  phy- 
siologic effects  about  which  we  are  still  largely  un- 
informed.— Jour.  A.  M.  A.,  February  22,  1930,  p.  580. 


426-427  Dalziel  Building 
OAKLAND 
PHONE  LAKESIDE  5659 


Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


54 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


§T„  MARY’S  HOSPITAL  San  Francisco 

Conducted  by  Sisters  of  Mercy 

Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.  A.  C.  3. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Burns,  M.  D. 


Obstetrics 

Philip  H.  Arnot,  M.  D. 
Medicine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 

Stephen  Cleary,  M.  D. 

T.  T.  Shea,  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M.  D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M.  D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Chas.  C.  Mohun,  M.  D. 

Randolph  G.  Flood,  M.  D. 

Heart 
Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 
Dentistry 

Thos.  Morris,  D.  D.  S. 
Francis  L.  Meagher,  D.  D.  S. 


Trademark  CL  C np^XTI  H /f  99  Trademark 
Registered  g UKlVl  Registered 

Binder  and  Abdominal  Supporter 


The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-Iliac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 


Katherine  L.  Storm,  M.  D. 

Originator,  Owner  and  Maher 
1701  Diamond  Street,  Philadelphia,  Pa.,  U.  S.  A. 


Hotel  Del  Monte 


Old  Whaling  Station. — This  picturesque  adobe,  with 
its  balcony  hanging  over  the  whale-bone  sidewalk  in 
front  of  the  old  house  on  Decatur  Street  at  the  corner 
of  Pacific  Street,  was  built  early  in  the  nineteenth 
century  as  a private  home.  It  was  later  used  as  head- 
quarters of  the  whalers  of  Monterey.  Despite  the 
street  improvements,  the  old  sidewalk,  made  of  tiles 
carved  from  the  vertebrae  of  whales,  is  still  an  object 
of  use  as  well  as  curiosity.  This  adobe  is  now  a pri- 
vate home. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

•F 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Year  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


California’s  First  Brick  House. — A stone’s  throw 
from  the  old  Custom  House  stands  the  first  brick 
structure  California  ever  saw.  A Virginian  named 
Dickinson  built  this  home  from  bricks  kilned  in  Mon- 
terey. In  those  days  before  the  gold  rush,  it  was  a 
show  spot  of  Monterey.  Like  the  old  adobes,  it  seems 
to  rest  eternally  beneath  the  soft  sun  and  wonder 
why  so  many  people  regard  it  awesomely.  Recently 
there  was  torn  down  in  Monterey  the  first  house  of 
milled  lumber  built  in  California,  brought  here  by  an 
Australian  who  did  not  know  trees  grew  in  America. 


The  Del  Monte  Gun  Club,  less  than  half  a mile 
from  the  hotel,  is  a busy  spot  the  year  round.  A well- 
equipped  field  house  takes  care  of  the  temporary 
needs  of  shooters,  while  eight  traps,  with  shooting 
positions  set  in  cement,  give  this  club  shooting  facili- 
ties found  nowhere  else.  This  club  is  managed  by 
O.  N.  Ford,  vice-president  of  the  American  Trap- 
shooting Association,  and  he  is  always  happy  to  give 
free  instruction  to  hotel  guests  who  wish  to  learn  the 
fundamentals  of  this  fascinating  sport. 


In  the  Del  Monte  Forest  are  to  be  found  two  coun- 
try clubs:  Cypress  Point  and  the  Monterey  Penin- 
sula Club,  each  with  its  own  golf  course  and  other 
recreational  facilities. 

To  the  south,  less  than  an  hour’s  drive  from  Del 
Monte,  is  the  Santa  Barbara  National  Forest,  includ- 
ing an  untouched  wilderness  of  half  a million  acres. 


Both  Monterey  and  Carmel  bays  afford  excellent 
sea  fishing,  with  a greater  variety  of  gamy  fish  than 
can  probably  be  found  anywhere  in  the  world.  Among 
the  most  prized  are  king  salmon,  sea  bass,  barracuda, 
tuna,  mackerel,  perch,  sea  trout,  rock  cod,  tom  cod, 
smelt,  and  in  the  rivers  and  streams  are  trout  and 
steelhead.  In  these  same  bays  are  beautiful  marine 
gardens  to  be  viewed  from  glass-bottomed  boats. 


Announcings 

THE  NEW  GALVA  SINE  WAVE 
APPARATUS 

The  only  Low- Volt  Apparatus  at  a 

low  price  $75.00 

RELIEVES  PAIN  INSTANTLY! 

Its  use  is  indicated  wherever  deep  penetration 
is  desired ; for  exercising  weak  muscles,  as  in 
muscular  atrophy,  intestinal  stasis,  post-opera- 
tive adhesions  and  many  other  conditions. 

Descriptive  literature  and  terms  sent  on  request 

Exclusive  Northern  California  Factory 
Representative 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Bldg. 

391  Sutter  Street  San  Francisco 

Telephone  SUTTER  5314 


5(> 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


NEW!  KOMPAK  MODEL 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . . and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


iir«Fir*Jnry  fST 


STANDARD  FOR  BLOODPRESSURE 


Demonstration,  or  Sent  for  Inspection  Upon  Request 


RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


A GOOD  COLLECTION  SERVICE 

"WE  GET  THE  COIN”  "WE  PAY ” 

BITTLESTON  COLLECTION  AGENCY,  Inc. 

1211  Citizens  National  Bank  Bldg.  LOS  ANGELES  TRinity  6861 


Amusements  to  Be  Had  at  Del  Monte. — Del  Monte 
since  1880  has  been  California’s  largest  and  best  loved 
playground.  It  is  known  the  world  over  for  its  natu- 
ral beauty,  its  diversity  of  entertainment,  its  accessi- 
bility, and  its  open  hospitality. 

To  the  east  of  the  hotel,  fifty  yards  away,  is  the 
tile  and  marble  outdoor  Roman  plunge.  The  salt 
water  is  crystal-clear  and  is  warmed  just  enough  to 
take  away  the  shock  of  the  first  dip.  Dressing-rooms, 
showers,  and  secluded  sun-bath  patios  add  to  the 
pleasure  of  bathers. 

Del  Monte  and  golf  mean  one  and  the  same  thing 
to  most  Californians.  Here  California  championships 
are  played  each  September.  Here  are  two  unsur- 
passed golf  courses.  The  old  Del  Monte  course, 
within  five  minutes'  walk  of  the  hotel,  is  probably 
the  most  popular  links  on  the  Pacific  Coast. 

More  than  two  hundred  miles  of  bridle  paths  and 
private  motor  roads  honeycomb  the  Del  Monte 
Forest. 

Both  Del  Monte  and  Pebble  Beach  have  well- 
equipped  riding  stables  with  excellent  horses  and 
courteous,  intelligent  riding  masters  and  grooms. 
Maps  of  the  various  woodland  trails  and  beach  gal- 
lops will  be  furnished  those  interested. 


President  Hoover  Temporarily  Bars  Importation 
of  Parrots. — A special  news  dispatch  from  Washing- 
ton, D.  C.,  to  the  New  York  Times  states  than  an 
executive  order  temporarily  barring  the  importation 


of  parrots  into  the  United  States  from  any  country 
was  issued  by  President  Hoover  on  January  24.  The 
order  is  designed  to  check  the  spread  of  psittacosis 
or  “parrot  fever”  and  reads  as  follows: 

Restricting  for  the  time  being  the  introduction  of 
parrots  into  the  United  States: 

Whereas,  there  has  been  officially  reported  in 
widely  separated  portions  of  the  United  States  since 
the  middle  of  December,  1929,  a considerable  number 
of  human  cases,  some  of  them  fatal,  of  a disease  com- 
municated by  infected  parrots;  and 

Whereas,  there  is  evidence  that  such  parrots  have 
been  introduced  from  ports  outside  of  the  Continental 
United  States;  and 

Whereas,  there  exists  danger  of  further  such  intro- 
duction; 

Therefore,  in  order  to  prevent  the  further  introduc- 
tion of  disease  communicable  from  parrots  to  human 
being  from  ports  outside  of  the  Continental  United 
States  into  the  United  States,  by  virtue  of  the 
authority  vested  in  me  by  Section  7 of  the  Act  of 
Congress  approved  February  15,  1893,  entitled  “An 
act  granting  additional  quarantine  powers  and  impos- 
ing additional  duties  on  the  Marine  Hospital  Service,” 
it  is  ordered  that  no  parrots  may  be  introduced  into 
the  United  States  or  any  of  its  possessions  or  depend- 
encies from  any  foreign  port  for  such  period  of  time 
as  may  be  deemed  necessary,  except  under  such  con- 
ditions as  may  be  prescribed  by  the  Secretary  of  the 
Treasury.  . . . — Health  News,  February  3,  1930. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  an  Approved 

Clinical  Laboratory 

DEFINITION 

"*  * * a clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application  of 
one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and  methods,  for 
for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in  the  human  body.” 

" Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  personnel  and 
records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed  as  approved.” 

" The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to  be 
properly  carried  out.” 

THE  DIRECTOR 

" The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college  or 
university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have  specialized  in 
clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for  at  least  three  years. 
He  must  be  a man  of  good  standing  in  his  profession.” 

" The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major  part  of 
his  time  to  the  supervision  of  the  laboratory  work.” 

" The  director  may  make  diagnoses  only  when  he  is  a licensed  graduate  of  medicine,  has  specialized 
in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of  disease  in  the 
patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports.” 

" The  director  may  have  assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hematologic, 
biochemical,  serologic  and  pathologic  should  be  made  to  the  director.” 

RECORDS 

" Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  laboratory 
should  have  appended  pertinent  ctinical  data.” 

PUBLICITY 

" Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bulletins 
or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the  name,  address, 
telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel,  fields  of  work  covered, 
office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain  misleading  statements.  Only 
the  names  of  those  rendering  regular  service  to  the  laboratory  should  appear  on  letterheads  or  other  form 
of  publicity.” 

FEES 

"*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director  and 
any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism,  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


5$ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Annual  Meeting 

of  the 

American  Association 
for  the  Study  of  Qoiter 

SEATTLE,  WASHINGTON 


July  10,  11,  12,  1930 


Addresses  or  Demonstrations 

will  be  made  by  the  following  (partial  list): 

ROY  D.  McCLURE,  Detroit 
WM.  J.  KERR,  San  Francisco 
J.  EARLE  ELSE,  Portland,  Oregon 
LEWIS  M.  HURXTHAL,  Boston 
THOMAS  M.  JOYCE,  Portland,  Oregon 
CHARLES  T.  STURGEON,  Los  Angeles 
LEO  P.  BELL,  Woodland,  California 
MARTIN  B.  TINKER,  Ithaca 
THOMAS  O.  BURGER,  San  Diego 
C.  G.  TOLAND,  Los  Angeles 
JOHN  S.  HELMS,  Tampa 
C.  A.  ROEDER,  Omaha 
LeROY  LONG,  Oklahoma  City 
HAROLD  BRUNN,  San  Francisco 
ROBERTSON  WARD,  San  Francisco 
R.  J.  MELLZNER,  San  Francisco 
PHILIP  K.  GILMAN,  San  Francisco 
E.  R.  ARN,  Dayton,  Ohio 
E.  STARR  JUDD,  Rochester,  Minn. 


All  Physicians  Interested  in  Recent  Advances  in 
Knowledge  of  Diseases  of  the  Thyroid  Gland 
Are  Cordially  Invited  to  Attend  This  Meeting. 

Special  Pullman  Cars  will  be  attached  to  the 
C.  and  N.  W.  Canadian  National  Train  leaving 
Chicago,  5:40  P.  M.,  Wednesday,  July  2.  Stop- 
over Thursday  night  and  Friday  at  Winnipeg 
for  Special  Clinics.  Stopover  Sunday  and  Mon- 
day in  Jasper  National  Park.  Travel  through 
the  Canadian  Rockies  Tuesday.  Arrive  in  Seattle, 

July  9. 

Headquarters:  OLYMPIC  HOTEL 

Communications  relative  to  this  meeting  should  be 
addressed  to: 

J.  TATE  MASON 

Chairman,  Committee  on  Arrangements 
Mason  Clinic,  Seattle,  Washington 


For  use  in  the  Prevention  and  Treatment 
of  the  Acid- Ash  Type  of 

ACIDOSIS 

California  Lima  Bean  FLOUR! 

Alkalinity,  of  course,  neutralizes  acidity.  And 
Limas  are  one  of  the  most  alkaline  foods 
known — 41.65  per  100  grams! 

To  meet  a definite  demand  from  the  medical 
profession,  we  have  developed,  to  a high  degree 
of  fineness,  a Lima  Bean  FLOUR — for  making 
non-acid  breads,  muffins,  pancakes  and  waffles 
for  Basic  Diet  menus! 

Lima  FLOUR  is  available  in  10- lb.  bags  at 
#1-20,  and  in  100-lb.  bags  at  $10.00.  Upon 
receipt  of  price  and  delivery  instructions  your 
order  will  be  shipped  parcel  post  or  express  col- 
lect. Send  orders,  and  make  check  or  money 
order  payable  to — 

CALIFORNIA  LIMA  BEAN 
GROWERS  ASSOCIATION 

Oxnard,  California 


How  Sir  Luke  Fildes  Painted  “The  Doctor.” — The 

death  of  Sir  Luke  Fildes,  R.  A.,  who  painted  the 
famous  picture,  “The  Doctor,”  was  announced  some 
little  time  ago.  How  the  painter  of  this  much  ad- 
mired masterpiece  brought  it  into  being  is  related  in 
an  illustrated  interview  which  appear  id  in  the  Strand 
Magazine  (London,  1893,  pp.  111-127). 

It  appears  that  Mr.  Fildes  loved  to  paint  the  people, 
the  country  folk — to  paint  them  as  they  were,  histori- 
cally and  artistically.  “The  Doctor”  was  intended  as 
a portrait  of  the  English  physician  of  1890  in  a home 
of  that  period  where  a little  child  lay  desperately  ill. 
The  surroundings  were  such  as  the  artist  had  sketched 
in  his  journeys  from  Devon  to  Inverness  to  get  the 
character  of  the  people  and  the  general  background 
for  the  picture.  The  cup  and  basin  and  odds  and  ends 
in  furnishings  were  purchased  during  these  wander- 
ings. He  sketched  many  interiors  in  cottages  and 
fishers’  huts  and  then  returned  home  and  built  exactly 
to  size  in  the  end  of  his  studio  the  one  he  wanted  for 
his  picture.  It  was  a most  substantial  structure,  even 
the  massive  rafters  were  there. 

The  lamp  was  lighted  and  the  rays  of  early  dawn 
were  coming  in  through  the  windows.  For  the  child 
Mr.  Fildes  took  his  own  little  boy,  Geoffrey,  and 
described  the  happening  as  follows  to  Harry  How, 
author  of  the  interview  in  the  Strand  Magazine: 

When  he  wanted  his  morning  sleep  he  used  to  be 
brought  up  to  the  studio.  The  nurse  would  watch  him 
as  he  lay  on  the  chairs.  As  he  slept  I painted.  You 
see  the  hand  falling  down  by  the  side  helplessly? 
One  day,  I had  just  finished  the  picture  with  the 
child’s  hands  tucked  up  close  together  at  the  neck,  as 
children  sleep,  when  I noticed  my  boy’s  hand  fall 
over  the  side.  I thought  it  exquisite — so  pleading  and 
pitiful.  I altered  the  hands  in  the  picture  at  once,  and 
painted  the  left  one  as  you  see  it  now. 

The  artist  had  difficulty  in  securing  as  a model  for 
the  doctor  a person  with  the  decision  of  manner  that 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 

BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 
Consultants: 

Walter  F.  Schaller,  M.  D. 

Walter  B.  Coffey,  M.  D. 

Charles  Miner  Cooper,  M.  D. 

Walter  W.  Boardman,  M.  D. 

Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSGH  & LOMB  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 

Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty-fourth  Avenue  Oakland,  Calif. 

Telephone  Fruitvale  488 


he  had  in  mind,  and  so  he  levied  freely  on  five  or  six 
of  his  friends  for  a feature  resembling  his  ideal  and 
got  them  to  sit  for  him.  He  said  this  picture  had  re- 
mained in  his  mind  for  a very  long  time,  though  even- 
tually it  proved  the  quickest  painted  of  any  he  had 
ever  done. 

He  received  many  letters  asking  for  the  name  of 
“The  Doctor,”  one  being  from  a lady  who  was  ill  and 
who  asked  for  his  address,  saying  that  if  she  only  had 
a doctor  like  him  to  attend  her  she  felt  sure  she  would 
soon  be  restored  to  health. — Health  News  of  New  York. 


Concoctions  Claiming  to  Contain  Radium  Are 
Fakes  in  Many  Cases.— “Highly  exaggerated  claims, 
evidently  designed  to  mislead  the  purchaser,  are  made 
for  many  alleged  radioactive  products,”  says  J.  W. 
Sale,  an.  expert  of  the  United  States  Food,  Drug,  and 
Insecticide  Administration,  the  organization  of  the 


Department  of  Agriculture  charged  with  the  enforce- 
ment of  the  Federal  Food  and  Drugs  Act. 

In  order  to  obtain  a minimum  daily  dosage  of  radio- 
activity it  would  be  necessary  to  drink  1957  gallons 
of  water  each  day,  in  the  case  of  one  of  the  alleged 
radioactive  waters  examined. 

Action  is  being  taken  under  the  Federal  Food  and 
Drugs  Act  against  alleged  radioactive  products  which 
are  falsely  or  fraudulently  misbranded  under  the  terms 
of  the  law.  Many  have  already  been  removed  from 
the  channels  of  trade  and  others  are  under  investi- 
gation. 

Although  most  of  the  products  are  found  to  be 
deficient  in  radium,  they  might  be  dangerous  if  they 
contained  too  much,  says  Mr.  Sales.  Radium  in  active 
dosage  can  do  harm  as  well  as  good  and  should  be 
administered  with  great  caution. — United  States  Depart- 
ment of  Agriculture,  February  4,  1930. 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


LA  VIDA 

Mineral  Water 


LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  #2.00  per  case  (4  gal.) 

Carbonated:  #2.00  per  dozen 
(12  oz.)  bottles 

Tonic  Ginger  Ale:  #2.25  per  doz. 

(12  oz.)  bottles 


^CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

LABORATORIES 

Celestins 

LA 

VICHY 

Grains  per  gallon 

VIDA 

of  France 

Calcium  Bicarbonate 

3.74 

43.28 

Magnesium  Bicarbonate 

0.98 

5.00 

Sodium  Bicarbonate  ...  

. 252.6 

205.53 

Sodium  Chloride  

94.0 

21.94 

Iron  Oxide  

0.07 

Trace 

Aluminum  Oxide  .... 

0.13 

Silica  

6.42 

2.63 

0.001 

Sodium  Sulphate  

14.97 

TOTAL 

-----  357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


I 

FourFifty 

I Sutter 

San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


Robert  Louis  Stevenson  House. — Here  is  one  of 
America’s  most  loved  shrines.  Stevenson,  attracted 
here  from  Europe  by  the  woman  who  became  his 
wife,  started  his  many  Peninsula  jaunts  from  this  old 
building.  In  this  great  old  adobe,  Stevenson  began 
“The  Amateur  Emigrant,”  wrote  “The  Pavilion  on 
the  Links”  and  his  essay  on  Thoreau.  From  this 
home,  Stevenson  explored  the  Peninsula,  and  gathered 
site  descriptions  for  later  books,  such  as  “Treasure 
Island.”  This  literary  memorial  is  said  to  be  visited 
by  more  people  annually  than  any  other  in  the  world, 
save  only  Shakespeare’s  home  at  Stratford-on-Avon. 


Points  of  Interest  Around  Monterey. — Monterey, 
with  its  wonderful  natural  seaside  and  forest  scenery, 
ideal  climate  that  varies  for  an  average  of  only  ten 
degrees  winter  and  summer,  assortment  of  countless 
historic  and  romantic  points  of  interest  and  developed 
recreations  and  business,  attracts  thousands  of  visi- 
tors at  all  seasons  of  the  year. 

You  will  find  much  of  interest  in  this  city  of  his- 
torical romance,  whether  you  come  for  pleasure  or 
business.  For  your  information  a few  of  the  points 
of  interest  are:  World-famous  seventeen-mile  drive. 
Colton  Hall,  where  the  constitution  of  California  was 
written.  Old  Custom’s  House,  which  has  flown  the 
flags  of  Spain,  Mexico,  and  the  United  States.  Home 
of  beloved  Robert  Louis  Stevenson.  First  Brick 
House  in  California.  San  Carlos  Mission.  Carmel 
Mission.  Quaint  adobes,  relics  of  Spanish  and  Mexi- 
can regimes.  First  theater,  where  Jenny  Lind  sang. 
Presidio  of  Monterey,  where  is  stationed  the  11th 
U.  S.  Cavalry  and  the  76th  Field  Artillery.  The  land- 
ing place  and  monument  to  Father  Junipero  Serra. 
The  monument  to  Commodore  Sloat,  who  first  raised 
the  American  flag  over  the  Custom  House,  July  7, 
1846,  making  California  a part  of  the  United  States. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


61 


MILK  of  MAGNESIA 

plus  MINERAL  OIL 

exerts  Lubricant  — Laxative  — Antacid  action  and  effect 


Perfectly  emulsified,  palatable,  unflavored,  producing  no  dis- 
turbance of  digestion,  rarely  if  ever  inducing  “leakage,” 

jlfagnesia-Mineral  Qil  <&) 

HALEY 

formerly  HALEY’S  M-O,  Magnesia  Oil, 

is  indicated  and  has  been  endorsed  as  effective  and  satisfactory  by 
thousands  of  physicians  in  the  treatment  of  Gastro-intestinal 
Hyperacidity,  Fermentation,  Flatulence,  Gastric  or  Duodenal 
Ulcer,  Constipation,  Autotoxemia,  Colitis,  Hemorrhoids,  before 
and  after  operation,  during  pregnancy  or  maternity,  in  infancy, 
childhood  and  old  age  and  by  dentists  as  an  EFFECTIVE  ANT- 
ACID MOUTH  WASH. 

Accepted  for  N.N.R.  by  the  A.M.A.  Council  on  Chemistry 
and  Pharmacy. 

Generous  sample  and  literature  on  request 

THE  HALEY  M-O  COMPANY,  INC.,  GENEVA,  N.  Y. 


FORMULA 

Each  Tablespoonful 
Contains  Magma 
Mag.  (U.S.P.)  dram 
i i i , PeTrolat.  Liq. 
(U.  S.P.)  dram  i. 


To  Merge  Is  To  Swallow  Up,,, 

So  we  are  not  in  any  merger 

We  Still  Retain  Our  Independence  and  Continue  to  Serve  You  as  in  the  Past 

“TRADE  IN  SACRAMENTO’’ 

WITH 

EUGENE  JAY  B. 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 

Surgeons 9 Instruments  i Physicians * and  Hospital  Supplies 


SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY 

Manufacturers  and  Fitters  of  Orthopedic  and  Surgical 
Appliances 


Agents  for  Bard-Parker  Company 


62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


When  Steers  Had 
Long  Horns 

THE  medicinal  value  of  the 
glands  of  internal  secretion 
was  not  recognized. 

But  times  have  changed,  as  well 
as  cattle.  Now,  the  therapeutic 
value  of  certain  gland  products 
is  definitely  established  and 
each  year  adds  to  our  knowl- 
edge in  this  important  field  of 
therapeutics. 

To  the  physician  prescribing 
gland  products  we  urge  specifi- 
cation of  “Wilson,”  because  it 
connotes  a product  made  at  the 
source  of  supply  from  fresh 
glands,  processed  promptly, with 
the  aim  of  conserving  maximum 
hormone  activity,  in  a labora- 
tory devoted  exclusively  to  the 
endocrine  field. 


'JhiA  nuwK 


W r\  CL 


THE  WILSON  LABORATORIES 


V7  W 


yam  (juanantee” 


4221  S.  Western  Boulevard 
CHICAGO,  ILL. 


Manufacturers  of 

STANDARDIZED  ANIMAL  DERIVATIVES, 
LIGATURES  and  DIGESTIVE  FERMENTS 


Johnston-Wickett 

Clinic 

ANAHEIM,  CALIFORNIA 

Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 

Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 

Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


Fewer  Deaths  From  Tuberculosis. — During  the  first 
nine  months  of  the  year  1929  there  were  4515  deaths 
from  tuberculosis  in  California.  During  the  corre- 
sponding period  of  the  preceding  year  there  were  4568 
deaths  from  this  disease.  In  1928  there  were  6074 
deaths  from  tuberculosis,  and  it  is  anticipated  that 
the  total  number  of  deaths  in  1929  will  not  be  more 
than  6000.  This  indicates  that  the  mortality  rate  per 
hundred  thousand  population  for  1929  will  probably 
be  about  135,  as  against  a rate  of  139.7  for  the  year 
1928.  The  population  in  California  increases  by  about 
one  hundred  thousand  each  year  and  the  reduced 
number  of  deaths,  together  with  the  natural  increase 
in  the  population,  works  to  advantage  in  making  a 
low  mortality  rate  for  the  year  1929. 

The  California  tuberculosis  death  rate  has  dropped 
consistently  since  1906.  In  that  year  the  rate  was 
221.8  per  hundred  thousand  population.  In  1920  it 
was  155  per  hundred  thousand  population.  Out  of  the 
6074  persons  in  California  who  died  of  tuberculosis 
last  year,  3004  had  lived  in  California  for  ten  years 
and  over,  1260  had  lived  here  five  to  nine  years,  894 
one  to  four  years,  and  453  had  lived  in  the  state  for 
less  than  one  year. 

It  is  generally  recognized  that  most  cases  of  tuber- 
culosis are  contracted  in  infancy,  but  do  not  develop 
into  acute  cases  of  the  disease  until  the  strains  and 
stresses  of  later  life  bring  on  the  acute  symptoms  of 
the  disease.  For  this  reason  the  work  of  the  preven- 
toria  is  of  the  utmost  importance.  Children  who  may 
be  predisposed  to  tuberculosis,  or  whose  parents  may 
be  tuberculous,  should  be  given  every  possible  pro- 
vision for  the  development  of  good  general  health,  in 
order  to  offset  the  possible  development  of  tubercu- 
losis. The  tendency  of  the  organizations  working  for 
the  prevention  of  tuberculosis  to  develop  preventoria 
for  children  is  generally  regarded  as  one  of  the  most 
important  activities  in  tuberculosis  prevention. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


H 


Colfax  School  for  the 
Tuberculous 

C°>!  ax,  California 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


i Patients  are  given  individ- 

* ual  care  by  experienced 
tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 
individual  needs. 

sy  Patients  are  taught  how  to 

* secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 

aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4  The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5  Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  Medical 'Director 

Colfax , California 


ft 

V 
ft 

V 
ft 

V 
ft 

V 
ft 
Vi 
ft 

V 
ft 


V 
ft 

V 
ft 

V 
ft 

V 
ft 

V 
ft 

V 


V 

Ift 

V 
ft 

V 
ft 

V 
ft 

V 
ft 


ft 

V 
ft 

V 
ft 

V 
ft 

V 
ft 


64 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Erythrol 

Tetranitrate 

Merck 

Literature  on  request 


Effective  Vasodilator 

Useful  in  Angina  Pectoris, 
vascular  diseases,  and  as 
a prophylactic  for  anginal 
pain. 

Tablets — lA  grn.  Bottles  of  50 

Tablets — V2  grn.  Tubes  of  24 

and  Bottles  of  100 


Chart  shows  relative  reduction 
of  pulse  tension  produced  by 

1.  Amyl  Nitrite 

2.  Nitroglycerin 

3.  Sodium  Nitrite 

4.  Erythrol  Tetranitrate 

MERCK  & CO. 

INC. 

Rahway,  N.  J. 


“Great  Men’s  Weakness.” — The  magazine  Time,  in 
various  issues,  devotes  space  to  medicine.  In  the 
issue  of  December  23,  there  is  an  article  entitled 
“Great  Men’s  Weakness,”  which  begins:  “Prince  Bis- 
marck, President  Wilson,  President  Harding,  ‘Tiger’ 
Clemenceau,  Napoleon  III  and  Alexander  Dumas  fils 
had  only  one  weakness  in  common:  prostatic  hyper- 
trophy.” 

The  article  is  illustrated  with  pictures  of  Wilson, 
Bismarck,  and  three  fellow  sufferers,  Poincare,  King 
Haakon  of  Norway,  and  King  Fuad  of  Egypt.  Refer- 
ence is  also  made  to  the  following  notables  who  have 
prostatic  hypertrophy:  Irigoyen  of  Brazil,  King 
George  of  England,  President  Doumergue  of  France, 
and  President  Masaryk  of  Czechoslovakia. 

In  discussion  of  the  condition  itself,  the  article 
contains  the  following  references.  “Authorities  esti- 
mate that  one  of  three  males  over  sixty  suffer  from 
prostatic  hypertrophy.  Gonorrhea  in  early  manhood 
is  a frequent  but  by  no  means  the  sole  cause.”  This 
reference  is  amplified  by  the  following  footnote:  “Dr. 
Winfield  Scott  Pugh,  famed  Manhattan  genito-urinary 
specialist,  estimates  that  four  out  of  five  males  have 
or  have  had  gonorrheal  infections.” 

Organized  medicine  is  the  greatest  proponent  of 
lay  education,  but  under  proper  medical  supervision 
and  control,  in  order  that  the  public  may  intelligently 
be  advised  in  regard  to  health  matters. 

No  one  can  read  an  article  of  this  kind  without 
resentment.  The  imputation  is  most  insulting.  What 
inference  can  be  drawn  by  readers  of  this  reference 
other  than  the  fact  that  gonorrhea  is  the  most  fre- 
quent cause,  notwithstanding  the  qualifying  statement 
“but  by  no  means  the  sole  cause.”  Readers  who 
have  relatives  or  friends  suffering  from  hypertrophied 
prostate  naturally  will  do  some  deep  thinking.  Again, 
we  repeat,  this  kind  of  lay  education  is  vicious,  and 
to  be  unqualifiedly  condemned. — The  Pennsylvania 
Medical  Journal. 


Rodent  Survey  Activities. — The  State  Department 
of  Public  Health  is  active  in  determining  the  pres- 
ence of  infected  rats  and  ground  squirrels  throughout 
California.  During  the  past  two  years,  the  Division 
of  Sanitation  has  collected  31,513  ground  squirrels 
and  27,646  rats,  upon  all  of  which  postmortem  exami- 
nations were  made.  Most  of  these  examinations  were 
carried  on  in  the  field,  only  such  animals  as  showed 
gross  signs  of  infection  being  shipped  to  the  labora- 
tory for  microscopical  examination.  These  surveys 
have  covered  nineteen  counties  and,  in  addition, 
rodent  control  work  has  been  carried  on,  under  the 
supervision  of  the  State  Department  of  Public  Health, 
during  the  past  two  years,  in  forty-two  cities  and 
towns  scattered  throughout  California. 

RODENT  SURVEY  ACTIVITIES 
Two  Years,  1928-1929 


Number  of  counties  in  which  surveys  were  made 19 

Number  of  ground  squirrels  collected 31,513 

Number  of  rats  collected 27.646 

Number  of  postmortem  examinations 59,159 

Number  of  cities  and  towns  in  which  rodent  control 
work  was  carried  on  under  supervision  of  State 
Department  of  Public  Health 42 


Deaths  in  California  and  the  United  States  Regis- 
tration Area. — A comparison  of  California  death  rates 
for  the  year  1928  with  similar  rates  for  the  United 
States  Registration  Area  (which  comprises  most  of 
the  states)  indicates  a lower  ratio  of  California  deaths 
from  most  of  the  communicable  diseases  (with  the 
exception  of  tuberculosis).  A larger  proportion  of 
California  individuals,  however,  died  of  those  diseases 
which  commonly  claim  the  lives  of  people  who  are 
past  middle  age.  In  other  words,  California  last  year 
made  marked  progress  in  saving  the  lives  of  its  chil- 
dren from  death  by  communicable  diseases,  but,  ac- 
cording to  the  records,  progress  was  not  made  in  the 
prevention  of  deaths  of  adults  from  cancer,  heart  dis- 
ease, nephritis,  and  other  causes. 


SIMPLICITY 


To  each 
measure  of 
S.  M.  A. 


+ 


ADD 


One  ounce 
of  boiled 
water 


One  fluid  ounce 
• of  S.  M.  A. 
ready  to  feed. 


NO  MODIFICATION 

NECESSARY 

It  is  not  necessary  to  further  modify  S.  M.  A. 
for  normal  full  term  infants,  for  the  same  reason 
that  it  is  not  necessary  to  modify  breast  milk  - - 
for  S.  M.  A.  contains  the  essential  food  elements 
in  proper  balance.  Because  of  this  close  resem- 
blance to  breast  milk,  the  very  young  infant  can 
tolerate  the  fat  as  well  as  the  other  essential 
constituents  of  S.  M.  A.  and  it  is  possible  to  give 
it  in  the  same  strength  to  normal  infants  from 
birth  to  twelve  months  of  age. 

As  the  infant  grows  older,  therefore,  it  is  only 
necessary  to  increase  the  total  amount  of  S.  M.  A. 
diluted  according  to  directions. 

Orange  juice,  of  course,  should  be  given  the 
infant  fed  on  S.  M.  A.  just  as  it  is  the  present 
practice  to  give  it  to  breast  fed  infants,  to 
supply  an  adequate  amount  of  the  anti-scoTbu- 
tic  vitamin  C . 


THE  LABORATORY  PRODUCTS  COMPANY 
CLEVELAND,  OHIO 


TRY  IT  AT  OUR  EXPENSE! 

(Ask  for  samples  and  folder  No.  F-88. ) 


Regional 
Test  Sets 


Convenient! 


Complete! 


Treatment 

Sets 

Containing 

60,000 

Pollen 

Units 

No 

Minimum 

Spoon-fed 

Dosage 

30  or  more 
doses  if 
necessary 


j THE  CUTTER  LABORATORY,  | 
j Berkeley,  California. 

1 Gentlemen: 

Please  send  me 

I □ Booklet  containing  Pollen  Chart. 

Spring  Test  Sets  for  my  region,  for  j 

which  find  enclosed  my  check  at  $1.00  | 

each. 


Street.. , , 

City State 


POLLEN  EXTRACTS  (CUTTER) 

Produced  for  the  physician  whose  desire  for 
maximum  results  overrides  any  questionable  short- 
cuts; such  as  group  testing,  stock  mixed  treatment 
sets,  spoonfed  dosage,  etc. 

Send  for  Literature  containing 
Geographical  Pollen  Chart. 

THE  CUTTER  LABORATORY 

Established  1897 

Berkeley,  California 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 
E.  A.  TRENKLE,  Manager  Phone  GRAYSTONE  1200 


ANNUAL  SESSIONS 

American  Medical  Association,  Detroit,  Michigan,  June  23-27,  1930 
Nevada  State  Medical  Association,  September  9-11,  1930 
Utah  State  Medical  Association,  September  26-27,  1930 


8* 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and  Published  £ Monthly  by  the  California  ^Medical  dissociation 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUME  XXXII 
NUMBER  5 


MAY  • 1930 


50  CENTS  A COPY 
85.00  A YEAR 


CONTENTS  AND  SUBJECT  INDEX 


SPECIAL  ARTICLES: 

Problems  Confronting  the  Medical  Pro- 
fession. By  Morton  R.  Gibbons,  San 

Francisco  305 

Superior  Mesenteric  Thrombosis.  By 

Wilburn  Smith,  Los  Angeles 308 

Discussion  by  John  Homer  Woolsey,  San 
Francisco;  Thomas  O.  Burger,  San  Diego. 

Treatment  of  Cancer — Present  Day 
Rationale.  By  Robert  C.  Coffey, 
Portland,  Oregon 313 

Chronic  Nonvalvular  Heart  Disease — Its 
Causes,  Diagnosis,  and  Management. 

By  Henry  A.  Christian,  Boston, 
Massachusetts  320 

Epidemic  Cerebrospinal  Fever  on  the 
Pacific  Coast.  By  J.  C.  Geiger,  San 
Francisco  322 

Fractures  of  the  Spine.  By  R.  W.  Har- 
baugh  and  R.  E.  Haggard,  San 
Francisco  325 

Discussion  by  Maynard  C.  Harding,  San 
Diego ; H.  W.  Chappel,  Los  Angeles ; Fred- 
erick H.  Rodenbaugh,  San  Francisco. 

Obstetrical  Analgesia.  By  Harry  S.  Fist, 
Los  Angeles 331 

Discussion  by  P.  Brooke  Bland,  Philadelphia ; 

E.  M.  Lazard,  Los  Angeles;  Lyman  H.  Robi- 
son, Los  Angeles. 

Childhood  Tuberculosis — Its  Treatment. 

By  Charles  L.  Ianne,  San  Jose 334 

Discussion  by  Charles  P.  Durney,  San  Jose; 
Chesley  Bush,  Livermore;  Ann  Martin,  Oak- 
land. 

Human  Torula  Infections — A Review. 

By  Howard  A.  Ball,  Los  Angeles 338 

Discussion  by  Newton  Lynch,  Los  Angeles; 
Willard  J.  Stone,  Pasadena. 

Duodenal  Ulcer  — Its  Surgical  Treat- 
ment. By  Robert  A.  Ostroff,  San 
Francisco  346 

Discussion  by  P.  K.  Gilman,  San  Francisco; 
Gunther  W.  Nagel,  San  Francisco. 

Anesthetic  Gases.  By  Donald  E.  Bax- 
ter, Glendale 349 

Hippocratic  Medicine  (Part  III) — The 
Lure  of  Medical  History.  By  Langley 

Porter,  San  Francisco . 350 

CLINICAL  NOTES  AND  CASE  REPORTS: 
Bacillus  Pyocyaneus  Septicemia.  By 


John  Martin  Askey,  Los  Angeles. 


.352 


BEDSIDE  MEDICINE: 

Postoperative  Treatment  Following  Ab- 
dominal Operations  354 

Discussion  by  Le  Roy  Brooks,  San  Francisco ; 
Thomas  O.  Burger,  San  Diego;  George  H. 
Sanderson,  Stockton. 

EDITORIALS: 

The  Del  Monte  “Pre-Convention  Bul- 
letin”— Comments  on  Some  of  Its 

Suggestions  357 

William  Henry  Welch 359 

Epidemic  Cerebrospinal  Fever 359 

Back  to  Nature  for  Discoveries  in 

Science  359 

California  Acquires  Two  Foundations 
for  Cancer  Research — The  First  at 
Los  Angeles  and  the  Second  at  San 
Francisco  360 

MEDICINE  TODAY: 

Modern  Advances  in  the  Therapy  of  Syphilis. 

By  H.  J.  Templeton,  Oakland 361 

Radon  in  Cancer  of  the  Esophagus.  By  H.  J. 

Hara,  Los  Angeles 361 

Paradoxical  Culture  Media.  By  W.  H.  Man- 

waring,  Stanford  University 362 

Sodium  Amytal  in  Thyroid  Surgery.  By  A.  B. 

Cooke,  Los  Angeles 362 

STATE  MEDICAL  ASSOCIATIONS: 

California  Medical  Association 363 

Woman’s  Auxiliary 367 

Nevada  State  Medical  Association 369 

Utah  State  Medical  Association 369 

MISCELLANY: 

News  371 

Clippings  From  the  Lay  Press 373 

Twenty-Five  Years  Ago 373 

Department  of  Public  Health 374 

California  Board  of  Medical  Examiners. .375 
Directory  of  Officers,  Sections,  County 
Units,  and  Woman’s  Auxiliary  of  the 

California  Medical  Association 

Adv.  page  2 

Book  Reviews  Adv.  page  11 

Truth  About  Medicines Adv.  page  31 

ADVERTISEMENTS— INDEX: 

Adv.  page  8 


"Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


GREENS’ 

EYE  HOSPITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


Resident  Staff 

Aaron  S.  Green,  M.  D. 

Louis  D.  Green,  M.  D. 

Martin  I.  Green,  M.  D. 

Einar  V.  Blak,  M.  D. 

George  S.  Lachman,  M.  D. 

Vincent  V.  Suglian,  M.  D. 

THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in  the  A.  M.  A. 
Facilities  are  especially  designed  for  Ophthalmology  and  include  X-Ray, 
Radium,  Physio-Therapy  and  Clinical  Laboratories. 

A private  out  patient  department  is  conducted  daily  between  the  hours  of 
9 a.  m.  and  5 P.M.  A report  of  findings  and  recommendations  for  treatment 
are  returned  with  the  patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for  patients  of  limited 
income.  Examination  fees  in  the  clinic  are  $2.50  for  the  first  visit  and 
$1.50  for  subsequent  visits.  Moderate  fees  for  drugs,  laboratory  work, 
X-Rays.  Operating  fees  are  arranged  according  to  the  circumstances  of 
each  individual. 


Bush  at  Octavia  Street  • Telephone  WEst  4300  • San  Francisco,  California 

Address  communications  to  Superintendent 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


m 


yi 

14 


14 


k 


U 0 I] 


Patronize  Your  Home  Firm 

Because  We  Are  Progressive 

The  GrofF  Diathermy  Knife 


A New  Departure  in 
Surgical  Diathermy 
A modified  Bard-Parker 
Knife  Handle 
which  delivers  a 
cutting  current  with 
an  ordinary 
Diathermy  Machine 


5*? 


Used  with  a 
Standardized 
Bi-Polar 
Technique 

Instructions 
Accompany  each 
Knife 

Price  $12.50 
(With  3 Blades) 


Groff  Diathermy  Knife  in  Operation 

We  carry  a complete  line  of  X-ray  and  Physio-Therapy  equipment,  including  textbooks 
by  T.  Howard  Plank,  M.  D.,  "Actinotherapy  and  Allied  Physical  Therapy”  and  others 


Manufactured  by 

BUSH  ELECTRIC  CORPORATION 


334  Sutter  Street 

San  Francisco,  Calif. 
SUtter  6088 


1207  West  Sixth  Street 

Los  Angeles,  Calif. 
MUtual  6324 


P5 

tiC 


2 

/fyj 


jk 


U 0 I] 


3 


Officers  of  the  California  Medical  Association 


General  Officers 


President — Morton  R.  Gibbons,  515  Union 
Square  Building,  350  Post  Street,  San 
Francisco. 

President-Elect — Lyell  C.  Kinney,  510  Med- 
ico-Dental Building,  233  A Street,  San 
Diego. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 

Vice-Speaker  of  House  of  Delegates — John 


H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw  Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 


Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 


Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  5th  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam Duffield  (1930),  516  Auditorium 

Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1930),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Cruz. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Junius  B.  Harris  (1930), 
Medico-Dental  Building,  1127  Eleventh 
Street,  Sacramento. 


Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 
lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1930),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large— T.  Henshaw  Kelly  (1930),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Robert  A.  Peers  (1931),  Colfax. 


Standing  Committees 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker  of  the  House 
of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair- 
man of  the  Auditing  Committee.  (Committee  Chairman,  T. 
Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


Harold  A.  Thompson,  San  Diego 1932 

William  Bowman  (Chairman),  Los  Angeles 1931 

George  H.  Kress,  Los  Angeles 1930 

Committee  on  Extension  Lectures 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge  (Chairman),  Berkeley 1931 

Robert  A.  Peers,  Colfax 1930 

The  Secretary ... Ex-officio 

Committee  on  Health  and  Public  Instruction 

Fred  B.  Clarke,  Long  Beach 1932 

Gertrude  Moore  (Chairman),  Oakland 1931 

Henry  S.  Rogers,  Petaluma 1930 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Cofifey,  San  Francisco 1931 

Gayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Industrial  Practice 

Packard  Thurber,  Los  Angeles... 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Cayle  G.  Moseley  (Chairman),  Redlands 1930 

Committee  on  Medical  Economics 

John  H.  Graves  (Chairman),  San  Francisco 1932 

William  T.  McArthur,  Los  Angeles 1931 

Ruggles  A.  Cushman,  Santa  Ana 1930 

Committee  on  Medical  Education  and  Medical  Institutions 

George  Dock  (Chairman),  Pasadena 1932 

H.  A.  L.  Rvfkogel,  San  Francisco 1931 

George  G.  Hunter,  Los  Angeles 1930 


Committee  on  Medical  Defense 


George  G.  Reinle  (Chairman),  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Mott  H.  Arnold,  San  Diego 1930 

Committee  on  Membership  and  Organization 

Harlan  Shoemaker,  Los  Angeles ...1932 

LeRoy  Brooks  (Chairman),  San  Francisco 1931 

Jesse  W.  Barnes,  Stockton 1930 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Charles  D.  Ball  (Chairman),  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

Emmet  Rixford,  San  Francisco 1930 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Alfred  C.  Reed,  San  Francisco 1932 

Percy  T.  Magan  (Chairman),  Los  Angeles 1931 

Frederick  F.  Gundrum,  Sacramento 1930 

The  Secretary Ex-officio 

The  Editor - Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

Joseph  Catton,  San  Francisco 1930 

The  President Ex-officio 

The  President-Elect Ex-officio 

Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco - 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland - 1931 

Robert  V.  Day,  Los  Angeles 1930 

Ernest  H.  Falconer,  Sec’y  Sect.  Med.,  San  Francisco 1930 

Sumner  Everingham,  Sec’y  Sect.  Surg.,  Oakland 1930 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland (1930-1931) 

Albert  Soiland.  Los  Angeles (1930-1931) 

Fitch  C.  E.  Mattison,  Pasadena (1930-1931) 

Victor  Vecki,  San  Francisco (1929-1930) 

Percy  T.  Magan,  Los  Angeles (1929-1930) 

Junius  B.  Harris,  Sacramento (1929-1930) 


ALTERNATES 

Joseph  Catton,  San  Francisco 

William  H.  Gilbert.  Los  Angeles 

James  F.  Percy,  Los  Angeles 

William  E.  Stevens,  San  Francisco 

Charles  D.  Lockwood,  Pasadena 

John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


Special  Motorcycle  Service 

HOURS:  Week  Days,  8 A.  M.  to  9 P.  M.;  Sundays,  9-1,  6-8  Phones:  GArfield  4417-4418-4419 

For  Emergencies  Only — Phone  WEST  1400 

M erthiolate  Lilly 

(SODIUM  ETHYL  MERCURI  THIOS ALIC YL ATE ) 

M ERTHIOLATE  is  a new  organic  mercurial  germicide  and  antiseptic,  potent  in  action  in 
the  presence  of  organic  matter,  non-toxic  in  effective  concentration,  and  non-hemolytic 
for  red  blood-cells. 

Merthiolate  is  non-irritating  to  tissue  surfaces.  It  does  not  stain,  is  stable  in  solution. 

Merthiolate  is  an  effective  agent  for  disinfecting  the  skin  and  tissue  surfaces,  for  the  preparation 
of  obstetrical  cases;  for  application  to  fresh  cuts,  abrasions,  denuded  areas;  for  use  as  wet  dressings 
and  packs;  for  topical  application  to  nasopharyngeal  mucous  membranes. 

Merthiolate  is  supplied  in  1 : 1 000  isotonic  solution  in  four-ounce  and  one-pint  bottles. 

Available  at 

Broemmel’s  Prescription  Pharmacy 

SERUMS  VACCINES  ANTITOXINS 

Free  Delivery 

Fitzhugh  Building,  Rooms  201-202-203  Post  and  Powell  Streets,  San  Francisco,  Calif. 


Radium  and  Oncologic  Institute 

1052  West  Sixth  Street,  Los  Angeles 


An  institution  providing  adequate  facilities  for  the  scientific  study,  diagnosis, 
and  treatment  of  cancer  and  other  neoplastic  diseases. 

Recognized  therapeutic  measures  for  the  treatment  of  cancer  are  radium, 
high  voltage  x-ray  and  surgery. 

Results  in  cancer  therapy  are  entirely  dependent  upon  early  diagnosis, 
thorough  study  and  proper  application  of  such  of  the  above  methods  of 
treatment,  either  alone  or  in  combination,  as  each  case  may  indicate. 

We  desire  to  confer  and  cooperate  with  the  medical  profession  in  the 
diagnosis  and  treatment  of  cancer  and  other  neoplastic  diseases. 

DR.  REX  DUNCAN  DR.  H.  H.  HATTERY 

AND  STAFF 

Office  Hours:  10  a.m.  to  4 p.m.  TRinity  3683 
1052  West  Sixth  Street  Los  Angeles 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  Lorruli  A.  Rethwilm,  2217  Web- 
ster Street,  San  Francisco. 

Secretary,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 


Dermatology  and  Syphilology 
Chairman,  Samuel  Ayres,  Jr.,  517  Westlake 
Professional  Building,  2007  Wilshire 
Boulevard,  Los  Angeles 
Vice-Chairman,  Stuart  C.  Way,  320  Medico- 
Dental  Bldg.,  -tyu  Post  St.,  oau  Franctsi... 
Secretary,  George  F.  Koetter,  812  Medical 
Office  Bldg.,  1 1 BO  W.  oth  St.,  Los  Angeles 
Vice-Secretary,  Merlin  T.  Maynard,  408 
Medico-Dental  Building.  San  Jose. 


Eye,  Ear,  Nose  and  Throat 
Chairman,  Barton  J.  Powell,  510  Medico- 
Dental  Building,  Stockton. 
Vice-Chairman,  Frederick  C.  Cordes,  811 
Fitzhugh  Building,  384  Post  Street,  Sai 
Francisco. 

Secretary,  Andrew  B.  Wessels,  1305  Medico 
Dental  Building,  233  A Street,  San  Diego 


General  Medicine 

Chairman,  Walter  P.  Bliss,  407  Professional 
Bldg.,  65  North  Madison  Ave.,  Pasadena 
Secretary,  Ernest  H.  Falconer,  316  Fitzhugh 
p.,;t^;„p-  tg4  Post  Street.  San  Francisco. 


Chairman  of  Section  Program  Committee 
Q.  O.  Gilbert,  301  Medical  Building,  1904 
Franklin  Street,  Oakland. 


General  Surgery 

Chairman,  Clarence  G.  Toland,  902  Wilshire 
Medical  Building,  1930  Wilshire  Boule- 
vard, Los  Angeles. 

Secretary,  Northern  Division,  Sumner  Ever- 
ingham,  400  29th  St.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Industrial  Medicine  and  Surgery 

Chairman,  Charles  A.  Dukes,  601  Wakefield 
Building,  426  17th  Street,  Oakland. 

Secretary,  Edmund  J.  Morrissey,  201  Med- 
ical Bldg.,  909  Hyde  St.,  San  Francisco. 

Chairman  of  Program  Committee,  Arthur  L. 
Fisher,  212  Medical  Building,  909  Hyde 
Street,  San  Francisco. 


N europsychiatry 

Chairman,  Thomas  G.  Inman,  2000  Van  Ness 
Avenue,  San  Francisco. 

Secretary,  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

Obstetrics  and  Gynecology 
Chairman,  Karl  L.  Schaupp,  835  Medico- 
Dental  Bldg.,  490  Post  St.,  San  Francisco. 
Secretary,  Clarence  A.  De  Puy,  Strad  Build- 
ing, 230  Grand  Avenue,  Oakland. 


Pathology  and  Bacteriology 

Chairman,  W.  T.  Cummins,  Southern  Pacific 
Hospital,  San  Francisco. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
H.  A.  Thompson,  907  Medico-Dental 
Building,  233  A Street,  San  Diego. 

Pediatrics 

Chairman,  Guy  L.  Bliss,  1723  East  First 
Street,  Long  Beach. 

Secretary,  Donald  K.  Woods,  5 th  and 
Laurel  Streets,  San  Diego. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Irving  S.  Ingber,  321  Medico- 
Dental  Building,  490  Post  Street,  San 
Francisco. 

Secretary,  William  H.  Sargent,  Franklin 
Building,  1624  Franklin  Street,  Oakland. 

Chairman  of  Section  Program  Committee, 
W.  E.  Chamberlain,  Stanford  Hospital, 
San  Francisco. 

Urology 

Chairman,  Charles  P.  Mathe,  Room  1831, 
450  Sutter  Street,  San  Francisco. 

Secretary,  Harry  W.  Martin,  1U10  Quinby 
Building,  650  S.  Grand  Ave.,  Los  Angeles. 


Alameda  County  Medical  Association 
2404  Broadway,  Oakland 
President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Secretary,  J.  O.  Chiapella,  Chiapella  Build- 
ing, Chico. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son  Building,  Fresno. 

Glenn  County  Medical  Society 
President,  Etta  S.  Lund,  143  North  Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Humboldt  County  Medical  Society 
President,  Edgar  Holm,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

Kern  County  Medical  Society 
President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

Lassen-Plumas  County  Medical  Society 
President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 
1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 

Street,  Los  Angeles. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary.  L.  L,  Robinson,  Larkspur. 

Mendocino  County  Medical  Society 
President,  L.  K.  Van  Allen,  Ukiah. 
Secretary,  Paul  J.  Bowman,  Fort  Bragg. 

Merced  County  Medical  Society 
President,  Chester  A.  Moyle,  6 Bank  of 
Italy  Bldg.,  Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building. 
Merced. 


Officers  of  County  Medical  Associations 

Monterey  County  Medical  Society 
President,  Charles  H.  Lowell,  Carmel. 
Secretary,  John  A.  Merrill,  308  Spazier 
Building,  Monterey. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Orange  County  Medical  Society 
President,  H.  Miller  Robertson,  212  Medical 
Bldg.,  Santa  Ana. 

Secretary,  Harry  G.  Huffman,  615  First 
National  Bank  Bldg.,  Santa  Ana. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 
Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary.  C.  J.  Durand,  Colfax. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block, 
Riverside. 

Sacramento  Society  for  Medical 
Improvement 

President,  Gustave  Wilson,  609  California 
State  Life  Building,  10th  and  J Streets, 
Sacramento. 

Secretary,  Frank  W.  Lee,  510  Physicians 
Bldg.,  1027  Tenth  St.,  Sacramento. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Eytinge,  47  East  Vine 
Street,  Redlands. 

San  Diego  County  Medical  Society 
Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 
President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

San  Francisco  County  Medical  Society 
2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street,  San  Francisco. 

San  Joaquin  County  Medical  Society 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

San  Luis  Obispo  County  Medical  Society 
President,  Howard  A.  Gallup,  774  Marsh 
Street,  San  Luis  Obispo. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 


San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Santa  Barbara  County  Medical  Society 
President,  Hugh  F.  Freidell,  1525  State 
St.,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment,  Santa  Barbara. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building.  San  Jose. 

Santa  Cruz  Countv  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldg..  Santa  Cruz. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Siskiyou  County  Medical  Society 
President, 

occrcLary,  Ruth  C.  Hart,  Fort  Jones. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street. 
Vallejo. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

Stanislaus  County  Medical  Society 
President,  R.  S.  Hiatt,  Beaty  Bldg.,  1024 
J Street,  Modesto. 

Secretary,  Donald  L.  Robertson,  1003  12th 
Street,  Modesto. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey.  Red  Bluff. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary.  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  D.  G.  Clark,  130  N Tenth  St., 
Santa  Paula. 

Secretary,  C.  A.  Smolt,  23  S.  California  St., 
Ventura. 

Yolo-Colusa  County  Medical  Society 
President,  Leo  P.  Bell,  Woodland  Clinic, 
Woodland. 

Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Yuba-Sutter  County  Medical  Society 
President,  Philip  Hoffman,  404  D Street, 
Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 


Maltine 

PLAIN 

is  an  important  adjunct 
in  the  regimen  of  both 

EXPECTANT  and  NURSING  MOTHERS 


In  an  article  published  last  fall*,  Dr. 
John  Howell  West  observes  that  many 
mothers  fail  to  supply  sufficient  Vitamin 
B to  their  babies.  He  quotes  McCollum 
on  the  fact  that  the  average  American 
diet  consists  principally  of  muscle  meats, 
potatoes  and  the  like.  In  such  a diet 
Vitamin  B is  usually  lacking  in  adequate 
amount.  He  reminds  us  that  Hoobler 
and  Dennet  have  found  that  a baby 
subsisting  on  a Vitamin-B-deficient- 
milk  suffers  from  loss  of  appetite, 
anemia,  restlessness,  fretfulness  — that 
weight  gains  are  indifferent. 

Certain  conclusions  may  be  drawn 
from  West’s  observations:  The  nurs- 
ing mother  needs  much  more  Vita- 
min B than  the  ordinary  individual. 
As  many  breast  failures 
occur  a few  weeks  after 


Council  Accepted 


birth,  an  extra  supply  of  Vitamin  B 
should  be  started  as  soon  as  possible 
during  pregnancy. 

Maltine  Plain,  a concentrated  ex- 
tract of  the  nourishing  elements  of 
malted  barley,  wheat  and  oats,  contains 
an  abundance  of  Vitamin  B.  It  is  nutri- 
tive without  being  bulky.  It  has  mineral 
salts  and  soluble  vegetable  albuminoids. 

Maltine  Plain  promotes  normal 
healthy  appetite,  good  digestion,  proper 
elimination.  It  protects  the  nervous 
system.  It  makes  the  expectant  mother 
more  comfortable,  happier,  healthier. 
It  helps  the  nursing  mother  to  give  her 
child  a good  healthy  start  in  its  life. 

The  Maltine  Company,  20  Vesey 
Street,  New  York.  Established  1875. 

* Archives  of  Pediatrics, 
October,  1929. 


Maltine  With  Cod  Liver 
Oil,  another  of  our  prep- 
arations, contains  in 
addition  to  Vitamin  B, 
adequate  amounts  of 
Vitamins  A and  D. 


6 


Miscellaneous  California  Medical  Organizations 


State  Board  of  Health 

San  Francisco,  337  State  Building 

Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.  Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 

Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 

Secretary,  Albert  K.  Dunlap,  Sacramento 
Hospital,  Sacramento. 

Treasurer,  Walter  E.  Bates,  Davis. 

Southern  California  Medical  Association 
President,  Joseph  K.  Swindt,  Pomona. 
Secretary,  William  J.  Norris,  509  Medical 
Office  Bldg.,  1136  W.  6th  Street,  Los 
Angeles. 

Better  Health  Foundation 

President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 

State  Board  of  Medical  Examiners 

San  Francisco,  623  State  Building 

Los  Angeles,  821  Associated  Realty  Bldg., 
510  West  Sixth  Street 

Sacramento,  420  State  Office  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 

California  Northern  District  Medical  Society 
President,  J.  D.  Lawson,  Woodland  Clinic, 
Woodland. 

Vice-President,  Dan  H.  Moulton,  Chico. 

Woman’s  Auxiliary  of  the  California  Medical  Association 

State  Auxiliary  Officers 

President,  Mrs.  H.  S.  Rogers,  Sunny  Slope 
Road,  Petaluma. 

First  Vice-President,  Mrs.  W.  H.  Geistweit, 
810  Medico-Dental  Building,  San  Diego. 

Second  Vice-President,  Mrs.  John  Hunt 
Shephard.  145  South  Twelfth  Street,  San 

Jose. 

Secretary-Treasurer,  Mrs.  R.  A.  Cushman, 
632  North  Broadway,  Santa  Ana. 

Officers  of  County  Auxiliaries 

Contra  Costa  County — President,  Mrs.  J.  M. 
McCullough,  Crockett ; Secretary-Treasurer, 
Mrs.  S.  N.  Weil,  Rodeo. 

Kern  County — President,  Mrs.  F.  A.  Hamlin, 
Bakersfield ; Secretary-Treasurer,  Mrs.  C.  S. 
Compton,  Bakersfield. 

Los  Angeles  County — President,  Mrs.  James 
F.  Percy,  Los  Angeles ; Secretary-Treas- 
urer, Mrs.  Martin  G.  Carter,  Los  Angeles. 
Monterey  County — President,  Mrs.  C.  H. 
Lowell,  Carmel ; Secretary-Treasurer,  Mrs. 
Arthur  A.  Arehart,  Pacific  Grove. 

Napa  County — President,  Mrs.  W.  L.  Blod- 
get,  Calistoga ; Secretary,  Mrs.  Lawrence 
Welti,  Napa. 

Orange  County — President,  Mrs.  F.  E.  Coul- 
ter, Santa  Ana ; Secretary-Treasurer,  Mrs. 
Dexter  R.  Ball,  Santa  Ana. 

San  Bernardino  County — President,  Mrs. 
F.  E.  Clough,  San  Bernardino;  Secretary- 
Treasurer,  Mrs.  C.  L.  Curtiss,  Redlands. 

Sonoma  County — President,  Mrs.  Leslie  G. 
Spear,  Santa  Rosa ; Secretary-Treasurer, 
Mrs.  Sara  J.  Pryor,  Santa  Rosa. 

W.  A.  SHAW,  Elko 

R.  P.  ROANTREE.  Elko 

H.  W.  SAWYER,  Fallon 

E.  E.  HAMER,  Carson  City 


President 

President-Elect 

...First  Vice-President 
Second  Vice-President 


HORACE  J.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 


Place  of  next  meeting.. 


Reno,  September  26-27,  1930 


H.  P.  KIRTLEY.  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


J.  U.  GIESY,  701  Medical  Arts  Building, 


Salt  Lake  City... Associate  Editor  for  Utah 

Place  of  next  meeting Salt  Lake  City.  September  9-11,  1930 


The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 
Belmont,  Calif. 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 
San  Jose,  California 

ANDERSON  SANATORIUM 
Mental  and  Nervous  Diseases 
2535  Twenty-fourth  Avenue 
Oakland,  Calif. 

BANNING  SANATORIUM 

Treatment  of  Tuberculosis  and  Throat 
Diseases 
Banning,  Calif. 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 
Belmont,  San  Mateo  County,  Calif. 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

CHILDREN’S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

DANTE  SANATORIUM 

Limited  General  Hospital 
Van  Ness  and  Broadway,  San  Francisco 


FRANKLIN  HOSPITAL 

Limited  General  Hospital 
Fourteenth  and  Noe  Streets,  San  Francisco 


GREENS'  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  of 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 


JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 


JOSLIN’S  SANATORIUM 

Nervous  and  Mental 
Lincoln,  Calif. 


LAS  ENCINAS  SANITARIUM 

Nervous  and  General  Diseases 
Las  Encinas,  Pasadena,  Calif. 


LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 


MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 


OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 
Los  Gatos,  Calif. 


PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 


POTTENGER  SANATORIUM 
AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

RADIUM  AND  ONCOLOGIC 
INSTITUTE 

Diagnosis  and  Treatment  of  Neoplastic 
Diseases 

1052  West  Sixth  Street,  Los  Angeles,  Calif. 


SAN  FRANCISCO  HOME  FOR 
INCURABLES,  AGED  AND  SICK 

2750  Geary  Street,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

SAINT  FRANCIS  HOSPITAL 

Limited  General  Hospital 
Bush  and  Hyde  Streets,  San  Francisco 

ST.  JOSEPH’S  HOSPITAL 

Limited  General  Hospital 
Buena  Vista  and  Park  Hill  Avenues 
San  Francisco,  Calif. 


ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 
27th  and  Valencia  Streets.  San  Francisco 

ST.  MARY’S  HOSPITAL 
General  Hospital 

2200  Hayes  Street.  San  Francisco.  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


,r*u  iit  rti 


e’J!n>nc 

i ~r  c 


5 O I 


' *• 

(firoc^ 

2,Su??' 

L ?*»“<«>  I 


COUNCIL-ACCEPTED 


PITOCIN 

OXYTOCIC  HORMONE  . . . (ALPHA- HYPOPH AMINE) 


Pitocin,  one  of  the  two  hormones  isolated  from 
the  posterior  pituitary  gland,  acts,  specifically, 
as  an  oxytocic.  It  does  not  raise  blood  pressure 
or  affect  the  symptoms  of  diabetes  insipidus. 

Until  the  isolation  of  Pitocin  (together  with 
Pitressin,  pressor  hormone),  all  pituitary 
extracts  for  obstetrical  use  contained  both 
hormones.  In  order  to  get  the  oxytocic  effect 
it  was  necessary  to  accompany  it  by  a circula- 
tory disturbance  that  was  not  always  desirable. 
Now  each  can  be  obtained  without  the  other. 

What  are  the  clinical  applications  of  Pi- 
tocin? Mainly  as  a stimulant  to  the  uterus 


in  labor  when  the  uterine  contractions  are 
inadequate,  and  especially  in  cases  where  it 
would  be  unwise  to  increase  blood  pressure,  or 
water  retention,  as  in  eclampsia  or  in  cases 
having  an  eclamptic  tendency. 

Pitocin  is  administered  in  the  same  way  and 
in  the  same  dosage  as  Pituitrin  Obstetrical. 
Each  cubic  centimeter  contains  10  International 
Oxytocic  Units,  which  is  the  oxytocic  strength 
of  Pituitrin  Obstetrical. 

Packages:  (Boxes  of  6 and  100  ampoules). 
Ampoule  No.  160,  Pitocin,  1 cc. 


Write  for  'Booklet  on  'Pitocin 


PARKE,  DAVIS  & COMPANY 

DETROIT,  MICHIGAN 

NEW  YORK  KANSAS  CITY  CHICAGO  BALTIMORE  NEW  ORLEANS  MINNEAPOLIS  SEATTLE 


In  Canada : walkerville 


MONTREAL 


WINNIPEG 


8 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 

Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

Anderson  Sanatorium,  The 59 

Annual  Meeting-  of  American 

Ass’n  for  Study  of  Goiter 58 

Approved  Clinical  Laboratories..  57 
Arlington  Chemical  Co.,  The 60 

Banning  Sanatorium  44 

Bard-Parker  Co.,  Inc 15 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  and  Rackerby 55 

Benjamin,  M.  J 51 

Bischoff’s  Surgical  House 48 

Bittleston  Collection  Agency 52 

Brady  & Co.,  George  W 37 

Broemmel's  Prescription  Phar- 
macy   3 

Brown  Press  53 

Bush  Electric  Corporation 1 

Butler  Building  1G 

California  Lima  Bean  Growers’ 

Ass’n  36 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co. 41 

Camp  & Co.,  S.  H 30 

Canyon  Sanatorium  18 

Certified  Laboratory  Products  ...  38 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 

Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co.. 35 

Dante  Sanatorium  4 Cover 

Dewar  & Hare 46 

Doctors’  Business  Bureau 19 

Dry  Milk  Co.,  The 47 

Four  Fifty  Sutter 38 

Franklin  Hospital  43 

Frazier,  Delmar  J 12 

Furscott,  Hazel  E 24 

General  Electric  X-Ray  Corp 45 

Golden  State  Milk  Products  Co.  30 
Greens’  Eye  Hospital 2 Cover 


Page 


Guardian  Life  Insurance  Co.  of 

America  46 

Gunn,  Herbert,  Stool  Examina- 
tion Laboratory  24 

Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H 10 

Hoffmann-La  Roche,  Inc 13 

Holland-Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning...  36 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic  48 

Joslin’s  Sanatorium  31 

Kelley-Koett  Mfg.  Co.,  Inc.,  The  . 16 

Keniston-Root  Corporation  41 

Knox  Gelatin  Laboratories 25 

Laboratory  Products  Co 3 Cover 

Las  Encinas  Sanitarium..  12 

La  Vida  Mineral  Water  Co 58 

Lederle  Antitoxin  Laboratories.  23 

Lengfeld’s  Pharmacy  24 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 11 

Livermore  Sanitarium  29 

Maltbie  Chemical  Co.,  The 28 

Maltine  Company,  The 5 

Mead  Johnson  & Co 21 

Medico-Dental  Finance  Co 40 

Mellin’s  Food  Co 64 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc 42 

Monrovia  Clinic  43 

Mulford  Co.,  H.  K 61 

National  Ice  Cream  and  Cold 

Storage  Co 29 

New  York  Polyclinic  Medical 

School  and  Hospital 9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital  53 

Nichols  Nasal  Syphon 44 

Nonspi  Company  28 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 
ical Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 

Park  Sanitarium  24 

Parke,  Davis  & Co 7 

Petrolagar  Laboratories,  Inc 62 


■ 0(^)0- 


Page 


Podesta  and  Baldocclii 43 

Pollard’s  High  Tension  Stetho- 
scope, Dr 44 

Post  Graduate  School  of  Surgical 

Technique  59 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 44 

Radium  and  Oncologic  Institute  3 

Rainier  Brewing  Co 36 

Reid  Bros 37 

Richter  & Druhe 39 

Riggs  Optical  Company 31 

Saint  Francis  Hospital 14 

San  Francisco  Home  for  Incur- 
ables, Aged,  and  Sick 18 

Sanitarium  For  Sale 40 

Santa  Barbara  Clinic,  The 52 

Scherer  Co.,  R.  L 26 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  18 

Sharp  & Dohme 34 

Sharp  & Smith 33 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription  Phar- 
macies   24 

Soiiand,  Albert  (Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stacey,  J.  W.,  Medical  Books 11 

St.  Joseph’s  Hospital 52 

St.  Luke’s  Hospital 23 

St.  Mary’s  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugar  Institute,  The 56 

Sugarman  Clinical  Laboratory....  16 

Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies... . 37 

Towns  Hospital,  Charles  B 39 

Trainer-Parsons  Optical  Co 26 

Travers’  Surgical  Co 33 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Vita-Fruit  Products,  Inc 35 

Vitalait  Laboratory  12 

Waiss  Hollow  Needle  & Holder.  ..  20 

Wallace,  Sidney  J 53 

Walters  Surgical  Company 38 

Wedekind,  Frank  F 39 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


9 


The  Oaks  Sanitarium  Los  Cjatos , (California 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 

WILLIAM  C.  VOORSANGER,  M.  D.  PAUL  C.  ALEXANDER,  M.  D. 

Medical  Director  Asst.  Medical  Director 

Sa n Francisco  Office  490  Post  Street 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 

COMPTON,  CALIF. 

30  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  beds  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 

Philip  J.  Cunnane,  M.  D.  G.  Creswell  Burns,  M.  D. 
Helen  Rislow  Burns,  M.  D. 

Office:  1052  West  6th  Street,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

( Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 


We  Announce 

POST-GRADUATE  INSTRUCTION 

Comprising 

MEDICINE,  SURGERY  and  ALLIED  SPECIALTIES 


For  information  address  MEDICAL  EXECUTIVE  OFFICER:  345  W.  50th  St.,  New  York  City 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Proof  of  the  Inward/Upward  Thrust 
of  the  Hittenberger  Ptosis  Supporter 


Note  the 
raised 
", line  of 
thrust” 
effected 
by  the 
patented 
springs 


Complete 

Circular 

on 

request 


C.  H.  HITTENBERGER  CO. 

MArket  4244 

1115  Market  Street  460  Post  Street 

Established  1 902 


Why 

Calcium  Gluco-nate  Sandoz? 


Because  . . . 


1.  Distinctly  superior  to  all  other  calcium  salts. 

Orally:  Palatable,  well  absorbed,  does  not  upset  the  digestive 
tract. 

Intravenously:  Better  tolerated  than  calcium  chloride. 
Intramuccularly:  Painless  and  non-irritating.  The  only  cal- 
cium salt  suitable  for  this  convenient  mode  of  in- 
jection. 

2.  Meets  the  requirements  of  any  given  case. 

By  vein,  for  acute  need. 

By  muicle,  for  intense  and  prolonged  action. 

By  mouth,  for  long  continued  use. 

3.  Effective,  safe,  free  from  risk  of  overdosage. 

4.  Council  Accepted. 

Indications 

Pregnancy,  Lactation,  Period  of  Growth,  Dental  Caries,  Fractures, 
Rickets. 

Tetany,  Convulsions,  Spasmophilia. 

B'orc'iial  Asthma,  Migraine,  essential  and  neurogenic  Pruritus. 
Dermatoses  (Particularly  the  Acute  and  Itching  Types):  Eczema, 
U t’caria,  Arsphenamine  dermatitis. 

Anaphylaxis.  Serum  Rashes,  Prevention  of  Arsphenamine  reactions. 
Certain  types  of  Hemorrhage  and  to  Shorten  Blood  Coagulation  Time. 

Supplied 

Tablets,  1.5  Gm.:  Tins  of  30  and  150. 

Powder:  Cartons  of  50,  100  and  500  Gm. 

Ampules,  10  cc.  sterile  10  per  cent  solution:  Boxes  of  5 and  20. 

C.  ECDCLPH  GUTH 

BIOLOGICS  & THERAPEUTIC  SPECIALTIES 
WILLIAM  H.  BANKS,  M.  D.,  Medical  Director 

Phone  KEarny  3644 
811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

Frates  a Lovotti,  Professional  Pharmacists 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less; 
additional  words  5 cents  each. 


WANTED— X-RAY  TECHNICIAN,  FEMALE,  FOR  OFFICE 

work  in  Sacramento.  Address  Box  520,  California  and  Western 
Medicine. 


FOR  SALE— MEDICAL  AND  EYE,  EAR,  NOSE  AND 

throat  equipment  of  the  late  Dr.  John  M.  Gardner,  Santa  Cruz. 
Address,  Doctor  Harriet  T.  Gardner,  318  Alta  Building,  Santa  Cruz. 


FOR  SALE— A MEDICAL  EQUIPMENT  COMPRISING 

modern  medical  library,  x-ray,  ultra-violet  Alpine  sun  lamp 
Hanovia,  infra-red  lamp,  Hogan  high  frequency  apparatus,  Sklar 
Aeroizer,  instruments,  tables,  cabinets,  etc.  Automobile  and  house 
furniture,  if  desired.  Doctor  died  suddenly.  Good  will  with  pur- 
chase. Apply  Doctor’s  office,  5314  South  Broadway,  Los  Angeles. 


FOR  SALE  IN  CENTRAL  CALIFORNIA  — GENERAL 

medical  and  surgical  practice,  six-bed  hospital  and  office  equip- 
ment, gas  machine.  Large  prosperous  Amercian  community,  5000 
population,  competition  light.  Annual  income  $7,500.  Can  be 
doubled  with  surgery.  Ideal  climate.  Cash  price  $1,500  for  imme- 
diate sale.  Specializing.  Address,  Box  500,  California  and  Western 
Medicine. 


WESTERN  SCHOOL  OF  PHYSICAL  THERAPY— THE 

Western  School  of  Physical  Therapy  will  be  held  in  Los  Angeles, 
June  9-12,  in  conjunction  with  Pacific  Physiotherapy  Association. 
Four  days’  instruction  conducted  by:  Doctors  Burton  B.  Grover, 
A.  D.  Willmoth,  J.  E.  G.  Waddington,  J.  C.  Elsom,  M.  W.  Kapp. 
Fee:  $15.00.  For  registration  blanks,  address  Dr.  Charles  Wood 
Fassett,  506  Detwiler  Building,  Los  Angeles. 


FOR  SALE— THOROUGHLY  EQUIPPED  PHYSICAL 

therapy  laboratory  established  five  years,  referred  cases  only, 
located  in  one  of  Oakland’s  leading  professional  buildings.  Gross 
income  $8,400.  Expenses  $3,600.  Equipment  $2,000.  Price  $5,000. 
Terms  can  be  arranged.  Address  Box  510,  California  and  Western 
Medicine. 


SITUATIONS  WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 


“RAINBOW  RIDGE”  CHARMING  COUNTRY  PLACE  IN 

Los  Gatos  Hills,  1800  feet  altitude  among  wonderful  redwood 
and  sequoia  groves.  Main  bungalow,  guest  cottage,  baths,  servants’ 
cabin,  double  garage  with  ample  storeroom,  tank  house,  hot  and 
cold  showers,  brick  driveways  and  walks.  Beautiful  shrubs,  forty 
trees  of  assorted  fruits.  Ideal  summer  or  all  year  home.  Famous 
health  building  climate.  Unexcelled  for  sanitarium.  Exceptionally 
good  road.  $25,000,  reduced  from  $35,000.  Address,  Howard 
Throckmorton,  Los  Gatos,  California,  or  756  South  Spring  Street, 
Los  Angeles. 


Ghosts  of  Words  “Walk  on  Old  Manuscripts.” — 

Ultra-violet  rays  have  achieved  a new  miracle.  Ghosts 
of  words  erased  many  centuries  ago  from  old  manu- 
script pages  are  “walking”  in  luminous  garb,  sum- 
moned back  from  oblivion  through  the  magic  of  a 
Viennese  scientist,  Prof.  G.  R.  Kogel. 

It  is  well  known  that  the  old  manuscript  writers 
often  erased  the  hand-lettering  on  parchments  and 
economically  used  the  same  pages  over  again.  Master- 
pieces of  literature  and  important  historic  documents 
thus  may  have  been  wiped  out  in  order  to  preserve 
facts  that  seemed  of  greater  value  to  the  makers  of 
manuscript  books.  A recent  communication  to  the 
British  journal  Antiquity  reports  that  a method  of 
photographing  the  invisible  writings  has  been  found. 

To  photograph  the  ghost  writing,  a mercury  vapor 
lamp  which  generates  ultra-violate  rays  is  used.  A 
filter  of  glass  almost  black  in  color  transmits  only 
the  ultra-violet  rays.  When  examined  beneath  the 
ultra-violet  rays,  many  dyes  and  other  substances  take 
on  a curious  glow,  or  fluorescence,  each  substance 
exhibiting  a characteristic  color.  By  using  a special 
filter  it  is  possible  to  eliminate  the  surface  writings 
and  to  photograph  only  the  lost  script. 

It  lias  sometimes  been  possible  in  the  past  to  re- 
store invisible  writings  by  use  of  chemicals,  but  the 
processes  were  damaging  and  not  very  satisfactory. 
The  new  method  will  enable  scholars  to  probe  into 
the  past  of  any  manuscript,  however  valuable,  and 
to  make  the  ghosts  not  only  walk,  but  talk. — Science 
Service. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


// 


BOOK  REVIEWS 

List  of  Books  Received 


BOOKS  RECEIVED 

Trauma,  Disease,  Compensation.  A Handbook  of  Their 
Medico-Legal  Relations.  By  A.  J.  Fraser,  M.  D.,  Chief 
Medical  Officer,  Workmen's  Compensation  Board,  Winni- 
peg. Cloth.  Pp.  524.  Price,  $6.50  net.  Philadelphia: 
F.  A.  Davis  Company,  1930. 


The  Treatment  of  Skin  Diseases  in  Detail.  Principles 
and  Practice  of  Dermatology.  Volume  III.  By  Noxon 
Toomey,  M.  D.,  late  Instructor  in  Dermatology,  St.  Louis 
University.  Cloth.  Pp.  512.  Price,  $7.50.  St.  Louis:  The 
Lister  Medical  Press,  1930. 


United  States  Naval  Medical  Bulletin.  Published  quar- 
terly for  the  information  of  the  Medical  Department  of 
the  Navy.  Issued  by  The  Bureau  of  Medicine  and  Sur- 
gery, Navy  Department,  Division  of  Planning  and  Publi- 
cations, Captain  W.  Chambers,  Medical  Corps,  U.  S.  Navy, 
in  charge.  Edited  by  Lieutenant  Commander  Robert  P. 
Parsons,  Medical  Corps,  U.  S.  Navy.  Compiled  and  pub- 
lished under  the  authority  of  Naval  Appropriation  Act 
for  1930,  approved  March  2,  1929.  Paper.  Pp.  522.  Wash- 
ington: Government  Printing  Office,  1930. 


The  Normal  Diet.  A Simple  Statement  of  the  Funda- 
mental Principles  of  Diet  for  the  Mutual  Use  of  Phy- 
sicians and  Patients.  By  W.  D.  Sansum,  M.  S.,  M.  D., 
F.  A.  C.  P.,  Director  of  the  Potter  Metabolic  Clinic,  De- 
partment of  Metabolism,  Santa  Barbara  Cottage  Hospital, 
Santa  Barbara.  Third  revised  edition.  Cloth.  Pp.  134. 
Price,  $1.50.  St.  Louis:  The  C.  V.  Mosby  Company,  1930. 


The  Modern  Hospital  Year  Book.  Tenth  edition.  The 
Hospital  Reference  Book.  An  Annual  Reference  Volume 
on  the  Building,  Equipment,  Organization  and  Main- 
tenance of  Hospitals  and  Institutions.  Cloth.  Pp.  973. 
Price.  $2.50.  Chicago:  The  Modern  Hospital  Publishing 
Co.,  Inc.,  1930. 


Venereal  Disease.  Its  Prevention,  Symptoms  and  Treat- 
ment. By  Hugh  Wansey  Bayly,  M.  C.,  Hon.  Sec.  Society 
for  the  Prevention  of  Venereal  Disease.  Fourth  (Ameri- 
can) edition,  with  three  colored  plates  and  seventy-four 
illustrations  in  the  text.  Cloth.  Pp.  242.  Price,  $3.50  net. 
Philadelphia:  F.  A.  Davis  Company,  1930. 


Varicose  Veins.  With  Special  Reference  to  the  Injection 
Treatment.  By  H.  O.  McPheeters,  M.  D.,  F.  A.  C.  S.,  Di- 
rector of  the  Varicose  Vein  and  Ulcer  Clinic,  Minneapolis 
General  Hospital.  Second  revised  and  enlarged  edition. 
Cloth.  Pp.  233,  illustrated  with  half-tone  and  line  engrav- 
ings. Price,  $3.50  net.  Philadelphia:  F.  A.  Davis  Com- 
pany, 1930. 


Normal  Facts  in  Diagnosis.  By  M.  Coleman  Harris, 
M.  D.,  Lecturer  on  Physical  Diagnosis,  New  York  Home- 
opathic College  and  Flower  Hospital  and  Benjamin  Fine- 
silver,  M.  D.,  Lecturer  on  Diseases  of  the  Nervous  System, 
New  York  Homeopathic  Medical  College  and  Flower  Hos- 
pital, New  York  City.  Cloth.  Pp.  247,  illustrated  with 
forty-two  engravings,  some  in  colors.  Price,  $2.50  net. 
Philadelphia:  F.  A.  Davis  Company,  1930. 


Modern  Otology.  By  Joseph  Clarence  Keeler,  M.  D., 
F.  A.  C.  S.,  Associate  Professor  of  Otology,  Jefferson  Med- 
ical College.  Cloth.  Pp.  858,  with  ninety  original  illus- 
trations and  fifteen  colored  plates.  Price,  $10  net.  Phil- 
adelphia: F.  A.  Davis  Company,  1930. 


BOOK  REVIEWS 

A Primer  for  the  Tuberculous  and  Other  Essays  on 
Tuberculosis.  By  Robert  A.  Peers,  M.  D.  Pp.  324. 
Illustrated.  San  Francisco:  The  James  H.  Barry  Com- 
pany. 1930.  Price  $3.50. 

“A  book  designed  for  the  layman,  although  it  is  hoped 
that  it  may  be  read  with  interest  by  members  of  the  med- 
ical profession.” 

This  modest  preface  introduces  a series  of  absorbingly 
interesting  essays  written  for  the  instruction  and  cheer 
of  tuberculous  patients — reliable  information  in  simple 
language  regarding  tuberculosis  as  a disease  entity,  and 
as  an  economic  problem. 

Equally  valuable  to  the  patient,  the  family  and  the 
doctor,  this  "Primer  for  the  Tuberculous”  should  be 
available  in  every  home  touched  by  tuberculosis,  in  every 
tuberculosis  sanatorium  and  in  the  office  of  every  doctor, 
for  none  escape  contact  with  some  manifestation  of  this 
ubiquitous  disease.  A book  to  recommend  or  to  lend 
with  full  assurance  of  its  helpfulness  and  veracity. 

E.  W.  P. 

(Continued  on  Next  Page) 


Exclusively 


PHYSICIANS  / SURGEONS  , DENTISTS 
350  Post  Street,  Facing  Union  Square 
GAr  field  1014 


► BOOK  SERVICE  i 


Backed  by  one  of  the  largest  stocks  of  Medical 
Publications  in  the  country,  we  can  truly  boast  of 
book  service.  This  is  the  only  book  concern  in  the 
West  devoted  solely  to  Medicine  and  the  Allied 
Sciences. 

We’ll  Send  Your  Books  on  Approval 

J.  W.  STACEY,  Inc. 

236-38  Flood  Building 
SAN  FRANCISCO,  CALIF. 


LISTERS 


NO 

Starch 


CASEIN  PALMNUT  DIETETIC 

FLOUR 


prescribed  in 

Diabetes  <■ 


Strictly  starch-free,  palatable  muffins,  bread,  cakes, 
pastry,  etc.,  are  easily  made  in  any  home  from 
Listers  Flour.  Recipes  are  easy  to  follow  and  Listers 
Flour  is  self-rising.  One  month’s  supply  $4.85 


Ask  for  nearest  Depot  or  order  direct. 


LISTER  BROS.  Inc.,  41  East  42nd  St.,  NEW  YORK,  N.Y. 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


A Thoroughly  Equipped 

PHYSICAL  THERAPY  LABORATORY 

Including  Hydrotherapy  and  Massage  Available  to  Patients  Under  Prescription  of  Licensed  Physicians 

426-427  Dalziel  Building 
OAKLAND 
PHONE  LAKESIDE  5659 


DELMER  J.  FRAZIER 


BOARD  OF  DIRECTORS:  George  Dock.,  M.D.,  Pres.;  W.  Jarvis  Barlow,  M.D.;  Stephen  Smith,  M.D. ; 

F.  C.  E.  Mattison,  M.D. ; F.  H.  Macpherson 

Address:  STEPHEN  SMITH,  or  CHARLES  W.  THOMPSON,  Medical  Directors , Pasadena,  California 


LAS  ENCINAS  - - - EASADENA,  CALIE. 

A SANITARIUM  FOR  THE  TREATMENT  OF  GENERAL  AND  NERVOUS  DISEASES 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 

Clinical  Obstetrics.  By  Paul  T.  Harper.  Pp.  629.  Illus- 
trated. Philadelphia:  F.  A.  Davis  Company.  1930. 

This  book  attracts  the  attention  at  once  and  holds  it 
throughout.  It  is  different  and  has  an  unusual  personality. 

The  author  uses  simple  language — in  short  sentences 
and  paragraphs.  His  major  premise  is  that  in  order  to 
understand  the  mechanics  of  labor,  one  must  be  able  to 
“see”  what  is  going  on.  Since  actual  vision  is  impossible 
in  all  but  a very  few  phases  of  parturition,  visualization 
has  to  be  resorted  to.  This  is  accomplished  by  the  use 
of  a series  Of  very  original  diagrammatic  drawings,  which 
show  the  different  conditions  and  situations  as  they 
develop,  and  then  in  like  manner  show  their  solutions. 

Natural  processes  such  as  the  separation  of  the  pla- 
centa, engagement,  moulding,  descent  and  extension  are 
so  simply  illustrated  and  explained  that  anyone  can 
understand  them.  Abnormal  situations  and  procedures 
such  as  breech  extractions,  application  of  forceps  and 
conduct  of  abnormal  presentations,  no  longer  should 
puzzle  the  operator,  who  has  had  even  only  a moderate 
experience,  if  he  studies  the  diagrams  and  reads  the  text 
carefully. 

A knowledge,  by  the  reader,  of  the  fundamentals  of 
obstetrics  is  taken  for  granted,  but  the  clinical  and  med- 
ical aspects  of  the  subject  are  all  considered  in  sufficient 
detail  to  make  a very  complete  though  brief  work.  It 
could  be  to  the  obstetrician  very  much  as  plans  and 
specifications  are  to  the  builder.  K.  L.  S. 


A Practical  Treatise  on  Disorders  of  the  Sexual  Function 
in  the  Male  and  Female.  By  Max  Huhner.  Third 
edition.  Pp.  342.  Philadelphia:  F.  A.  Davis  Company. 
1929.  Price  $3. 

Doctor  Huhner  gives  a very  good  and  complete  classi- 
fication of  the  sexual  disorders.  It  is  a book  that  can  be 
highly  recommended  to  the  general  practitioner,  in  fact 
the  author  brings  out  the  important  truth  that  many 
a physician  regards  a man’s  sexual  complaint  as  insig- 
nificant and  wonders  why  that  patient  falls  into  the  hands 
of  the  quack. 

The  treatments  for  masturbation  and  coitus  interruptus 
are  particularly  well  outlined.  One  can  obtain  a clear 
conception  of  the  differences  in  the  nervous  mechanism 
between  normal  coitus,  impotence  and  pollutions,  from 
the  author’s  analysis  of  Groag’s  diagrammatic  schemes. 

The  book  gives  many  helpful  suggestions  to  the  genito- 
urinary specialist  and  can  be  recommended  as  a valuable 
addition  to  his  reference  library.  M.  V. 


The  Treatment  of  Varicose  Veins  of  the  Lower  Extrem- 
ities by  Injections.  By  T.  Henry  Treves-Barber. 
Pp.  120.  Illustrated.  New  York:  William  Wood  and 
Company.  1929.  Price  $2.25. 

This  monograph,  like  many  British  medical  books,  is 
characterized  by  its  minute  attention  to  detail  and  by 
the  excellence  of  its  literary  style.  No  space  is  wasted 
in  descriptions  of  obsolete  surgical  procedures,  but  every 
possible  angle  of  the  modern  injection  technic  is  fully 
dealt  with.  The  important  subject  of  the  prevention  and 
treatment  of  complications  is  taken  up  in  a refreshingly 


practical  manner,  and  the  list  of  contraindications  is 
shorter  than  usual,  as  it  should  be.  Some  interesting  new 
concepts  are  introduced  in  the  sections  on  classification 
and  etiology,  subjects  which  are  often  poorly  discussed 
in  the  literature.  The  author's  injection  technic  is  excel- 
lent, and  he  wisely  reserves  the  standing  posture  for  the 
insertion  of  the  needle  in  difficult  cases,  his  injections 
being  made  with  the  patient  recumbent.  He  has  never 
(Continued  on  Page  14) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


13 


V 40  Tablets 

Isacen 

“Roche" 

Diacetyl  - 

dioxyphenyl  isatin 
^ Nuriev,  N'gw Jersey 


..i- — 


A safe  laxative 
substance 
Entirely  new 
Non  - absorbable 
Non-toxic 
Cannot  injure 
the  vital  organs 
Acts  solely  in  the 
intestines 
Eliminated 
with  the  feces 
No  trace 
in  the  urine 

0? 

'Roche  xJMedicine 
of  'Rare  Quality 

trial  supply  sent  to 
physicians  on  request. 


Hoffmann- 
La  Roche 
Inc. 

NUTLEY 
NEW  JERSEY 


It  was  i iislmy 
who  wrote: 

“The  ideal  purgative  is  devoid  of 
any  effects  whatsoever,  save  in 
the  intestine,  it  passes  through 
the  stomach  without  materially 
deranging  its  function  and  is  not 
absorbed,  or  at  any  rate  lias  no 
significant  action  after  absorp- 
tion.”  . . . 


It  was  4Roclie* 
who  made 

a laxative  which  passes  through 
the  stomach  unchanged  and  with- 
out any  action  there;  which  acts 
only  in  the  intestine  and  is  not 
absorbed 


Isacen 

(diace  tyl-di-oxyphenyl-isatiri) 

In  place  of  “patent  medicine”  laxatives 
have  your  patients  take  the  non-absorb- 
able  laxative  Isacen,  in  the  knowledge 
that  it  cannot  cause  harm  to  kidneys, 
liver  or  other  organs. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 


Telephone  Main  7676 


Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


SAINT  FRANCIS  HOSPITAL 

AND 

SCHOOL  OF  NURSING 

A General  Hospital  With  Accommodations  for  Three  Hundred  Patients 

DIRECTORS 

JOHN  GALLWEY,  M.  D.  W.  W.  WYMORE,  M.  D. 

W.  B.  COFFEY,  M.  D.  JOHN  H.  GRAVES,  M.  D. 

THOS.  E.  SHUMATE,  M.  D.  M.  O.  AUSTIN,  M.  D. 

Managing  Director,  L.  B.  ROGERS,  M.  D. 

Address  Communications 

SAINT  FRANCIS  HOSPITAL 

Bush  and  Hyde  Streets  Telephone  PROSPECT  7600  San  Francisco 


J.  H.  O’CONNOR,  M.  D. 
B.  A.  MARDIS,  M.  D. 
H.  E.  MANWARING 


ELASTIC  HOSIERY 

Seamed  or  Seamless 

Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 

Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  < TRUSSES  r ELASTIC  WEAR 

Clark-Gandion  Co.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
522  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


BOOK  REVIEWS 


(Continued  from  Page  12) 

used  tourniquets,  which  many  have  found  useful,  and 
apparently  also  dispenses  with  the  elastic  bandage.  He 
uses  sodium  chlorid  solution  exclusively  in  his  work,  and 
seems  to  regard  the  intense  cramp  which  it  produces 
as  a beneficent  effect.  He  states  that  mercurial  solutions 
(biniodid)  should  only  be  given  to  syphilitic  subjects, 
although  we  now  know  that  syphilitics  are  no  more  tol- 
erant of  mercury  than  normal  individuals.  The  various 
sugar  solutions  are  not  mentioned,  but  he  condemns  the 
use  of  arsphenamin  for  this  purpose,  a practice  unheard 
of  in  America.  The  American  reader  will  stumble  over 
an  occasional  unfamiliar  word,  e.  g.,  phlyctena,  lipothy- 
mia,  but  otherwise  this  little  treatise  makes  most  pleas- 
ant and  profitable  reading.  H.  S. 


The  Volume  of  the  Blood  and  Plasma  in  Health  and  Dis- 
ease. By  Leonard  G.  Rowntree  and  George  E.  Brown, 
with  the  technical  assistance  of  Grace  M.  Roth. 
Pp.  219.  Illustrated.  (Mayo  Clinic  Monographs.) 
Philadelphia  and  London:  W.  B.  Saunders  Company. 
1929.  Price  $3. 

This  work  is  a brief  but  thorough  review  of  the  present 
status  of  blood  volume  studies.  The  subject  is  presented 
in  a clear  and  logical  manner.  The  authors  prefer  the 
dye  method  of  blood  volume  determination  because  it  is 
more  practical  for  clinical  application  and  more  accurate 
than  the  other  methods  proposed. 

Blood  volume  of  a group  of  normal  individuals  was  first 
determined  and  this  standard  used  for  comparison  with 
the  findings  in  various  diseases. 

The  practical  value  of  blood  volume  estimation  will 
undoubtedly  increase  with  time  and  its  greater  use. 

An  illustration  of  the  importance  of  blood  volume 
studies  in  our  understanding  of  certain  diseases  is  pointed 
out  by  the  authors  in  discussing  hypertension.  They  find 
a decreased  blood  volume  in  hypertension  showing  that 
the  vascular  bed  is  probably  too  small  for  the  amount 
of  blood  in  the  body  rather  than  that  the  blood  volume 
is  increased  above  the  normal.  N.  E. 


Practical  Massage  and  Corrective  Exercises  With  Applied 
Anatomy.  By  Hartvig  Nissen.  Fifth  edition.  Pp.  271. 
Illustrated.  Philadelphia:  F.  A.  Davis  Company.  1929. 
Price  $2.50. 

In  this  revised  edition  the  author  has  given  us  the 
essentials  of  massage  technic  mellowed  by  his  extensive 
experience.  The  presentation  is  clear,  well  arranged  and 
(Continued  on  Page  19) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


J5 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


16 


ANNOUNCEMENT 


OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION.  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION,  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FU LG U RATION  OF  BLADDER  TUMORS.  ETC., 
WILL  BE  GIVEN. 


LOUIS  CLIVE  JACOBS,  M.  D.,  Urologist 


FOURTEENTH  FLOOR-FOUR-FIFTY 
SUTTER 

SAN  FRANCISCO,  CALIFORNIA 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  DAvenport  7322 


SUGARMAN  CLINICAL  LABORATORY 

SUITE  1439 

450  Sutter  Street  San  Francisco,  Calif. 

Telephone:  DAvenport  0342  Emergency:  WEst  1400 

Keleket  and  the 

Medical  Profession 

THE  progress  of  the  KELEKET  Insti- 
tution— from  an  obscure  plant  23 
years  ago,  to  the  x-ray  manufacturing 
concern  that  it  is  today — is  due  to  the 
sound  policy  of  development  laid  down 
by  its  founders:  Never  to  introduce  a 
major  instrument  or  an  accessory  until 
the  widest  range  of  practical  tests  had 
proved  it  to  be  an  x-ray  contribution  of 
first  magnitude. 

KELEKET  Radiographic  and  Physical  Therapy  apparatus  and  accessories 
have  so  consistently  been  ahead  of  usual  comparisons  that  the  name, 

KELEKET,  is  now  intimately  linked  with  the  progress  of  Roentgenology 
by  many  of  the  foremost  practitioners,  both  in  this  nation  and  abroad. 

The  KELLEY-KOETT  MFG.  CO.,  Inc. 

COVINGTON,  KENTUCKY,  U.  S.  A. 

SAN  FRANCISCO,  CALIFORNIA  LOS  ANGELES,  CALIFORNIA 

278  Post  Street  1401  S.  Hope  Street 

Telephone  SUtter  7431  Telephone  WEstmore  5972 


Vertical  Fluoroscope 


Keleket  X-Ray  Power  Plus  Apparatus 
for  ultra-fast  radiography,  fluoroscopy 
and  moderate  therapy 


PURIFIED,  CONCENTRATED  (GLOBULIN) 


S.  Gov't.  License 
No.  56 


Cecp  at  a uniform  rempcrat 
tween  35°  and  50°  Fahrcn 


«E£ 


LY  AND  COMPANY 


INDIANAPOLIS,  U.  S. 


rf  ,*%$*  •• 


^sssaapw^ 


Though  less  spectacular  than  the 
achievements  ol  the  engineer  the  fruits 
of  research  in  the  medical  sciences  are 
quite  as  essential  to  human  welfare  and 
progress. 

Biological  research  has  provided  the 
means  of  combating  the  increased 
danger  of  infection  by  tetanus  spores 
due  to  the  multiplied  wounds  of  indus- 
try, travel,  and  play. 

The  administration  of  Tetanus  Anti- 
toxin should  be  a routine  treatment  of 
all  wounds  liable  to  be  infected  with 
tetanus  spores.  In  manifested  tetanus 
the  antitoxin  gives  better  results  than 


IN  SYRINGE  CONTAINER 


f mg, 

MkMWM*  ■ • 


sSfl 


any  other  treatment. 


TETANUS  ANTITOXIN,  LILLY,  is  purified  and  concentrated  by 
methods  which  give  remarkable  clarity  and  limpidity,  low  total 
solids,  and  a material  reduction  in  serum-sickness-producing  con- 
stituents. 

TETANUS,  ANTITOXIN,  LILLY,  is  supplied  through  the  drug 
trade  in  syringe  containers  practically  assembled  ready  for  use: 

A 39  1,500  units  A 47  ic.coo  units 

A 45  5,000  units  A 49  10,000  units 

A 38  1,500  units,  in  vials 


nniiiiiiHiiinniiiiiiiniiiimiiminiiiiiiiiiiiiiiiiiiiiiiiinii 


TETANUS  ANTITOXIN 


ILETIN 

INSULIN,  LILLY 

Iletin  { Insulin , Lilly } ivas  the  first  Insulin  com- 
mercially available  in  the  United  States 


By  faithful  use  of  Insulin  and  adherence  to  proper 
diet  the  life  and  usefulness  of  the  patient  may  be  ex- 
tended indefinitely  in  so  far  as  diabetes  is  concerned. 

Many  patients  have  been  using  Iletin  (Insulin, 
Lilly)  throughout  all  or  themajor  part  of  the  seven 
and  a half  years  in  which  it  has  been  available. 

Children  are  growing  normally  and  continuing 
in  school,  young  men  and  women  are  completing 
college  and  older  patients  are  leading  active, 
useful  lives. 


Medical  Building,  University  of  Toronto,  in  which  Insulin  was  discovered 
and  first  prepared  for  medical  r 


On  account  of  its  characteristic  uniformity,  purity, 
and  stability  Iletin  (Insulin,  Lilly)  may  be  relied 
upon  whenever  Insulin  is  needed.  Supplied  through 
the  drug  trade  in  5 cc.  and  10  cc.  vials. 

Write  for  pamphlets  and  diet  charts. 


The  Lilly  Research  Laboratories  which  co-operated  with  the  Insulin  Com- 
mittee of  the  University  of  Toronto  in  the  commercial  development  of  Insulin. 


ELI  LILLY  AND  COMPANY,  Indianapolis,  U.  S.  A. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


‘7 


IMPROVED  IODINE  THERAPY 


Accepted  by  the  Council  on  Pharmacy  and  Chemistry  of  the  American  Medical  Association 


THOROUGH 

DISTRIBUTION 

COMPLETE 

ABSORPTION 

SLOW 

ELIMINATION 

PLEASANT 

TASTING 

NO  GASTRIC 
IRRITATION 

NO  IODISM 
IN  THERAPEUTIC 
DOSES 


Lipoiodine,  “Ciba” — an  organic  lipoid  combination  of 
iodine — is  being  widely  used  instead  of  alkaline  iodides 
because  of  its  many  salient  features.  It  passes  through 
the  stomach  without  decomposition  and  is  absorbed 
from  the  intestine;  it  is  distributed  to  all  tissues  even  to 
the  nervous  system.  As  Lipoiodine,  “Ciba”  is  gradually 
eliminated,  the  organism  may  be  kept  under  the  influ- 
ence of  iodine  with  small  doses  over  prolonged  periods 
without  producing  gastric  irritation  or  iodism. 

Many  leading  physicians  prescribe  one  or  two  Lipoiodine, 
“Ciba”  tablets  after  meals  in  those  cases  where  the  use 
of  iodides  is  indicated.  Lipoiodine,  “Ciba”  tablets  are 
packed  in  tubes  of  20’s  and  in  bottles  of  100’s— each 
tablet  containing  0.3  gram  (approximately  4V2  grains) 
of  pure  Lipoiodine,  “Ciba”. 


fA  trade-size  package  of  Lipoiodine,**  Ciba ” 11 
ivill  be  sent  free  of  charge  upon  request 


Cl  BA  COMPANY,  Inc  NEW  YORK  CITY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


j8 


CANYON  SANATORIUM 


An  Open  Air  Sanatorium  for 
the  Treatment  of  Tuberculosis 


REDWOOD  CITY,  CALIFORNIA 


NESTLED  IN  THE  FOOTHILLS 

For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  DOuglas  4486 


The  Scripps 
Metabolic  Clinic 

For  the  treament  and  investigation  of: 

Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


San  Francisco  Home  for 
Incurables,  Aged  and  Sick 

2750  Geary  Street,  N.  E.  corner  Wood  Street 

Telephone  WEst  5700 

A non-profit  institution  for  the  service  of  persons  of 
limited  means.  Two  large  courts  with  gardens; 
solariums,  roof  garden  and  sun  room. 

Day  and  night  nursing  care — Staff  Physician  in  at- 
tendance— Private  Physician  if  desired. 

Convalescent  patients  received. 

No  mental,  alcoholic  or  contagious  cases  accepted. 
Formal  application  required  before  admission. 

DR.  GEO.  W.  COX 
(John9  Hopkins)  Attending  Physician 
MISS  MARY  A.  TAUTPHAUS,  R.N.,  Superintendent 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


‘9 


The  Doctors  Business  Bureau 

701-705  Balboa  Building 

SAN  FRANCISCO,  CALIFORNIA 

Fourteen  years  of  successful  and  satisfactory  service  to  doctors. 

More  than  eighteen  hundred  members  of  the  California  Medical  Association  are  using  the 
Bureau  to  their  advantage. 

At  the  urgent  solicitation  of  doctors  in  Sonoma  County  and  vicinity  an  office  has  been  estab- 
lished at  Santa  Rosa. 

( Ask  the  Sonoma  County  Medical  Society  about  it.) 

Collection  stamps  service  for  your  own  office  use  is  recommended  for  economy  and  efficiency. 
Every  account  referred  to  the  Bureau’s  Collection  Department  receives  the  most  careful  and 
confidential  personal  attention. 

TELEPHONE  OR  WRITE  FOR  PARTICULARS 

COLLECTION  DEPARTMENT 

THE  DOCTORS  BUSINESS  BUREAU 

Balboa  Building,  San  Francisco,  California 

SANTA  ROSA  Phone  GARFIELD  0460  LOS  ANGELES 

BONDED  LICENSED 


BOOK  REVIEWS 


(Continued  from  Page  14) 

easily  comprehended.  Massage  has  long  been  recognized 
as  a most  valuable  procedure  in  physical  therapeutics — 
scientific  research  has  given  the  medical  profession  defi- 
nite knowledge  of  the  reaction  produced  by  massage 
treatment — most  beneficial  when  indicated  and  properly 
administered;  decidedly  harmful  when  employed  by  an 
unskilled  technician  without  medical  direction.  The 
author’s  methods  are  definitely  set  forth  in  the  employ- 
ment of  the  indicated  type  of  massage  movement;  the 
emphasis  on  active,  assistive  and  resistive  exercise  to 
restore  or  repair  normal  function;  the  recognition  that 
the  properly  qualified  technician  under  medical  super- 
vision can  be  of  definite  assistance  to  the  physician  in 
comprehending  and  administering  massage  treatment  to 
bring  about  the  desired  effect. 

This  book  should  top  the  list  on  practical  massage  and 
therapeutic  exercise.  H.  L.  L. 


Laboratory  Methods  of  the  United  States  Army.  By 

Charles  F.  Craig.  Second  edition.  Philadelphia:  Lea 
and  Febiger.  1929. 

It  is  a delightful  small  manual  covering  the  subject 
in  a most  thorough  and  complete  manner. 

It  is  all  that  can  be  desired  as  a hasty  reference  manual. 
There  are  several  new  additions  and  new  sections  added 
in  this  edition.  H.  R.  O. 


Practical  Local  Anesthesia  and  Its  Surgical  Technic. 

By  Robert  Emmett  Farr.  Second  edition.  Philadel- 
phia and  New  York:  Lea  and  Febiger.  1929. 

In  writing  this  volume,  the  author  has  done  much  more 
than  present  clearly  and  concisely  the  subject  of  practical 
local  anesthesia  by  adding  many  details  indispensable  in 
making  up  the  cooperative  team  in  the  operating  room. 
His  style  of  writing  is  free  and  easy.  At  no  time  is  he 
positive,  yet  by  drawing  all  his  conclusions  from  his  own 
personal  experience  over  a long  period  of  time  every 
statement  he  makes  is  convincing. 

The  book  is  filled  with  surgical  technic,  operating 
room  technic  and  surgical  anatomy.  Considerable  space 
is  given  to  the  chemistry,  action,  strength  used,  toxicity, 
etc.,  of  all  the  different  anesthetics  used  for  local 
anesthesia. 

The  excellent  description  of  how  to  inject  1 per  cent 
novocain  into  the  tissues,  calling  attention  to  the  necessity 
of  constantly  moving  the  needle,  of  using  large  amounts 
of  weak  solution,  is  certainly  worth  the  time  and  the 
price  of  the  book. 

(Continued  on  Page  23) 


Alum  Rock  Sanatorium 
TUBERCULOSIS 


Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 

RATES  AND  FOLDER  ON  APPLICATION 


Consultants: 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


is  no  longer  necessary; 


e Ordinaiy  Needle 


Waiss  Hollow  Needli 


Enlarged  drawing  showing  excessive 
trauma  produced  by  ordinary  needle  _ , , 

wi,h  doubled  suture. 

I merit  of  suture.  \ 


Suture  remains  in  situ  when  needle  is 
withdrawn.  Waiss  Hollow  Needle  re- 
duces suture  trauma  to  minimum. 


WAISS  Um  NEEDLE 

permits  an  unusual  degree  of  safety  and  ease  in  suturing,  heretofore  impos- 
sible with  the  ordinary  surgical  needle  and  its  concomitant  doubled  suture. 

Waiss  holders,  to  which  the  hollow  needles  handles.  Both  needles  and  holders  are 
are  attached  when  in  use,  are  made  in  guaranteed  to  be  free  of  mechanical 
three  models,  with  either  plain  or  grooved  imperfections. 


Needles  are  made  in  all  standard  sizes  \X/A  1 1 
and  types  and  can  be  used  with  any  h ||‘“"y^edle 

lolder 


brand  of  sutures  preferred  by  surgeons. 


Write  for  free  booklet  with  photo- 
graphs of  needles  and  holders,  giving 
complete  details. 


BRACKWOOD  CORPORATION™ 

6331  Hollywood  Boulevard 

LOS  ANGELES 


CALIFORNIA 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


21 


The  Modification  of  Powdered  Milks 

Governed  by  the  Same  Rules 

as  Cow’s  Milk 

When  physicians  are  confronted 
with  undependable  fresh  milk  sup- 
plies in  feeding  infants,  it  is  well  to 
consider  the  use  of  reliable  powdered 
whole  milks  such  as  Mead’s  or  the 
well-known  Klim  brand.  Such  milk 
is  safe,  of  standard  composition,  and 
is  easily  reliquefied. 

Under  these  conditions,  Dextri- 
Maltose  is  the  physician’s  carbohy- 
drate of  choice  just  as  it  is  when  fresh 
cow’s  milk  is  employed. 

The  best  method  to  follow  is  first  to 
restore  the  powdered  milk  in  the  pro- 
portion of  one  ounce  of  milk  to  seven 
ounces  of  water,  and  then  to  proceed 
building  up  the  formula  as  usual. 


DEXTRI-MALTOSE  NOS  1.  2 AND  3.  SUPPLIED  IN  1-LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITERATURE  ON 
REQUEST.  MEAD  JOHNSON  & CO  , EVANSVILLE.  IND  . U S A 


— In  Rickets,  Tetany  and  Osteomalacia 


(2)  The  clinical  experience  which 
safely  settled  the  question  of 
activated  ergosterol  dosage  was 
obtained  under  fellowships  es- 
tablished by  Mead  Johnson  & 
Co.,  at  five  leading  universities. 
This  rich  experience  is  behind 
every  bottle  of  Mead’s  Viosterol 
in  Oil,  100  D (originally  Acter- 
ol) — the  American  Pioneer — 
Council-accepted. 

Specify  the  American  Pioneer  Product — 

— MEAD’S  Viosterol  in  Oil,  100  D— — — 

Mead  Johnson  &.  Co.,  Evansville,  Indiana 


The  PHYSICIAN’S  POLICY  is  MEAD’S  POLICY 


Besides  producing  dependable  Infant  Diet  Materials  such  as  Dextri-Maltose, 
and  maintaining  a model  laboratory  devoted  exclusively  to  research.  Mead 
Johnson  & Company  for  years  have  been  rendering  physicians  distinguished 
service  by  rigidly  adhering  to  their  well-known  policy,  namely: 


“Mead’s  Infant  Diet  Materials  are  advertised  only  to  physicians. 

No  feeding  directions  accompany  trade  packages.  Information  in 
regard  to  feeding  is  supplied  to  the  mother  by  written  instructions 
from  her  doctor  who  changes  the  feedings  from  time  to  time  to  meet 
the  nutritional  requirements  of  the  growing  infant.  Literature  is 
furnished  only  to  physicians.” 

Every  physician  would  do  well  to  bear  in  mind  that  in  this  commercial 
age,  here  is  one  firm  that  instead  of  exploiting  the  medical  profession,  lends 
its  powerful  influence  to  promote  the  best  interests  of  the  medical  profes- 
sion it  so  ably  serves. 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 
by  mouth.” 

ALQUA  WATER — In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 

To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 

Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 

The  Shasta  Water  Company 

Bottlers  and  ControlUng  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 

At  All  Druggists 


ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 

ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


SOUTHERN  SIERRAS  SANATORIUM 

For  Tuberculosis  and  Allied  Affections 

BANNING,  CALIFORNIA 

Climate  Favorable  Throughout  The  Year 


Many  aids  for  comfort  and  convenience. 
Simmons’  Beautyrest  mattresses  throughout. 
Radio  connection  in  each  apartment. 


Tempting,  tasteful  foods  prepared  by  a woman  cook. 
Special  dietaries  when  required. 

A spot  of  beauty  in  an  atmosphere  of  contentment. 


RATES  WITHIN  THE  MEANS  OF  THE  AVERAGE  PATIENT 
A REPUTATION  FOR  SERVICE  AND  SATISFACTION 


Charles  E.  Atkinson,  M.  D. 
Medical  Director 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


BENJAMIN  H.  DIBBLEE 
President 


I.  C.  KNOWLTON 

Secretary 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 

W.  G.  Moore,  M.D. 

Harold  P.  Hill,  M.D. 

Geo.  D.  Lyman,  M.D. 

Howard  H.  Johnson, 
M.  D.,  Med.  Dir. 
Secretary,  Executive 
Committee. 


BOOK  REVIEWS 


(Continued  from  Page  19) 

He  calls  attention  to  the  fact  that  novocain  imme- 
diately after  it  is  injected  into  the  tissues  unites  with 
the  protoplasm  and  becomes  inert,  and  for  that  reason  is 
poisonous  only  when  injected  into  the  blood  stream. 
I wonder  how  many  surgeons  using  local  anesthesia 
know  that. 

Another  subject  which  is  given  considerable  space  is 
the  importance  or  necessity  of  the  psycho-anesthetist. 
That  particular  individual,  in  my  opinion,  is  indispen- 
sable when  working  on  highly  nervous  patients.  In 
charity  hospitals,  the  surgeon  can  as  a rule  act  as  his 
own  psycho-anesthetist  by  injecting  a little  concentrated 
vocal  profanity  with  the  weak  solution  of  novocain. 

The  most  important  requirement  of  an  anesthetic,  next 
to  reducing  pain  to  a minimum,  is,  as  all  surgeons  know, 
relaxation.  That  subject  is  beautifully  handled  all 
through  the  paper  and  one  is  convinced  beyond  all  doubt 
that  relaxation  can  be  obtained  with  local  anesthesia  just 
as  well  as  with  ether  and  certainly  much  better  than 
with  combined  local  and  gas,  when  it  is  no  longer  pos- 
sible to  have  the  cooperation  of  the  patient  with  the 
surgeon. 

The  problem  of  how  to  place  the  patient  on  the  table, 
how  to  tilt  the  table,  where  to  place  the  sand-bags,  etc., 
so  as  to  obtain  the  maximum  relaxation,  is  presented 
very  scientifically,  being  based  absolutely  on  anatomy, 
physiology  and  physics. 

No  surgeon,  whether  intensely  interested,  slightly  inter- 
ested, or  not  interested  at  all  in  local  anesthesia,  can 
afford  to  be  without  this  book  on  practical  local  anes- 
thesia because  of  the  many  practical  things  it  contains 
so  indispensable  in  making  up  the  chain  of  perfect  sur- 
gical technic.  A.  H.  R. 


Hemorrhoids:  The  Injection  Treatment  and  Pruritus  Ani. 

By  Lawrence  Goldbacher.  Pp.  205.  Illustrated 
Philadelphia:  F.  A.  Davis  Company.  1930.  Price  $3.50. 

The  essential  point  of  the  author's  treatment  is  the 
large  quantity  of  5 per  cent  phenol  oil  solution  used — 
up  to  10  cubic  centimeters  per  pile.  On  one  occasion 
he  injected  20  cubic  centimeters,  a dose  containing 
1 cubic  centimeter  of  the  pure  drug. 

The  poisonous  dose  of  carbolic  varies,  the  minimum 
being  rather  more  than  4 cubic  centimeters  (Shoemaker), 
although  seven  drops  (Sajous)  have  caused  alarming 
symptoms.  If  this  is  the  case  then  the  author  is  well 
within  the  margin  of  safety.  He  claims  good  results  with 
no  untoward  after-effects. 

(Continued  on  Page  26) 


HAY 

FEVER 

has  been  prevented  in 
thousands  of  cases  with 

Pollen  Antigen 

j£>ederle 

Prophylactic  Treatment 

may  be  commenced  as  late  as  two  weeks 
before  the  date  of  the  expected  attack. 
Fifteen  graduated  doses  of  an  appropriate 
Antigen  are  required.  Patients  usually 
suffer  little  inconvenience  from  the  nv 
jections,  and  many  are  completely  pro- 
tected  from  Hay  Fever  attacks. 

Full  information  upon  request 

Lederlf,  Laboratories 

INCORPORATED 

ii  New  York 


24 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  MArket  0331 


Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with 
especial  reference  to  parasites. 

Containers  will  be  fur- 
nished upon  request. 

HERBERT  GUNN,  M.  D. 

2000  Van  Ness  Avenue 

San  Francisco  Telephone:  GRaystone  1027 


THE  HILL- YOUNG  SCHOOL 
OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi- 
culty. Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child's 
physician.  Testimonials  from  physicians. 

School  Publications — $2.00  each:  ’'Overcoming  Cleft 
Palate  Speech,"  "Help  for  You  Who  Stutter." 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 
2809-15  South  Hoover  Street  WEstmore  0512 


Shumate’s 

PRESCRIPTION  PHARMACIES 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 
Refrigerated  Biologies  i Prescription 
Technique 

Catering  to  the  Medical  Profession  Since  1890 
SAN  FRANCISCO 


We  solicit  correspondence  from  physicians 
regarding  pharmaceutical  and  proprietary 
preparations. 

LENGFELD’S  PHARMACY 

216  Stockton  Street  San  Francisco,  Calif. 

Telephone  SUtter  0080 


HOLLAND-RANTOS 
COMPANY,  Inc. 

Gynecological  and  Obstetrical 
Specialties 

Descriptive  Leaflets,  Reports  and  Price  List 
Send  on  Request 


156  FIFTH  AVENUE 


NEW  YORK  CITY 


Hazel  E.  Furscott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  DOuglas  9124  380  Post  St. 

San  Francisco,  California 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


DIET  QUESTIONS  have  GELATINE  ANSWERS 


CAN  THE  BOTTLE  BABY  HAVE  LESS 
STOMACH  DISTURBANCE  AND 
MORE  BODY  NOURISHMENT? 


The  answer  to  these  two  questions  will  be  found  in 
the  same  package. 

It  has  been  proved  by  medical  research  that  the 
addition  of  1%  of  Knox  Sparkling  Gelatine  to  the  bottle 
baby’s  milk  modifies  the  tendency  of  cow's  milk  to 
curdle  in  the  natural  acids  and  enzyme  rennin  of  the 
infant  stomach. 

Not  only  does  the  gelatine  lessen  stomach  disturb- 
ance but,  in  many  cases,  increases  the  absorption  of  the 
milk  — enhancing  the  nourishment  the  infant  obtains 
from  its  food. 

Care  should  be  taken,  however,  to  use  only  real 
gelatine— the  clear,  unsweetened, unflavored,  unbleached 
kind.  For  more  than  40  years  Knox  Sparkling  Gelatine 
has  been  regarded  by  the  medical  profession  as  meet- 
ing each  of  these  requirements. 

Be  sure  you  specify  Knox  Gelatine— the  real  gelatine 
—when  you  prescribe  gelatine  for  baby’s  milk. 

The  following  is  the  formula  prescribed  by  authori- 
ties in  infant  feeding:  Soak,  for  about  10  minutes,  one 
level  tablespoonful  of  Knox  Sparkling  Gelatine  in  one- 
half  cup  of  milk  taken  from  the  baby’s  formula;  cover 
while  soaking;  then  place  the  cup  in  boiling  water, 
stirring  until  gelatine  is  fully  dissolved;  add  this  dis- 
solved gelatine  to  the  quart  of  cold  milk  or  regular 
formula. 

We  have  listed  here  some  booklets  -which  we  believe  will 
help  you  in  your  practice.  Kindly  mail  the  coupon  today. 


KIMOX 

is  the  real 


TTTTTTTTTTTT  TTTTTTTTTTTT  TTTTTTTTTTTT  TT  TTTTTTTTTTTT TTTTTTTTTTTT  T TTTTTTTTTTY 

KNOX  GELATINE  LABORATORIES 
417  Knox  Avenue,  Johnstown,  N.  Y. 

Please  send  me,  without  obligation  or  expense,  the  booklets  which  I have 
marked.  Also  register  my  name  for  future  reports  on  clinical  gelatine  tests 
as  they  are  issued. 

□ Varying  the  Monotony  of  Liquid  and  Soft  Diets.  □ Recipes  for  Anemia. 

□ Diet  in  the  Treatment  of  Diabetes.  □ Reducing  Diet. 

□ Value  of  Gelatine  in  Infant  and  Child  Feeding. 


Name  ... 
Address 


GELATINE 


26 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PHYSIOTHERAPY  EQUIPMENT  AND 

ACCESSORIES 

WAPPLER  DIATHERMY  APPARATUS 

Complete  assortment  of  models  to  fit  all  requirements  from  Portable 
work  to  Hospital  use. 

WAPPLER  MYOSTAT 

A galvanic  and  sine  machine  giving  a complete  range  of  low  voltage 
currents. 

ULTRA  VIOLET  QUARTZ  AND  INFRA  RED  LAMPS 

All  equipment  installed  and  operation  taught  by  experienced  technicians 
Expert  service  at  your  call  at  all  times 

R.  L.  SCHERER  COMPANY 

Los  Angeles,  California  Fresno  San  Franc‘sco>  Calif. 

736  South  Flower  Street  c t-..  679  Sutter  Street 

San  Diego 

TRINITY  6377  PROSPECT  3248 


CARL  ZEISS,  JENA 

MICROSCOPES 

Represent  the  finest  possible  craftsmanship,  opti- 
cally and  mechanically,  in  the  microscope  field. 
Priced  from  ^128.00  up.  Terms  if  desired. 

Trainer-Parsons  Optical  Co. 

228  POST  STREET  SAN  FRANCISCO 


BOOK  REVIEWS 


(Continued  from  Page  23) 

Pruritus  ani  is  treated  with  the  same  solution,  10  cubic 
centimeters  being  injected  under  the  skin  one-half  inch 
from  the  anus  at  the  spot  where  the  itching  is  most 
severe.  Injections  are  repeated  weekly.  The  author 
claims  the  treatments  are  painless  and  curative. 

While  Goldbacher  may,  and  probably  does,  get  the 
splendid  results  he  claims  for  his  method  of  massive 
injection  of  carbolic  acid  solution — 10  cubic  centimeters 
equals  one-third  ounce,  it  would  behoove  those  who  would 
imitate  him  to  proceed  cautiously  lest  they  get  the 
untoward  results.  A.  N. 


Gall-Bladder  Disease,  Roentgen  Interpretation  and  Diag- 
nosis. By  David  S.  Beilin.  Saint  Paul:  Bruce  Pub- 
lishing Company.  1929.  Price  $6. 

This  is  a unique  and  rather  attractively  arranged  book 
on  roentgen  diagnosis.  In  the  preface,  the  author  explains 
that  he  is  writing  a brief  resume  of  the  embryology, 
anatomy,  physiology  and  pathology  of  the  gall-bladder,  as 
well  as  a study  of  its  x-ray  features.  These  chapters  are 
to  be  used  in  relation  to  x-ray  work.  However,  it  seems 
to  me  that  they  are  too  brief  to  be  of  much  value;  unfor- 
tunately some  of  the  data  are  not  up  to  date  and  there- 
fore not  quite  correct. 

The  chapters  on  the  technic  of  cholecystography  are 
easily  read,  brief,  and  of  value.  The  illustrations  that 
accompany  it  are  unusually  good.  The  chapters  on  differ- 
ential diagnosis  are  too  brief  to  be  of  much  help,  although 
the  x-ray  plates  illustrating  these  features  are  good. 
There  are  only  sixty-five  pages  in  the  whole  book;  of 
course  this  is  too  small  a number  to  give  any  complete 
resume  on  the  subject  of  differential  interpretation  of 
the  gall-bladder  disease,  but  it  is  a very  readable  book 
and  of  value  because  of  its  concise  presentation. 

S.  H.  M. 


Practical  Materia  Medica,  an  Introductory  Text  to  the 
Study  of  Pharmacology  and  Therapeutics  Designed 
for  Students  of  Medicine.  By  Clayton  S.  Smith  and 
Helen  L.  Wikoff.  Pp.  300.  Philadelphia:  Lea  and 
Febiger.  1929. 

This  book  is  intended  to  serve  as  a medical  text  and 
laboratory  guide  in  materia  medica  and  pharmacology. 
The  drugs  are  presented  according  to  a chemical  classifi- 
cation, discussing  for  each  its  composition,  method  of 
preparation,  official  preparation,  and  an  extremely  brief 
hint  of  its  pharmacodynamic  and  therapeutic  actions. 

(Continued  on  Page  28) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


SQUIBBS  VITAMIN  PRODUCTS 

Since  the  earliest  research  on  vitamins,  E.  R.  Squibb  & 

Sons  has  been  actively  engaged  in  studying  the  impor- 
tance of  these  factors  to  the  physician.  Squibb  was  among 
the  first  to  develop  products  which  contained  these  fac- 
tors for  prophylactic  and  therapeutic  uses.  Squibb  Vita- 
min Products  are  available  for  almost  all  professional 
needs.  Here  at  a glance  are  given  their  content  and  use. 


SQUIBBS 

VITAVOSE 

A palatable 
maltose-dextrin 
preparation,  ex- 
ceedingly rich  in 
Vitamin  B and 
assimilable  iron 
salts.  Stimulates 
the  appetite.  For 
modification  of 
milk  in  infant 
feeding,  and  as  a 
diet  supplement. 


SQUIBBS 

DEXTROVITAVOSEI 

A sweetened  and 
readily  soluble 
form  of  Vitavose 
in  which  the  car- 
bohydrate (dex- 
trose) content  has 
been  materially 
increased.  For  the 
modification  of 
cow ’ s m ilk  for 
very  young  in- 
fants, especially 
those  with  gastro- 
intestinal dis- 
turbances. 


SQUIBBS 

VIOSTEROL 

IN  OIL-IOO  D 

A specific  for 
rickets,  tetany, 
osteomalacia. 
Irradiated  ergo- 
sterol  in  Oil,  guar- 
anteed to  contain 
ioo  times  the 
Vitamin  D poten- 
cy of  Cod-Liver 
Oil,  as  defined  by 
the  Wisconsin 
Alumni  Research 
Foundation. 


SQUIBBS 

CODLIVEROIL 

WITH  VIOSTEROL  5D 

Squibb’s  regular 
Vitamin-Tested 
and  Vitamin-Pro- 
tected Cod-Liver 
Oil  with  the  Vita- 
min D content 
increased  by  the 
addition  of  Vio- 
sterolsothatithas 
five  times  the  an- 
tirachitic strength 
of  standard  cod- 
liver  oil. 


The  above  Squibb  Products  are  accepted  by  the  Council  on 
Pharmacy  and  Chemistry  of  the  A.  M.  A. 


Write  Professional  Service  Department  for  samples  and  literature 

ERSquibb  & Sons,  New  York 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1858. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


28 


^jpHE  foundation 
of  Calcreose  is 
creosote  — ob- 
tained from  the 
wood  of  selected 
trees. 


Tablets 
Calcreose 
4 grs. 

Each  Tablet  Cal- 
creose A grains, 
contains  2 grains 
pure  creosote 
combined  with 
hydrated  calcium 
oxide.  The  full 
expectorant  ac- 
tion of  creosote  is 
provided  in  a form 
which  patients 
will  tolerate. 


rtAtTBIt 


We  suggest  you  also  test  Calcreose  Tab- 
lets in  the  treatment  of  your  elderly  patients 
troubled  -with  frequent  and  burning  urina- 
tion  2 tablets  A times  daily.  Liberal 

sample  of  Tablets  and  Syrup  gratis.  The 
JVlaltbie  Chemical  Co.,  Newark.,  N.  J. 


Compound 
Syrup  of 
Calcreose 


/) 

J : 


Available  for  the  less- 
er ailments  of  the  re- 
spiratory tract  ...  a 
tasty,  effective  cough 
syrup  that  does  not 
nauseate  . . . each 
fluid  ounce  represent- 
ing Calcreose  Solu- 
tion, 160  minims;  Al- 
cohol, 2 A minims; 
Chloroform,  approxi- 
mately 3 minims; 
Wild  Cherry  Bark, 
20  grains;  Pepper- 
mint, Aromatics  and 
Syrup  q.  s. 


THE  • MALTBIE  • CHEMICAL  • COMPANY  • NEWARK  • NEW  • JERSEY 


( An  Antiseptic  Liquid) 

&xcmwz  c^vmfut  cftAifuMtlim 


e Thysician’s  samples 
sent  without  cost 
or  obligation. 


THE  NONSPI  COMPANY 

2652  WALNUT  STREET 
KANSAS  CITY.  MISSOURI 

Name 
Street 

City 


Send  free  NONSPI 
samples  to: 


BOOK  REVIEWS 


(Continued  from  Page  26) 

Detailed  chemical  and  analytical  directions  are  included 
in  great  profusion.  Sections  on  toxicology  and  prescrip- 
tion writing  form  concluding  chapters.  At  intervals 
throughout  the  text  questions  are  introduced  to  bring  out 
salient  points. 

The  authors  state  that  this  book  is  designed  as  a med- 
ical text,  and  in  fairness  to  them  it  must  therefore  be 
judged  strictly  from  that  standpoint.  Unfortunately,  it 
fails  to  develop  its  subject  in  such  a way  as  to  give  a 
medical  student  the  type  of  knowledge  he  needs,  or  for 
which  he  has  any  use.  Much  space  is  devoted  to  com- 
pounds of  little  or  no  importance,  while  truly  valuable 
ones  are  passed  over  in  a word.  A single  instance  may 
be  cited  to  illustrate  this  misplaced  emphasis  and  lack 
of  applicability  to  medical  needs.  Thus,  the  three  ex- 
tremely important  compounds,  epinephrine,  ephedrine  and 
thyroxine  are  dismissed  in  a single  page,  and  part,  even, 
of  that  one  page  is  taken  up  by  their  structural  formulae. 
Contrast  the  knowledge  needed  by  a medical  student  of 
these  drugs  with  that  required,  for  instance,  of  one  given 
a whole  page  by  itself,  the  preparation  of  soft  soap  and 
its  liniment.  Many  such  examples  could  be  quoted  if 
there  were  any  point  in  multiplying  illustrations.  By 
using  this  text,  a student  might  become  well  versed  in 
pharmaceutical  chemistry,  but  he  would  have  little  or 
no  concept  of  the  practical  significance  of  the  drugs, 
their  mechanism  of  action,  limitations,  side-actions,  toxi- 
cology, or  of  the  many  other  factors  which  should  be 
considered  in  their  clinical  employment. 

The  reviewer  cannot  help  but  feel  that  if  this  text 
represents  a current  concept  of  what  a medical  student 
should  know  of  pharmacology  and  therapeutics,  there  is 
some  reason  for  the  irrational  and  empirical  treatment 
of  disease.  On  the  other  hand,  if  it  is  intended  to  cover 
only  what  might  be  termed  chemical  pharmacology,  the 
greater  part  of  the  material  is  superfluous  for  medical 
students,  in  this  age  of  adequate  facilities  for  drug 
manufacture  and  distribution,  and  of  crowded  medical 
curricula.  M.  L.  T. 


An  Introduction  to  the  Study  of  the  Nervous  System. 

By  E.  E.  Hewer  and  G.  M.  Sandes.  Pp.  104.  Illus- 
trated. St.  Louis:  C.  V.  Mosby  Company.  1929. 
Price  $6.50. 

This  book,  as  its  name  implies,  has  been  written  pri- 
marily for  students.  It  is  divided  into  two  parts. 

Part  I includes  chapters  on  nerve  cells  and  fibres, 
changes  following  nerve  section,  the  ascending  and 
descending  tracts  of  the  cord,  cerebellar  connections,  the 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


29 


LIVERMORE  SANITARIUM 


GENERAL 

Climatic  advantages  not  excelled  In  United  States. 
Indoor  and  outdoor  gymnastics  under  the  charge 
Department. 

A resident  medical  staff.  A large  and  well  trained 
individual  attention. 

Information  and  circulars  upon  request 
Address:  CLIFFORD  W.  MACK,  M.  D. 

Medical  Director 
Livermore,  California 
Telephone  7-J 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
and  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 

FEATURES 

Beautiful  grounds  and  attractive  surrounding  country, 
of  an  athletic  director.  An  excellent  Occupational 

nursing  staff  so  that  each  patient  is  given  careful 


CITY  OFFICES: 


San  Francisco 
450  Sutter  Street 
KEarny  6434 


Oakland 

1624  Franklin  Street 
GLencourt  5989 


1. 

2. 

S. 


connections  of  the  cranial  nerves  and  basal  ganglia,  the 
microscopic  structure  of  the  cerebral  and  cerebellar 
cortices,  the  cerebrospinal  fluid  and  the  autonomic 
system. 

Part  II  comprehends  the  normal  physiology  of  the 
sensory  and  motor  pathways  and  the  results  of  interfer- 
ence with  them  at  various  points,  with  further  chapters 
on  the  cerebral  cortex,  reflex  action,  levels  of  integra- 
tion and  mechanism  of  coordinated  muscular  movement, 
as  well  as  notes  on  certain  pathological  conditions. 

There  is  an  appendix  on  histological  methods,  and  a 
comprehensive  index.  Each  chapter  concludes  with  a list 
of  references  for  further  study.  There  are  fifty-five  dia- 
grams, most  of  them  in  color,  to  illustrate  the  text.  The 
subject  matter  has  been  boiled  down  as  much  as  possible, 
hence  a certain  amount  of  dogmatism  has  been  unavoid- 
able. 

However,  for  students  interested  in  neurology,  the 
volume  is  valuable  for  quick  reference.  The  American 
edition  contains  an  introduction  by  Sydney  I.  Schwab. 

W.  S. 

Diseases  Transmitted  from  Animal  to  Man.  By  Thomas 
G.  Hull.  Springfield:  Charles  C.  Thomas.  1930. 

A reading  of  this  volume  leads  to  the  conclusion  that 
the  author  says  too  much  and  not  enough.  He  makes 
many  sweeping,  indefinite  statements,  so  that  the  actual 
meat  of  his  discourse  could  well  be  epitomized  in  concise 
paragraphs  rather  than  extended  over  as  many  pages. 
On  the  other  hand,  the  material  is  entirely  inadequate 
for  reference  by  the  student  and  is  totally  insufficient  to 
be  of  assistance  to  the  worker  who  comes  with  a con- 
crete problem.  There  is  not  enough  accurate  detail  and, 
in  general,  descriptions  are  incomplete  and  often  inexact. 
The  book  is  loosely  written  and  should  either  be  con- 
densed in  a vade  mecum  or  expanded  into  a real  manual. 

I seriously  question  the  usefulness  of  this  volume. 

A.  C.  R. 

Diseases  of  the  Chest  and  the  Principles  of  Physical  Diag- 
nosis. By  George  William  Norris  and  Henry  R.  M. 
Landis.  With  a chapter  on  The  Transmission  of 
Sounds  Through  the  Chest  by  Charles  M.  Montgom- 
ery, and  a chapter  on  The  Electrocardiograph  in 
Heart  Disease  by  Edward  B.  Krumbhaar.  Fourth 
edition.  Pp.  954.  Illustrated.  Philadelphia  and  Lon- 
don: W.  B.  Saunders  Company.  1929.  Price  $10. 

The  fourth  edition  of  Diseases  of  the  Chest  and  Prin- 
ciples of  Physical  Diagnosis  by  Norris  and  Landis  includes 
a chapter  on  transmission  of  sounds  in  the  chest  and  one 
on  electrocardiography  in  heart  disease.  The  chapter  on 
bronchoscopy  by  Dr.  Clerf  is  clear  and  instructive.  These 
additions  are  very  important  steps  in  making  this  book 
more  useful.  ^ 

(Continued  on  Next  Page) 


For  Medicinal,  Industrial  and  Drinking  Purposes 


3° 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Soiland  Clinic 

Drs.  Soiland,  Costolow  and 
Meland 

1407  South  Hope  Street,  Los  Angeles,  Calif. 
Telephone  WEstmore  1418 
HOURS:  9:00  to  4:00 

An  institution  fully  equipped  for  the  study, 
diagnosis  and  treatment  of  neoplastic  disease. 
Radiation  therapy  and  modern  electro- 
surgical  methods  featured. 

ALBERT  SOILAND,  M.  D. 

WM.  E.  COSTOLOW,  M.  D. 

ORVILLE  N.  MELAND,  M.  D. 

EGBERT  J.  BAILEY,  M.  D. 

A.  H.  WARNER,  Ph.  D.,  Physicist 


Satisfying  the  Most 
Discriminating  ♦ ♦ ♦ 

Qolden  State 

Rigid  safeguarding  of  the 
purity  and  richness  of  its 
products — combined  with 
efficient  service — has  gain- 
ed for  Golden  State  milk 
products  an  enviable 
reputation. 

Its  satisfied  customers  are  Golden 
State’s  best  endorsement 

Golden  State 
Milk  Products  Company 

MILK  , CREAM  < BUTTER 
ICE  CREAM  / COTTAGE  CHEESE 


Supporting  Qarments 

’ For  Diaphragm  and 
Upp  er  Body  Support 


This  new  Camp  High  Belt 
provides  adequate  support  to 
the  diaphragm  and  upper 
body.  Designed  particularly 
for  use  following  gall  bladder 
and  stomach  operations  and 
in  all  cases  where  scientific 
body  support  is  desired.  As  in 
all  Camp  Supports,  the  Camp 
Patented  Adjustment  is  the 
distinctive  feature — giving 
sacro'iliac  and  lumbar  support 
to  the  back.  Note  two  sets  of 
straps,  a new  departure  which 
makes  manipulation  easy  and 
a strong  pull  possible,  fitting 
the  support  closely  to  the 
body  and  assuring  comfort  to 
the  wearer. 

Write  for  physican’s  manual. 


Two  Models:  For  [he  tall  man  with  full  upper  body— for  the  short  full  fig- 
ure.  Adjustable  to  all  types.  Dealers  stocking  these  items  mill  find  a ready 
sale  with  fine  profit  possibilities.  Sold  by  better  drug  and  surgical  houses. 

“V  44 

S.  H.  CAMP  AND  COMPANY 

I Manufacturer 9.  JACKSON.  MICHIGAN 

CHICAGO  LONDON  NEW  YORK 

69  B-  Madiaon  St.  252  Regent  St..  W.  880  Fifth  Ave. 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 

The  authors  have  painstakingly  pictured  by  clear  de- 
scriptive words  and  a wealth  of  photographic  material 
the  essentials  in  understanding  the  proper  methods  of 
examining  the  organs  in  the  thorax.  Too  often  a short 
cut  is  desired  in  making  diagnoses,  particularly  by 
numerous  laboratory  aids,  but  they  have  manifested  the 
prime  importance  of  using  all  of  our  powers  of  observa- 
tion and  considering  the  laboratory  “our  partner  rather 
than  our  master.” 

It  is  needless  to  say  that  all  the  latest  ideas  have  been 
incorporated  in  this  excellent  book.  P.  H.  P. 


Essentials  of  Medical  Electricity.  By  Elkin  P.  Cumber- 
batch.  Sixth  edition.  Pp.  443.  Illustrated.  St.  Louis: 
The  C.  V.  Mosby  Company.  1929.  Price  $4.25. 

The  first  edition  of  this  book  was  printed  in  1905.  This 
sixth  edition  is  the  first  revision  since  1921  and  brings 
the  subject  up  to  date. 

Doctor  Cumberbatch  is  well  qualified  to  write  on  the 
subject  of  electrical  currents  because  of  his  long  years  of 
practical  experience  with  them. 

His  chapter  on  “Physical  Principles”  is  well  worth  care- 
ful perusal  by  those  just  entering  the  study  of  electrical 
means  of  treating  the  various  body  disabilities. 

The  chapter  on  “Electrical  Currents  Used  in  Medi- 
cine” will  give  one  the  necessary  information  for  applying 
physical  therapeutics,  while  the  "Index  of  Electrical 
Treatments”  gives  one  the  details  of  application  necessary 
to  obtain  results. 

Doctor  Cumberbatch’s  concise  style  makes  the  reading 
of  dull  subject  matter  refreshing. 

It  is  a book  that  should  be  in  the  library  of  every 
physical  therapeutist.  T.  H.  P. 


Typhoid  Regulations  Amended. — The  regulations 
of  the  State  Board  of  Public  Health  for  the  preven- 
tion and  control  of  typhoid  fever  have  been  amended 
so  as  to  include  paratyphoid  fever.  Minor  changes  in 
the  regulations  have  been  made,  with  particular  refer- 
ence to  milk  supplies  from  premises  where  these 
typhoid  or  paratyphoid  cases  are  present.  Copies  of 
the  newly  printed  regulations  have  been  sent  to  all 
health  officers.  Copies  may  be  obtained  by  writing 
to  the  California  Department  of  Public  Health,  Sac- 
ramento, California. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3‘ 


I 


N maturity 
we  depend 

more  upon  our  eyes  than  in  youth.  Vital  to 
success  and  happiness  as  clear,  strain-free  vision 
at  all  time  is,  it  becomes  more  needful  and 
more  a source  of  pleasure  as  we  advance  in 
years. 

In  youth  we  are  active.  We  use  our 
arms  and  legs.  We  rush  around  doing  this  or 
that  with  great  activity.  As  we  grow  older 
we  slow  down.  We  do  more  head  work;  more 
eye  work.  In  business  we  “make  our  heads 
save  our  heels.”  We  graduate  from  running 
errands  to  the  office  and  desk  of  the  executive. 


When  Vision  is  Priceless 

Our  sight  becomes  the  principal  tool  of  our 
brain.  Vision  becomes  vital  to  success. 

Then,  as  we  grow  older,  we  find  that  our 
eyes  give  us  more  pleasure.  Active  sports  are 
indulged  in  less  and  less.  The  library  finds 
us  more  than  the  golf  course  and  the  tennis 
court.  Reading  becomes  our  most  pleasurable 
recreation.  We  discover  that  vision  is  vital  to 
happiness. 

When  you  prescribe  bifocal  lenses  for  your 
mature  patients,  keep  in  mind  that  their  vision 
is  daily  increasing  in  value.  Remember,  also, 
that  the  precision  and  definition  of  the  Ortho- 
gon  is  available  in  bifocals,  just  as  in  single 
focus  lenses. 

Orthogon  Bifocals  are  supplied  by  Riggs 
in  four  segment  sizes  and  in  both  White  and 
Soft-Lite  glass. 

Give  your  patients  the  best  that  Optical 
Science  offers.  It  will  be  appreciated,  for 
maturity  brings  a realization  that  vision  is 
truly  priceless. 


CICGT  OPTICAL  COMPANY 


SAN  FRANCISCO 


Featuring  Prompt  Orthogon  Service 

OAKLAND  FRESNO  RENO  OGDEN 


SALT  LAKE  CITY 


TRUTH  ABOUT  MEDICINES 

New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

Eli  Lilly  & Co. — Merthiolate  Jelly  (Lilly);  Mer- 
thiolate  Ointment  (Lilly). 

E.  R.  Squibb  & Sons. — Squibb’s  Dextrose-Vitavose. 

Frederick  Stearns  & Co. — Synephrin;  Synephrin 
Solution  “A”;  Ampoules  Synephrin-Procain,  3 cubic 
centimeters;  Hypodermic  Tablets  Synephrin-Procain. 

The  following  article  has  been  exempted  and  in- 
cluded with  the  list  of  exempted  medicinal  articles 
(New  and  Nonofficial  Remedies,  1929,  p.  481): 

G.  D.  Searle  & Co. — Stable  Solution  Dextrose  and 
Sodium  Chlorid  (Searle). 

Butesin  Picrate  Eye  Ointment. — An  ointment  con- 
taining one  per  cent  of  butesin  picrate  (New  and 
Nonofficial  Remedies,  1929,  p.  54),  in  a petrolatum 
base.  Abbott  Laboratories,  North  Chicago. 

Pneumococcus  Antibody  Solution,  Types  I,  II,  and 
III  Combined — Mulford  (New  and  Nonofficial  Reme- 
dies, 1929,  p.  346).— T his  product  is  also  marketed 
in  packages  of  four  50  cubic  centimeter  double-ended 
vials  with  one  complete  intravenous  outfit.  H.  K. 
Mulford  Co.,  Philadelphia. 

Ampoules  Dextrose  (d-Glucose)  10  Grams,  20  Cubic 
Centimeters. — Each  ampoule  contains  dextrose  (New 
and  Nonofficial  Remedies,  1929,  p.  340),  10  grams,  in 
distilled  water,  to  make  20  cubic  centimeters.  Lake- 
side Laboratories,  Inc.,  Milwaukee,  Wisconsin. 

Ampoules  Sodium  Cacodylate  0.243  Gram  (3% 
Grains),  5 Cubic  Centimeters. — Each  ampoule  con- 
tains sodium  cacodylate  (New  and  Nonofficial  Reme- 
(Continued  on  Page  35) 


J oslin  s Sanatorium 

For  Treatment  of 

Nervous  and  Mental 
Disorders 

Home  for  Aged  and 
Infirm 

A quiet,  secluded  place  in  the  country 
RATES  REASONABLE 

Phone  118F2  Lincoln,  Calif. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


32 


Typhoid  Fever  Is  Preventable 


Immunization  of  millions  of  soldiers  against  typhoid  during 
the  World  War  proved  that  the  use  of  typhoid  vaccine  is  a safe, 
simple,  and  effective  measure.  Its  use  should  be  extended  to 
protect  those  who  may  be  exposed  to  infected  water,  milk,  or  food. 


Typhoid  Mixed  Vaccine 

LILLY 


SPECIFY  THROUGH  YOUR  DRUGGIST 

V 760  Three  1 cc.  vials  for  complete  immunization 
of  one  patient. 

packages  are  available  for  group  immunization . 


ppgliwipiwiipwi^^ 


Morton  Raymond  Gibbons 

President , California  Medical  Association 

1929-1930 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXII  MAY,  1930  I 


PROBLEMS  CONFRONTING  THE  MEDICAL 
PROFESSION 

PRESIDENTIAL  ADDRESS,  CALIFORNIA  MEDICAL 
ASSOCIATION,  FIFTY-NINTH  ANNUAL 
SESSION 

By  Morton  R.  Gibbons,  M.  D. 

San  Francisco 

¥ AST  year,  by  way  of  introducing  the  subject 
^ which  I expected  to  discuss  in  the  following 
remarks,  I recounted  some  of  the  problems  which 
the  old  records  show  to  have  been  the  problems 
confronting  the  medical  profession  of  California 
seventy-five  years  ago.  My  rudimentary  fore- 
cast made  at  that  time  of  the  scope  of  my  present 
subject  shows  that  I displayed  little  conception 
of  the  problems  which  more  thought  has  revealed. 

Whereas  the  problems  of  the  pioneers  arose 
mainly  from  within,  ours  come  mainly  from  with- 
out. Comparatively,  medical  practice  then  was  a 
fixed  matter — ours  is  in  the  midst  of  important 
changes,  just  as  are  all  phases  of  social  and  busi- 
ness activity. 

Our  problems  are  mainly  from  without  in  the 
sense  that  the  ways  of  the  world  today  bear  upon 
us  so  heavily  that  either  we  must  present  a firm 
front  if  we  wish  to  preserve  long-established 
medical  custom,  or  succumb  to  pressure  from 
various  directions  and  alter  our  concepts  of  what 
is  proper.  What  shall  we  do?  What  shall  we 
change?  Shall  we  make  the  first  move?  Shall 
we  wait  until  the  pressure  can  no  longer  be  re- 
sisted and  be  overwhelmed?  Or  shall  we  study 
our  problems,  prepare  ourselves  and  act  when 
it  seems  expedient,  and  approach  our  destiny  in 
a manner  of  our  own  selection  by  virtue  of  spe- 
cial knowledge  and  preparedness.  I fancy  the 
last  is  our  best  course. 

I have  selected  two  important  topics  which 
seem  to  me  to  deserve  your  thought.  One  is  the 
influence  which  the  physician  wields  in  society, 
and  the  other  is  the  tendency  toward  some  form 
of  state  health  care.  These  matters  may  not  ap- 
pear to  be  related,  but  I can  see  a very  positive 
dependence  of  one  upon  the  other. 

INFLUENCE  OF  THE  PHYSICIAN  IN  SOCIETY 

The  esteem  in  which  we  are  held  as  a group 
has  everything  to  do  with  proper  direction  of  the 
changes  which  many  of  us  think  are  inevitable. 

The  medical  profession  is  the  largest  educated 
group  with  a common  interest.  It  is  a highly 


educated  group.  It  has  a very  high  proportion 
of  good  minds ; yet,  are  we  respected  and  do  we 
carry  weight  in  proportion  to  our  mental  equip- 
ment and  attainments?  I think  not.  If  not,  what 
are  the  reasons?  I believe  that  it  is  because 
(1)  we  are  not  a business  group;  (2)  we  submit 
to  exploitation;  (3)  we  do  not  exhibit  cohesion 
or  concert  of  action;  (4)  we  do  not  talk  the 
same  language  as  laymen;  (5)  our  code  of  ethics 
disconcerts  them. 

(1)  We  are  not  a business  group — that  is,  we 
are  not  businesslike.  The  income  and  aggregate 
wealth  of  physicians  is  not  comparable  to  that 
of  others  outside  of  our  profession  bearing  com- 
parable responsibilities.  Power  and  wealth  are  so 
nearly  synonymous  in  this  country  that,  not  hav- 
ing wealth,  we  have  no  power.  To  the  layman 
the  money  value  of  a physician  counts  as  much 
as  does  that  of  another  layman.  The  same  atti- 
tude is  true  to  marked  extent  even  among  our- 
selves. Yet  we  well  know  that  a physician’s 
income  is  not  determined  by  his  scientific  value. 
What  I am  working  up  to  here  is  a statement 
of  my  positive  belief — that  the  California  Medi- 
cal Association  does  well  to  have  a substantial 
(impressive  would  be  better)  reserve  fund,  if  for 
no  other  purpose  than  for  the  world  to  con- 
template. 

(2)  We  submit  to  exploitation.  Does  it  ever 
occur  to  you  that  it  is  illogical  for  the  medical 
profession  to  take  care  of  the  sick  poor  for  noth- 
ing? It  is  the  habit  of  laymen  to  assert  that  we 
have  our  compensation  in  our  experience.  Not 
one-fifth  of  the  work  which  a physician  does  for 
the  poor  is  of  any  value  to  him,  unless  it  is  that 
it  occupies  his  time,  and  diverts  his  mind  from 
unhappy  contemplation  of  his  spare  time. 

The  physician  is  not  responsible  for  his  fellow 
man’s  poverty.  But  society  is.  If  society  per- 
mits the  poor  man  to  exist,  then  society  should 
share  equally  with  the  physician  the  burden  of 
the  poor  man’s  sickness.  I don’t  know  what  we 
can  do  about  it.  I don’t  know  that  we  should 
do  anything  different  if  we  could.  Probably  it  is 
best  to  do  as  we  do,  and  retain  the  consciousness 
of  doing  the  decent  thing. 

Have  you  ever  realized  how  we  are  exploited, 
and  why?  Most  philanthropic  work  requires  ser- 
vices of  physicians  prominently  in  its  structure. 
The  machinery  is  set  up  and  the  physician  is  more 
or  less  pleased  to  act  as  an  essential  part  for 


306 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


nothing  or  for  a fee  far  smaller  than  that  which 
other  officials  of  equal  importance  would  accept. 
Is  he  ever  offered  compensation  commensurate 
with  his  importance  in  the  humanitarian  scheme? 
He  is  not.  The  philanthropist  gets  the  glory 
because  he  gets  the  publicity.  The  physician  gets 
none ; he  has  no  publicity.  His  satisfaction  is 
found  in  the  opportunity  for  service.  But  the 
public  never  understands  that  sort  of  thrill ! 

(3)  We  do  not  exhibit  cohesion  or  concert  of 
action.  We  do  not  organize  strongly.  Com- 
paratively few  individuals  will  put  themselves 
out  for  the  good  of  the  group. 

Any  Rotary  Club  can  get  more  done  than  any 
medical  group  and  in  a minute  fraction  of  the 
time.  The  reason  is  Rotary  is  a unit.  A member 
must  pull  his  own  weight,  must  work  and  must 
attend  meetings,  or  else  get  out  and  make  room 
for  someone  who  will.  Rotary  publicity  is  fault- 
less. Whatever  individuals  may  be  or  do,  Rotary 
principles  receive  the  publicity,  and  the  princi- 
ples are  easily  understood  and  above  reproach. 
Did  you  ever  hear  of  an  individual  Rotarian 
making  comment  or  expressing  opinions  on 
Rotary  business  for  public  consumption?  No. 

Unhappily,  the  medical  man  dearly  loves  to 
express  minute  variations  in  nonessentials.  It  is 
not  undignified  to  say  the  same  thing  in  the  same 
way  as  one’s  confreres  or  to  find  out  from  one’s 
associates  what  others  are  doing  and  thinking, 
but  it  is  not  necessary  to  engage  in  quarrels  over 
minor  differences  of  opinion.  The  newspapers 
and  the  public  love  an  internal  scrap,  but  our 
prestige  falls  every  time  it  happens. 

Why  is  it  that  when  a man  gets  in  the  limelight 
he  is  so  prone  to  make  statements  at  variance 
with  the  best  interests  and  expressed  policies  of 
his  confreres?  He  knows  that  the  newspapers 
will  use  his  words  as  they  see  fit.  Sadly  enough, 
he  is  often  willing  to  talk  without  knowledge  of 
his  subject.  He  seems  to  feel  that  he  acquires 
virtue  by  his  puny  exhibition  of  independence. 
He  makes  himself— and  the  rest  of  us — ridicu- 
lous. The  public  is  delighted  when  newspapers 
provoke  acrimonious  discussions. 

(4)  We  do  not  speak  the  same  language  as 
the  layman.  The  medical  specialty  is  farther 
removed  from  the  bulk  of  human  activities  than 
are  all  others,  than  possibly  the  clergy.  We  liter- 
ally speak  a different  language.  Everyone  likes  to 
exercise  any  thoughts  he  takes  interest  in  as  well 
as  anything  in  which  he  has  developed  facility. 
It  is  natural,  but  thoughtless,  for  physicians  to 
talk  shop  among  laymen.  Medical  affairs  always 
imply  trouble  or  disaster  to  a layman.  To  a phy- 
sician the  scientific  considerations  are  interesting 
and  technically  pleasing. 

These  attitudes  cannot  be  reconciled.  One  way 
to  be  less  misunderstood  by  the  public  is  to  dis- 
cuss medical  subjects  with  them  and  make  them 
understand,  and  not  discuss  cases  with  other 
physicians  in  the  presence  of  laymen  in  a manner 


they  cannot  understand.  Some  doctors  exhibit 
shocking  bad  taste,  as  well  as  commit  tactical 
blunders  along  these  lines.  We  are  not  under- 
stood, but  that  is  no  reason  why  we  should 
actively  cause  misunderstanding. 

Did  it  ever  occur  to  you  that  we  are  suspected 
of  some  unfathomed  but  very  clever  trick  because 
we  do  not  patent  our  discoveries,  and  because  we 
go  about  apparently  trying  to  forestall  perfectly 
good  business  by  practicing  preventive  medicine? 

It  has  become  the  common  trait  of  the  Ameri- 
can, as  the  ratio  of  the  knowledge  in  his  posses- 
sion to  the  whole  store  of  knowledge  diminishes, 
to  exercise  his  vanity,  or  save  his  face,  by 
assuming  a cheap  cynicism  and  disbelief.  This 
is  directed  most  toward  medical  matters.  Gulli- 
bility remains  the  same.  Hence  the  conservative 
claims  of  the  scientist  are  discarded  in  favor  of 
the  ballyhoo  of  the  charlatan. 

But  ignorance  and  misunderstanding  are  not 
always  spontaneous.  There  is  a calculating  kind 
of  hostility  and  antagonism.  There  is  active 
mobilization  of  ignorance  and  prejudice  by  agen- 
cies actively  hostile  to  medical  science. 

(5)  Our  code  of  ethics  disconcerts  the  layman. 
Our  code  of  ethics  is  commonly  thought  to  be 
a provision  for  our  own  advantage ; whereas  it 
is  designed  primarily  for  the  protection  of  all 
society. 

Our  ethics  and  customs  are  time-honored ; and 
the  mechanism  has  been  well  worked  in  and  is 
reliable. 

Such  prosperity  as  that  of  certain  of  our 
notorious  licentiates  is  attractive.  If  one  is  en- 
dowed with  the  Barnum  characteristics,  and  is 
not  trammeled  by  ethical  considerations,  he  may 
prosper  to  a much  greater  degree  than  he  who 
retains  the  respect  of  his  confreres.  Plenty 
among  us  have  the  requisite  daring  but  not  the 
lack  of  standards. 

The  fact  is  we  know  intuitively,  even  if  we 
have  not  reasoned  it  out,  that  our  present  stand- 
ards of  interrelation  within  the  profession  are 
the  best  for  the  public  and  the  best  for  ourselves. 
Individuals  and  little  groups  depart  from  our 
standard,  attracted  away  for  short  adventures, 
but  few  fail  to  gravitate  back  to  the  substantial 
mass.  They  would  be  grieved  and  shocked  if 
they  could  not  have  communion  with  the  parent 
group  and  find  sanctuary  in  its  laws,  no  matter 
what  they  may  do  to  others.  They  are  like  the 
traffic  violators  who  take  liberties  with  the  rights 
of  others,  but  complain  most  bitterly  when  their 
own  rights  are  infringed. 

The  successful  man,  high  in  his  profession, 
who  through  a subconscious  feeling  that  the  laws 
do  not  apply  to  him  because  of  his  power  or 
position,  would  be  scandalized  if  he  could  not 
have  the  protection  which  he  should  give  to  his 
less  fortunate  brethren. 

The  mark  of  the  strong  man  everywhere  is 
punctilious  observance  of  the  rights  of  others. 


May,  1930 


MEDICAL  PROBLEMS — GIBBONS 


307 


It  lies  in  a sense  of  fair  play ; and  it  is  exactly 
that  which  onr  ethics  mean. 

We  do  not  need  to  depart  from,  nor  ever  alter 
onr  standards.  If  we  do  adhere  to  the  old  stand- 
ards, what  then.  I am  no  idealist  in  the  sense 
that  I believe  the  profession  to  be  chemically 
pnre.  I have  ample  evidence  that  there  is  a pro- 
portion of  the  profession,  but  not  nearly  so  large 
as  in  other  callings,  whose  excellence  of  behavior 
is  in  direct  ratio  to  the  proximity  of  the  police, 
so  to  speak.  In  that  we  are  just  the  same  as  our 
lay  fellow  citizens.  However,  the  high-minded 
and  high-principled  majority  will  always  remain 
the  same,  and  there  can  be  no  failure  of  our 
standards  by  a process  of  attrition.  No  change 
is  necessary  in  our  standards. 

Can  anyone  doubt  that  the  ethics  of  business 
and  government  and  all  human  relations  have 
become  higher  within  our  own  time?  We  may 
be  beset,  but  we  will  be  strong  if  we  will  present 
the  unbroken  front  of  our  common  understand- 
ing and  our  ethical  cohesion.  We  must  play  our 
own  game  with  our  own  rules — not  try  to  play 
the  other  fellow’s  game. 

TENDENCY  TOWARD  STATE  HEALTH  CARE 

And  now  I come  to  the  most  important  eco- 
nomic subject  before  the  medical  profession 
today — state  health  insurance. 

All  about  us  are  evidences  of  forces  working 
in  that  direction : ( 1 ) The  various  federal  pro- 
visions for  wholesale  health  care,  the  Army, 
Navy,  Public  Health  Service,  Veterans’  Bureau, 
and  all  that  these  embrace.  (2)  The  state  and  city 
health  machinery.  (3)  County  hospitals  provid- 
ing medical  care  at  wholesale  rates.  (4)  Employ- 
ers’ hospitals  and  health  service.  (5)  Workmen’s 
compensation  for  industrial  injuries.  (6)  Pri- 
vate health  insurance  and  hospital  associations. 
(7)  And  most  of  all,  the  attention  focused  on 
the  high  cost  of  medical  care  by  the  activities 
of  the  national  committee. 

It  will  be  easy  for  the  people  to  accept  the 
idea  of  state  health  insurance.  Insurance  is 
understood  and  is  gaining  more  adherents  every 
day,  due  to  the  supposed  efficiency  and  economy 
of  large  organizations.  Hence,  it  will  be  easy  to 
reason  that  the  independent  doctor  is  inefficient, 
whereas  the  medical  machine  would  be  efficient. 
Such  reasoning,  we  know,  is  not  true  without 
important  qualifications,  but  we  must  be  prepared 
to  convince  many  people. 

If  we  exhibit  prejudice,  we  can  have  little 
influence  in  shaping  legislation. 

Chester  Rowell,  a friend  of  our  profession  and 
a man  who  has  more  intimate  knowledge  of 
our  problems  than  any  other  layman  of  whom  I 
know,  would  have  some  European  system  of 
health  insurance  adopted  in  California.  He  said 
what  is  good  enough  for  Europe  is  good  enough 
for  us.  • 


I cannot  believe  that  he  had  in  mind  the  in- 
human treatment,  the  long  dreary  queues,  the 
obliteration  of  the  individual  which  the  European 
methods  entail.  No  American  public  would  sub- 
mit to  such  treatment. 

I believe  Mr.  Rowell  spoke  of  an  idealized  sys- 
tem of  health  insurance  when  he  spoke  as  he  did 
at  the  Commonwealth  Club.  And  he  does  not 
want,  I am  sure,  the  manner  of  treatment  of 
European  patients,  with  its  herding  and  bullying. 
Nor  does  he  want  the  application  of  the  methods 
of  our  own  workmen’s  compensation  law  to 
health  insurance.  It  is  customary  to  consider  the 
California  Workmen’s  Compensation  Law  to  be 
practically  perfect.  It  is  a remarkably  effec- 
tive law  and  is  administered  in  an  enlightened 
manner.  However,  in  its  insurance  phase,  where 
the  patient-doctor  relation  comes  in,  it  permits  the 
interposition  between  the  patient  and  the  doctor 
of  a layman,  ordinarily  without  sympathy  or 
knowledge  or  appreciation  of  the  delicate  balance 
necessary  for  the  best  results. 

The  production  of  the  traumatic  neurosis  cases 
is  chargeable  in  a large  measure  to  this  arrange- 
ment. There  is  no  means  of  knowing  to  what 
degree  this  is  a fact.  My  estimate  is  that  one-half 
of  all  such  cases  are  precipitated  or  aggravated 
by  unsympathetic  or  harsh  or  misguided  hand- 
ling by  laymen.  These  conditions  should  be 
prevented. 

Another  objection  to  lay  intervention  is  that 
laymen  have  shown  a knack  for  selection  of  doc- 
tors who  are  insurance-minded,  or  are  at  least 
pliable.  The  doctors  reflect  the  insurance  com- 
pany’s attitude  toward  the  injured.  The  fine 
example  of  some  insurance  companies  which  have 
enlightened  medical  supervision  shows  what  is 
possible. 

As  I said  above,  the  Workmen’s  Compensation 
Law  is  a splendid  law  and  I gladly  pay  tribute 
to  it.  It  is  brought  into  the  discussion  to  empha- 
size the  fact  that  a state  health  insurance  law 
must  possess  all  necessary  good  features  and, 
besides,  qualities  which  will  prevent  the  possi- 
bility of  entrance  of  bad  features. 

We  must  become  experts  and  we  must  be  able 
to  prove  to  the  people  of  California  that  what  we 
advocate  is  the  best. 

Bear  in  mind  that  the  first  attempt  at  a state 
health  law  will  probably  be  made  by  enthusiasts. 
The  chances  are  that  the  desire  to  pass  the  law 
will  be  far  stronger  than  the  desire  that  it  be 
right. 

I have  avoided  reference  to  other  subjects  in 
an  effort  to  focus  attention  on  the  important 
subject  which  is  here  considered. 

In  times  of  stress  the  medical  profession  has 
gotten  together,  but  generally  it  was  too  late.  Let 
us  make  it  not  too  late  this  time. 

Let  us  make  of  ourselves  the  best-informed 
group  on  health  insurance  in  California. 


308 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Let  us  prepare  our  minds  to  join  quickly  in 
furtherance  of  a sound  plan  when  it  is  presented. 

Let  us  stand  ready  to  throw  our  weight  and 
resources  of  knowledge  behind  that  plan. 

Let  us  be  ready  to  mobilize  with  alacrity. 

Above  all,  let  us  select  leaders  whom  we  can 
trust— and  then  trust  them. 

350  Post  Street. 


SUPERIOR  MESENTERIC  THROMBOSIS 

REPORT  OF  CASES 

By  Wilburn  Smith,  M.  D. 

Los  Angeles 

Discussion  by  John  Homer  fVoolsey,  M.  D.,  San  Fran- 
cisco; Thomas  O.  Burger,  M.D.,  San  Diego. 

SUPERIOR  mesenteric  thrombosis  was  practi- 
cally  unknown  until  that  brilliant  German 
pathologist,  Virchow,  discovered  and  described  a 
postmortem  case  of  a superior  mesenteric  artery 
enlarged,  and  so  completely  closed  with  a throm- 
bus that  it  appeared  as  a fibrous  cord.  The  pa- 
tient, a woman,  had  succumbed  to  some  other 
disease,  and  he  wrote  in  detail  of  the  case  in  1847. 
The  clinical  side  is  not  reported,  for  the  condition 
had  existed  for  some  time,  and  nature  had  estab- 
lished a collateral  circulation.  This  type  of  case 
usually  passes  unrecognized  and  is  often  entirely 
overlooked,  being  diagnosed  as  one  of  colic,  or 
some  partial  intestinal  obstruction.  The  patient 
may  recover  and  succumb  to  some  other  disease. 
A postmortem  may  never  be  made,  and  should 
one  be  made  the  examiner  may  not  be  thorough 
enough  to  examine  all  the  tissues,  as  did  the 
brilliant  Virchow,  and  so  the  condition  never  be 
discovered. 

This  condition  is  not  common,  for  since  the 
first  careful  description  in  1847  about  five  hun- 
dred cases  have  been  described,  with  only  thirty- 
five  of  these  surviving  the  attack  whether  oper- 
ated or  not.  This  gives  the  appalling  mortality 
of  93  per  cent.  The  artery  is  involved  about  five 
times  as  often  as  the  vein,  and  the  superior 
mesenteric  is  involved  about  forty  times  more 
often  than  the  inferior.  It  is  true  the  amount  of 
intestine  supplied  by  the  superior  is  much  greater, 
as  it  extends  from  the  duodenum  to  the  anastomo- 
sis with  the  inferior  at  the  middle  colic.  Also 
Litten  maintains  that  the  superior  is  a type  of 
end-artery  and  has  more  of  a tendency  to  favor 
an  infarct,  while  the  inferior  tends  to  establish 
a collateral  circulation.  One  would  suppose  in  an 
artery  which  forms  arcades  that  collateral  circu- 
lation would  easily  and  most  frequently  obtain. 
Even  though  Virchow,1  Karcher,2  Chiene,3  and 
others  have  discovered  cases  in  the  postmortem 
room  that  had  died  of  other  more  marked  pa- 
thology, yet  collateral  formation  is  the  exception 
in  this  artery.  Ivarcher’s  case  was  in  a woman, 
forty-one  years  of  age,  who  had  cardiac  decom- 
pensation symptoms  with  abdominal  pain.  She 
developed  femoral  thrombosis,  and  in  six  weeks 


was  operated  upon  for  gangrene  of  the  leg.  She 
died  a week  later  and  on  postmortem  showed,  in 
addition  to  disease  of  the  mitral,  tricuspid  and 
aortic  valves,  lateral  thrombi  in  both  auricles,  in- 
farcts in  lungs,  spleen  and  kidney,  an  obliterating 
thrombus  in  the  profunda  femoris  and,  what  is 
more  interesting,  a thrombus  obliterating  com- 
pletely the  superior  mesenteric  artery  for  a dis- 
tance of  thirty-seven  millimeters.  This  thrombus 
was  firmly  adherent  to  the  walls  of  the  artery, 
but  in  spite  of  the  same  there  was  only  slight 
reddening  of  the  mucous  membrane  of  the  ileum. 
Chiene’s  case  showed  an  aneurysm  in  a woman 
sixty-five  years  of  age  with  the  celiac  axis, 
superior  and  inferior,  involved ; and  the  latter 
vessels  were  completely  obliterated,  forming 
fibrous  cords. 

The  causes  of  this  rather  rare  condition  may 
be  better  studied  if  we  separate  the  pathology  of 
the  artery  from  that  of  the  vein.  Under  the 
artery  we  think  first  of  embolus  which  is  often 
followed  by  thrombus,  or  of  thrombus  alone.  The 
embolus  comes  from  heart  valves  and  vegeta- 
tions. from  atheromatous  plaques,  and  from  the 
breaking  up  of  a thrombus  in  the  auricles  or 
ventricles.  The  thrombus  arises  from  diseased 
arteries,  from  aneurysm  with  extension  of  the 
clot,  and  from  pressure  on  an  artery  due  to  an 
aneurysm  or  a tumor.  In  venous  involvement 
various  causes  which  may  injure  the  veins,  or 
infect  them,  or  a combination  of  the  two,  are  the 
factors.  The  more  frequent  causes  are  crushing 
and  ligating  of  the  appendicular  veins,  pelvic  sur- 
gery where  adhesions  are  present,  splenectomy, 
volvulus,  intussusception,  strangulated  hernia  or 
extension  from  the  splenic  or  portal  veins.  Clini- 
cally arterial  and  venous  thrombi  differ  in  that 
the  arterial  thrombus  disposes  to  be  sudden  in 
onset,  while  the  venous  tends  to  be  gradual. 

EXPERIMENTAL  WORK 

Much  experimental  work  has  been  done  to  as- 
certain the  exact  pathology  and  account  for  the 
variety  of  clinical  symptoms  manifest  in  these 
cases.  Sprengel’s  theory  that  obliteration  of  an 
artery  gave  an  anemic  infarct,  while  the  same  in 
a vein  gave  an  hemorrhagic  one,  does  not  here 
obtain ; for,  regardless  of  the  cause,  the  infarct 
disposes  to  be  hemorrhagic.  This  hemorrhagic 
infarct  is  usually  followed  by  peritonitis,  the 
mucous  membrane  ulcerates  and  breaks  down 
with  hemorrhage  into  the  canal.  The  mesentery 
becomes  edematous  and  the  intestine  may  perfo- 
rate and  cause  the  peritonitis  from  macroscopic 
lesions.  Extensive  gangrene  may  develop  in 
forty-  eight  hours  and  there  may  or  may  not  be 
a distinct  line  of  demarcation. 

Following  Litten’s  suggestion  that  the  arteries 
are  terminal,  various  experiments,  namely,  liga- 
tion of  the  artery  or  vein ; making  of  artificial 
emboli  by  oil  which  is  not  typical  and  so  not  par- 
allel ; cutting  portions  of  the  mesentery  along 
the  intestinal  attachment  to  study  the  effect  on 


May,  1930 


TH  ROM  BOSIS — SM ITH 


309 


the  mucous  membrane,  have  been  done  upon  the 
lower  animals,  but  whether  the  conclusions  are 
safe  to  accept  for  the  human  is  a question. 

The  result  of  the  experiment  of  ligating  the 
artery  was  anemia  followed  by  violent  tetanic 
contractions  of  the  small  intestine,  followed  in 
two  or  three  hours  by  relaxation  and  a conges- 
tion which  terminated  in  a hemorrhagic  infarct. 
Beckman  and  Ravenna  showed,  in  operations  on 
rabbits,  dogs,  and  cats,  that  no  effect  was  pro- 
duced and  that  collateral  circulation  was  estab- 
lished. On  injection  of  paraffin,  a large  infarct 
was  produced  the  center  of  which  tended  to  be 
anemic  and  the  periphery  hemorrhagic.  Tying 
the  mesentery  along  the  border  of  the  intestine 
in  three-centimeter  lengths  produced  first  the 
change  in  the  mucous  membrane  of  areas  of 
necrosis,  while  five-centimeter  lengths  produced 
necrosis  in  greater  extent,  first  of  the  mucous 
membrane  and  later  of  the  wall  itself. 

The  deductions  from  the  various  experiments 
are  as  follows : Lodgment  of  embolus  may  not 
produce  infarct  and  a collateral  circulation  may 
be  established ; slow  closure  by  a thrombus  may 
stimulate  collateral  circulation;  many  cases  of 
closure  of  the  artery  may  be  overlooked,  due  to 
the  collateral  anastomosis,  and  the  closed  artery 
may  escape  detection  at  autopsy,  since  the  cause 
of  death  is  foreign  to  this  pathology. 

Welch  and  Mall  ligated  the  collateral  circu- 
lation of  the  small  intestine  at  the  pancreatico- 
duodenal and  at  the  middle  colic  and  nothing  hap- 
pened, as  the  superior  mesenteric  was  still  intact. 
They  then'  compressed  this  artery  and  when  it 
reached  one-fifth  of  normal  they  began  to  get  an 
infarction.  This  led  them  to  believe  it  was  a 
matter  of  pressure  in  the  artery,  whether  due 
to  pressure  constricting  the  vessel  or  cardiac ; 
namely,  vis  a fronte. 

CASES  FROM  LITERATURE  WHICH  CORROBORATE 
THESE  DEDUCTIONS 

Karcher’s  case  seems  to  corroborate  the  latter. 
A woman,  forty-one  years  of  age,  with  cardiac 
failure  and  collapse,  was  brought  into  the  hospi- 
tal. There  was  violent  abdominal  pain  and  fre- 
quent bloody  stools,  with  distention  of  the 
abdomen  and  tenderness.  The  left  leg  was  very 
painful  along  the  femoral  and  later  had  to  be  am- 
putated, due  to  gangrene.  Heart  decompensation 
continued  and  death  followed  a week  after  the 
amputation.  The  autopsy  showed  multiple  lesions 
in  the  heart  with  infarcts  in  lungs,  spleen  and 
kidneys,  and  thrombosis  of  the  femoral  vein  with 
obliteration  of  the  superior  mesenteric.  Abdomi- 
nal pain  was  due  to  lodgment  of  the  embolus 
with  injury  to  the  intestinal  mucosa,  as  evidenced 
by  the  bloody  stools,  but  collateral  circulation  was 
fairly  established.  Many  cases  have  cardiac 
lesions  that  have  so  lessened  vis  a fronte  and  de- 
creased circulation,  that  venous  stasis  limits  the 
blood  passing  through  the  part  and  lessens  the 
ability  to  form  collateral  channels. 


Councilman’s  4 case  was  incomplete  obliteration 
with  fecal  vomiting  and  obstipation  and  death 
from  intestinal  obstruction.  Here  the  pathologist 
reported  atheroma,  blocking  incompletely  the  su- 
perior mesenteric  artery  with  no  changes  in  the 
intestines.  So  the  circulation  may  be  partially 
disarranged  with  intestinal  obstruction  and  the 
intestine  still  remain  normal.  Thus  it  requires 
more  blood  to  keep  the  peristaltic  function  intact 
than  it  does  to  keep  the  life  of  the  tissues.  This 
conclusion  is  supported  by  intermittent  claudica- 
tion where  the  function  is  disturbed  before  the 
life  of  the  tissues. 

Reich’s 5 case  gave  all  the  symptoms  of  in- 
testinal obstruction;  was  operated  for  the  same 
and,  after  careful  exploration,  nothing  was  found. 
The  symptoms  persisted  and  a colostomy  and 
ileostomy  was  later  done  for  the  same,  but  the  pa- 
tient died.  The  autopsy  findings  showed  arterio- 
sclerosis of  the  aorta,  partial  thrombosis  of  the 
superior  mesenteric,  and  an  infarct  involving 
the  jejunum  to  the  extent  of  eighty  centimeters. 
No.  doubt  the  thrombus  existed  and  produced  the 
ileus  of  this  loop  writh  the  clinical  symptoms, 
though  the  condition  was  not  apparent  at  the  time 
of  operation. 

In  the  above  cases  we  see  three  very  distinct 
classes  of  cases : ( 1 ) Karcher’s,  with  other  pa- 
thology overshadowing  the  thrombus  and  with 
the  collateral  circulation  becoming  established. 
(2)  Reich’s,  the  opposite  extreme,  with  marked 
infarction  and  destruction  of  the  mucosa.  (3) 
Councilman’s,  intermediate,  with  intestinal  ob- 
struction the  overshadowing  symptom,  and  no 
marked  pathology  in  tissues.  The  amount  of  pa- 
thology will  depend  on  the  cardiac  compensation 
and  the  vis  a fronte. 

VALUE  OF  HISTORY 

A careful  history  is  of  value  in  about  twTo- 
thirds  of  the  cases,  and  will  show  some  sugges- 
tion of  an  etiology,  namely,  valvular  disease, 
arteriosclerosis  or  aneurysm,  with  exciting  causes 
of  abdominal  surgery  on  stomach,  appendix,  or 
hernia.  There  may  be  exertion,  but  pregnancy  is 
also  a factor.  In  the  balance  of  the  cases  the 
history  has  no  bearing.  Cases  in  men  are  twice 
as  frequent  as  in  women,  and  occur  between 
twenty  and  sixty  years  of  age. 

SYMPTOMS 

Pain  is  constant  in  type  and  paroxysmal,  wave- 
like, merging  into  the  continuous  pain  of  peri- 
tonitis. The  intermittent  type  of  pain  may  be 
ascribed  to  the  anemia  which  for  the  first  few 
hours  is  tetanic  in  type.  As  it  becomes  inter- 
mittent it  simulates  the  pain  of  intermittent 
claudication.  There  may  be  some  association  with 
peristalsis  disturbed  by  the  obstruction. 

Vomiting  is  frequently  present,  at  first  reflex, 
then  obstructive,  and  later  due  to  the  ileus  of 
peritonitis.  This  is  of  the  stomach  contents  and 
in  the  severe  pathology,  of  the  intestinal  contents, 
which  will  be  eventually  bloody. 


310 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Constipation  or  obstipation  is  present  in  two 
types  of  cases,  namely,  those  with  the  severe  de- 
struction of  the  mucosa  and  those  where  peris- 
talsis is  paralyzed  without  destruction  of  mucosa. 
There  may  be  slight  amount  of  flatus  with  enema, 
but  if  the  involvement  is  marked  none  will  pass. 
Blood  is  present  in  the  more  severe  form  and 
will  be  present  in  about  41  per  cent.  Early  diar- 
rhea may  precede  the  constipation.  The  constipa- 
tion may  at  first  be  due  to  the  paresis,  or  in  turn 
to  the  gangrene,  and  later  be  followed  by  that 
due  to  the  peritonitis. 

The  temperature  may  at  first  be  subnormal  but 
rise  later,  due  to  the  peritonitis.  The  abdomen  is 
tender  throughout,  but  may  be  accentuated  in  a 
certain  area.  Gradual  distention  appears  which 
is  usually  tympanitic,  but  may  be  flat  in  the  sides 
later,  due  to  fluid. 

Palpation  may  reveal  a local  mass  due  to  the 
edema  in  the  mesentery,  and  if  palpated,  with  the 
other  symptoms  and  findings,  helps  one  to  make 
a diagnosis.  On  auscultation  one  finds  a gradu- 
ally decreasing  amount  due  to  the  paresis,  and 
the  onset  of  the  peritonitis. 

A leukocytosis  is  usually  present,  approxi- 
mately 20,000,  with  a differential  of  above  85  per 
cent  polymorphonuclear  leukocytes. 

The  symptoms  referable  to  the  pathology : 
(1)  In  very  severe  destruction  the  main  symp- 
toms are  diarrhea  with  bloody  stools  and  hema- 
temesis,  associated  with  collapse.  (2)  In  less 
severe,  all  the  symptoms  and  landmarks  are  of 
obstruction.  (3)  Combinations  of  the  above, 
namely,  bloody  stools  and  hematemesis,  with  ob- 
struction symptoms,  may  occur.  (4)  In  cases 
with  a meager  pathology  but  with  symptoms  ov.er- 
shadowed  by  greater  pathology  the  patient  may 
form  collateral  circulation.  (5)  With  very  mild 
pathology,  the  symptoms  are  akin  to  ulcer,  namely, 
pain  following  eating,  which  is  relieved  by  vomit- 
ing.  The  pain  is  explained  by  the  food  stimulation 
of  peristalsis,  and  this  pain  is  like  the  intermittent 
claudication  due  to  the  anemia,  and  a partial  ileus 
exists.  This  is  followed  by  vomiting  and  relief. 
With  this  may  be  associated  cardiac  disease  and 
hence  low  pressure  in  the  superior  mesenteric 
artery.  This  is  also  seen  in  splanchnic  sclerosis 
where  there  is  a decrease  in  the  blood  supply. 

Gerhardt 6 says  a typical  case  should  present 
the  following : A definite  cause  for  an  embolus, 
intestinal  hemorrhage,  paroxysmal  pains,  ileus, 
fluid  in  the  abdomen,  subnormal  temperature  with 
a palpable  abdominal  mass.  If  there  is  no  vomit- 
ing of  blood  or  diarrhea  with  bloody  stools,  then 
superior  mesenteric  thrombosis  will  resemble 
Councilman’s  case  and  be  diagnosed  intestinal 
obstruction. 

DIFFERENTIAL  DIAGNOSIS 

The  differential  diagnosis  from  the  following 
are  to  be  thought  of : acute  perforative  appendici- 
tis, volvulus,  intussusception,  and  intestinal  ob- 
struction. The  more  severe  cases  of  thrombosis 


with  the  manifestation  of  bloody  stools  and  vomit- 
ing are  not  confused  with  the  appendix.  In  the 
latter  the  pain  is  about  the  umbilicus,  with  initial 
vomiting  and  then  temperature ; in  the  former  the 
pain  passes  to  the  right  iliac  fossa ; there  is  no 
obstipation  and  a return  of  the  vomiting  is  much 
later. 

V olvulus  occurs  in  older  people  with  no  specific 
etiology  of  thrombus,  no  bloody  stools,  but  ob- 
stipation and  distention  and  vomiting  tend  to  place 
it  as  an  intestinal  obstruction.  This  in  turn  may 
be  the  points  in  the  middle  class  of  the  thrombus 
where  all  symptoms,  as  in  Councilman’s,  are 
obstruction. 

Intussusception  is  more  nearly  like  the  severe 
type  of  thrombus.  Here  we  see  more  often  a child 
with  sudden  attack  of  obstruction  with  vomiting 
(not  bloody),  with  bloody  stools  and  often  the 
sausage-shaped  tumor,  palpable  per  abdomen  or 
(the  head)  per  rectum.  If  there  be  no  diarrhea 
of  blood,  and  hematemesis,  the  cases  are  diag- 
nosed as  intestinal  obstruction. 

FROGNOSIS 

The  prognosis  depends  on  the  extent  of  the 
thrombosis  and  the  early  recognition  and  treat- 
ment. The  progress  is  rapidly  downward,  with 
rising  temperature,  collapse  and  peritonitis.  Sixty 
per  cent  die  in  the  first  week  and  the  mortality 
approximates  95  per  cent.  Five  hundred  cases  are 
reported  in  the  literature  and  only  thirty-five 
survived. 

TREATMENT 

Treatment  may  be  classified  according  to  the 
degree  of  the  pathology. 

In  the  very  mild,  the  symptoms  are  ulcer  with 
the  pains  as  recited  above,  which  are  due  to  the 
peristalsis  being  excited  by  the  food  intake,  and 
due  to  the  anemia  of  the  part,  there  is  spasm. 
Here  diets  easily  digested,  with  medication  to  as- 
sist digestion.  The  pathology  is  a partial  closure 
or  a very  decreased  blood  supply  due  to  splanchnic 
sclerosis. 

In  the  more  severe,  with  overwhelming  other 
pathology,  the  abdominal  symptoms  are  not  of 
sufficient  severity  to  warrant  a laparotomy  with 
the  other  cardiac,  or  cardiovascular  symptoms, 
and  here  eventually,  under  symptomatic  treatment, 
the  collateral  circulation  is  reestablished. 

In  the  very  severe  types  where  infarct  forms, 
operation  is  the  only  method  of  choice. 

REPORT  OF  CASES 

Case  1. — At  this  point  I wish  briefly  to  describe  two 
cases.  The  first  was  during  my  intern  days,  and  was 
so  unique  that  it  was  not  easy  to  forget.  A woman, 
approximately  twenty-eight  years  of  age,  came  into 
the  hospital  with  only  the  symptoms  of  a chronic 
appendix.  She  was  of  the  upper  strata  of  society  and 
could  have  everything  she  desired.  My  chief,  one  of 
the  best  surgeons  I have  ever  known,  operated  and 
removed  a small  chronic  appendix  and  there  was  no 
other  pathology.  The  following  days  were  tragic. 
Consultations  were  frequent.  The  patient  began  to 
vomit  slightly,  the  abdomen  to  distend,  and  the 
bowels  became  more  and  more  constipated.  The  tern- 


May,  1930 


THROMBOSIS — SMITH 


311 


perature  rose  gradually,  and  the  abdomen  became 
more  silent  until  all  the  symptoms  were  of  a peri- 
tonitis. The  father  was  a prominent  citizen  and  every 
means  to  quiet  the  vomiting  was  exhausted.  Consul- 
tants had  only  suggestions  of  no  avail;  the  eventual 
came.  The  postmortem  revealed  a thrombus  in  the 
ileocolic  vein  and  a portion  of  the  ileum  was  gan- 
grenous with  a diffuse  peritonitis.  I can  see  the  pa- 
tient, a reasonably  healthy  young  woman,  restless, 
vomiting,  distended  abdomen,  nothing  relieving  the 
same  and  the  anxiety  of  the  relatives.  It  certainly 
impressed  me  that  a chronic  appendix  is  not  to  be 
despised  nor  a suppurating  appendix  to  be  despaired. 

i < / 

Case  2. — The  next  case,  a nurse,  thirty-two  years 
of  age,  single,  was  admitted  to  the  hospital  complain- 
ing of  pain  in  the  right  side.  She  had  a negative  urine, 
blood,  and  Wassermann.  At  this  time,  September  21, 
1927,  I removed  her  appendix  and  did  a subtotal 
hysterectomy  for  a multinodular  fibroid  uterus.  She 
was  brought  into  the  hospital  almost  four  months  later 
with  a very  acute  abdomen,  which  had  its  onset  about 
fifteen  minutes  after  she  had  eaten  a ham  and  lettuce 
sandwich.  Her  temperature  was  97  degrees  upon  ad- 
mittance, pulse  of  64,  and  respiration  of  20.  On  the 
19th  of  January',  the  dayr  following  the  admission,  I 
saw  her  for  the  first  time.  She  was  now  transferred 
to  the  surgical  service.  She  gave  a history  of  nausea 
and  vomiting,  severe  paroxysmal  attacks ' of  pain, 
though  it  was  more  or  less  continuous. 

The  pains  on  admission  were  much  more  severe 
and  the  patient  rolled  in  agony  at  the  time.  The  ad- 
mitting physician  could  not  account  for  the  severity 
of  the  pain,  and  being  in  a woman  he  feared  it  might 
be  exaggerated.  Since  I had  removed  the  uterus  and 
appendix  only  four  months  prior,  and  there  was  no 
history'  of  ulcer,  I was  firmly  convinced  there  was  a 
relation  to  the  food,  even  though  friends  had  partaken 
of  the  same  kind  of  sandwich  at  the  same  time. 
Enemas  were  followed  by  a great  discharge  of  blood, 
and  the  results  of  the  enemas  were  not  satisfactory 
as  far  as  flatus  and  feces.  The  tenesmus  and  also  the 
vomiting  continued.  The  patient  assumed  a dorsal  or 
lateral  position,  with  the  knees  flexed,  and  the  hands 
on  the  abdomen,  in  great  pain.  She  had  received  an 
opiate  under  the  medical  care,  so  was  not  in  the 
severe  pain  of  the  day  previous.  Her  face  was  anxious 
and  she  looked  haggard  and  tired.  The  heart  was 
negative  for  valvular  pathology;  blood  pressure  of 
138-70.  The  abdomen  was  distended  and  tympanitic, 
with  a suggestion  of  flatness  in  each  flank.  Definite 
rigidity  existed  of  the  lower  abdomen,  possibly'  more 
pronounced  on  the  left  rectus.  My  impression  was 
gastro-enteritis  from  the  sandwich.  A urine  and  blood 
examination  was  suggested,  and  this  was  later  phoned 
to  me  as  follows:  20,400  leukocytes,  with  85  per  cent 
polymorphonuclears.  Urine  1.026,  with  one  per  cent 
indican.  The  urine  showed  the  dehydration  with  a 
suggestion  in  the  indican  of  small  intestine  trouble. 
The  temperature  was  99.2,  pulse  76,  respiration  20  in 
the  morning,  but  in  the  evening  it  was  99.6,  84,  and  22. 

On  January  20  the  abdomen  showed  more  tympany 
with  less  peristalsis,  and  only  in  the  upper  abdomen 
was  there  audible  peristalsis.  The  lower  abdomen 
was  more  tender  and  more  rigid.  A pelvic  examina- 
tion showed  the  cervix  mobile  and  no  evident  tender- 
ness in  the  cul-de-sac  or  the  adnexal  regions.  The 
evidence  was  not  conclusive,  as  the  abdomen  was  too 
tender  and  rigid  to  allow  abdominal  palpation.  A 
repetition  of  the  enema  gave  blood  and  practically  no 
flatus.  A repetition  of  the  blood  count  gave  20,450, 
with  86  per  cent  polymorphonuclears.  A special  urine 
was  examined  for  indican  and  showed  1.030  specific 
gravity  with  a three  plus  indican.  Temperature,  pulse, 
and  respiration  in  the  morning  were  99-100-16,  and 


later  in  the  day  the  temperature,  pulse,  and  respira- 
tion were  99.6-100-18. 

Because  of  the  severe  pain,  followed  by  vomiting, 
which  was  marked  at  first  but  less  the  second  day 
with  continuing  nausea;  the  unsatisfactory  results 
with  enemas  and  the  presence  of  blood;  the  white 
blood  count  persisting  and,  if  anything,  a little  in- 
creasing; and  the  marked  increase  in  the  indican,  I 
made  a tentative  diagnosis  of  incomplete  obstruction 
of  the  small  intestine  probably  associated  with  the 
appendix  operation.  My  reasons  for  the  diagnosis 
were  that  appendicitis,  salpingitis,  and  ectopic  preg- 
nancy were  eliminated  by  the  first  operation.  The 
paroxysmal  severe  pain  associated  with  peristalsis, 
and  the  apresence  of  indican  in  excess,  suggested 
small  intestinal  obstruction  while  the  passage  of  the 
blood  and  slight  flatus  made  me  modify  to  incomplete 
obstruction. 

Upon  the  above  diagnosis  I made  a right  rectus 
incision  and  removed  the  old  scar,  believing  the 
trouble  would  be  due  to  adhesions  from  the  previous 
operation.  On  reaching  the  peritoneum  it  was  dark, 
like  that  seen  in  a recent  ectopic  rupture,  and  on 
entering  the  abdomen  free  blood  was  present.  It 
could  not  be  ectopic,  and  I had  never  seen  an  ulcer 
give  free  blood  and  there  were  no  food  particles. 
I made  a culture  of  the  blood,  which  had  a slight 
odor.  On  examining  into  the  left  pelvis  I found  a few 
recent  adhesions  trying  to  wall  off  a loop  of  ileum 
about  fifteen  inches  long,  absolutely  black,  and  the 
endothelium  losing  its  sheen  and  gloss.  There  was 
no  evidence  of  bands  nor  volvulus,  but  the  mesentery 
was  thick  and  edematous  and  this  blackness  faded 
into  the  edema  of  the  normal  intestine.  The  vessels 
were  thrombosed  and  the  extent  of  the  pathology  was 
uncertain.  The  loop  was  withdrawn  and  excised  and 
the  ends  of  the  ileum  sutured  into  the  lower  angle 
of  the  wound.  Plenty  of  drainage  was  inserted,  a 
wide  sheet  of  rubber  tissue  placed  to  wall  off  the 
upper  from  the  lower  abdomen,  and  the  wound  closed. 
A tube  was  inserted  into  the  proximal  and  the  distal 
loops  of  the  bowel. 

The  patient  made  an  uneventful  recovery  with  an 
ileostomy  wound.  We  used  the  distal  end  to  give 
Murphy  drip  and  thus  save  the  patient  from  nausea 
incident  to  the  need  for  excess  fluids.  In  about  four 
weeks  I again  operated  and  did  an  end-to-end  anas- 
tomosis. The  patient  had  a good  recovery  and  left 
the  hospital  March  14  with  only  slight  soiling  of  the 
dressings  due  to  a very  small  fistula,  which  later 
healed. 

CHOICE  IN  METHOD  OF  SURGICAL  TREATMENT 

One  can  never  estimate  the  extent  of  the  dam- 
age. It  may  have  reached  its  limit  or  it  may  ex- 
tend farther  after  the  operation.  There  are  two 
methods  of  handling  the  case.  Moynihan  suggests 
the  excision  I did  in  this  case,  and  makes  the 
enterostomy  openings  to  use  for  fluids  and  food, 
etc. ; others  treat  the  loop  as  in  a Mikulicz  opera- 
tion, and  later  excise  the  loop  and  have  the  gun- 
barrel  effect,  and  then  anastomose.  It  is  usually 
inadvisable  to  anastomose  at  the  time  because  the 
patient  is  in  great  shock  and  the  added  time  is 
an  item.  Also  the  edema  of  the  apparently  normal 
bowel  is  great  and  makes  the  operation  difficult. 

CONCLUSIONS 

Occlusion  of  the  mesenteric  artery  is  usually 
from  an  embolus  followed  by  thrombosis.  In  the 
mesenteric  vein  it  is  thrombosis  from  the  start. 

The  lesions  produced  are  variable,  from  slight 


312 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


congestion  to  marked  ulceration  and  extensive 
gangrene. 

1.  The  occlusion  may  be  followed  by  collateral 
circulation  either  of  a temporary  or  permanent 
nature. 

2.  The  occlusion  may  be  followed  by  cessation 
of  function  yet  the  vitality  of  the  intestine  be 
intact. 

3.  It  may  be  an  infarct  with  death  of  a variable 
amount  of  the  small  intestine. 

If  we  have  occlusion  of  a branch  and  get  col- 
lateral circulation,  we  may  have  slight  abdominal 
pain  and  distention  and  these  be  overshadowed 
with  a greater  pathology  and  the  patient  survive. 

In  number  two,  where  the  occlusion  is  in  part 
only,  and  the  function  disturbed  without  the  life 
of  the  tissues,  the  symptoms  may  be  those  of  ulcer 
or  intermittent  claudication.  These  patients  in  the 
more  severe  type  have  pain  incident  to  food  and 
the  tetanic  pains  like  the  spasm  incident  to  the 
anemia.  Symptoms  of  obstruction  supervene  and 
the  patient  may  be  operated  and  no  obstruction 
discovered. 

In  the  most  severe  type,  number  three,  there  is 
definite  evidence  of  obstruction  with  hemorrhage 
from  the  bowels  and  vomiting,  often  with  blood. 
These  gradually  fuse  with  the  clinical  findings  of 
peritonitis. 

This  condition  should  be  regarded  as  requiring 
surgery  though  a few  milder  cases  have  had  a 
favorable  outcome  without  surgery. 

1401  South  Hope  Street. 

REFERENCES 

1.  Virchow:  Ueber  die  akute  Entzuendung  der 
Arterien,  Arch.  f.  Path.  Anat.,  etc.,  Berl.,  1847,  i,  332. 
Verstopfung  der  Gekrosarterie  durch  einen  eingewan- 
derten  Propf.,  Verhandl.  d.  phys.-med.  Gesellsch.  in 
Wiirzb.,  1854,  iv,  341. 

2.  Karcher:  Ein  Fall  von  Embolie  der  Arteria  Mes- 
enterica  Superior,  Cor.-Bl.  f.  schweiz.  Aerzte,  Basel, 
1897,  xxvii,  548-552. 

3.  Chiene:  Complete  Obliteration  of  the  Celiac  and 
Mesenteric  Arteries,  the  Viscera  Receiving  their  Blood 
Supply  Through  the  Extraperitoneal  System  of  Ves- 
sels, J.  Anat.  and  Physiol.,  Lond.,  1869,  iii,  65-72. 

4.  Councilman:  Three  Cases  of  Occlusion  of  the 
Superior  Mesenteric  Artery,  Boston  M.  and  S.  J.,  1894, 
cxxx,  410. 

5.  Reich:  Beitrag  zur  Chirurgie  der  mesenteriellen 
Gefassverschliisse  und  Darminfarkte,  Beitr.  z.  klin. 
Chir.,  Tubing.,  1913,  lxxxvii,  317-331.  Embolie  und 
Thrombose  der  Mesenterialgefasse,  Ergebn.  d.  Chir. 
u.  Orthop.,  Berk,  1913,  vii,  515-597. 

6.  Gerhardt:  Embolie  der  Arteriae  mesentericae, 
Wiirzb.  med.  Ztschr.,  1863,  iv,  141-149.  Stetten:  Acute 
Obstruction  of  Superior  Mesenteric  Vein,  Ann.  Surg., 
Phila.,  1922,  lxxvi,  666-668.  Klein:  Embolism  and 
Thrombosis  of  the  Superior  Mesenteric  Artery,  Surg., 
Gynec.  and  Obst.,  Chicago,  1921,  xxxiii,  385-405. 

DISCUSSION 

John  Homer  Woolsey,  M.  D.  (490  Post  Street,  San 
Francisco). — This  subject  may  seem  to  some  as  too 
rare  in  occurrence  to  merit  the  attention  and  space 
devoted  by  the  author  but,  let  me  emphasize,  errone- 
ously so. 


I am  impressed  with  three  aspects  of  superior  mes- 
enteric thrombosis,  all  emphasized  by  Doctor  Smith: 
(1)  In  making  a diagnosis  the  importance  of  the  his- 
tory, both  antecedent  and  present;  (2)  the  varying 
degree  of  injury  and,  therefore,  variability  of  symp- 
toms; and  (3)  the  importance  of  early  surgical  ex- 
ploration in  this  as  in  any  acute,  critical  and  undeter- 
mined intra-abdominal  complaint. 

The  antecedent  history  of  an  endocarditis,  or  of  any 
infection  with  which  there  might  be  accompanying 
emboli;  the  history  of  an  abdominal  injury  or  the 
existence  of  arteriosclerosis  are  provocative  causes 
subsequent  to  which  arterial  mesenteric  thrombosis 
most  often  occurs.  This  history  of  an  enteric  in- 
flammatory lesion  is  the  one  common  antecedent  of 
a venous  mesenteric  thrombosis. 

The  result  of  an  obliteration  of  a portion  of  the 
arterial  supply  or  the  venous  return  is  dependent  upon 
the  degree  of  involvement.  Therefore  the  symptoms 
and  signs  will  vary  as  to  whether  there  is  only  a lim- 
ited necrosis  of  mucosa  or  an  extensive  infraction  of 
the  entire  intestinal  wall.  Undoubtedly  people  live 
after  a mild  degree  of  mesenteric  thrombosis,  as  they 
do  after  acute  pancreatitis  of  a limited  degree  and  in 
such  instances  without  surgery  and,  therefore,  with- 
out a direct  view,  the  diagnosis  often  remains  in 
doubt. 

Surgery  today  has  reached  the  stage  where  an  intra- 
abdominal exploration  can  be  done  with  little  to  no 
shock.  Early  recourse  to  a direct  view  of  a serious 
and  undetermined  intra-abdominal  disturbance  should 
be  the  rule.  Mesenteric  thrombosis  of  such  a degree 
as  to  cause  death  of  a portion  of  bowel,  giving,  there- 
fore, symptoms  of  severe  intra-abdominal  pain,  shock 
and,  as  a rule,  a marked  leukocytosis  and  later  a dis- 
tended motor  function  of  the  intestines,  vomiting,  and 
bloody  stools,  should  have  prompt  intra-abdominal 
exploration,  regardless  of  whether  the  diagnosis  is, 
or  is  not,  made.  The  primary  diagnosis  in  such  an 
instance  is  “a  surgical  abdomen”  and  early  diagnosis 
gives  far  better  returns  than  malefic  procrastination. 

Thomas  O.  Burger,  M.  D.  (1301  Medico-Dental 
Building,  San  Diego).— Doctor  Smith  has  added  a 
valuable  contribution  to  the  medical  literature  in  this 
complete  discourse  on  the  subject.  It  is  rare,  though 
often  enough,  to  have  our  attention  called  to  the 
possibility  of  such  a condition  when  a diagnosis  is  not 
fairly  definite. 

After  taking  into  consideration  the  past  history,  age, 
and  the  possibility  of  emboli,  I have  made  a preoper- 
ative diagnosis  of  occlusion  of  the  vessels  in  the  case 
of  two  patients.  One  of  these  in  mind  was  inoperable, 
as  proved  at  autopsy.  The  second  one  was  opened 
with  the  hope  that  the  operative  procedure  might  re- 
lieve the  condition,  but  the  findings  were  such  that 
it  was  hopelessly  impossible.  In  both  of  these  cases 
there  was  occlusion  of  the  arterial  circulation. 

The  differentiation  between  arterial  and  venous 
block,  I think,  is  clinically  quite  difficult,  and  prob- 
ably of  very  little  difference  insofar  as  results  are 
concerned. 

While  thinking  of  occlusion  of  the  mesentery  ves- 
sels, we  must  also  think  of  and  consider  the  possi- 
bility of  a coronary  occlusion  in  these  same  types  of 
people.  Both  these  conditions  coming  from — in  the 
majority  of  instances — the  same  source,  it  is  very  diffi- 
cult and  almost  impossible  at  times  to  differentiate 
from  some  of  the  more  common  catastrophes  of  the 
upper  abdomen.  They  are  both  attended  with  terrific 
pain,  shock,  vomiting,  rigidity,  and  with  a leukocytosis 
in  a very  short  time,  also  a rise  in  temperature  due 
to  the  autolysis  of  the  tissues  similar  to  that  of  an 
infection. 


May,  1930 


CANCER — COFFEY 


313 


It  behooves  the  surgeon  to  be  on  the  lookout  for 
these  conditions  from  a diagnostic  standpoint  in  order 
to  avoid  operating  unnecessarily. 

# 

Doctor  Smith  (Closing).— I appreciate  very  much 
the  discussion  by  Dr.  John  Homer  Woolsey  in  which 
he  emphasizes  the  etiology  of  the  condition  and  the 
importance  of  early  .abdominal  exploration. 

Also  the  discussion  by  Dr.  Thomas  O.  Burger  in 
which  he  also  emphasizes  the  etiology  and  makes  the 
point  that  differential  diagnosis  between  arterial  and 
venous  block  is  impossible  clinically.  To  this  I fully 
agree  because  the  treatment  is  essentially  the  same. 

I only  wish  to  reemphasize  the  importance  of  the 
careful  history,  physical  examination,  and  laboratory 
work.  It  is  quite  true  that  the  history,  particularly 
as  to  cardiovascular  disease,  is  very  important,  the 
suddenness  of  the  onset  and  the  acuteness  of  the  pain 
also  are  very  marked.  The  urinalysis  should  always 
be  taken  into  consideration,  because  the  indican  is 
usually  very  high  due  to  stasis  produced  by  the 
paresis  of  the  small  intestines.  The  bloody  stools  will 
give  a suggestion,  and  must  not  be  confused  with 
intussusception  or  enteritis. 

I also  wish  to  emphasize  that  we  must  limit  oper- 
ation on  these  patients.  They  are  in  extreme  shock, 
ileus  is  marked,  and  an  anastomosis  should  not  be 
attempted.  It  is  preferable  to  do  as  little  as  possible, 
and  either  to  bring  the  gangrenous  loop  out  of  the 
abdominal  wound  and  fix  it  there  so  that  at  a later 
date  it  can  be  excised  and  the  usual  operations  for 
closure  performed;  or  else  bring  out  the  loop,  suture 
it  into  the  wound  and  excise  it  immediately,  leaving 
two  openings,  one  to  relieve  the  obstruction  and  the 
other  through  which  saline  may  be  administered  if 
desired  to  relieve  the  toxemia. 


TREATMENT  OF  CANCER — PRESENT  DAY 
RATIONALE* 

By  Robert  C.  Coffey,  M.  D. 

Portland,  Oregon 

NOTWITHSTANDING  the  fact  that  practi- 
cally every  general  medical  meeting  of  im- 
portance has  one  or  more  papers  or  addresses 
on  cancer  and  every  public  health  meeting  of 
importance  has  a discussion  of  the  subject,  and 
every  medical  institution  of  research  does  work 
on  cancer,  there  has  been  no  notable  contribution 
to  our  knowledge  as  to  the  nature  of  cancer 
within  a generation.  If  we  would  devote  our  time 
to  systematizing  and  inculcating  our  present 
knowledge  of  cancer  into  the  minds  of  the  medi- 
cal profession  and  the  laity  instead  of  following 
every  new  theory,  we  could  easily  save  twice  as 
many  cancer  patients  as  we  are  now  saving.  At- 
tempts to  promulgate  new  theories  as  to  the 
nature,  cause,  and  treatment  of  cancer,  and  the 
publication  of  half-baked  theories  with  no  founda- 
tion of  fact  for  the  reading  of  the  general  public 
so  muddles  the  lay  mind  that  all  our  attempts  to 
establish  the  cancer  question  on  a sound  scientific 
basis  for  the  benefit  of  humanity  are  largely  nulli- 
fied. So  that  today  the  layman  is  probably  no 
better  prepared  to  decide  matters  pertaining  to 
cancer  than  he  was  twenty-five  years  ago. 

* Read  before  the  general  meeting  of  the  California 
State  Medical  Association  at  the  fifty-eighth  annual  ses- 
sion, Coronado,  May  6-9,  1929. 


PARASITIC  THEORY  OF  CANCER  CAUSATION 

The  parasitic  theory  is  the  most  harmful  of  all 
because  it  paves  the  way  for  the  groundless  hope 
of  both  a preventive  and  curative  serum.  The 
parasitic  theory  of  cancer  is  not  new.  It  has  been 
brought  forward  and  rejuvenated  every  time  a 
new  advance  has  been  made  in  bacteriology,  be- 
ginning with  the  discovery  of  the  tubercle  bacillus. 
Each  time  the  subject  is  rejuvenated  it  is  es- 
poused with  enthusiasm  by  certain  members  of 
the  profession  and  the  laity.  Yet,  there  is  no  more 
hope  or  evidence  today  that  cancer  is  a parasitic 
disease  than  there  was  when  Koch  discovered  the 
tubercle  bacillus.  On  the  contrary,  the  evidence 
is  even  less  convincing.  There  is  strong  evidence 
that  cancer  is  one  of  the  degenerative  or  terminal 
diseases ; natural  processes  of  maturity  and  death. 
This  is  indicated  by  the  fact  that  cancer,  cardio- 
vascular disease,  and  kidney  disease  are  all  on 
the  increase  as  far  as  the  general  population  is 
concerned,  while  death  from  infectious  disease  is 
decreasing.  The  increase  of  these  three  diseases 
run  parallel.  Why  this  increase?  Is  it  real  or 
only  apparent? 

FACTORS  IN  LIFE  EXPECTANCY  INCREASE 

Forty  years  ago  the  average  life  of  the  human 
being  born  into  the  world  in  a civilized  country 
was  forty-two  years.  Today  it  is  fifty-eight  years. 
This  increased  longevity  is  chiefly  brought  about 
by  scientific  preventive  medicine  and  hygiene. 
The  mortality  from  acute  infectious  diseases, 
such  as  diphtheria,  malaria,  typhoid  fever,  has 
been  reduced  sufficiently  to  account  for  most  of 
the  increased  longevity.  Given  100,000  children 
bom  today,  a much  larger  per  cent  of  them  will 
die  of  these  three  diseases  than  would  have  died 
in  100,000  births  forty  years  ago.  But  given 
100,000  individuals  past  forty  years  of  age  today, 
there  is  no  evidence  to  show  that  a greater  per 
cent  of  these  would  die  of  these  three  diseases 
than  would  have  died  in  100,000  people  past  forty 
years  of  age  forty  years  ago.  This  means  that 
there  is  an  enormous  increase  in  the  number  of 
people  who  reach  the  age  of  forty,  which  may  be 
termed  middle  life,  or  the  turning  point  at  which 
our  body  resistance  weakens  and  physical  de- 
generation begins.  At  this  time  in  life,  cancer, 
cardiovascular  disease,  and  renal  disease  all  begin 
to  develop.  The  heart  valves  and  blood  vessels 
begin  to  receive  the  deposits  of  lime  which  replace 
vital  tissues.  The  kidneys  begin  to  harden  and  the 
connective  tissue  to  contract.  Normally,  new  epi- 
thelial cells  are  generated  to  strengthen  and  repair 
areas  which  are  subjected  to  injury  or  excessive 
use.  About  the  age  of  forty  these  physical  processes 
begin  to  wane.  Often  these  repair  cells  are  put 
into  the  breach  in  an  immature  state  and  degenera- 
tion begins.  While  the  average  human  life  has  in- 
creased, the  maximum  longevity  has  not  increased. 
Man  will  continue  to  die.  If  he  escapes  accident 
and  infective  diseases,  he  will  nevertheless  finally 
die  of  a degenerative  or  terminal  disease. 


314 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


ANALOGY  OF  CANCER  AS  A WEED 

Most  people  are  acquainted  with  farm  life.  I 
have  found  the  average  individual  may  under- 
stand the  analogy  of  cancer  to  a weed  or  pest  on 
the  farm.  In  opening  the  subject  to  a layman, 
let  us  assume  that  a noxious  weed  comes  up  in 
the  farmer’s  field.  It  is  strange  to  him.  He  looks 
it  over,  trying  to  decide  what  to  do.  It  has  a 
beautiful  flower  and  might  well  be  cultivated  in 
a flower  garden.  Let  us  suppose  that  he  decides 
that  he  will  destroy  this  weed.  If  he  destroys  the 
weed  at  this  time,  the  menace  is  destroyed.  On 
the  other  hand,  let  us  suppose  that  the  weed  ma- 
tures and  forms  thousands  of  seeds  which  are 
scattered  in  an  area  of  a few  feet.  Next  year  the 
farmer  sees  the  menacing  increase  of  this  weed. 
He  pulls  up  all  of  the  weeds  and  destroys  them 
and  the  menace  is  averted  the  second  year  instead 
of  the  first.  On  the  other  hand,  let  us  suppose 
that  the  farmer  ignores  the  weed  the  second  year. 
He  cuts  it  with  his  mowing  machine;  millions  of 
seeds  are  harvested  with  his  hay.  The  seeds  are 
not  only  scattered  through  the  hay,  but  scattered 
by  the  wayside,  picked  up  by  the  birds  and  carried 
to  out  of  the  way  places,  so  that  when  the  third 
year  comes  millions  of  these  weeds  are  scattered 
in  inaccessible  places.  The  pest  is  out  of  bounds 
of  the  farmer  and  is  hopelessly  distributed 
throughout  the  entire  section  of  country.  This 
noxious  weed  is  a cancer.  It  is  not  good  for  feed. 
It  cannot  be  used  to  aid  the  animal  life  of  the 
community.  It  toils  not,  neither  does  it  spin,  but 
it  absorbs  food  from  the  soil  which  should  be 
making  useful  products. 

A similar  analogy  may  be  drawn  with  human 
society.  In  any  large  audience  there  may  be  de- 
generates, criminals,  mental  defectives,  and  other 
types.  As  a speaker  looks  out  over  a sea  of  faces 
of  this  kind,  he  is  unable  to  differentiate  the 
degenerate  from  the  genius  or  other  useful  citizen. 
Yet  it  is  impossible  to  organize  the  physical  or 
moral  degenerate  into  a working  unit  of  society. 
He  claims  the  right  to  a living  and  the  pleasures 
of  life,  but  sees  no  reason  why  he  should  enter 
into  a contract  with  society  by  which  he  should 
do  his  part  of  the  work.  He  reproduces  his  kind, 
he  absorbs  all  the  good  things  in  life  necessary  to 
his  sustenance  and  reproduction  of  his  species 
without  giving  anything  in  return.  The  cancer 
cell,  let  us  say  on  the  lip,  developing  at  a point 
where  a pipe  stem  has  made  pressure  and  caused 
irritation,  cannot  be  differentiated  except  by  the 
most  expert  microscopist  from  the  normal  cells. 
These  cells  multiply,  reproduce  their  kind,  extract 
nourishment  from  tissues  in  their  neighborhood, 
but  they  are  incapable  of  being  organized  into  epi- 
thelial covering  of  the  lip  or  mucous  glands  or 
blood  vessels  or  any  other  useful  structure.  They 
are  outlaws.  They  are  weeds.  They  are  degener- 
ates. They  toil  not,  neither  do  they  spin.  The 
smoker  has  carried  his  pipe  stem  on  this  spot  on 
his  lip  through  all  his  young  adult  life.  Nature 


has  manufactured  good  epithelial  cells  and  ar- 
ranged them  in  many  layers  so  as  to  protect  the 
lip  from  this  extra  pressure  and  from  the  irrita- 
tion of  the  nicotin  by  the  formation  of  a callus. 
After  forty,  the  age  of  maturity  and  beginning 
decline,  the  reparative  processes  are  more  taxed. 
Nature  is  tired,  sends  up  cells  before  they  are 
mature.  This  is  repeated  until  finally  these  im- 
mature cells  begin  to  reproduce  themselves  as  a 
species  and  cancer  begins.  Cancer  is  simply  an 
aggregation  of  immature  nonfunctioning  cells 
which  cannot  be  differentiated  and  organized  for 
the  repair  of  the  normal  tissues  but  which  repro- 
duce their  kind  and  which  seek  their  sustenance 
from  any  source  in  their  neighborhood. 

ANALOGY  ON  HOW  CANCER  IS  SPREAD 

How  does  the  cancer  cell  differ  from  the  benign 
cell,  is  a natural  question  for  a layman  to  ask. 
A cancer  cell  has  the  power  to  reproduce  its  kind 
after  it  has  been  transported  to  another  part  of 
the  body.  A benign  tumor  cell  will  not  reproduce 
its  kind  when  transported  to  another  part  of  the 
body.  Any  tumor  whose  cells  will  reproduce  when 
transported  to  another  part  of  the  body  will  finally 
destroy  life  and  must,  therefore,  be  classed  as  a 
malignant  tumor.  For  example,  hypernephroma 
is  not  classed  as  a cancer  and  yet  it  produces 
death  of  the  patient. 

How  is  cancer  transported  to  other  parts  of  the 
body  ? This  may  be  presented  to  the  layman  as 
follows : Coming  to  our  homes  are  water  pipes 
bringing  pure  water  for  our  nourishment.  Going 
from  our  home  are  other  pipes  carrying  away  the 
waste  products.  These  we  call  sewers.  Going  to 
every  part  of  the  body  are  blood  vessels  carrying 
nutrition  for  the  sustenance  and  repair  of  our 
tissues.  Going  away  from  every  part  of  the  body 
are  lymphatic  vessels  which  pick  up  waste  mate- 
rial and  float  them  back  toward  the  central  circu- 
lation to  be  carried  to  certain  eliminative  organs 
where  they  are  cast  out.  Often  at  the  beginning 
of  a sewer,  or  a sink,  there  is  a filter  to  prevent 
undesirable  substances  from  entering  the  sewer. 
In  the  course  of  the  lymphatic  vessels  there  are 
filters  placed  there  for  the  purpose  of  preventing 
undesirable  substances  from  entering  the  blood 
stream.  These  filters  are  lymphatic  glands.  The 
cancer  cell,  in  its  avidity  for  food  and  its  lawless- 
ness, forces  its  way  into  these  lymphatic  vessels, 
floats  down  and  is  caught  in  the  filters  or  lym- 
phatic glands.  Here  the  immature  or  cancer  cell 
begins  to  multiply  and  produce  another  cancer 
cytologically  similar  to  the  parent  cancer  from 
which  it  came.  As  this  second  cancer  develops, 
one  of  its  cells  in  turn  may  break  into  the  lym- 
phatic stream  below  and  may  float  on  down  and 
be  caught  in  still  another  filter  or  lymphatic  and 
the  third  cancer  of  exactly  the  same  kind  de- 
velops. The  cancer  cell  from  the  third  cancer 
breaks  loose  and  floats  down  the  lymphatic  stream 
beyond  the  last  filter.  It  enters  the  blood  stream 
and  is  carried  to  remote  parts  of  the  body  where 


May,  1930 


CANCER — COFFEY 


31S 


it  is  lodged  in  a small  capillary,  too  small  to 
admit  the  passage  of  a cancer  cell,  and  there  it 
begins  to  reproduce  its  kind  and  forms  a fourth 
cancer  entirely  out  of  reach  of  any  means  of  de- 
struction. When  the  cancer  cell  passes  the  last 
filter  and  enters  the  blood  stream  the  case  is  hope- 
less. On  the  other  hand,  if  no  cancer  cell  has 
left  the  parent  growth  and  the  parent  growth  is 
destroyed  or  removed  by  any  means  whatsoever, 
the  cancer  is  cured.  If  a single  cell  has  left  the 
parent  growth  and  is  caught  in  a lymphatic  gland 
or  filter  at  a distance  from  the  original  growth, 
simple  removal  or  destruction  of  the  parent 
growth  does  no  good.  Life  is  not  prolonged,  for 
the  second  growth  in  the  lymphatic  gland  will 
proceed  at  increased  speed  and  produce  death  just 
as  quickly  as  if  the  parent  growth  had  not  been 
removed.  On  the  other  hand,  if  the  parent  growth 
and  the  remote  lymphatic  gland  containing  the 
second  growth  is  removed,  the  cancer  is  cured.  If 
any  lymphatic  containing  a cancer  cell  is  allowed 
to  remain  the  cancer  is  not  cured.  If  any  cancer 
cell  has  escaped  into  the  blood  stream  the  cancer 
is  incurable  entirely.  With  this  knowledge  the 
layman  can  understand  why  a local  growth  re- 
moved by  a paste  will  cure  only  when  the  disease 
is  entirely  local.  He  may  further  understand  that 
an  operation  for  cancer  must  be  radical ; must 
remove  all  the  glands  intervening  between  the 
growth  and  the  point  where  presumably  the  lym- 
phatics enter  the  blood  stream.  He  may  then 
understand  why  cancer  becomes  the  greatest 
emergency.  The  woman  with  cancer  of  the  breast, 
contemplating  its  surgical  removal,  may  under- 
stand why  it  is  not  advisable  to  wait  two  or  three 
months  until  a relative  comes  to  take  care  of  the 
children. 

TREATMENT 

Considering  the  treatment  of  cancer,  there  are 
two  clear-cut  lines  of  procedure : 


Fig.  1. — Low  cancer  of  the  rectum.  The  dotted  line 
across  the  intestine  and  the  severed  blood  vessels  indi- 
cates the  amount  of  intestine,  mesentery  and  lymphatic 
glands  to  be  removed  by  the  radical  operation. 


1.  Radical  removal  or  destruction,  not  only  of 
the  growth  itself  but  of  the  tissues  containing 
the  growth  along  with  the  tissues  containing  the 
lymphatic  passages  and  glands  intervening  be- 
tween the  growth  and  the  point  where  the  lym- 
phatics presumably  enter  the  blood  stream  or  pass 
into  inaccessible  anatomical  depths. 

2.  Destruction  of  the  cancer  cells  as  they  lie 
in  the  tissues  without  destroying  the  tissues  them- 
selves. 

The  first  or  radical  removal  procedure  is  accom- 
plished by:  (a)  surgery;  ( b ) cautery;  ( c ) electro- 
coagulation. 


Fig.  2. — After  the  rectum  and  sigmoid  have  been  mobil- 
ized by  cutting  the  peritoneum  on  either  side  of  the 
mesentery  and  severing  the  rectal  and  sigmoid  arteries, 
the  fat  in  the  hollow  of  the  sacrum  is  mobilized  down  to 
the  tip  of  the  coccyx  by  finger  dissection. 

The  second  or  destruction  procedure  is  carried 
out  by  the  use  of  radiotherapy:  (a)  radium; 
( b ) deep  x-ray. 

It  cannot  be  disputed  that  surgery  is  the  ideal 
treatment  in  most  cases  of  cancer  which  are  so 
located  that  not  only  the  cancer  in  its  original 
site,  but  the  organ  containing  the  cancer,  as  well 
as  the  lymphatic  vessels  and  glands  which  drain 
the  organ,  can  be  removed.  For  example,  cancer 
of  the  lip,  the  breast,  the  large  intestine  and 
rectum,  the  pyloric  end  of  the  stomach,  the  body 
of  the  uterus  and  the  ovaries  and  now  the  bladder. 

Cancer  of  the  Lip. — Cancer  of  the  lip  is  a field 
that  is  also  claimed  by  the  radiologist,  and  the 
physician  is  too  apt  to  thoughtlessly  refer  a sus- 
picious epithelial  growth  on  the  lip  to  the  nearest 
radiologist.  The  surgeon  who  treats  a great  deal 
of  cancer  is  appalled  at  the  number  of  patients 
coming  in  for  recurrence  of  epithelioma  of  the  lip 
along  with  enlarged  lymphatic  glands  in  the  sub- 
maxillary and  submental  spaces  following  radio- 
therapy. The  patient  has  been  referred  or  has 
gone  by  the  advice  of  his  physician  to  an  x-ray 
technician  or  a dermatologist  who  uses  x-ray  or 


316 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  S 


Fig.  3 — Sigmoid  is  being  inverted  and  drawn  out 
through  the  anus.  The  mesentery  of  the  sigmoid  and 
rectum  has  been  ligated  and  is  being  removed.  The 
proximal  sigmoid  is  brought  out  through  the  left  rectus 
muscle  for  a colostomy.  (A)  In  the  male  the  inverted 
sigmoid  is  pinned  outside  the  buttocks  so  that  it  cannot 
retract.  (B)  In  the  female  a drainage  opening  has  been 
made  in  the  posterior  fornix  of  the  vagina  and  drainage 
placed.  Uterus  fixed  in  retroversion. 

radium.  The  growth  disappears  very  quickly,  and 
the  patient  goes  on  with  a sense  of  peace  and 
safety  until  the  recurrence  takes  place.  At  this 
time  his  chances  of  cure  have  been  reduced  from 
85  to  about  50  per  cent.  Had  he  been  referred 
to  a surgeon  in  the  first  place,  the  surgeon,  under 
local  anesthetic,  would  have  removed  the  growth 
and  a section  of  the  lip  without  pain  and  without 
shock  and  would  have  submitted  it  for  micro- 
scopic examination.  If  the  growth  proved  to  be 
very  malignant  or  penetrated  the  deeper  layers 
of  the  skin,  the  submaxillary  and  submental 
glands  would  have  been  removed  and  the  patient 


Fig.  4. — In  the  male,  a large  protected  quarantine  drain 
made  of  a dozen  or  more  wicks  enclosed  in  rubber  tissue, 
which  is  made  to  surround  the  wicks  after  they  are  in 
place,  is  placed  down  to  the  hollow  of  the  sacrum.  It  is 
made  extraperitoneal  by  bringing  the  peritoneum  of  the 
two  sides  of  the  pelvis  together  above  the  drainage  area. 


would  have  had  85  per  cent  chance  of  cure.  I 
think  every  thoughtful  surgeon  who  sees  these 
cases  has  reached  the  conclusion  that  since  the 
advent  of  radiotherapy  the  number  of  deaths 
from  carcinoma  of  the  lip  is  greater  than  before 
its  introduction.  The  same  holds  true  in  cancer 
of  the  breast.  This  is  not  saying  that  the  most 
highly  skilled  radiologists,  who  are  thoroughly 
grounded  in  the  principles  of  cancer,  cannot  get 
results  in  many  of  these  cases.  But  the  great 
majority  of  these  superficial  cancers  never  reach 
the  highly  skilled  cancer  radiologist.  Therefore 
these  patients  are  simply  soothed  by  the  tempo- 


Fig.  5. — Second  step  of  the  operation.  The  coccyx  and  last  joint  of  the  sacrum  are  removed  and,  after  an 
incision  is  made  around  the  anus  to  include  the  anal  muscles,  the  fingers  easily  enucleate  the  rectum  without  hemor- 
rhage (A  and  B),  leaving  a large  open  cavity  to  heal  by  granulation  (C). 


May,  1930 


CANCER — COFFEY 


317 


i S/q/noi/C/rt  *7- 


rior  Hemorrhoida/  // 


Fig  6. — In  carcinoma  of  the  rectosigmoid  we  must  deal 
with  intestinal  obstruction  by  a colostomy  which  is  left 
open  from  two  to  four  weeks  before  the  two-stage  oper- 
ation for  removal  of  cancer  of  the  rectum  is  begun. 


rary  disappearance  of  the  growth  under  inefficient 
treatment. 

For  cancer  of  the  large  intestine  and  cancer  of 
the  body  of  the  uterus,  as  well  as  cancer  of  the 
pylorus,  surgery  holds  undisputed  sway. 

Cancer  of  the  Rectum. — In  cancer  of  the  rec- 
tum and  rectosigmoid,  which  may  be  reached  by 
radium,  the  field  is  in  dispute.  I think,  however, 
that  any  surgeon  who  has  had  considerable  expe- 
rience in  such  major  surgery  as  removal  of  the 
rectum  and  who  at  the  same  time  has  access  to 
ample  quantities  of  radium,  must  conclude  that 
cancer  of  the  rectum  must  primarily  be  given  to 
the  surgical  field  when  it  is  at  all  possible  to 
remove  the  rectum  and  possible  metastatic  glands 


/Tvitfr  77ssae 
<Sat/z*  UicAscf 


Super/ nr  Memorrho/daC  /!. 


Fig.  7. — Two  to  four  weeks  after  the  colostomy  has 
been  performed,  the  abdomen  is  opened  through  the  right 
rectus,  the  vessels  are  ligated,  the  intestine  severed  and 
mobilized  as  in  Figs.  2 and  3,  after  which  the  sigmoid  is 
clamped  and  severed  between  clamps  below  the  colostomy 
and  below  the  growth.  The  distal  stub  of  the  colostomy 
is  turned  in,  distal  stub  of  rectum  held  in  a clamp  or 
inverted  with  a purse  string,  and  the  area  drained  with 
a quarantine  pack  (A)  as  described  in  Fig.  4.  The  rectum 
is  later  removed  as  shown  in  Fig.  5. 


entirely.  As  a matter  of  fact,  cancer  of  the  rec- 
tum is  probably  the  most  definitely  surgical  cancer 
in  the  body,  for  here  the  entire  organ  may  be 
removed  along  with  all  the  glands  in  the  hollow 
of  the  sacrum  and  pelvis  into  which  the  lym- 
phatics of  the  rectum  drain.  The  technique  for 
radical  removal  of  cancer  of  the  rectum  has  been 
given  in  Surgery,  Gynecology,  and  Obstetrics, 
June  1924,  and  in  the  Annals  of  Surgery,  Octo- 
ber 1922.  In  considering  surgery  for  cancer  of 
the  rectum,  it  must  be  classified  in  two  distinct 
divisions : High  cancer  or  cancer  of  the  recto- 
sigmoid in  which  obstruction  is  usually  the  first 
symptom,  and  cancer  of  the  ampulla  of  the  rec- 
tum in  which  obstruction  does  not  take  place 
early  but  in  which  other  symptoms  appear  rela- 
tively early  and  in  which  the  sigmoid  may  still 
be  inverted  and  drawn  out  through  the  anus  at 
the  first  stage  of  the  operation.  The  low  mor- 
tality and  high  curability  of  cancer  of  the  rectum 
is  very  encouraging.  In  cancer  of  the  recto- 
sigmoid the  results  are  not  so  good.  We  have 
another  separate  problem,  namely,  intestinal  ob- 


Table 1 

Total  cases  of 
sigmoid 

carcinoma  of  the  rectum  and  recto- 

152 

Inoperable  even  for  exploration 

13 

lotal  patients  not 
operated  on 

Refused  operation 

6 

Went  elsewhere 

5 

24 

Exploration  12 

Exploration 
and  pallia- 
tive oper- 
ations 

Colostomy  with 
or  without 
radium  32 

Rectum 

25 

49 

Tube  resection  1 

Radium  alone  4 

Rectosigmoid 

24 

Radical 

removal 

Rectosigmoid  including  obstructive 

cases 

14 

Rectum 

65 

79 

struction.  This  must  be  dealt  with  and  completely 
relieved  by  colostomy  before  any  attempt  is  made 
for  removal  of  the  cancer  itself  (Figs.  1,  2,  3,  4, 
5,  6,  and  7). 

My  personal  experience  is  shown  in  the  follow- 
ing tables,  which  represent  the  results  of  a 
follow-up  survey  made  in  May  1928 : 

Rectosigmoid  group  includes  all  obstructive 
cases  and  includes  a large  per  cent  of  the  mor- 
tality of  my  series.  Because  of  the  inclusion  of 
these  obstructive  cases,  and  the  consequent  high 
mortality,  the  three-stage  operation  has  been 
adopted  as  a routine  procedure  for  rectosigmoid 
cancer.  Therefore  statistics  in  this  group  are 
omitted  and  only  statistics  on  cancer  of  the  rectum 
proper,  in  which  it  is  possible  to  invert  the  sig- 
moid through  the  rectum,  will  be  included. 

Table  2 

Cancer  of  rectum  (inversion  technique)— 


Mortality  statistics: 

Total  cases  operated  upon 65 

Deaths  from  operation — 4 mortality 6.25% 


318 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


End  Results 

In  considering  end  results  only  five-year  cures 
are  included.  Therefore  only  those  cases  operated 
upon  more  than  five  years  ago  are  studied.  Total 
cases,  32;  deaths,  2;  mortality,  6.25  per  cent.  Of 
the  thirty  surviving  operations,  three  have  not 
been  traced  since  operation.  Six  were  traced  and 
were  well  two  years  or  more  after  operation  since 
which  time  we  have  not  been  able  to  trace  them. 
This  leaves  twenty-one  cases  for  the  study  of  end 


End  results  in  twenty-one  cases: 


1.  Patients  dying  before  the  expiration  of  five  years 8 

Cause  and  date  not  known 1 

Recurrence  in  liver,  three  and  one-half  years 1 

Recurrence  in  liver  three  years 1 

Cause  not  known,  two  years 1 

Local  recurrence  of  cancer,  two  years 1 

Local  recurrence  of  cancer,  twenty  months 1 

Local  recurrence  of  cancer,  seven  months 1 

Recurrence  in  lung,  eight  months 1 


2.  Lived  five  years  or  more — (62  per  cent) 13 


3.  Still  alive  and  well 8 


Thirteen  years;  twelve  years;  six  years,  four 
months;  six  years,  three  months;  six  years,  one 
month;  five  years,  eleven  months;  five  years, 
three  months;  and  five  years  after  operation. 


4.  Patients  dying  after  expiration  of  five  years 5 

Apoplexy,  thirteen  years ....  1 

Pneumonia,  six  years 1 

Local  recurrence,  six  years.  1 

Auto-accident,  five  years 1 

Local  recurrence,  five  years .....  1 


Recapitulation 

In  thirty-two  cases  there  were  two  deaths 
(6.25  per  cent).  In  fifty-four  cases  still  two 
deaths  (3.7  per  cent).  In  sixty-five  cases  four 
deaths  (6.25  per  cent). 

Taking  into  account  the  inaccuracy  of  such 
small  statistics,  it  would  seem  fair  to  estimate 
that  a death  rate  ranging  from  5 to  10  per  cent 
in  the  hands  of  skilled  surgeons  may  be  expected 
when  this  technique  is  used. 

In  twenty-one  traced  patients,  thirteen  lived 
five  years  or  more,  62  per  cent  five-year  cures. 
Nine  in  a series  of  thirty  is  a large  per  cent  of 
untraced  patients.  To  remove  all  doubt,  let  us 
assume  that  all  the  untraced  are  dead ; we  would 
still  have  43  per  cent  of  five-year  cures.  I am 
very  sure  that  at  least  three  of  the  untraced  pa- 
tients lived  more  than  five  years  and  that  it  would 
be  safe  to  predict  50  per  cent  of  five-year  cures. 

Cancer  of  the  Bladder. — Cancer  of  the  bladder, 
since  we  have  learned  to  transplant  the  ureters 
successfully  comes  definitely  into  the  field  of 
radical  treatment.  After  a cancerous  bladder  has 
been  eliminated  as  a reservoir  for  urine,  we  are 
left  to  choose  between  destructive  doses  of  radium 
and  radical  surgery.  We  have  used  both  means 
with  considerable  encouragement,  but  do  not  feel 
justified  in  drawing  conclusions  at  this  time. 

RADIUM 

Considering  the  use  of  radium,  we  must  thor- 
oughly consider  its  physical  activities  as  a thera- 
peutic agent.  Generally  speaking,  a large  dose  of 


radium  in  an  open  wound  in  which  the  skin  flaps  have 
been  dissected  far  back.  The  skin  is  held  away  from 
radium  by  gauze  and  the  edges  will  be  sewed  together 
for  primary  union  when  the  gauze  and  radium  are 
removed. 

unscreened  radium,  applied  close  to  a given  area 
or  growth  in  large  quantities  for  a sufficient 
length  of  time,  will  destroy  the  tissues  for  a given 
distance  just  as  thoroughly  as  if  the  actual  cau- 
tery had  been  used.  Radium,  screened  by  metallic 
coverings  or  located  farther  away  in  a limited 
area,  will  destroy  the  cancer  cells  without  de- 
stroying the  tissue  cells.  A little  farther  away 
the  radium  destroys  some  of  the  cells  and  by  its 
irritation  develops  connective  tissue  which  im- 
prisons other  cells  and  holds  them  inert  for  a 
length  of  time.  Still  more  remote  from  the 
radium,  a stimulation  seems  to  develop  so  that 
the  cancer  actually  grows  faster.  Therefore  the 
ideal  indication  for  the  use  of  radium  is  found 
where  cancer  involves  an  organ  which  is  sur- 
rounded by  other  vital  structures  that  must  not 
be  destroyed.  Such  a condition  is  found  in  cancer 
of  the  cervix  uteri,  for  here  we  have  the  bladder 
in  front,  rectum  behind,  and  ureters  on  the  sides, 
and  an  organ  which  is  thick  enough  to  amply 
screen  the  harsh  rays  of  the  radium  and  thereby 
prevent  destruction  of  the  surrounding  organs. 
On  the  other  hand,  surgery  for  cancer  of  the 
cervix  uteri  has  not  been  conspicuously  success- 


Fig.  9. — Wound  which  has  been  closed  after  subcuta- 
neous application  of  radium  following  excision  of  a 
cancerous  growth. 


May,  1930 


CANCER— COFFEY 


319 


Fig.  10. — Cancer  of  the  tongue.  Wyeth’s  electric  endo- 
therm  point  contacting  with  one  of  a series  of  long 
needles  which  have  been  inserted  in  different  parts  of 
the  tongue.  Note  area  of  coagulation  spreading  from  the 
contacted  needle. 

ful,  because : One,  it  is  not  discovered  early ; two, 
it  is  difficult  to  remove  the  surrounding  tissues 
which  are  likely  to  be  involved  without  doing 
damage  to  vital  organs.  In  very  early  cases  of 
cancer  of  the  cervix  uteri,  there  is  no  doubt  that 
surgery  is  to  be  preferred  and  will  give  better 
results  than  radium.  But  if  we  are  to  consider 
cancer  of  the  cervix  in  all  stages  and  base  our 
decision  on  the  number  of  comfortable  days  a 
given  number  of  (say  one  hundred)  cancer  pa- 
tients would  have  following  surgery,  as  compared 
with  an  equal  number  of  cases  following  radium 
treatment,  there  could  be  no  question  in  the  minds 
of  those  who  have  had  experience  with  both 
agents  as  to  the  superiority  of  radium.  While 
possibly  25  per  cent  of  the  cases  would  yield 
better  results  with  surgery,  the  other  75  per  cent 
would  be  overwhelmingly  better  off  treated  with 
radium  while  many  of  the  inoperable  cases  could 
be  greatly  benefited  and  some  of  them  entirely 
cured  by  radium.  Surgery  would  mutilate  such, 
resulting  in  great  mortality,  without  offering  any 
reasonable  chance  for  cure.  There  is  no  doubt 
that  a surgeon  who  has  ample  radium  would  use 
both  radium  and  surgery  in  the  treatment  of 
cancer  of  the  cervix  in  a considerable  percentage 
of  cases. 

RADIUM  AND  DEEP  X-RAY  THERAPY 

The  field  of  deep  x-ray  is  very  large  and  it  is 
to  be  used  where  a very  large  area  is  to  be  cov- 
ered, and  particularly  as  a palliative  agent  in  ad- 
vanced cases  or  areas  where  the  growth  is  located 
out  of  reach  of  radium  or  surgery.  It  shrinks 
the  lymphatics  and  retards  the  growth  in  deep- 
seated  cases,  but  probably  rarely  cures.  In  some 
extensive  areas  of  cancer  involvement  in  which 
surgery  is  not  applicable,  radium  is  possibly 
better  than  the  deep  x-ray.  We  have  found  that 
in  advanced  cancer  of  the  breast  of  the  acute  type 
in  which  the  skin  far  away  from  the  nipple  is 
involved,  the  growth  may  be  removed,  the  in- 


volved skin  lifted  from  the  chest  a long  distance 
away  and  a number  of  twenty-five  and  fifty 
milligram  tubes  of  radium,  well  screened  with 
metal  and  gauze,  packed  beneath  the  flaps,  work 
most  admirably  with  a single  dose  (Fig.  8).  After 
twenty-four  hours  the  gauze  and  radium  may  be 
removed  and  the  wound  closed,  with  full  assur- 
ance of  primary  union  and  surprisingly  good 
results.  This  is  applicable  in  the  neck  and  is 
particularly  suitable  for  recurrence  in  the  supra- 
clavicular glands  following  a radical  breast  am- 
putation. It  is  a routine  in  our  clinic  when  a 
supraclavicular  gland  shows  recurrent  carcinoma, 
a skin  incision  about  three  inches  long  is  made 
just  above  the  clavicle.  The  skin  is  lifted  and  the 
deep  fascia  separated.  The  upper  involved  gland 
is  exposed.  A fifty  milligram  tube  of  radium  in 
brass  and  enclosed  in  one  millimeter  of  lead,  one 
millimeter  of  rubber,  and  a one-quarter  inch 
covering  of  gauze,  is  packed  in  the  neck  directly 
on  the  gland.  The  skin  flaps  are  lifted  and  the 
wound  is  filled  with  gauze  so  as  to  lift  the  skin 
away  from  the  radium.  Temporary  sutures  draw 
the  skin  across  the  gauze,  where  it  is  left  for 
twenty-four  hours.  Novocain  is  then  injected  into 
the  skin  edges  as  a local  anesthetic.  The  gauze 
and  radium  is  removed  and  the  wound  closed. 
Primary  union  without  accumulation  of  fluid  is 
the  rule.  In  most  cases  there  has  been  no  recur- 
rence in  the  neck.  Those  patients  who  have  later 
died  have  had  recurrence  in  the  chest  or  liver  in- 
stead of  by  extension  up  the  neck.  A number  of 
our  patients  have  lived  two  and  three  years.  It 
seems  that  the  radium  applied  at  this  point  treats 
the  first  supraclavicular  gland,  which  is  just  under 
the  clavicle,  and  so  destroys  the  lymphatic  glands 
and  vessels  that  the  growth  does  not  go  upward. 

CAUTERY  AND  ELECTROCOAGULATION 

Much  has  been  said  about  the  electric  knife 
and  electrocoagulation,  so-called  electrosurgery. 
I have  an  elaborate  outfit  of  this  kind,  procured 
at  considerable  expense.  I am  frank  to  say  that 
I have  not  been  able  to  see  as  marked  advantage 
over  the  ordinary  cautery  as  I had  expected.  As 


Fig.  11.— Right  half  of  tongue  has  been  coagulated  by 
electric  currents. 


320 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


and  patient  kept  under  niorphin  while  radium  is  in  place. 

to  the  superiority  of  an  electric  knife  or  cautery 
knife  over  a steel  knife,  I have  not  been  fully 
convinced.  It  seems  reasonable  that  if  we  cut 
entirely  outside  the  cancer  it  really  does  not  matter 
what  kind  of  a knife  we  use.  The  patient  will 
be  cured  anyway.  On  the  other  hand,  if  we  cut 
through  a cancer,  it  does  not  matter  what  kind 
of  a knife  we  use;  the  patient  will  not  be  cured 
anyway.  Those  more  skilled  with  an  electric 
knife  or  cautery  knife  may  do  better  work  with 
these  agencies.  Good  surgeons  who  are  not 
skilled  with  these  agencies  will  probably  do  better 
with  the  ordinary  knife.  One  skilled  in  both 
methods  will  use  both  knives,  to  suit  the  case  in 
hand. 

The  one  outstanding  field  for  electrocoagula- 
tion is  in  the  mouth,  particularly  in  cancer  of  the 
tongue.  By  passing  a loop  of  thread  or  silkworm 
through  the  tongue,  it  may  be  pulled  out  and 
easily  anesthetized.  Let  us  consider  a cancer 
located  midway  between  the  tip  and  base  of  the 
tongue  on  one  side.  The  tip  of  the  tongue  is  first 
anesthetized  around  the  traction  loop.  The  tongue 
is  then  drawn  out.  The  left  index  finger  is  passed 
down  to  the  base  of  the  tongue.  With  a long 
needle,  the  tongue  is  fully  infiltrated  with  novo- 
cain solution  on  the  side  of  the  raphe  correspond- 
ing to  the  growth.  Long  needles  are  then  inserted 
in  the  tongue  near  the  raphe  and  the  one  farthest 
back  is  pushed  almost  to  the  surface  of  the  root 
of  the  tongue,  the  finger  acting  as  a guide  to  avoid 
injury  to  the  epiglottis.  The  coagulation  current 
is  made  to  contact  the  various  needles  until  the 
entire  side  of  the  tongue  is  cooked  and  turns 
black.  Two  fifty  milligram  tubes  of  radium,  en- 
closed in  silver  capsule  and  put  in  large  trocars 
in  which  a trocar  point  closes  the  end,  are  driven 
into  the  dead  side  of  the  tongue,  following  the 
holes  from  which  the  coagulation  needles  have 


been  removed.  The  lower  or  more  re- 
mote trocar  containing  radium  is  driven 
through  the  length  of  the  tongue,  well 
down  to  the  base  but  not  puncturing 
the  mucous  membrane.  The  other  trocar 
stops  somewhat  nearer  the  tip.  If  the 
floor  of  the  mouth  is  involved  with  the 
cancer,  extra  radium  needles  are  driven 
into  this  area.  While  the  tongue  is  pulled 
out,  a large  pack  of  gauze  is  made  to  fill 
the  entire  mouth,  literally  stuffing  the 
mouth,  including  the  buccal  cavity.  The 
ends  of  the  radium  containers  are  brought 
out  through  the  mouth.  The  teeth  are 
held  apart  with  the'  gauze,  and  radium 
containers  are  firmly  fixed  by  the  gauze 
pack.  Patient  is  then  given  morphin  in 
doses  sufficient  to  keep  him  entirely 
comfortable.  The  radium  may  be  left 
in  for  twenty-four  hours.  We  have  used 
as  much  as  four  thousand  milligram 
hour  doses  in  this  way  at  one  treat- 
ment. If  properly  packed,  there  is  no 
injury  to  the  other  mucous  membrane 
and  the  treatment  is  most  thorough. 
A few  days  later  the  dead  tongue  may  be 
trimmed  away.  The  patient  has  one-half  of  the 
tongue  left,  which  has  been  thoroughly  radi- 
dated  (Figs.  9,  10,  11,  and  12).  We  have  tried 
no  other  method  of  treatment  of  cancer  of  the 
tongue  that  is  comparable  to  this  combination. 

611  Lovejoy  Street. 


CHRONIC  NONVALVULAR  HEART  DISEASE — 
ITS  CAUSES,  DIAGNOSIS,  AND 
MANAGEMENT* 

By  Henry  A.  Christian,  M.  D. 

Boston,  Massachusetts 

AMONG  adults  this  is  the  form  of  chronic 
cardiac  disease  encountered  most  frequently, 
comprising,  in  my  clinic  at  the  Peter  Bent  Brig- 
ham Hospital,  61  per  cent  of  the  patients  diag- 
nosed as  having  some  form  of  chronic  heart 
disease  in  a ten-year  period.  By  chronic  non- 
valvular  heart  disease  we  understand  that  form 
of  cardiac  failure  in  which  the  defective  function 
is  due  to  myocardial  disturbance,  for  in  these 
patients  valves  and  pericardium  show  no  organic 
lesion.  Usually  there  is  cardiac  hypertrophy  and 
dilatation;  rarely  there  is  an  interstitial  (fibrous) 
myocarditis ; there  may  be  coronary  sclerosis,  but 
in  very  many  of  these  patients  the  arteries  of  the 
myocardium  are  normal.  Microscopically  there 
may  be  evidences  of  degenerative  changes  in  the 
muscle  fibers,  but  in  the  majority  of  cases  the 
microscope  reveals  no  change  other  than  hyper- 
trophy of  the  fibers.  Occasional  foci  of  round-cell 
infiltration  and  scattered  areas  of  fibrosis  may 
occur.  Generalized  fibrosis  rarely  is  found. 

It  would  seem  as  if  we  had,  in  these  patients, 
the  paradox  of  a powerful,  healthy  looking  heart 

* Annual  Scripps  Metabolic  Clinic  Lecture  before  the 
San  Diego  County  Medical  Society  at  La  Jolla,  California, 
January  25,  1930. 


May,  1930 


HEART  DISEASE — CHRISTIAN 


321 


muscle,  which  actually  was  unable  to  carry  on  the 
ordinary  circulatory  function  needed  in  daily  life. 
It  does  seem  to  he  a fact  that  once  the  heart  has 
enlarged,  it  has  already  begun  on  a career  of  in- 
creasing inefficiency.  Four  years  ago,  in  an  ad- 
dress before  the  Southern  Medical  Association, 
I stated  it  in  this  way:  “It  seems  to  be  a clinical 
fact  that,  so  soon  as  a heart  begins  to  enlarge, 
it  has  commenced  a cycle  of  changes  that,  in  a 
relatively  short  time,  will  result  in  signs  of  some 
circulatory  disability.”  Within  a few  weeks 
Cloetta  ( Journal  of  the  American  Medical  As- 
sociation, November  9,  1929),  has  expressed  the 
same  idea,  saying:  “Contrary  to  the  former  con- 
ception, I now  consider  every  heart  with  dilata- 
tion and  hypertrophy  as  in  an  abnormal  state  and 
of  diminished  efficiency.” 

CAUSES 

If  heart  hypertrophy  is  a malevolent  rather 
than  a benevolent  process,  the  real  problem  then 
is,  what  causes  the  heart  to  hypertrophy  ? V arious 
explanations  have  been  offered.  A popular  ex- 
planation is  that  it  is  a work  hypertrophy,  incident 
usually  to  hypertension.  Some  observers  go  so 
far  as  to  say  that  in  all  patients  of  this  group 
there  has  been,  at  some  time,  a maintained  hyper- 
tension, even  if  blood  pressure  is  normal  when 
the  patient  is  observed  after  cardiac  failure  has 
begun.  I believe,  however,  that  observations  have 
been  made  over  long  enough  periods  prior  to 
cardiac  disturbance  in  enough  patients  to  justify 
not  agreeing  that  hypertension  has  been  a cause 
of  this  change  in  all  cases.  In  many  of  the  pa- 
tients, however,  it  has  existed.  However,  some 
other  causative  factor  must  enter,  for  so  often 
we  observe  patients  who  have  sustained  hyper- 
tension for  long  periods  without  cardiac  hyper- 
trophy as  well  as  those  with  cardiac  hypertrophy 
and  no  hypertension.  Furthermore  in  such  indi- 
viduals as  long-distance  runners,  who  place  an 
increased  amount  of  work  on  their  circulation, 
there  is  no  cardiac  hypertrophy  or  dilatation.  The 
heart  actually  grows  smaller  during  a twenty-five- 
mile  run  in  a successful  long-distance  runner. 

Arteriosclerosis  and  syphilis  are  not  present 
often  enough  to  be  important  causative  factors. 
Rheumatic  fever  has  not  occurred.  Infections  at 
times  seem  to  have  a very  direct  relationship,  but 
various  infectious  diseases  and  focal  infections 
seem  no  more  frequent  in  this  type  of  cardiac 
disease  than  in  similar  control  groups  with  no 
cardiac  disease.  Valve  lesions  do  not  occur,  ex- 
cept dilatation  of  the  valve  ring  after  the  process 
is  well  advanced.  Arrhythmias  appear  too  late  to 
be  of  any  significant  causative  effect. 

In  other  words,  no  common  antecedent  condi- 
tion can  be  discovered  in  studying  the  past  history 
of  these  patients  to  account  for  the  development 
of  the  cardiac  disturbance. 

There  are  experimental  studies  indicating  that 
strain  of  not  long  duration  may  lead  to  subse- 
quent hypertrophy  and  dilatation  of  the  heart. 
Strain,  combined  with  varying  other  factors,  such 
as  hypertension,  infection,  etc.,  may  play  an  im- 
portant role  in  etiology. 


It  is  probable  that  the  relationship  of  the  car- 
diac musculature  to  a blood-containing  cavity,  as 
in  the  heart,  may  determine  a difference  between 
the  response  of  cardiac  and  skeletal  muscle  to  in- 
creased demands  on  their  function.  In  the  heart, 
in  order  to  increase  cardiac  output,  cardiac  cavi- 
ties must  dilate.  This  stretches  the  muscle  wall. 
Increased  tension  on  muscle  fibers  is  known  to 
increase  the  amount  of  work  a muscle  can  do. 
If  hypertrophy  is  a response  to  this  physiologic 
process,  then  the  cavity  enlarges  more  and  this 
repeats  itself  in  cycles.  As  Cloetta  has  put  this, 
“It  must  not  be  forgotten,  however,  that  the  heart 
is  a spherical  organ  and  that  it  contracts  around 
a fluid  content.  No  sooner  does  the  heart  dilate 
than  this  fluid  mass  or  resistance  increases, 
thereby  partly  nullifying  the  advantage  gained  by 
dilatation.  Thus  a stage  must  be  reached  at  which 
improvement  due  to  cardiac  hypertrophy  is  over- 
compensated by  the  greater  load,  and  this  is  where 
cardiac  insufficiency  really  begins ; the  heart  has 
stretched  itself  beyond  its  physiologic  limits  and 
signs  of  insufficiency,  such  as  diminished  volume 
of  beats  and  lessened  capacity,  begin  to  appear.” 
This  seems  to  be  what  happens. 

DIAGNOSIS 

Diagnosis  of  this  type  of  cardiac  failure  is  not 
difficult.  There  are  the  usual  evidences  of  cardiac 
insufficiency.  There  are  the  physical  signs  of  car- 
diac enlargement,  for  it  is  very  rare  for  the  heart 
not  to  be  enlarged.  Evidences  of  valve  lesion  are 
lacking.  There  is  no  history  of  rheumatic  fever. 
Most  of  the  patients  are  past  forty.  A systolic 
murmur  may  be  heard  or  there  may  be  no  mur- 
murs. Rhythm  often  is  regular,  but  there  may 
be  extrasystoles  or  auricular  fibrillation.  Other 
arrhythmias  occur  but  are  unusual. 

Two  groups  of  these  cases  are  misdiagnosed 
with  considerable  frequency:  (1)  The  markedly 
edematous  patient  with  a regular,  not  very  rapid, 
pulse  often  is  considered  as  a case  of  nephritis 
with  edema.  The  urine,  containing  albumin  and 
casts,  suggests  nephritis,  but  the  urine  picture  is 
due  to  passive  congestion  of  the  kidney,  as  shown 
by  the  speedy  disappearance  of  albumin  and  casts 
as  a sequence  to  adequate  cardiac  therapy. 
(2)  The  patient  with  paroxysmal  type  of  dyspnea 
is  regarded  as  having  bronchial  asthma  or  asth- 
matic bronchitis,  the  underlying  cardiac  disturb- 
ance having  been  overlooked,  in  part  due  to  the 
increased  difficulty  in  making  out  the  enlargement 
of  the  heart  owing  to  pulmonary  emphysema,  and 
in  part  owing  to  the  physical  signs  of  chronic 
bronchitis  so  often  seen  in  patients  of  this  type. 

These  two  diagnostic  mistakes  are  of  more  than 
academic  interest  because,  if  the  cardiac  disturb- 
ance is  not  recognized,  the  patients  are  given 
treatment  appropriate  to  the  erroneous  diagnosis 
of  nephritis  or  asthma  and  fail  to  respond, 
whereas  if  treated  as  patients  with  cardiac  failure 
the  response  often  is  dramatically  successful. 

TREATMENT 

Treatment  for  these  patients  is  that  for  other 
forms  of  cardiac  failure,  with  rest  in  bed,  diet, 
digitalis,  etc.,  in  adequate  dosage.  In  the  ones 


322 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


with  more  marked  edema  diuretics  may  be  re- 
quired to  remove  the  edema  though  very  fre- 
quently the  digitalis  is  all  that  is  needed.  Any 
form  of  potent  digitalis  is  satisfactory,  and  any 
method  of  dosage  may  be  followed.  The  impor- 
tant thing  is  to  give  sufficient  digitalis  to  produce 
a digitalis  action. 

It  is  a common  error  to  believe  that  in  this 
group  of  patients  digitalis  has  little  effect  in  the 
absence  of  auricular  fibrillation.  It  is  true  that 
digitalis  produces  marked  therapeutic  effects  in 
patients  with  auricular  fibrillation.  It  is  equally 
true  that  it  is  just  as  effective  in  patients  with 
regular  rhythm.  In  the  two  groups  of  patients 
already  mentioned  as  frequently  misdiagnosed  as 
nephritis  with  edema  or  bronchial  asthma  respec- 
tively, digitalis  therapy  often  gives  brilliant  effects. 
What  can  be  more  dramatic  than  the  rapid  dis- 
appearance of  excessive  edema  or  the  cessation  of 
paroxysms  of  severe  dyspnea,  as  one  so  often 
sees  follow  adequate  digitalis  therapy  in  these 
patients  ? 

In  patients  with  chronic  nonvalvular  cardiac 
disease  one  often  sees  great  benefit  from  a daily 
ration  of  digitalis,  0.1  to  0.15  gram  of  powdered 
digitalis  leaves  per  twenty-four  hours,  or  corre- 
sponding amounts  of  other  digitalis  preparations, 
kept  up  long  after  all  obvious  evidences  of  car- 
diac insufficiency  have  disappeared.  As  I watch 
these  patients  I am  becoming  more  and  more 
convinced  of  the  value  of  this  form  of  usage  of 
digitalis  and  inclining  more  and  more  to  use  these 
daily  doses  of  digitalis  in  patients  with  cardiac 
hypertrophy  even  before  there  develop  any  very 
evident  signs  of  decompensation. 

Digitalis  is  a drug  peculiarly  well  adapted  to 
give  a continued  effect  from  interval  doses.  The 
pharmacologists  have  taught  us  the  underlying 
principles  responsible  for  this.  We  have  learned 
that  as  digitalis  circulates  through  the  heart 
muscle,  it  passes  through  the  vessel  wall  to  be- 
come fixed  in  the  heart  muscle,  where  it  is  inactive 
until  it  is  split  up  into  an  active  form,  a toxigenin 
or  aglykon.  This  splitting  up  goes  on  gradually 
and  the  split-product  produces  the  digitalis  effect. 
Straub  and  Cloetta  have  been  particularly  active 
investigators  in  this  matter.  This  is  the  process 
that  permits  of  continued  digitalis  effect  at  a 
reasonably  steady  rate  without  any  toxic  effects. 
If  the  amount  of  digitalis  given  in  a single  dose 
is  increased  beyond  a certain  point,  then  this  new 
digitalis  is  fixed  in  the  muscle  before  that  previ- 
ously there  has  been  split  up  completely  and  has 
finished  producing  its  digitalis  action.  So  cumula- 
tive and  toxic  effects  appear. 

There  is  experimental  work  to  indicate  that 
continued  use  of  small  doses  of  digitalis  in  ani- 
mals with  damaged  aortic  valves  retards  cardiac 
hypertrophy.  If  so,  then  there  is  additional  reason 
for  giving  digitalis  in  daily  rations  in  the  early 
stages  of  the  development  of  those  cardiac  lesions 
now  under  discussion,  for,  as  we  have  already 
seen,  hypertrophy  in  itself,  as  it  increases,  is  a 
detrimental  process.  These  experiments  are  in 
accord  with  certain  clinical  observation  of  the 


benefit  from  continued  use  of  small  doses  of 
digitalis. 

Diuretics  are  very  valuable  drugs  to  remove 
excessive  edema  not  satisfactorily  decreasing  from 
digitalis  alone.  Diuretics  should  be  given  at  the 
time  digitalization  has  been  obtained.  Diuretics 
are  more  satisfactory  in  their  results  when  given 
in  one  or  several  doses  before  noon  and  not  re- 
peated on  the  next  or  second  succeeding  day.  Of 
them  I have  found  theobromin  sodiosalicylate 
(diuretin),  0.5  gram  by  mouth  at  8,  10,  and  12 
o’clock;  theophyllin  (theocin),  0.3  gram  the  same 
way;  novasurol  (merbaphen)  and  salyrgan  (both 
given  as  one  dose  early  in  the  day,  preferably 
intravenously)  most  useful  and  effective,  as  a 
rule,  in  the  order  in  which  I have  named  them. 
Of  these  the  first  two  have  the  advantage  of 
effectiveness  by  mouth  dosage,  while  the  second 
two  require  intramuscular  or  intravenous  routes 
of  administration,  preferably  the  latter,  as  they 
are  somewhat  irritating  even  after  deep  injection. 
The  second  two  act  better  after  a preliminary 
period  of  three  to  four  days  on  which  the  patient 
receives  from  three  to  four  doses  of  one  gram  of 
ammonium  chlorid  or  ammonium  nitrate.  Larger 
doses  of  these,  as  often  recommended,  may  cause 
nausea  and,  in  my  experience,  give  no  better  re- 
sults than  the  one-gram  doses  just  advised.  If 
there  is  gastric  upset,  the  ammonium  chlorid  may 
be  given  by  rectum. 

Treatment  along  the  general  lines,  as  just  de- 
scribed, gives  very  satisfactory  results,  and  often 
it  is  most  surprising  how  much  may  be  accom- 
plished in  patients  apparently  in  very  bad  con- 
dition. The  skillful  combination  of  these  methods 
to  obtain  such  results  is  the  evidence  of  that  sound 
clinical  knowledge  which  our  patients  should  ex- 
pect of  us. 

Peter  Bent  Brigham  Hospital. 


EPIDEMIC  CEREBROSPINAL  FEVER  ON  THE 
PACIFIC  COAST* 


By  J.  C.  Geiger,  M.  D. 
San  Francisco 


Tp'PIDEMIC  cerebrospinal  fever  occurs  with 
^ piquant  irregularity.  Indeed,  since  the  out- 
break of  1904-05,  this  disease  has  been  sometimes 
epidemic,  sometimes  sporadic,  without  complete 
cessation.  Europe,  Africa,  South  America,  Aus- 
tralia, and  China  have  been  harassed. 


EPIDEMIOLOGY 

In  other  words,  the  disease  has  been  pandemic 
practically  over  the  world  between  1904-10  with 
never  a real  quiescent  period  in  the  United  States 
or  Europe.  In  fact,  in  the  United  States,  each 
winter,  in  one  locality  or  another,  groups  of  cases 
have  occurred.  There  is  no  doubt  that  severe 
epidemics  leave  viable  foci  which  add  to  the  con- 
tinuity of  the  propagation  of  the  disease.  The 
meningococcus  only  survives  in  nature  in  the 
human  being.  The  epidemiology  is  by  no  means 
as  simple  as  it  seems.  The  epidemiology  of  pneu- 

* Read  before  the  Pacific  Interurban  Clinical  Club,  San 
Francisco  meeting,  December  19  and  20,  1929. 


May,  1930 


CEREBROSPINAL  FEVER — GEIGER 


323 


monia  has  often  been  contrasted  with  that  of  epi- 
demic cerebrospinal  fever.  Apparently  the  latter 
disease  only  reaches  epidemic  proportions  not  as 
much  to  case  contact  as  from  chronic  carriers. 
Constituting  as  they  do  an  often  unsuspected  and 
innocent  participant,  they  become  malevolent 
agencies,  usually  in  the  vicinity  of  cases  in  the 
spread  of  the  disease.  The  carrier  generally  out- 
numbers the  cases  many  to  one.  Consequently 
their  detection  and  control,  mainly  because  of  the 
fact  that  the  meningococcus  is  decidedly  selective 
in  medium  and  infinitely  sensitive  to  environment 
and  technically  difficult  to  recognize,  makes  bogy- 
haunted  creatures  of  painstaking  and  careful  health 
officials.  The  sporadic  character  of  many  of  the 
cases  speaks  for  a widespread  resistance  of  the 
disease  in  the  general  population.  This  assumed 
resistance  may  be  to  the  causative  strain  itself. 
The  low  case  incidence  is,  however,  laid  to  the 
door  of  the  carrier,  for  it  is  stated,  and  oftentimes 
accepted,  that  the  case  incidence  is  dependent  on 
the  carrier  incidence  reaching  a comparatively 
high  ratio  around  twenty.  That  this  does  not 
always  hold  true  can  be  shown  by  the  carrier 
incidence  recently  found  aboard  ships  on  which 
cerebrospinal  fever  had  occurred.  This  carrier 
incidence  was  exceedingly  low  (2.5  to  4 per  cent), 
even  in  the  face  of  the  known  close  contact  so 
apparent  in  the  steerage.  Therefore,  in  some 
outbreaks,  there  may  be  a racial  or  otherwise  in- 
creased susceptibility  to  the  particular  causative 
type  strains  and  this  was  probably  true  in  the  Fili- 
pino cases.  Certainly,  when  large  aggregates  of 
people  are  brought  together  from  divergent  com- 
munities, the  presence  of  a carrier  of  meningo- 
cocci may  be  a foregone  conclusion. 

ROLE  OF  CARRIERS 

Of  practical  importance  are  the  measures  to 
control  carriers  and  the  culturing  of  carriers.  The 
results  have  not  been  brilliantly  conclusive  even 
under  controlled  conditions,  as  in  military  camps. 
The  persistence  of  the  carrier  state  is,  conceiv- 
ably, one  important  condition  for  consideration. 
Carriers  may  persist  for  weeks.  Norton,1  in  his 
large  experience  in  the  outbreak  in  Detroit  in 
1928-29,  states : “The  persistence  of  carriers  is 
a point  of  some  importance.  We  were  able  to 
follow  most  of  our  carriers  for  two  weeks  but 
no  longer,  since  that  time  was  fixed  in  our  isola- 
tion regulations.  Again  using  the  three  divisions 
of  the  six  months’  study — in  the  first  period  32.8 
per  cent  of  carriers  had  not  given  two  consecu- 
tive negatives  before  release,  in  the  second  period 
25.6  per  cent,  and  in  the  third  period  30.4  per 
cent  had  not  satisfactorily  cleared  up.  While  the 
advent  of  warm  weather  was  coincident  with  a 
great  decrease  in  the  number  of  carriers,  propor- 
tionately the  tendency  to  persist  was  about  the 
same. 

“It  is  necessary  to  stress  the  uncertainty  of  ob- 
taining accurate  results  in  the  detection  of  menin- 
gococcic  carriers.  We  have  had  many  experiences 
which  convince  us  that  conclusions  from  our  lab- 
oratory data  must  be  drawn  with  care.  Either 
the  carrier  state  is  an  intermittent  one  or  our 


CEREBRO -SPINAL  MENINGITIS 


CALIFORNIA 


OREGON 


WASHINGTON 


technique  is  not  sufficiently  exact — -possibly  both. 
Sometimes  inconsistent  results  can  be  explained, 
but  at  other  times  not.  One  of  our  contacts  gave 
the  following  results  for  meningococci,  minus, 
plus,  minus,  minus,  and  accordingly  was  released. 
One  week  later  she  was  sent  to  the  laboratory  by 
her  physician  because  he  found  that  she  had  been 
using  a gargle  during  the  time  the  last  two  nega- 
tives* were  obtained.  The  next  four  examinations 
gave  plus,  plus,  minus,  minus.  One  month  later 
she  was  still  negative.  This  is  by  no  means  an 
isolated  instance.” 

Moreover  this  same  author  covers  another 
argumentative  point  as  follows : “Crowding  is 
supposed  to  be  a factor  in  meningitis.  Presuma- 
bly, in  a civil  population  we  would  expect  to  find 
a higher  percentage  of  carriers  in  crowded  room- 
ing houses  than  in  residential  districts  containing 
five  or  less  persons  to  a home.  The  131  cases 
investigated  between  February  6 and  March  31 
were  grouped  on  the  basis  of  number  of  contacts 
per  case.  In  the  group  with  four  or  less  contacts 
per  case  there  were  fifty-one  cases  and  157  con- 
tacts, of  whom  sixty-four,  or  40.7  per  cent,  were 
carriers.  In  the  group  with  five  to  nine  contacts 
per  case  there  were  seventy-one  cases  and  446 
contacts,  of  which  211,  or  47.2  per  cent,  were 
positive.  The  final  group,  with  ten  or  more  con- 
tacts per  case,  was  composed  of  nine  cases  and 
106  contacts,  of  which  fifty-seven,  or  53.7  per 
cent,  were  carriers.  These  figures  indicate  a some- 
what greater  tendency  for  carriers  to  be  found 
in  the  more  crowded  houses.  However,  the  fig- 
ures for  the  second  period  (April  1 to  June  1) 
show  just  the  reverse,  being  15.2,  15.2,  and  11.9 
per  cent  for  the  three  groups  respectively.” 

PAST  CEREBROSPINAL  FEVER  EPIDEMICS 

The  history  of  cerebrospinal  fever  indicates 
periods  of  high  incidence  recurring  at  fairly  long 
intervals.  The  Great  War  years,  1915-18,  could  be 
considered  epidemic  periods.  Similarly,  1928-29 
was  an  epidemic  period.  The  future  is  only 
problematical.  The  expectancy  by  weeks  in  Cali- 
fornia is  about  five  cases.  Last  week  this  was 
four  times  as  great.  In  the  period  of  1913-16,  the 
case  incidence  could  be  considered  low  or  our 
normal  expectancy  two  cases  per  100,000  popula- 

* Negative  for  meningococci.  Other  organisms  are 
always  present. 


324 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


tion.  In  1918  the  case  incidence  was  six  times 
greater  than  the  assumed  expectancy.  The  present 
increased  incidence  began  about  1925.  The  city 
of  New  York  showed,  in  1928,  a higher  mortality 
rate  than  in  the  previous  eighteen  years.  The  city 
of  Chicago  reported  similar  increased  incidence. 
In  fact,  Pope  and  White  2 reported  as  follows : 

“After  a lapse  of  some  ten  years,  during  which 
epidemic  meningitis  persisted  at  a uniformly  low 
level,  the  disease  assumed  serious  proportions  in 
Chicago  in  the  spring  of  1927.  Since  that  time 
over  450  cases  and  220  deaths  have  been  reported 
and  the  disease  still  continues  in  epidemic  pro- 
portions. 

“The  peak  of  the  outbreak  appears  to  have  been 
reached  in  the  spring  of  1928,  but  the  high  inci- 
dence has  continued  through  two  summers  and 
there  is  every  indication  of  its  lasting  at  least 
another  winter.  In  addition  to  its  sustained  preva- 
lence this  epidemic  is  notable  for  its  high  case 
fatality,  in  spite  of  the  fact  that  practically  all 
cases  received  antimeningococcic  serum.” 

CEREBROSPINAL  FEVER  IN  PACIFIC  COAST 
STATES 

The  Public  Health  Reports 3 stated  in  sum- 
marizing the  situation  that  “the  reported  inci- 
dence of  meningococcus  meningitis  for  January 
1929  represented  the  highest  attack  rate  for  that 
disease  since  1918.”  No  mention  was  made  of 
the  Pacific  Coast  states.  California,  as  well  as 
Oregon  and  Washington,  reported  a decided  rise 
in  number  of  cases  in  1926.  In  fact,  this  increase 
was  manifest  in  Oregon  in  1925.  The  important 
thing  to  observe  is  that  the  increased  incidence 
was  maintained  for  1927  and  1928  for  reported 
cases  and  deaths.  Likewise,  cases  were  continu- 
ously being  reported  throughout  the  summer 
months.  For  instance,  Washington  reported  in 
1925,  55  cases  and  39  deaths;  in  1926,  190  cases 
and  84  deaths;  in  1927,  162  cases  and  95  deaths; 
in  1928,  123  cases  and  95  deaths;  and  for  Janu- 
ary to  September  1929,  243  cases  and  68  deaths. 
The  number  of  cases  reported  for  August,  sixteen 
with  two  deaths,  may  prove  to  be  a statistical 
warning  as  to  increased  winter  expectancies. 
Oregon  reported  in  1925,  86  cases  and  37  deaths ; 
in  1926,  99  cases  and  65  deaths ; in  1927,  89  cases 
and  35  deaths ; in  1928,  76  cases  and  36  deaths ; 
and  for  January  to  September  1929,  44  cases  and 
36  deaths.  Oregon’s  definitely  high  mortality  rate 
may  perhaps  be  explained  on  incomplete  report- 
ing. Here  again  cases  continue  to  be  reported 
through  the  summer  months.  California  reported 
in  1925,  97  cases  and  30  deaths ; in  1926,  192 
cases  and  91  deaths;  in  1927,  222  cases  and  91 
deaths;  in  1928,  224  cases  and  93  deaths;  and  for 
January  to  September  1929,  610  cases  and  285 
deaths.  The  number  of  deaths,  however,  are  not 
available  for  August. 

The  situation  as  to  cases  in  steerage  passengers 
appeared  at  first  to  be  not  serious  and  gave  little 
concern  to  health  and  shipping  officials.  The  dis- 
ease was  practically  limited  to  steerage  passengers 
of  one  line  and  mainly  prevalent  in  one  national- 
ity, the  Filipino,  whose  individual  resistance  to 


the  causative  strain  of  organism  was  probably 
low.  The  two  Pacific  Coast  ports  most  affected 
were  Seattle  and  San  Francisco.  Since  November 
1928  there  occurred  on  ships  en  route  to  these 
ports  from  the  Orient,  in  only  steerage  passen- 
gers of  one  ship  transportation  company  and  on 
sixteen  ships,  193  cases  of  acute  cerebrospinal 
meningitis;  166  of  these  were  Filipinos,  21  were 
Chinese;  two  were  Japanese;  and  four,  two  of 
which  were  Chinese,  were  members  of  the  crew. 
Many  of  these  died  at  sea.  It  was  interesting  to 
note  that  cases  were  found  on  five  ships  on  two 
different  trips.  These  trips  approximate  sixty 
days  in  length.  On  three  ships  there  occurred  a 
small  number  of  cases  on  the  first  trip.  On  the 
following  trip,  however,  from  the  Orient,  cases 
were  remarkably  increased,  even  reaching  as  high 
as  forty-three  for  the  trip.  There  were  no  cases 
reported  on  any  of  the  trips  to  the  Orient  from 
the  states.  Until  laboratory  search  for  carriers 
and  reasonable  control  of  contacts  were  fully 
established  in  the  ports  affected,  contact  cases 
in  the  general  population  did  appear  probably 
as  a result.  Such  contact  cases  should  primarily 
be  most  prominent  in  resident  Filipinos. 

Oregon,  however,  reports  for  1929  only  one 
case  and  one  death  in  Filipinos  and  that  in  April ; 
Washington  reports  twenty-six  cases  or  approxi- 
mately 10  per  cent  of  the  total,  and  three  deaths 
in  Filipinos,  exclusive  of  ship  cases;  and  in  Cali- 
fornia, where  statistical  data  are  only  available 
as  to  Filipino  nationality  in  the  city  and  county 
of  San  Francisco,  in  the  county  of  San  Joaquin, 
the  county  of  Monterey,  and  in  the  city  of  Sacra- 
mento, San  Francisco  reported  (January  to  June 
1929)  fifteen  cases  in  Filipinos,  exclusive  of  ship 
cases.  The  county  of  Monterey  reported  thirty- 
three  cases;  San  Joaquin  County,  fourteen  cases 
and  six  deaths  in  Filipinos ; and  the  city  of  Sacra- 
mento reported  three  cases  since  the  beginning 
of  1929.  The  available  data  would  indicate  that 
there  were  sixty-five  or  approximately  10  per  cent 
of  the  total  possible  contact  cases  in  Filipinos  in 
California  for  the  above  communities  and  period 
under  discussion. 

If  it  were  possible  to  determine  the  population 
contact  rate  of  Filipinos  for  cerebrospinal  menin- 
gitis in  the  states  of  California  and  Washington 
such  rates  would  perhaps  be  comparatively  high. 

There  has  been  specifically  stressed  the  appear- 
ance of  this  disease  among  Filipino  steerage  pas- 
sengers on  ships  of  one  company  arriving  in 
Seattle  and  San  Francisco  from  Oriental  ports. 
Apparently  the  measures  advocated  by  health  offi- 
cials and  presumably  adopted  by  the  American 
shipping  company  involved,  have  been  efficacious ; 
for  all  ships  have  arrived  “clean”  since  sailing 
from  Manila,  as  far  back  as  May  11.  Epidemi- 
ologic information  is  available,  however,  that  the 
epidemic  of  this  disease  that  had  been  prevailing 
in  Shanghai,  China,  passed  its  peak  in  April. 
This  declining  epidemic  incidence  in  this  port 
which  is  touched  by  these  ships,  and  the  preven- 
tion of  contact  of  evidently  highly  susceptible 
Filipino  steerage  passengers,  with  possible  cases 
and  carriers  in  Shanghai,  may  be  of  significance 


May,  1930 


SPINE  FRACTURES — HARBAUGH  AND  HAGGARD 


325 


in  the  light  of  the  absence  of  recent  cases  on  ship- 
board. On  the  other  hand,  the  Oriental  epidemic 
may  be  only  subsiding  until  winter.  The  other 
interesting  point  is  the  extraordinary  executive 
order  of  President  Hoover  dated  June  21,  1929, 
taking  cognizance  of  the  epidemic  and  the  sub- 
sequent promulgation  of  additional  regulations  by 
the  United  States  Public  Health  Service  made 
effective  in  July.  These  regulations  go  as  far  back 
as  the  Navigation  Act  of  1882  and  drastically  re- 
duce the  present  steerage  (capacity  75  per  cent), 
basing  it  on  cubic  feet  space  rather  than  on  cer- 
tain ventilation  requirements.  Whether  this  can 
be  made  to  apply  to  shipping  companies  other 
than  American,  thereby  establishing  equal  com- 
petition and  equal  curbing  of  Filipino  immigra- 
tion, is  an  argumentative  point.  The  presidential 
order  calls  attention  to  the  overtaxing  of  avail- 
able quarantine  facilities  in  ports.  In  this  connec- 
tion it  could  be  earnestly  urged  that  these  much 
needed  appropriations  by  Congress,  particularly 
in  Seattle  and  San  Francisco,  be  made.  The  ap- 
parent clearance  of  the  epidemic  of  this  disease 
on  ships  antedating  the  present  regulations  must 
make  it  exceedingly  difficult  for  the  shipping  com- 
pany involved,  particularly  because  of  the  drastic 
cut  in  steerage  capacity,  to  grasp  their  public 
health  significance.  Moreover  the  whole  situation, 
with  reference  to  meningitis,  shows  the  urgent 
need  of  prompt  exchange  of  epidemiologic  infor- 
mation throughout  the  world  for  diseases  trans- 
missible by  means  of  ships  and  on  the  other  faster 
commercial  transports,  the  aeroplane.  Unfortu- 
nately our  quarantine  measures  do  not  generally 
keep  pace  with  our  rapidly  changing  transporta- 
tion and  sometimes  with  the  available  scientific 
information. 

The  generally  accepted  classification  as  to 
groups  is  that  of  Gordon.  These  immunological 
groups,  four  in  number,  were  demonstrated  dur- 
ing the  World  War.  There  are  yet  some  differ- 
ences to  reconcile,  but  presumably  the  meningo- 
coccus strains  are  homogeneous  and  true  to  type 
among  which  there  exist  well-defined  immuno- 
logical groups.  Apparently,  also  there  are  aber- 
rant or  so-called  intermediate  strains  that  do  not 
lend  themselves  to  definite  serological  classifica- 
tion within  the  well-known  groups.  For  a well- 
balanced  therapeutic  serum  it  is  considered  by 
many  workers  to  include  a number  of  strains  in 
its  preparation.  The  types  isolated  in  the  Cali- 
fornia outbreak  of  1928-29  were  six  strains  of 
type  one,  and  five  strains  of  type  three,  Gordon 
classification.  The  group  type  or  types  involved 
in  the  present  Oakland  cases  are  not  as  yet  known. 

The  mortality  in  the  ship  cases  was  high.  In 
fact,  the  case  mortality  rate  in  California  from 
1922-25  inclusive  was  36.6  per  cent ; in  1928  it 
was  44,  and  in  the  epidemic  period  of  1929  it 
rose  as  high  as  50.8.  The  Oakland  cases  now  are 
showing  a rapidly  fatal  clinical  type  of  the  dis- 
ease. Many  cases  of  meningitis,  if  investigated 
early,  show  organisms  in  the  blood  and,  of  course, 
some  of  these  may  be  only  a true  meningococcus 
septicemia  without  meningeal  symptoms.  The 
mortality  rate  for  serum-treated  cases  should  be 
around  16  to  37  per  cent.  One  of  the  argumenta- 


tive points  is  the  use  of  sera  with  low  titre  when 
tested  against  causative  or  unheated  strains. 
Whether  high  agglutination  titre  serum  is  thera- 
peutically more  effective  is  not  susceptible  to  lab- 
oratory proof,  as  we  have  no  method  other  than 
clinical  of  gauging  its  value  accordingly.  One  of 
the  failures  of  sera  treatment  is  accredited  to 
spinal  subarachnoid  blocking,  and  therefore  punc- 
tures of  the  cysterna  magna  has  become  an  opti- 
mal route  of  treatment.  There  appears  to  be  no 
doubt  that  different  strains  of  meningococci  may 
be  active  in  epidemic,  and  in  interepidemic  periods. 
Epidemiologically  this  may  be  of  doubtful  impor- 
tance. The  potency  and  efficacy  of  available  anti- 
meningococcus  serum,  however,  is  of  serious 
clinical  importance.  Unfortunately  the  definite 
guiding  factors  remain  obscure.  Therefore  other 
measures,  as  continued  drainage  of  the  spinal 
cord  and  chemotherapeutic  measures  such  as 
a bacteriostatic  substance  as  acriflavine  and 
optochin,  have  been  advocated. 

Hooper  Foundation,  University  of  California. 

REFERENCES 

1.  American  Journal  Public  Health  and  the  Nation’s 
Health,  1929,  Vol.  19,  pp.  1098-1102. 

2.  Journal  Preventive  Medicine,  1929,  Vol.  3,  pp. 
63-76. 

3.  Public  Health  Reports,  March  1,  1929. 


FRACTURES  OF  THE  SPINE* * 

WITH  AND  WITHOUT  OPERATION A STATISTICAL 

STUDY 

By  R.  W.  Harbauch,  M.  D. 

AND 

R.  E.  Haggard 
San  Francisco 

Discussion  by  Maynard  C.  Harding,  M.  D.,  San  Diego ; 
H.  IV.  Chappel,  M.  D.,  Los  A ngeles ; Frederick  H.  Roden- 
baugh,  M.  D.,  San  Francisco. 

HP  HE  object  of  this  paper  is  to  give  the  end 
^ results  in  fractures  of  the  lower  spine 
observed  in  our  work  with  the  California  Indus- 
trial Accident  Commission  during  the  past  few 
years. 

The  investigation  was  initiated  as  the  result 
of  the  controversy  which  exists  between  capable 
surgeons  as  to  the  type  of  treatment  advisable. 
Should  it  be  early  operation,  or  rest,  immobiliza- 
tion, etc.,  without  operation? 

We  have  never  been  particularly  impressed 
with  the  general  statistics  advanced  to  prove 
medical  questions,  feeling  that  most  anything  can 
be  proved  by  statistics  and  that  the  personal  opin- 
ion of  some  enthusiastic  investigator  was  apt  to 
enter  into  the  final  result. 

MATERIAL  FOR  THIS  ANALYSIS 

In  looking  over  the  available  material  we  find 
that  there  are  about  175  cases  per  year  that  will 
be  suitable  for  our  purposes.  That  is,  cases  of 
fracture  of  the  lower  thoracic  and  lumbar  regions. 
We  have  attempted  to  choose  fractures  of  the 
bodies  of  the  vertebrae  and  fractures  of  some 

* From  the  California  State  Industrial  Accident  Com- 
mission. 

* Read  before  the  Industrial  Medicine  and  Surgery  Sec- 
tion of  the  California  Medical  Association  at  the  fifty- 
eighth  annual  session.  May  6-9,  1929. 


326 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Table  1. — Spine  Injuries  (Rated  Between  Jan- 
uary 1,  1928,  and  March  31,  1929) 


Operated  Cases: 

Fractures  of  body  (compressions,  etc.)  .. 
Fractures  of  body  and  lamina  and 

processes  

Lamina  only.  

Processes  only 

No  fractures 

Total  Cases 

Operated  twice  

Total  operations  

Hibbs  

Albee  

Combined  Hibbs-Albee  

Operating  surgeons: 

San  Francisco  

Los  Angeles  

Fresno  

Sacramento  

Unknown  


18 

transverse 
9 

1 

. 1 

2 

22 

2 

24 

7 

14 

2 

14 

4 

1 

3 

2 


Site  of  Fractures  Operated:  Hibbs  Albee  Combined 


Lower  lumbar  (L  IV  to  V) 1 

Upper  lumbar  (L  I to  III) 3 6 

Upper  and  dorsal  lumbar 1 

Lower  dorsal  (D  IX  to  XII) 2 5 

Middle  dorsal  (D  V to  VIII) 

Upper  dorsal  (D  I to  IV) 

Dorsolumbar  

Lumbosacral  111 

No  fracture  1 1 

Total  7 14  2 


Subluxations  (in  addition  to  fracture)  3. 


severity.  Some  error  must  enter  into  any  final 
opinion  as  it  is  manifestly  impossible  to  obtain 
exactly  comparable  cases.  In  general,  however, 
the  cases  should  average  up  well  in  so  far  as  com- 
parative severity  between  operated  and  non- 
operated  is  concerned.  The  majority  of  these 
cases  have  been  treated  in  San  Francisco  and  Los 
Angeles  and  by  leading  orthopedic  surgeons.  The 
patients  have  practically  all  been  workmen,  the 
ages  ranging  between  twenty-six  and  sixty-five 
years. 

The  results  upon  which  we  are  giving  this  data 
are  based  upon  permanent  disability  ratings 
issued  to  these  men  by  the  permanent  disability 
rating  department  of  the  California  State  Indus- 
trial Accident  Commission. 


Table  2. — Shozving  Some  Rating  Elements 


Average  Rating: 

Hibbs — 7 cases  50.82% 

Albee — 13  cases  . 52.38% 

Combined — 1 case  28.25% 

Unsuccessful  operations — 

Albee — 1 
Combined — -1 


Average  Rating  by  Ages  and  Operation 


Ages 

Operated  Cases 

Nonoperated  Cases 

To.al 

Under  26 

(3) 

57.50% 

(13) 

47.51% 

16 

26  - 35 

(6) 

32.58% 

(21) 

49.05% 

27 

36  - 45 

(8) 

52.28% 

(23) 

49.55% 

31 

46  - 55 

(5) 

63.05% 

(11) 

56.41% 

16 

56  - 65 

( 6) 

62.46% 

6 

Over  65 

( 1) 

52.50% 

1 

Total 

22 

75 

97 

Of  seventy-five  nonoperated  back  cases  involving  frac- 
ture of  body  of  vertebra  (including  fractures  also  of 
lamina  or  processes) — average  rating  was  51.14  per  cent. 

Of  these,  sixty-seven  did  not  have  any  cord  injury. 
Average  rating  was  45.3  per  cent. 

Of  these,  eight  had  cord  injury.  Average  rating  was 
100  per  cent. 

Average  Age: 

22  operated  cases  36.36  years 

Nonoperated  cases  

67  not  involving  cord  39.31  years 

8 involving  cord  28.875  years 

75  both  types  38.20  years 

Average  Time  from  Date  of  Injury  to  Date  Rated: 

22  operated  cases  50.2  months 

75  nonoperated  cases  39.0  months 

67  not  involving  cord  .29.0  months 

8 involving  cord  ...  .46.9  months 


HOW  THE  PERMANENT  DISABILITY  RATINGS 
ARE  MADE 

The  ratings  are  based  upon  reports  from  the 
attending  physicians  in  addition  to  reports  from 
all  physicians  who  had  examined  the  patients  and 
from  the  statements  by  the  patients  setting  forth 
their  complaints  and  ability  to  work.  In  a large 


Table  3. — Ratings  Given  in  Twenty-two  Operated  Cases  and  Seventy-five  Nonoperated, 

Compression  or  Body  Fractures 


Ages 

Under  21% 

21  to  40% 

41  to  60% 

61  to  80  % 

81  to  90% 

100% 

Total 

Under  26 
Operated 

2 

1 

3 

Nonoperated 

4 

2 

4 

13 

26  to  35 
Operated 

1 

3 

2 

6 

Nonoperated 

5 

6 

4 

1 

1 

4 

21 

36  to  45 
Operated 

1 

2 

1 

3 

1 

8 

Nonoperated 

4 

9 

2 

2 

3 

2 

22 

46  to  55 
Operated 

1 

3 

1 

5 

Nonoperated 

2 

5 

4 

11 

56  to  65 

Operated 

Nonoperated 

1 

3 

1 

1 

6 

Over  65 

Operated 

Nonoperated 

1 

1 

Operated 

2 

6 

8 

4 

2 

22 

Nonoperated 

13 

20 

19 

7 

5 

11 

75 

Average  rating  twenty-two  operated  cases — 50.16  per  cent. 
Average  rating  sixty-seven  nonoperated  cases — 45.30  per  cent. 


May,  1930 


Sl’INE  FRACTURES — HARBAUGH  AND  HAGGARD 


327 


percentage  of  the  cases  here  reported,  I have 
personally  examined  the  applicant  and  made  an 
additional  written  report  for  the  record.  In  my 
official  position,  if  my  opinions  relative  to  the 
factors  entering  into  a disability  are  not  reason- 
ably in  accord  with  those  expressed  by  an  attend- 
ing physician  or  other  examiners,  I always  so 
state  and  advise  additional  examination  by  an 


impartial  examiner.  Our  constant  endeavor  has 
been  to  get  accurate  data  on  which  to  base  our 
rating  estimate.  This  has  not  always  been  easy. 
Some  physicians  surely  do  not  realize  what  injus- 
tice they  are  doing  when  they  sign  their  names  to 
inaccurate,  haphazard,  incomplete  reports. 

The  same  method  of  work  is  carried  on  by  the 
Commission’s  medical  staff  in  Los  Angeles.  The 


Table  4. — Study  of  Operated  Spine  Cases — Details  of  Summary 


Type  of  Injury 

Age 

Occupation 

Operation 

Vertebra 

Operated 

Mos. 

Before 

Rating 

Rating 
Made  % 

JBe 

Wedge  fracture  lumbar  I 
Fracture  transverse 
processes  lumbar  II 
Osteoarthritis 

44 

Stevedore 

Hibbs 

44.7 

100 

LJDa 

Compound  fracture 
lumbar  V 

Fracture  transverse 
process  lumbar  IV 

40 

Helper 

Double 

Albee 

Lumbar  II, 

III,  IV,  V 
and  Sacrum 

14.2 

25% 

GGE 

Dislocation  lumbar  II  (com- 
plete) lumbar  III  and  IV 
Fractured  body  lumbar  II 
Fractured  lumbar  I 

23 

Mechanic 

Hibbs 

Dorsal  XII 
to  lumbar  V 

23.8 

60% 

JFi 

Compound  fracture 
dorsal  XII 

26 

Repairman 

Hibbs 

48.3 

46% 

CNPo 

Back  strain 

30 

Auto 

Mechanic 

Hibbs- 

Albee 

Lumbar  III,  IV, 
V and  sacrum 

26.7 

28  % 

EPHa 

Crushed  fracture  lumbar  I, 
fracture  3 spinal  proc- 
esses 

51 

Carpenter 

Albee 

Dorsal  X to 
lumbar  IV 

22.0 

59% 

HHo 

Fractured  lamina  lumbar  II 

29 

Order  Clerk 

Hibbs 

Lumbar  I,  II,  III 

39.7 

23 

JLaM 

Compound  fracture  spinal 
process  and  lamina  of 
dorsal  IX 

27 

Teamster 

Hibbs- 

Internal 

12.0 

13% 

ELev 

Fracture  spinal  process  I, 
II,  III,  IV,  lumbar-sacral 
subluxation 

19 

Bricklayer 

Hibbs-Albee 

Hibbs- 

Modified 

Lumbar  IV,  V 
and  sacrum 

31.3 

66 

WIMcE 

Compound  fracture 
lumbar  I 

Fracture  lumbar  III 

53 

Janitor 

Hunkin 

Dorsal  XI,  XII, 
Lumbar  V 

20.5 

38% 

MMcK 

Compound  fracture,  frac- 
tured laminae,  spinal  and 
transverse  processes, 
lumbar  I 

42 

Carpenter 

Albee- 

Bilateral 

32.1 

45% 

NDNa 

Exacerbation  of  hypertro- 
phic osteoarthritis 

42 

Laborer 

Albee 

Dorsal  XI  to 
lumbar  IV 

41.1 

61 

VHNe 

Chip  fracture  articular 
facet,  lumbar  III  and  IV 

23 

Area 

Salesman 

Hibbs- 

Modified 

Lumbar  II, 

III,  IV 

24.4 

45% 

JSp 

Compound  fracture  dorsal 
XII,  hypertrophic 
arthritis 

37 

Carpenter 

Albee 

46.6 

63 

Osv 

Compound  fracture  lumbar 
II  and  III 

51 

Carpenter 

Albee- 

Bilateral 

Dorsal  XII  to 
lumbar  IV, 
dorsal  XI,  to 
lumbar  V 

14.3 

59% 

ABi 

Compound  fracture 
lumbar  III 

41 

Laborer 

Albee- 

Bilateral 

Lumbar  I to  V 

40.9 

80% 

WABr 

Subluxation  cervical  VI  on 
cervical  VII 

Fracture  anterior  superior 
border  cervical  VII 

36 

Laborer 

Albee 

Cervical  VI 
and  VII 

25.3 

24% 

ELea 

Compound  fracture 
lumbar  II 

26 

High  Climber 

Albee- 

Bilateral 

Dorsal  XI  to 
lumbar  IV 

23.6 

47 

AVi 

Slight  compound  fracture 
dorsal  XII 

26 

Laborer 

Albee 

Dorsal  IX  to 
Lumbar  III 

24.8 

37 

GOM 

Fractured  dorsal  XII 

46 

Salesman 

Albee 

Dorsal  X,  XI,  XII 

33.0 

58% 

TJCo 

Compound  fracture 
dorsal  XII 

47 

Carpenter 

Albee 

Albee 

Dorsal  X to 
lumbar  II 
Dorsal  XII  to 
lumbar  IV 

39.3 

100 

PHMcL 

Compound  fracture 
lumbar  I 

41 

Truckdriver 

Albee- 

Modified 

Dorsal  XII  to 
lumbar  II 

61.0 

20% 

Average 

36.36 

31.35 

50.159 

328 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


records  of  that  division  are  then  sent  to  the  San 
Francisco  office  for  an  estimate  as  to  the  perma- 
nent disability  rating. 

We  have  spoken  of  incomplete  records  and 
checking  up  on  surgeons’  reports.  We  would 
likewise  state  that  we  advise  insurance  carriers 
when  we  feel  that  there  are  neurologic  elements 
in  the  case,  or  when  we  see  that  there  will  be 
definite  improvement. 

THE  BEST  TIME  FOR  A PERMANENT  DISABILITY 
RATING 

Our  efifort  is,  however,  to  leave  the  time  of 
permanent  rating  to  the  attending  physician. 
He  should  know  best  when  this  stage  has  been 
reached.  Likewise  he  should  realize  that  we  take 
the  case  as  he  presents  it  over  his  signed  state- 
ment to  the  effect  that  the  condition  is  permanent. 
Insurance  carriers  as  a rule  are  poorly  advised 
by  physicians  on  this  point.  The  average  doctor 
and  likewise  the  insurance  carrier  seem  to  be  in 
too  great  a hurry  to  get  their  cases  rated  and 
closed.  If  they  would  make  the  same  effort  to 
rehabilitate  their  men  that  they  do  to  rate  them, 
all  parties  concerned  would  be  benefited.  It  is 
true  that  some  men  think  their  chances  of  a 
good  rating  are  impaired  by  returning  to  work, 
but  it  is  likewise  more  than  certain  that  in  the 
average  case  the  insurance  carrier  makes  no 
effort  to  explain  the  situation  and  to  assure  the 
man  that  it  will  stand  behind  him  to  the  extent 
that  the  law  obliges  it  to  and  that  he  should 
return  to  the  work  which  has  been  provided  for 
him  until  maximum  improvement  has  been 
reached  before  rating.  It  does  not  seem  altogether 
fair  for  an  insurance  company  to  rate  and  then 
call  the  man  in  every  three  months  in  an  attempt 
to  get  a reduction.  Such  a method  promotes  malin- 


gering and  continued  controversy  and  the  injured 
man  never  knows  what  amount  he  can  depend  on 
finally  receiving. 

TIME  AVERAGE  IN  THIS  SERIES 

An  average  of  50.2  months  have  elapsed  in 
this  series  between  injury  and  rating  in  the 
operated  cases  and  30.9  months  in  the  non- 
operated  cases.  This  is  decidedly  a weak  factor 
if  one  cares  to  form  any  conclusions  from  this 
study.  It  is  clear  that  the  nonoperated  cases 
might  have  made  still  greater  recovery  in  a few 
more  months.  With  then,  as  complete  a record 
as  it  seems  possible  to  obtain,  the  rating  in  these 
back  cases  is  established  by  our  “Rating  Com- 
mittee.” Some  of  the  factors  considered  are: 
(1)  Ability  to  work.  (2)  Range  of  motion  of 
spine.  (3)  Pain.  (4)  Necessity  of  a back  brace, 
etc.  It  should  be  explained  here  that  a rating  of 
25  per  cent,  for  example,  does  not  mean  that  this 
injured  man  is  25  per  cent  disabled.  It  means 
that  he  will  receive  65  per  cent  of  his  wages  up  to 
the  maximum  of  $20.83  per  week  for  twenty- 
five  months.  Our  rating  schedule  is  based  upon 
the  theory  that  the  man  will  need  help  for  that 
period  of  time  and  after  its  elapse  should  have 
rehabilitated  himself,  so  that  he  can  again  earn  a 
living  and  not  be  a public  charge. 

I cannot  criticize  our  conclusions  from  the 
standpoint  of  neurologic  factors  and  hope  for 
compensation,  as  the  same  factors  would  enter 
into  operated  and  nonoperated  cases. 

TYPE  OF  OPERATIONS  PERFORMED 

As  to  the  type  of  operation  performed,  i.  e., 
the  number  of  Hibbs’  and  the  number  of  Albee’s 
and  their  modifications  we  would  state  that  the 
Albee  method  has  been  used  twice  as  frequently 


Table  5 — Spine  Injury  Study 


Main  Cause 
of 

Accident 

Compression 

Fracture. 
Fracture  of 
Body  or 
Articular 
Facets 

Fracture 
of  Body 
and 

Lamina 

and/or 

Process 

Fracture 
of  Lamina 
and/or 
Process 

Fracture 
and  Cord 
Injury 

Fracture 
of  Spine 
and 
Pelvis 

Fracture 

of 

Pelvis 

Back 

Strain 

Muscle 

Strain 

Sacro- 
iliac and 
Lumbo- 
Sacral 
Trauma 

Exacer- 
bation of 
Disease 
or 

Arthritis 

Percent- 

age 

Totals 

Falls  from 
elevators 

44 

6 

7 

6 

4 

3 

3 

5 

42.2 

78 

Struck  by 
falling  objects 

8 

6 

4 

1 

2 

3 

13.0 

24 

Slips  and 
falls 

1 

3 

5 

6 

8.1 

15 

Caught  in 
cave-in 

3 

1 

2 

1 

3.8 

7 

Automobile 

accident 

5 

2 

1 

3 

2 

2 

8.1 

15 

Thrown 

4 

1 

1 

3.2 

6 

Lifting 

Straining 

Sudden  body 
wrenching 

1 

2 

4 

14 

3 

13.0 

24 

Struck  by  or 
against  object 
Crushed  between 
objects 

2 

1 

1 

1 

1 

5 

2 

3 

8.6 

16 

Percentage 

Totals 

36.7 

68 

8.1 

15 

7.6 

14 

4.3 

8 

1.1 

2 

8.6 

16 

6.5 

12 

14.1 

26 

13.0 

24 

185 

Case 


Table  6. — Unoperated  Spine  Injuries — Fractures  of  Vertebrae 


A.  A. 

C.  A. 

J.  B. 

M.  B. 

.1.  B. 

M.  B. 

D.  B. 

C.  B.  B. 

D.  B. 

E.  B. 

O.  R.  C. 

A.  C. 

D.  C. 

B.  Li.  C. 

M.  P.  C. 

W.  D. 

J.  F. 

W.  G.  G. 

W.  P.  G. 

G.  S.  H. 

H.  H. 

A.  N.  H. 

T.  R.  H. 

W.  H.  H. 

R.  F.  H. 

P.  J. 

C.  E.  K. 

W.  Li.  M. 

J.  T.  L. 

•T.  L.  McA. 

M.  T.  M. 

J.  W.  M. 

A.  M. 

T.  J.  M. 

A.  B.  N. 

P.  H.  N. 

C.  P. 

J.  P. 

W.  G.  P. 

W.  J.  P. 

J.  R.  P. 

S.  R. 

T.  M.  R. 

c.  c.  s. 

C.  Q.  S. 

J.  A.  S. 

J.  F.  S. 

L.  B.  T. 

N.  S. 

M.  V. 

H.  E.  W. 

B.  B. 

H.  A.  D. 

C.  E.  V. 

H.  L.  W. 

C.  H.  G. 

J.  H.  W. 

W.  W. 

F.  J.  W. 

O.  Z. 

W.  J.  G. 

J.  P.  G. 

R.  B.  G. 

J.  L.  J. 

A.  N.  P. 

J.  R. 

G.  E.  R. 

Type  of  Injury 

Age 

Rating  % 

Compound  fracture  lumbar  11  (or  dorsal  XII) 

26 

46.75 

Compound  fracture  lumbar  II 

50 

32.50 

Fracture  lumbar  I and  II 

39 

59.00 

Fracture  cervical  I;  fracture  odontoid  process  cervical  II; 
fractured  skull 

43 

31.00 

Compound  fracture  lumbar  I 

23 

55.75 

Compound  fracture  lumbar  I and  dorsal  XI 

40 

45.50 

Compound  fracture  and  subluxation  lumbar  I 

29 

32.50 

Compound  fracture  dorsal  IX 

33 

19.00 

Compound  fracture  (slight)  vertebrae 

26 

18.00 

Fracture  spinal  process  lumbar  V ; marked  compound 
fracture  lumbar  I;  arthritis 

53 

77.75 

Compound  fracture  lumbar  I 

35 

49.00 

Fracture  lumbar  I;  arthritis 

40 

35.50 

Compound  fracture  lumbar  II;  fracture  transverse  proc- 
esses all  lumbar  vertebrae 

21 

50.25 

Compound  fracture  lumbar  I;  lumbosacral  sprain 

35 

37.50 

Chip  fracture  dorsal  VI;  fracture  dorsal  XII  through  body 

41 

93.00 

Compound  fracture  dorsal  X (or  XI  and  XII?);  arthritis 

66 

52.50 

Compound  fracture  lumbar  III 

47 

47.00 

Impacted  fracture  lumbar  III 

41 

64.25 

Marked  compound  fracture  lumbar  II  and  IV 

61 

56.00 

Compound  fracture  dorsal  XII 

36 

23.25 

Fracture  dorsal  XII;  fracture  lamina  lumbar  I 

41 

34.75 

Chip  fracture  lumbar  IV 

34 

37.25 

Compound  fracture  lumbar  I;  fracture  right  fibula;  dislo- 
cated astragalus 

22 

8.50 

Compound  fracture  dorsal  XII 

33 

38.50 

Fractured  body  cervical  IV 

46 

57.00 

Compound  fracture  lumbar  I;  chip  fracture  lumbar  III 

35 

89.50 

Compound  fracture  dorsal  IX  and  X 

49 

47.75 

Crushed  fracture  lumbar  III;  fracture  right  transverse 
process  lumbar  I,  II  and  III;  fracture  cervical  VII 

42 

100.00 

Compound  fracture  lumbar  I 

55 

61.00 

Fracture  lumbar  I and  dorsal  VII  and  VIII;  and  skull 

43 

25.25 

Fracture  lumbar  I 

56 

28.50 

Fracture  lumbar  I and  dorsal  XII 

31 

26.00 

Compound  fracture  dorsal  XI  and  XII;  posttraumatic 
pneumonia;  empyema 

53 

79.50 

Comminuted  compound  fracture  and  subluxation  lumbar  I 

25 

47.75 

New  compound  fracture  dorsal  XII;  old  compound  frac- 
ture lumbar  I 

42 

25.25 

Bad  compound  fracture  lumbar  I 

32 

32.50 

Fracture  lumbar  V 

32 

48.50 

Compound  fracture  dorsal  XII 

42 

15.50 

Slight  compound  fracture  dorsal  X and  XI;  fracture  both 
legs;  arthritis 

34 

62.25 

Slight  compound  fracture  lumbar  III;  arthritis  hypertro- 
phic type 

45 

91.00 

Compound  fracture  lumbar  III,  right  side  (and  tenth  and 
twelfth  ribs) 

44 

31.25 

Compound  fracture  and  subluxation  lumbar  I 

36- 

9.75 

Compound  fracture  dorsal  V 

53 

63.50 

Compound  fracture  lumbar  I 

40 

34.75 

Fracture  body  and  transverse  process  lumbar  II 

52 

59.25 

Compound  fracture  lumbar  II? 

58 

41.75 

Compound  fracture  lumbar  I;  fracture  left  clavicle 

26 

13.25 

Compound  fracture  (slight  subluxation)  dorsal  IV  and  V; 
fractured  skull 

37 

84.75 

Compound  fracture  lumbar  I;  marked  wedging  (new?); 
marked  arthritis 

59 

100.00 

Compound  fracture  dorsal  XII  and  lumbar  IV ; fracture 
left  transverse  process  lumbar  I,  II,  III 

25 

17.50 

Compound  fracture  dorsal  VI 

25 

8.75 

Compound  fracture  dorsal  VIII 

37 

24.50 

Compound  fracture  dorsal  VII  and  IX 

24 

6.00 

Comminuted  compound  fracture  lumbar  I,  II  and  III; 
subluxation  lumbar  II 

48 

37.50 

Fracture  dorsal  IV,  cervical  IV,  V,  VI 

44 

20.75 

Compound  fracture  lumbar  I 

57 

91.75 

Compound  fracture  lumbar  I,  and  dorsal  XI;  sacro-iliac 
sprain;  hypertrophic  arthritis 

57 

56.75 

Compound  fracture  lumbar  I;  multiple  pelvic  fracture 

33 

41.50 

Compound  fracture  dorsal  XII 

28 

18.25 

Articular  fracture  lumbar  I and  IV;  arthritis 

40 

20.25 

Compound  fracture  lumbar  I;  slight  subluxation 

43 

70.50 

Compound  fracture  lumbar  II  and  IV;  fracture  left  trans- 
verse process  lumbar  II,  III  and  IV;  fractured  humerus 
and  neck  of  femur 

41 

100.00 

Compound  fracture  lumbar  I;  arthritis 

49 

57.75 

Compound  fracture  lumbar  I 

25 

26.25 

Subluxation  lateral  lumbar  II,  III,  IV;  fracture  lumbar  III; 
fracture  right  transverse  process  lumbar  III 

25 

40.75 

Compound  fracture  lumbar  II 

25 

56.25 

Compound  fracture  lumbar  I 

26 

19.75 

Temporary 

Disability 


22.0 


18.3 


22.0 


25.3 


34.0 


20.3 


41.0 


23.0 


19.0 


26.3 


24.5 

23.7 

15.0 

21.5 

27.0 

49.3 

24.7 

23.7 

40.3 

21.0 

28.0 

40.3 

29.0 

36.5 

23.0 

23.5 

39.3 

19.7 

34.3 

39.3 

28.7 

18.0 

50.3 

30.0 

17.2 

18.2 

24.1 

19.8 

35.2 

41.0 

27.4 

25.0 

43.1 

51.3 

27.7 

23.4 

20.9 

32.4 

28.1 

34.4 


14.9 


32.3 


18.5 


34.0 


19.0 


21.0 


24.2 


30.0 


14.5 


27.3 


55.7 


47.4 


41.6 


42.0 


48.8 


19.7 


22.3 


330 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


as  the  Hibbs’  in  the  cases  cited,  and  that  the  end 
results  have  been  practically  the  same.  In  regard 
to  the  type  of  treatment  in  nonoperated  cases,  it 
has  been  in  general,  rest  and  immobilization  with 
braces  of  various  types,  together  with  physio- 
therapy and  massage,  and  such  measures.  We 
cannot  say  just  how  long  treatment  has  been  car- 
ried out.  We  do  not  feel  that  such  information 
would  be  of  great  value  in  drawing  conclusions, 
for  the  treatment  would  vary  too  much  in  each 
individual  case  depending,  as  it  does,  upon  the 
severity  of  injury,  type  of  patient  and  judgment 
of  various  physicians.  In  this  paper  are  given 
the  results  in  cases  rated  between  January  1,  1928, 
and  March  31,  1929.  The  cases  were  chosen  as 
being  comparative,  to  the  best  of  our  judgment. 
These  cases  show  that  in  sixty-seven  nonoperated 
cases  the  average  rating  given  was  45.3  per  cent. 
The  average  rating  given  in  twenty-two  similar 
operated  cases  was  50.16  per  cent.  Our  conclu- 
sions would  then  be  that  in  the  cases  studied 
operative  and  unoperated  cases  have  presented 
practically  the  same  degree  of  permanent  dis- 
ability. 

Our  general  personal  opinion  is  that  it  is  unwise 
for  surgeons  to  have  any  set  rule  for  or  against 
operation  in  the  type  of  injury  under  discussion. 
Each  case  presents  its  own  individual  problems 
and  these  should  be  solved  as  accurately  as  pos- 
sible before  the  decision  is  made  as  to  whether 
operation  or  conservative  treatment  is  indicated. 

350  Post  Street. 

DISCUSSION 

Maynard  C.  Harding,  M.  D.  (700  Electric  Building, 
San  Diego). — It  is  of  the  utmost  importance  that  the 
immense  experience  of  the  Commission  and  of  the 
large  insurance  companies  be  made  available  to  the 
medical  profession  by  such  studies  as  have  just  been 
presented. 

I wish  to  ask  the  speaker  whether  these  cases  were 
operated  upon  early,  or  were  they  operated  after  con- 
servative treatment  had  failed  to  give  the  expected 
relief?  ^ 

H.  W.  Chappel,  M.  D.  (1136  West  Sixth  Street,  Los 
Angeles. — Doctor  Harbaugh’s  report  shows  a great 
economic  loss,  both  to  the  insurance  companies  and 
to  the  injured  man,  that  does  not  exist  with  similar 
injuries  to  private  patients.  For  financial  reasons 
there  seems  to  be  a psychologic  element  in  the  indus- 
trial case  which  is  not  present  in  the  private  case.  The 
latter  patient  is  always  anxious  to  get  well,  while  the 
industrial  patient  seems  to  prefer  to  have  his  disabil- 
ity drag  on  as  long  as  possible.  Although  many  pri- 
vate patients  are  not  obliged  to  return  to  heavy  labor, 
some  are,  and  are  now  doing  the  hardest  kind  of  work. 

The  psychologic  element  is  not  the  only  handicap 
in  the  industrial  case.  Early  diagnosis  is  very  im- 
portant. There  is  a wide  difference  of  opinion  as  to 
the  type  of  treatment  most  advisable  for  crushing 
fractures  of  the  vertebrae.  Doctor  Harbaugh’s  figures 
have  shown  that  there  is  practically  the  same  degree 
of  disability  of  the  operated  and  of  the  nonoperated 
cases.  He  gives  an  average  rating  higher  than  45  per 
cent,  after  thirty  to  fifty-two  months  had  elapsed 
since  the  injury,  compared  with  private  patients  who 
return  to  work  in  from  three  to  twelve  months, 
usually  with  no  disability. 

I have  found  the  following  method  most  satisfac- 
tory: recumbency  on  a straight  or  slightly  curved 


Bradford  frame  for  two  months,  with  frequent  lower 
extremity  exercises,  and  voluntary  turning  of  the 
patient  to  prone  position.  It  hastens  healing,  prevents 
the  formation  of  adhesions,  and  gives  the  patient 
assurance  that  the  back  is  getting  strong  and  well. 
No  weight  bearing  for  about  two  months,  then  a back 
brace  for  at  least  six  months.  Three  months  after 
the  injury,  carefully  directed  gymnasium  work  should 
be  commenced,  and  continued  until  a full  painless 
range  of  body  movements  has  been  obtained. 

How  few  doctors  do  this,  and  how  frequently  the 
rigidly  immobilized,  or  fused  spine  becomes  stiff, 
weak  and  painful,  with  no  effort  to  obtain  a normal 
and  painless  range  of  body  movement. 

The  vertebrae  heal  just  as  completely  as  the  long 
bones  and  nearly  as  quickly,  with  plenty  of  fractional 
and  slight  mechanical  irritation.  The  compression 
fracture  of  the  industrial  patient  should  heal  just  as 
quickly  and  just  as  completely  as  in  the  private 
patient,  who  rarely  has  any  disability  twelve  months 
after  the  injury.  Most  of  them  return  to  work  in  less 
than  six  months  and  some  of  them  in  three  months. 

If  many  of  the  industrial  surgeons  would  change 
their  treatment  of  compression  fractures  of  the  back, 
or  refer  the  case  to  those  who  are  constantly  treating 
such  conditions,  the  prognosis  would  not  only  be 
much  better,  but  there  would  be  a decided  improve- 
ment of  the  psychologic  element  which  has  always 
been  so  discouraging  to  the  surgeon. 

* 

Frederick  H.  Rodenbaugh,  M.  D.  (323  Medico-Dental 
Building,  San  Francisco). — With  reference  to  Doctor 
Harbaugh’s  interesting  presentation: 

From  the  standpoint  of  the  roentgenologist,  the 
question  of  accurate  early  diagnosis  of  the  exact 
nature  of  the  injury  is  most  important.  The  number 
of  these  injuries  is  increasing  and  it  is  now  possible, 
with  modern  technique,  to  demonstrate  varieties  of 
lesions  which  in  the  past,  when  present,  were  not 
recognized. 

In  our  experience,  the  necessity  for  a more  com- 
plete study  of  the  spine  has  been  called  to  our  atten- 
tion by  the  increasing  number  of  small  injuries  which 
are  demonstrable  with  present  technique  but  which 
formerly  were  not  recognized. 

To  cite  particular  instances:  Fractures  of  the 
lamina  and  articular  facets  are  not  rare  with  improved 
technique  and  increased  experience  in  the  interpreta- 
tion of  these  lesions. 

I have  been  much  impressed  with  the  number  of 
these  cases  and  results  and  feel  that  in  many  instances 
with  early  complete  studies  of  the  type  and  extent 
of  injury,  that  the  course  of  treatment  may  have  been 
changed  and  the  end  results  improved. 

* 

Doctor  Harbaugh  (Closing). — I am  unable  to  give 
an  accurate  answer  to  Doctor  Harding  in  reply  to  his 
inquiry  as  to  whether  the  patients  cited  were  operated 
upon  early  or  after  conservative  treatment  had  failed. 
I believe  that  the  patients  were  about  equally  divided, 
about  half  of  them  being  operated  upon  a short  time 
after  the  original  injury. 

I am  very  much  interested  in  the  remarks  of  Doctor 
Chappel  in  regard  to  the  relative  subsequent  disability 
in  industrial  cases  and  in  private  patients.  W e 
read  often  in  the  literatures  of  these  comparisons. 
Personally  my  own  experience  has  been  that  there  is 
not  such  a great  difference  as  the  various  writers 
claim.  I do  not  believe  that  the  psychologic  element 
and  the  hope  for  compensation  is  a major  factor  in 
prolonging  the  disability  in  the  average  case  of  this 
type.  It  may  be  a factor,  but  I think  it  is  entirely 
a minor  factor.  These  men  have  disability  because 
they  must  of  necessity  return  to  heavy  manual  labor. 
I believe  that  if  the  average  private  patient  had  to  do 
this  same  type  of  work  he  would  have  about  the  same 
proportion  of  disability  as  the  average  workman  has. 


May,  1930 


ANALGESIA — FIST 


331 


OBSTETRICAL  ANALGESIA* 

By  Harry  S.  Fist,  M.  D. 

Los  Angeles 

Discussion  by  P.  Brooke  Bland,  M.  D.,  Philadelphia; 
E.  M.  Lazard,  M.D.,  Los  Angeles;  Lyman  II.  Robison, 
M.  D.,  Los  Angeles. 

T})  HYSICIANS  have  sought  for  many  years 
means  wherewith  they  might  lessen  the  suffer- 
ing of  labor,  but  no  universally  satisfactory  drug 
or  combination  of  drugs  has  yet  been  found. 

No  one  method  is  applicable  to  every  case. 
Often  when  one  drug  is  contraindicated  another 
may  be  given  with  safety  if  proper  precautions 
are  taken.  None  of  the  analgesics  now  in  general 
use  should  be  given  in  the  average  home  confine- 
ment. The  patient  must  be  in  a maternity  insti- 
tution of  moderate  size  with  ample  nursing  and 
medical  staff;  under  the  supervision  of  a trained 
obstetrician.  Any  simplification  of  technique,  or 
decrease  of  risk  to  mother  or  child,  would  there- 
fore be  welcomed. 

THE  STAGES  OF  LABOR 

Proper  administration  of  the  analgesia  of  labor 
requires  a consideration  of  the  mechanism. 

The  first  stage  is  one  of  dilatation  and  canal- 
ization. The  upper  uterine  segment  contracts, 
pulling  the  lower  uterine  segment  around  the  pre- 
senting part.  At  this  time  no  voluntary  expulsive 
effort  is  necessary,  but  analgesia  must  not  inter- 
fere with  uterine  contractions. 

The  second  stage  is  the  stage  of  expulsion. 
During  this  stage,  contractions  of  the  uterus  and 
the  accessory  muscles  cause  the  presenting  part 
to  descend  and  flex  so  that  rotation  may  follow 
and  labor  continue.  Prolonged  labor,  the  result  of 
poor  contractions  of  uterus  or  accessory  muscles, 
tends  to  cause  exhaustion  and  resulting  post- 
partum hemorrhage.  It  prolongs  birth  pressure, 
thus  endangering  the  child.  Analgesia,  therefore, 
must  not  interfere  with  voluntary  efforts  during 
the  second  stage,  or  decrease  strength  or  fre- 
quency of  uterine  contractions.  Surgical  inter- 
ference must  be  feasible  at  any  time,  if  indicated, 
so  that  labor  may  be  terminated.  The  child  must 
breathe ; analgesia  should  not  cause  apnea  or  as- 
phyxiation. 

In  the  third  stage  the  secundines  are  expelled. 
Failure  to  conserve  the  strength  during  the  first 
or  second  stage  may  cause  relaxation  and  post- 
partum hemorrhage  in  the  third.  Lacerations  of 
cervix  and  perineum  should  be  repaired  at  once. 
The  mother  should  be  in  the  best  possible  con- 
dition for  a favorable  puerperium.  She  must  not 
be  exhausted.  The  rectum  and  colon  should  not 
be  injured. 

ANALGESICS  IN  LABOR 

Among  the  analgesics  now  employed  are : ether, 
chloroform,  nitrous  oxid-oxygen,  morphin,  mor- 
phin-scopolamin,  and  the  so-called  synergistic  an- 
algesia. Some  work  has  been  done  on  the  use 
of  hypnotism,  lumbar  spinal  injections,1  and  also 
injections  of  local  anesthetics  into  the  cervix. 


* Read  before  the  Obstetrical  Section  of  the  Los  Angeles 
County  Medical  Association,  March  12,  1929. 


Rucker 2 reports  that,  in  the  order  given,  the 
following  drugs  lessen  uterine  contractions  ; paral- 
dehyd,  magnesium  sulphate,  morphin,  bromids, 
chloral.  General  anesthetics  in  the  order  of 
uterine  power  inhibition  are : chloroform,  ether, 
nitrous  oxid-oxygen  and  ethylene. 

Chloroform-Ether. — Chloroform,  properly  ad- 
ministered, is  a fairly  safe  anesthetic  for  the  peri- 
neal stage  of  labor.  Ether  is  much  safer,  for  it 
is  a stimulant  instead  of  a depressant.  Although 
its  action  is  slower,  the  margin  of  safety  is 
greater,  and  it  affords  warning  signs  long  before 
danger  of  fatality  develops. 

Nitrous  O xid-0 xygen-Ethylene . — Nitrous  oxid- 
oxygen  is  comparatively  free  from  danger,  and, 
except  for  the  expense,  is  an  excellent  anesthetic, 
especially  for  the  perineal  stage.  Ether  may  be 
combined  with  it  for  forceps,  repair,  etc.  Nitrous 
oxid  is  reported3  as  prolonging  the  average  bleed- 
ing time  at  birth  one  minute,  and  increasing  the 
coagulation  time  two  minutes.  Ethylene  increased 
bleeding  time  at  birth  two  minutes,  and  coagula- 
tion time  by  three  minutes. 

Twilight  Sleep. — Twilight  sleep  was  first  used 
in  1902  by  Steinbrickel.4  Morphin  and  scopo- 
lamin  are  the  active  drugs  employed.  This  com- 
bination is  now  often  used  by  the  surgeon  and 
nose  and  throat  specialist,  preliminary  to  local 
operation,  but  is  not  in  great  favor  with  the 
obstetrician,  partly  because  of  newspaper  noto- 
riety, and  partly  because  it  has  caused  prolonged 
labors,  delayed  rotation,  unmanageable  patients, 
apneic  babies,  and  postpartum  hemorrhage.  Pain 
is  not  always  relieved  and  labor  must  often  be 
terminated  by  the  use  of  forceps.  This  method 
requires  special  hospital  care,  absolute  quiet,  and 
many  hours  of  attendance  by  the  physician. 

A twilight  sleep  patient  is  not  amenable  to  sug- 
gestions. She  may  be  restless  on  the  delivery 
table  and  thus  unsterilize  the  drapes.  Leg  holders 
must  be  provided,  and  the  wrists  fastened  to  the 
head  of  the  bed.  Thirty  to  forty-five  minutes 
must  elapse  before  relief  is  experienced ; gas  may 
be  used  temporarily.  It  is,  however,  possible  to 
apply  forceps,  iron  out  the  perineum,  and  repair 
without  further  anesthesia. 

Gwathmey  Method. — At  present  the  morphin, 
magnesium  sulphate,  colonic-ether-oil  method,  ad- 
vocated by  Gwathmey,  enjoys  great  popularity. 
It  is  a much  discussed  method ; some  users  being 
enthusiastic,  while  others 5 (possibly  including 
many  who  do  not  observe  the  proper  technique) 
condemn  it  just  as  emphatically.  It  requires  care- 
ful watching  of  the  patient  and  judgment  in  dos- 
age of  drugs  and  time  of  administration.  Good 
analgesia  is  often  obtained,  but  there  is  an  oc- 
casional apneic  child,  and  always  more  or  less 
irritation  of  the  rectum  and  sigmoid.  Labor  is 
prolonged,  and  must,  in  many  cases,  be  termi- 
nated by  episiotomy  and  forceps. 

Six  drugs  are  employed  for  this  method : mor- 
phin, magnesium  sulphate,  ether,  quinin  hydro- 
bromate,  alcohol,  and  olive  oil. 


332 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Rectal  ether  anesthesia  was  suggested  by  Roux 6 
in  1847.  Its  use  was  abandoned  shortly  after- 
ward. 

Wade  in  1919 7 reported  intestinal  paralysis 
following  rectal  administration  of  ether. 

Zalka  in  1924 8 reported  two  autopsies  after 
rectal  narcosis  which  showed  proctitis  and  great 
intestinal  irritation.  Rectal  anesthesia  is  not  under 
control  as  is  inhalation  anesthesia,  for  the  amount 
of  absorption  cannot  be  so  readily  regulated. 
There  is  some  irritation  of  the  intestine  in  every 
case,  a certain  small  number  showing  severe  and 
even  fatal  irritation  with  hemorrhage.  The  phy- 
sician who  tests  the  possibilities  for  irritation  of 
mucous  membranes  by  attempting  to  hold  in 
his  mouth  some  of  the  ether-oil  mixture,  will 
be  somewhat  cautious  in  administering  such  a 
combination. 

Because  of  the  tendency  of  ether  or  morphin 
to  arrest  uterine  contractions,  the  quinin  salt  is 
included  in  the  rectal  injection  as  a stimulant. 
Frequently  labor  must  be  terminated  by  episiot- 
omy  and  forceps.  Olive  oil  is  used  as  a vehicle 
to  lessen  the  irritation. 

Morphin. — The  chief  source  of  danger  seems 
to  be  the  morphin.  Hatcher,9  in  a masterful  re- 
view of  obstetrical  analgesia,  states  that  morphin 
in  doses  over  one-sixth  grain,  and  followed  by 
ether  or  chloroform,  involves  danger  to  the  child, 
which  rises  as  the  dose  of  morphin  increases. 
One-fourth  grain  or  more  of  morphin  is  used  by 
Gwathmey.  When  administered  within  one  or 
two  hours  of  delivery,  there  is  grave  danger  of 
apnea  or  asphyxiation.  Pantopon 10  also  depresses 
the  respiration,  although  to  a lesser  extent  than 
morphin. 

Magnesium  Sulphate.  — Magnesium  sulphate 
has  long  been  known  as  an  analgesic  and  seda- 
tive. Its  use  in  eclampsia,  described  by  Lazard,11 
has  been  very  successful.  In  the  dosage  here  used 
(two  cubic  centimeters  of  50  per  cent  solution) 
it  is  harmless.  According  to  Gwathmey,12  mor- 
phin and  magnesium  sulphate  are  synergistic. 
Beckman  13  states  that  there  is  no  synergism  be- 
tween morphin  and  magnesium  sulphate,  and  that 
the  combination  is  more  toxic  than  either  drug 
used  alone.  This  is  denied  by  Gwathmey.  In  any 
event,  the  administration  of  morphin  to  the  par- 
turient woman  endangers  the  child  more  or  less. 

Scopolamin. — Experiments  conducted  in  1915 
at  the  Washington  University  Medical  School,14 
“demonstrated  that  scopolamin  in  doses  much 
larger  than  were  ever  recommended  for  twilight 
sleep,  has  no  material  effect  on  blood  pressure  or 
on  respiration.”  For  some  cases  the  above  clinic 
uses  scopolamin  supplemented  by  nitrous  oxid 
inhalations. 

Bertha  Van  Hoosen,15  states  that  she  first  re- 
duced the  amount  of  morphin  given  to  this  type  of 
patient  to  one-sixteenth  grain,  and  now  uses  none, 
relying  on  scopolamin  alone.  Her  statistics  show 
excellent  results ; no  asphyxia  and  very  slight 
blood  loss.  The  scopolamin  induces  analgesia 
with  increased  muscle  tone,  and  relaxes  the 
sphincters.  The  patients  must  be  watched  closely, 


and  are  kept  with  hands  fastened  above  the  head 
during  delivery  because  of  danger  of  contami- 
nation of  the  sterile  field.  The  scopolamin  method 
may  also  be  used  for  minor  obstetric  operations. 

Doctor  Van  Hoosen  16  reviews  2023  deliveries 
which  show  excellent  results  with  scopolamin  as 
the  analgesic.  At  the  onset  of  active  labor,  1/100 
grain  is  given  every  half  hour  for  two  or  three 
doses  as  needed,  then  1/100  grain  every  two 
hours  as  needed.  Since  the  morphin  seems  to  be 
the  objectionable  ingredient  of  both  the  twilight 
sleep  and  Gwathmey  treatments,  its  substitution 
by  scopolamin  and  magnesium  sulphate  seems 
very  logical. 

AUTHOR  S METHOD 

According  to  Beckman,17  magnesium  sulphate 
and  scopolamin  really  prove  synergistic.  Isse- 
kutz18  concludes  that  when  magnesium  sulphate  is 
combined  with  scopolamin  there  is  a true  potenti- 
ation of  the  action.  These  two  drugs,  then,  should 
induce  satisfactory  obstetrical  analgesia. 

During  the  past  four  years,  in  private  practice 
and  in  a small  series  of  cases  delivered  by  stu- 
dents at  the  College  of  Medical  Evangelists,  the 
author  has  produced  very  satisfactory  analgesia 
with  a combination  of  magnesium  sulphate  and 
scopolamin.  When  the  cervix  has  dilated  to  two 
centimeters  and  pains  are  strong,  occurring  at 
five-minute  intervals  or  less,  magnesium  sulphate, 
two  cubic  centimeters  of  50  per  cent  solution,  and 
scopolamin,  grain  1/200,  are  injected  intramuscu- 
larly. The  magnesium  sulphate  is  repeated  every 
half  hour  until  pain  is  relieved,  and  the  scopo- 
lamin is  repeated  every  hour,  if  necessary,  to  ob- 
tain relief.  In  about  twenty  minutes  the  patient 
becomes  drowsy.  She  dozes  off  between  pains, 
but  awakens  during  contractions.  The  scene 
changes  from  a very  noisy  to  a quiet,  calm  one. 
No  decrease  in  strength  or  frequency  of  contrac- 
tions is  evident.  The  pain  factor  is  eliminated 
and  the  sphincters  seem  to  relax  better.  The 
patient  is  tractable  and  fully  able  to  cooperate 
during  the  second  stage.  She  may  complain  dur- 
ing contractions,  and  on  the  following  day  de- 
scribe the  delivery  as  a not  unpleasant  dream, 
during  which  she  felt  more  or  less  like  a detached 
onlooker.  The  child  is  not  born  apneic.  There  is 
no  increased  tendency  to  postpartum  hemorrhage. 
Nitrous  oxid  or  ether  may  be  given  for  surgery 
or  during  the  perineal  stage. 

This  method  does  not  increase  the  danger,  but 
every  patient  must  he  carefully  watched  through- 
out any  labor,  whether  or  not  any  analgesic  be 
used.  Pain  is  not  entirely  eliminated,  but  is 
greatly  decreased.  The  use  of  inhalation  anes- 
thesia is  not  contraindicated. 

The  variability  in  the  scopolamins  on  the 
market  has  been  a great  cause  of  failure  in  the 
administration  of  twilight  sleep.  The  ampoules 
prepared  by  Roche  have  proved  stable  and  de- 
pendable. The  patients  have  not  been  restless  or 
obstreperous.  Whether  or  not  this  quiet  and  calm 
is  due  to  synergism  between  scopolamin  and  mag- 
nesium sulphate,  we  are  not  prepared  to  state. 
The  question  of  synergism  is  a debatable  one  and 


May,  1930 


ANALGESIA — FIST 


333 


will  bear  further  investigation,  but  the  combi- 
nation has  proved  so  satisfactory  that  its  further 
trial  is  justified. 

SUMMARY 

Morphin  has  proved  unsatisfactory  as  an  an- 
algesic during  labor. 

Scopolamin,  given  alone,  relieves  suffering  and 
does  not  endanger  mother  or  child,  but  sometimes 
causes  restlessness,  thus  interfering  with  proper 
asepsis. 

Use  of  magnesium  sulphate  with  scopolamin 
eliminates  the  restlessness  and  provides  a simple, 
safe,  efficient  obstetrical  analgesia. 

1930  Wilshire  Boulevard. 

REFERENCES 

1.  Cosgrove,  S.  A.:  Spinal  Anesthesia  in  Obstetrics, 
Am.  J.  Obst.  and  Gynec.,  14:751,  December  1927. 

2.  Rucker,  M.  P. : Action  of  Various  Anesthetics 
upon  Uterine  Contractions,  Anesth.  and  Analg.,  5:235- 
246,  October  1926. 

3.  Sanford,  Heyworth  N.:  J.  A.  M.  A.,  86:267, 
January  23,  1926. 

4.  Williams:  Textbook  of  Obstetrics,  Ed.  5,  p.  363. 

5.  Schumacher,  P.:  Monatschr.  f.  Geburtsh  u.  Gynak., 
77 :3 1 3-325,  November  1927.  Unfavorable  Results  of 
Gwathmey’s  Synergistic  Analgesia  in  Eighty  Cases 
of  Labor. 

6.  Hatcher,  Robert  A.:  The  Rectal  Administration 
of  Ether  in  Oil,  J.  A.  M.  A.,  89:2114,  December  17, 

1927. 

7.  Wade:  Am.  J.  Surg.,  33:92,  1919. 

8.  Von  Zalka,  E.:  Arch.  f.  klin.  Chir.  (Langen- 
becks),  129:547,  1924. 

9.  Hatcher,  Robert  A.:  The  Rectal  Administration 
of  Ether  and  Oil,  J.  A.  M.  A.,  89:2114,  89:2189, 
89:2258,  December  17,  1927. 

10.  Macht,  D.  I.:  Action  of  the  Opium  Alkaloids, 
J,  Pharmacol,  and  Exper.  Therap.,  7:339,  October, 
1915. 

11.  Lazard:  A Preliminary  Report  on  the  Intra- 
venous Use  of  Magnesium  Sulphate  in  Puerperal 
Eclampsia,  Am.  J.  Obst.  and  Gynec.,  February  1925. 

12.  Gwathmey:  J.  A.  M.  A.,  91:1774,  December  8, 

1928. 

13.  Beckman,  Harry:  The  Alleged  Synergism  of 
Magnesium  Sulphate  and  Morphin,  Am.  J.  Obst.  and 
Gynec.,  15:72,  January  1928. 

14.  Schwartz,  O.  H.,  and  Krebs,  O.  S.:  Scopolamin- 
Morphin  Seminarcosis,  J.  A.  M.  A.,  81:1083,  Septem- 
ber 29,  1923. 

15.  Van  Hoosen,  B.:  Scopolamin  Anesthesia  in  Ob- 
stetrics, Anesth.  and  Analg.,  7:151-154,  May-June  1928. 

16.  Van  Hoosen,  B.:  Scopolamin  Anesthesia  in  the 
Second  Stage  of  Abnormal  Labor,  Anesth.  and  Analg., 
7:353,  November-December  1928. 

17.  Beckman,  Harry:  The  Alleged  Synergism  of 
Magnesium  Sulphate  and  Morphin,  J.  A.  M.  A.,  85:332, 
August  1,  1925. 

18.  Issekutz,  B.:  Therap.  Monatsh.,  29:379,  1915. 

DISCUSSION 

P.  Brooke  Bland,  M.  D.  (1621  Spruce  Street,  Phila- 
delphia).— There  are  so  many  problems  involved  in 
this  question  that  it  is  absolutely  impossible  for  me 
to  express  in  a few  words  my  feeling  regarding  the 
administration  of  anesthetics  in  labor. 

No  one  will  deny  the  benefits  of  anesthesia,  prop- 
erly administered,  to  women  during  confinement. 

It  is  my  custom  to  advocate  and  practice  analgesia 
or  anesthesia  of  some  sort  in  every  case  of  labor. 

I would  no  more  think  of  allowing  a woman  to  pass 
through  the  throes  of  confinement  without  an  anes- 
thetic than  I would  think  of  doing  a hysterectomy, 
for  example,  without  anesthesia. 

It  is  almost  inconceivable  that  we  were  at  one  time 
taught  that  anesthetics  were  not  indicated  and  that 
they  should  not  be  used  in  maternity  practice.  Why 


women  have  been  made  to  bear  the  intolerable  suffer- 
ing of  childbirth,  I have  never  been  able  to  under- 
stand. 

In  recent  years  efforts  have  been  made  to  discover 
or  develop  some  form  of  obstetrical  anesthesia  that 
one  could  look  upon  as  more  or  less  ideal,  but  thus 
far  the  ideal  agent  has  not  been  discovered. 

A separate  and  distinct  anesthetic  is  not  applicable 
to  all  obstetric  patients.  It  is  my  habit  in  both  primi- 
gravida  and  multigravida  to  administer  morphin  with 
hyoscin  or  scopolamin  in  the  very  discomforting 
period  of  the  second  stage.  This  is  not  given  to  any 
patient,  if  the  conclusion  of  the  second  stage  is 
imminent. 

We  refrain  from  giving  morphin  at  this  time,  be- 
cause we  routinely  employ  some  form  of  inhalation 
anesthesia — and  almost  invariably  ether — just  as  the 
completion  of  the  second  stage  takes  place.  Morphin 
administered  within  an  hour  or  two  before  the  birth 
of  the  baby,  as  Doctor  Fist  has  properly  pointed  out, 
has  a decided  deleterious  effect  on  the  child,  so  much 
so,  that  resuscitation  is  sometimes  difficult  and  occa- 
sionally may  result  in  fetal  death. 

In  primigravida  the  method  of  Gwathmey  or  rectal 
analgesia  appeals  to  me,  and  is  employed  quite  regu- 
larly in  my  department  as  well  as  in  my  private  prac- 
tice. We  have  not  observed  any  serious  untoward 
effect  from  its  use  either  in  the  mother  or  her  off- 
spring. For  the  best  results  it  must  obviously  be 
carried  out  in  strict  accordance  with  the  directions 
laid  down  by  its  originator. 

Recently  we  have  used  in  our  ward  service  spinal 
analgesia  in  certain  cases  of  operative  delivery  with 
a view  of  determining  its  true  value.  I am  quite  con- 
vinced that  it  fills  a niche  in  some  instances,  though 
I believe  that  its  scope  of  usefulness  is  more  or  less 
limited. 

Chloroform  I seldom,  if  ever,  use,  although  I have 
great  respect  for  it  as  an  obstetric  anesthetic  if  prop- 
erly and  wisely  administered. 

Twilight  sleep  in  modified  form,  such  as  suggested 
by  Doctor  Fist,  is  probably  employed  more  or  less 
unconsciously  by  most  accoucheurs. 

I would  hesitate,  however,  to  administer  a 50  per 
cent  solution  of  magnesium  sulphate  in  two  cubic 
centimeter  doses  every  half  hour,  nor  could  I be  per- 
suaded to  hypodermically  administer  scopolamin  in 
doses  of  grain  1/200  every  hour,  “if  necessary  to 
obtain  relief,”  as  advocated  by  the  essayist. 

I,  however,  have  not  had  wide  experience  in  ad- 
ministering the  combination  of  magnesium  sulphate 
and  scopolamin  in  accordance  with  the  plan  advised 
by  Doctor  Fist  and,  therefore,  I am  not  qualified  to 
express  an  intelligent  opinion  as  to  its  usefulness. 

& 

E.  M.  Lazard,  M.  D.  (311  Wilshire  Medical  Build- 
ing, Los  Angeles). — The  relief  of  pain  in  labor  is  a 
subject  which  is  always  of  the  greatest  interest  to  the 
obstetrician.  Doctor  Fist’s  review  of  the  methods  of 
analgesia  that  have  been  used,  as  well  as  the  method 
which  he  describes,  must  therefore  engage  our  serious 
attention.  In  our  endeavors  to  attain  a “painless  child- 
birth” we  must  keep  in  mind  that  any  such  method, 
to  be  successful,  must  not  carry  any  additional  danger 
to  mother  or  child,  must  not  interfere  with  the  prog- 
ress of  labor,  and  must  be  reasonably  easy  to  carry 
out. 

The  method  described  by  Doctor  Fist  would  seem 
to  be  simple,  and  one  would  expect  to  get  good  re- 
sults from  the  combination  of  scopolamin  and  mag- 
nesium sulphate.  I have  not  had  sufficient  experience 
with  the  method  as  yet  to  be  able  to  arrive  at  any 
conclusion  as  to  its  value.  I believe,  however,  that 
any  such  method  should  be  limited  to  the  first  stage 
of  labor.  Doctor  Fist  recommends  “two  cubic  centi- 
meters of  a 50  per  cent  solution  of  magnesium  sul- 
phate every  half  hour  until  pain  is  relieved.”  He  does 
not  state  any  maximum  number  of  doses  which  he 
has  found  it  necessary  to  administer.  Criticism  might 
be  made  of  this  advice  because  of  the  possibility  of 
getting  toxic  effects  if  too  many  such  doses  were 


334 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  S 


given.  In  our  work  at  the  Los  Angeles  General  Hos- 
pital with  the  eclamptic  toxemias,  we  have  used  as 
much  as  22  grams,  intravenously,  in  twelve  hours 
without  any  evident  ill  effects.  Assuming  that  not 
more  than  three  or  four  doses  of  two  cubic  centi- 
meters of  50  per  cent  solution,  intramuscularly,  would 
be  necessary  in  any  case,  I believe  that  one  would  be 
well  within  the  limits  of  safety  and  need  not  fear  any 
ill  effects. 

For  the  second  stage,  I personally  prefer  nitrous 
oxid  analgesia.  In  our  endeavors  to  obtain  a good 
analgesia,  we  must  not  overlook  the  fact  that  a most 
important  factor  in  securing  a “painless  labor,”  is  the 
early  recognition  and  correction  of  any  malpositions 
or  malpresentations;  for  we  must  not  allow  too  long 
a second  stage  in  the  hope  of  having  such  abnormali- 
ties spontaneously  corrected. 

■» 

Lyman  H.  Robison,  M.  D.  (222  Westlake  Profes- 
sional Building,  Los  Angeles). — Obstetrical  analgesia 
is  a subject  receiving  considerable  attention  and  dis- 
cussion, not  only  by  obstetricians,  but  by  the  laity 
as  well,  and  more  and  more  are  women  demanding 
a “painless  childbirth”  from  their  physicians.  As  a 
result  the  obstetrician  frequently  has  a difficult  course 
to  pursue  in  attempting  to  accede  to  the  patient’s 
requests  and  yet  keep  clear  of  the  dangers  and  com- 
plications of  the  several  methods  of  analgesia  now  in 
use.  On  the  other  hand,  the  woman  in  labor  is  en- 
tirely right  in  expecting  an  effort  at  the  relief  of  pain 
and,  with  our  present  knowledge  of  analgesia,  we  are 
not  giving  her  the  protection  to  which  she  is  entitled 
if  some  pain-relieving  procedure  is  not  employed. 

With  Doctor  Fist,  I feel  that  morphin  in  labor  is 
not  free  from  danger  to  the  child  and  that  it  should 
never  be  used  late  in  labor.  Even  when  used  early 
and  followed  by  an  inhalation  anesthesia,  one  not  in- 
frequently finds  some  difficulty  in  resuscitating  the 
infant.  If  the  morphin  could  be  replaced  with  some 
efficient  preparation  free  from  the  untoward  effects 
of  the  narcotic,  it  would  add  materially  to  the  safety 
of  an  analgesic  method  in  obstetrics. 

The  suggestion  made  by  Doctor  Fist  of  combining 
scopolamin  and  magnesium  sulphate  interests  me.  It 
appears  to  be  a simple  procedure  and,  while  I have 
had  no  personal  experience  with  the  method,  the  com- 
bination should  enable  one  to  obtain  good  results. 
The  only  drawback  that  I see  to  the  method  is  the 
rather  uncertain  action  of  the  scopolamin  when  used 
alone,  not  infrequently  acting  as  a cerebral  excitant 
rather  than  a hypnotic.  If,  as  Doctor  Fist  claims,  the 
presence  of  the  magnesium  sulphate  prevents  this  un- 
toward action,  it  appears  to  me  to  be  a procedure  well 
worth  while  in  inducing  analgesia  during  labor. 

* 

Doctor  Fist  (Closing).— The  interest  in  obstetrical 
analgesia,  as  evidenced  by  the  discussions  of  Doctors 
Bland,  Lazard,  and  Robison,  indicates  the  attitude  of 
present-day  obstetricians.  Relief  of  pain  during  child- 
birth is  no  longer  considered  unnecessary.  The 
method  under  discussion  is  presented  because  of  its 
simplicity,  safety  and  effectiveness. 

Elimination  of  the  use  of  morphin  seems  highly 
desirable.  Magnesium  sulphate  and  scopolamin  in  the 
dosage  employed  have  proved  to  be  well  within  the 
safety  limits.  The  average  patient  will  not  require, 
at  the  outside,  more  than  three  doses  of  scopolamin 
grain  1/200,  nor  more  than  five  doses  of  magnesium 
sulphate,  two  cubic  centimeters,  of  a 50  per  cent 
solution. 

Van  Hoosen  administers  scopolamin,  grain  1/100, 
every  half  hour  as  needed,  without  any  ill  effects. 
Lazard  gives  as  much  as  22  grams  of  magnesium  sul- 
phate, intravenously,  in  twelve  hours.  Lee  Dorsett 
(. American  Journal  of  Obstetrics,  February  1926,  p.  227) 
gives  as  much  as  100  cubic  centimeters  of  magnesium 
sulphate,  25  per  cent  solution,  intramuscularly,  in 
twenty  hours.  Our  average  dosage  is  4 to  5 grams, 
intramuscularly,  during  the  course  of  the  labor.  Care 
must  be  taken  to  inject  the  magnesium  sulphate 
deeply  into  the  muscles  to  avoid  abscess  and  slough. 


CHILDHOOD  TUBERCULOSIS — ITS 
TREATMENT* 

REPORT  OF  CASES 

By  Charles  L.  Ianne,  M.  D. 

San  Jose 

Discussion  by  Charles  P.  Durney,  M.D.,  San  Jose; 
Chesley  Bush,  M.  D.,  Livermore ; Ann  Martin,  M.  D., 
Oakland. 

HP  HE  problems  met  in  treating  a chronic  disease 
such  as  tuberculosis  in  childhood  are  of  two 
distinct  natures.  They  are  problems  of  the  mind 
and  of  the  body.  The  aim  of  the  physician  of  a 
child  so  afflicted  must  be  to  produce  a mentally 
and  physically  well  adult. 

PLACE  OF  PARENTS  IN  TREATMENT 

As  the  treatment  of  disease  begins  with  the 
diagnosis,  and  as  the  child  can  only  be  treated 
through  a third  person — the  parent — the  manner 
in  which  the  diagnosis  is  received  will  have  a 
direct  bearing  upon  the  course  of  the  disease,  and 
the  future  welfare  of  the  child.  J.  A.  Meyers,1 
in  a recent  paper,  states  that  there  are  three  main 
types  of  reactors : the  first,  the  mother  who  feels 
the  diagnosis  is  impossible,  as  tuberculosis  has  not 
been  in  the  family  before ; the  second,  who  be- 
comes hysterical,  as  she  considers  all  forms  of 
tuberculosis  fatal ; and  the  third,  who  is  relieved 
to  know  that  at  last  a diagnosis  has  been  arrived 
at  and  that  with  the  proper  institution  of  treat- 
ment, good  opportunity  for  recovery  is  assured. 

A good  type  of  the  hysterical  mother  consulted 
me  concerning  her  child  of  ten  years.  The  history 
showed  that  the  child  had  been  subject  to  frequent 
colds  and  headaches.  He  recently  had  had  scarlet 
fever  with  a complicating  nephritis.  A tonsillec- 
tomy had  been  performed  because  of  continuation 
of  fever.  A change  of  doctors  then  occurred,  as 
the  child  did  not  improve  immediately.  The 
second  physician  on  finding  “moisture”  in  the 
chest  ordered  an  x-ray.  On  the  subsequent  visit 
the  diagnosis  of  hilum  gland  tuberculosis  was 
given  the  parent,  together  with  indefinite  un- 
written instructions  to  give  the  child  rest,  plenty 
of  food,  fresh  air,  and  sun  baths.  I gathered  that 
she  believed  her  child  to  be  threatened  by  death. 
She  placed  him  on  twenty-four  hours  bed  rest 
regimen  without  lavatory  privileges ; put  him  on 
a high  caloric  diet ; began  a rigorous  course  of 
sun  baths  with  the  initial  dose  of  fifteen  minutes 
to  complete  body;  and  took  frequent  temperature 
readings. 

On  examination  the  child  was  found  to  weigh 
one  hundred  pounds,  thirty-two  pounds  over  the 
average  for  age  and  height;  lungs  and  heart  were 
negative ; purulent  secretion  was  present  in  the 
nasopharynx. 

The  x-ray  was  consistent  but  not  conclusive  of 
hilum  gland  tuberculosis. 

The  mother  was  assured  that  the  child  did  not 
have  a fatal  form  of  tuberculosis  and  that  the 
rigid  regimen  should  be  modified.  She  was  told 

* Read  before  the  Pediatric  Section  of  the  California 
Medical  Association  at  the  fifty-eighth  annual  session, 
Coronado,  May  6-9,  1929. 


May,  1930 


T UBE  RC  U LOS  I S — IAN  N E 


33S 


her  morbid  fear  and  anxiety  was  detrimental  to 
her  child,  who  was  precocious  and  delighted  in 
helping  in  the  recitation  of  his  symptoms.  A re- 
cent letter  from  the  mother  states  that  she  is 
following  my  advice  and  that  both  the  child  and 
herself  were  much  happier. 

I felt  that  in  this  case  the  doctor  wTas  at  fault 
in  the  manner  in  which  the  diagnosis  was  pre- 
sented. A written  program  of  the  prescribed 
hours  of  rest,  sun  baths  and  nourishment  should 
have  been  given,  as  one  would  do  in  prescribing 
drugs.  At  the  same  time  it  should  have  been 
explained  that  many  conditions  have  the  same 
group  of  symptoms  and  that  only  a tentative  diag- 
nosis could  be  arrived  at  for  the  present. 

We  do  not  doubt  that  the  finding  of  calcified 
glands  in  the  hilum  may  have  indicated  the  pres- 
ence of  a tuberculous  infection,  but  the  disease 
from  which  the  child  was  suffering  was  appar- 
ently a chronic  nasal  infection  with  recent  bron- 
chitis. At  Del  Valle  Preventorium,  at  which  insti- 
tution I was  on  the  staff  for  four  years,  Bush 
found  that  from  10  to  25  per  cent  of  contacts 
who  were  admitted  had  other  foci  of  infection 
besides  their  tuberculosis  to  account  for  their 
present  symptoms. 

From  a purely  medical  viewpoint  the  problems 
are  as  varied  as  are  the  manifestations  of  tuber- 
culosis. The  infantile  and  adult  form  of  pulmo- 
nary disease,  the  lymphatic  and  bone  manifesta- 
tions, each  present  problems  entirely  alien  to  the 
other.  They  are  similar  only  in  that  rest  and 
hygienic  measures  are  common  in  the  treatment 
of  all  types. 

The  treatment  of  the  infantile  and  the  adult 
types  of  pulmonary  disease,  because  of  their 
gravity  at  this  age,  have  to  my  mind  only  one  cor- 
rect method  of  treatment,  that  is,  the  removal  of 
the  child  to  a hospital  or  sanatorium  where  the 
strictest  regimen  can  be  pursued.  The  lesions  at 
this  time  are  of  the  preponderately  exudative 
form,  and  are  usually  bilateral  and  progressive. 
Armand  DeLille  2 has  treated  many  children  by 
induction  of  artificial  pneumothorax,  but  a report 
of  his  results  is  inconclusive,  for  his  cases  were 
apparently  still  under  treatment.  He  feels  that 
because  of  the  high  mortality,  that  this  type  of 
interference  is  indicated.  At  best,  interference  is 
palliative  in  the  majority  so  afflicted. 

TUBERCULOSIS  OF  BONES  AND  JOINTS 

The  next  form  of  tuberculosis  to  be  considered 
is  that  affecting  the  bones  and  joints.  Since 
Rollier  startled  the  medical  and  lay  world  by  his 
conservative  nonsurgical  method  of  combined  sun 
exposures  and  fixation  apparatus,  physiothera- 
pists have  tried  his  methods  with  indifferent  re- 
sults. A few  men,  such  as  Gauvain  of  England 
and  Lo  Grasso  and  Hyde  of  the  United  States, 
have  reported  good  results  from  these  methods. 
The  majority  have  called  in  orthopedists,  who 
tempered  the  medical  treatment  with  conservative 
surgical  procedures.  In  the  place  of  bone  curette- 
ments,  extra-articular  fixation  bone  graft  opera- 
tions with  correction  of  deformities  are  now 


resorted  to.  By  the  fixation  of  the  joint  the  addi- 
tional local  rest  to  the  part  is  insured,  and  heal- 
ing takes  place  more  rapidly,  safely,  and  securely. 
The  danger  in  surgical  treatment  is  the  false 
security  that  may  result  from  the  immediate 
operative  results,  for  we  must  not  lose  sight  of 
the  fact  that  the  local  disease  is  only  one  mani- 
festation of  a general  disease,  and  that  rest  and 
other  measures  are  necessary  for  several  months 
until  all  symptoms  of  activity  have  subsided. 

TUBERCULOSIS  OF  LYMPH  GLANDS 

Perhaps  the  most  difficult  form  of  tuberculosis 
to  treat  and  the  type  that  gives  the  practitioner 
more  worry  because  of  its  indefinite  diagnosis  and 
symptomatology,  is  tuberculosis  of  the  lymph 
glandular  system.  The  problems  are  many.  It  is 
a fairly  simple  procedure  to  treat  a sick  child 
during  the  course  of  an  acute  illness ; but  to  treat 
an  apparently  well  child  who  has  a basic  chronic 
infection  will  tax  the  ingenuity  of  the  physician 
and  the  patience  of  the  parent. 

Because  of  the  chronicity  of  the  disease,  and 
need  for  institutional  treatment  during  the  forma- 
tive years  of  childhood,  inferiority  complexes  may 
be  set  up  that  will  hamper  future  initiative. 

Before  going  into  the  procedure  used  in  treat- 
ing this  form  of  the  disease,  two  cases,  illustrat- 
ing the  inefficacy  of  treating  tuberculous  glands 
by  local  measures  only,  will  be  presented. 

REPORT  OF  CASES 

Case  1. — A husky  boy  of  ten  came  under  my  ob- 
servation. The  only  appearance  of  general  toxemia 
was  a slight  pallor,  dark  circles  under  the  eyes,  and 
an  irregular  low-grade  fever.  He  had  been  treated 
at  a San  Francisco  hospital  for  enlarged  cervical 
glands  during  the  preceding  year.  First  a tonsillec- 
tomy, followed  by  a course  of  x-ray  treatment;  then 
an  attempt  at  a radical  bilateral  gland  dissection  was 
done.  His  neck  and  face  were  frightfully  scarred  by 
large  keloids  that  continued  to  suppurate.  A few 
weeks  preceding  admission  to  the  sanatorium  the 
posterior  cervical  glands  began  to  enlarge  and  one 
abscess  was  incised.  Investigation  showed  that  no  at- 
tempt at  rest  regimen  had  been  advised  or  attempted. 
After  a few  months  of  sanatorium  rest  the  enlarged 
glands  subsided,  the  suppuration  of  scars  ceased  and 
the  general  condition  was  markedly  improved. 

iii 

Case  2. — Another  child  had  had  a lupus  of  the  dor- 
sum of  the  foot  of  six  years’  standing  and  multiple 
sinuses  of  the  neck  following  bilateral  dissection. 
Upon  being  placed  on  a strict  rest  regimen  with  re- 
moval of  dressings,  thus  exposing  the  neck  to  the 
air  and  sunlight,  the  wounds  showed  immediate  im- 
provement. A complete  healing  of  lesion  of  the  foot 
occurred  in  a few  months. 

COMMENT 

The  proper  care  for  this  type  of  child  in  the 
home  consists  in  finding  the  causes  for  the  sub- 
standard condition  and  eliminating  them.  Inade- 
quate diet,  focal  infection,  systemic  diseases,  and 
insufficient  rest  are  found  to  be  the  chief  factors 
that  undermine  the  resistance  against  tuberculosis. 

Inadequate  diet  may  be  due  to  poor  budgeting 
or  ignorance  of  dietary  principles.  Through  edu- 
cation of  parents,  as  is  being  done  at  the  Oakland 
Health  Center,  with  the  cooperation  of  the  adult 
educational  department,3  this  problem  becomes  a 


336 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


simpler  procedure.  The  elimination  of  focal  in- 
fections is  taken  care  of  through  frequent  surveys 
in  both  the  preschool  and  school  clinics.  Systemic 
diseases  are  being  made  less  dangerous  through 
conferring  of  artificial  immunity,  as  for  diph- 
theria, smallpox,  and  scarlet  fever.  The  most 
difficult  factor  to  apply  in  the  home  treatment  is 
rest. 

As  a preliminary  to  the  application  of  rest  in 
the  home,  a careful  survey  of  the  child’s  daily 
activities  is  necessary. 

Case  3.- — A case  illustrating  this  point  is  that  of  a 
16-year  old  high  school  girl  exposed  to  a tuberculous 
mother  since  birth.  One  year  previous,  because  of  the 
presence  of  fever  notwithstanding  a negatively  read 
x-ray  plate,  the  child  was  put  on  a short  rest  period 
which  was  taken  rather  indifferently.  A careful  his- 
tory of  her  daily  activities  elicited  the  following: 

She  arose  at  6 a.  m.  to  study  for  one  hour  before 
breakfast.  Breakfast  at  7 a.  m.;  7:15  to  8 more  study; 
in  school  from  8 to  12  noon.  Then  followed  a sand- 
wich lunch  without  milk  or  hot  soup,  accompanied 
by  further  study.  In  the  afternoon,  gymnasium  and 
school  until  3:30  o’clock;  home  at  4 o’clock;  studied 
organ  lessons  until  5:30  o’clock.  Supper,  and  then 
more  study  from  7:30  to  9:30  p.  m.  or  until  she  fell 
asleep  over  her  books. 

The  above  would  be  a big  day  for  an  adult,  let 
alone  a girl  in  whom  the  following  symptoms  were 
noted:  nineteen  pounds  underweight;  lymphatic  gland 
enlargement,  necessitating  removal  of  one  gland  in 
the  previous  year;  cessation  of  menses;  repeated  colds 
and  fever  99.2  to  99.4  F.  She  cried  frequently  and  was 
emotionally  upset,  as  her  school  work  was  not  so 
good  as  formerly. 

The  physical  examination  revealed  a few  fine  in- 
constant rales  at  right  apex;  second  x-ray  showed  a 
calcified  primary  focus  under  right  clavicle.  In  retro- 
spect, the  first  x-ray  showed  a slight  haze  in  this  area. 

The  following  changes  were  made  in  her  schedule: 

The  child  was  to  rise  at  7 a.  m.  instead  of  at  6 a.  m., 
eliminating  morning  studies.  One  subject  and  gym- 
nasium were  dropped,  and  a two-hour  rest  period  was 
substituted  at  school.  Study  after  supper,  and  to  bed 
at  8 p.  m.  After  one  month  her  menses  returned,  she 
began  to  put  on  weight,  nervousness  and  hyper- 
emotionalism disappeared. 

REST  AND  OTHER  REGIMEN 

As  was  stated  before,  the  application  of  rest  in 
the  home  is  not  an  easy  matter.  Explicit  orders 
should  be  given  as  to  the  time,  amount  and  place 
where  the  child  should  be  put  to  rest.  One  must 
stipulate  that  the  child  be  clothed  as  for  bed,  be- 
cause psychologically  he  will  respond  to  sleep 
more  readily.  It  is  difficult  to  get  the  child’s  co- 
operation, as  rest  is  uninteresting  for  the  active 
mind,  and  he  cannot  see  the  why  of  rest  when 
all  persons  about  him  are  active. 

If  rest  at  home  is  impossible,  it  may  be  given 
as  a “rest  gym”  at  school.  Those  children  who 
do  not  respond  to  this  modified  home-school  rest 
program  should  be  referred  to  a preventorium. 

In  the  preventorium,  children  are  protected 
from  repeated  systemic  diseases  by  a two  weeks’ 
isolation  of  the  new  child,  and  prohibition  of 
child  visitors.  Rest  is  easily  applied,  as  he  is  ad- 
mitted into  a group  that  is  already  disciplined. 
He  soon  finds  that  he  must  eat  the  foods  that 
he  refused  at  home.  His  play  and  school  hours 
are  allotted  as  he  is  able  to  tolerate  them.  He  is 
also  given  short  sun  and  air  baths  as  a tonic  to 


metabolism.  The  .child  is  soon  transformed  into 
a picture  of  health,  rarely  seen  in  an  ordinary 
school  group. 

But  this  is  only  a start  on  the  road  to  health. 
As  Trimble  4 puts  it,  “the  parent  is  liable  to  think 
that  an  institution  is  a place  to  get  perfectly  well 
and  leave  all  troubles  behind.”  This  is  far  from 
the  truth.  The  factors  at  home  which  originally 
produced  the  subnormal  condition  will,  in  a short 
time,  undo  all  the  good  done  by  the  stay  at  the 
preventorium. 

SOME  PREVENTORIUM  OBSERVATIONS 

In  a preliminary  report  by  the  author 5 of  a 
survey  made  by  the  Oakland  Health  Center  of 
one  hundred  children  who  had  been  discharged 
from  Del  Valle  Preventorium,  about  40  per  cent 
were  found  to  be  underweight.  A later  and  more 
complete  report  by  Bush  and  Shepard,6  showed 
the  following:  Of  120  discharged  Oakland  chil- 
dren 107  were  accounted  for,  and  of  this  group, 
fifty-eight  were  underweight;  only  fourteen  of 
this  number  having  been  discharged  below  normal 
weight.  In  the  Berkeley  group  of  forty  patients, 
nine  were  readmitted  to  the  preventorium,  ten 
were  awaiting  readmission,  seventeen  failed  to 
improve,  and  four  showed  steady  improvement. 
This  is  certainly  a discouraging  situation. 

Several  factors  account  for  the  inability  of  this 
type  of  child  to  get  the  additional  rest  that  is 
necessary  to  keep  him  fit.  Parental  ignorance 
with  lack  of  understanding  of  what  constitutes 
proper  health,  thus  failing  to  see  the  need  for  the 
application  of  the  efforts  required,  accounts  for 
some  failures.  Secondly,  there  is  poverty,  requir- 
ing that  both  parents  be  at  work,  putting  the 
responsibility  of  taking  the  rest  period  on  the 
child  himself.  Thirdly,  there  is  a group  who  try 
to  apply  the  rest  ordered,  but  because  of  the  diffi- 
culty of  getting  the  child’s  cooperation,  finally 
give  up  in  despair. 

To  readmit  these  children  in  a preventorium  is 
only  wasted  effort,  for  on  discharge  the  same 
picture  is  enacted.  This  may  be  done  repeatedly 
until  the  child  has  passed  puberty,  but  the  dis- 
cipline of  an  institution  may  insure  a healthy  body 
at  the  expense  of  a proper  mental  outlook  on  life. 
The  gap  between  the  sheltered  life  of  a preven- 
torium and  home  seems  too  great. 

HOW  THE  SCHOOL  MAY  AID 

The  home  having  failed,  the  school  may  then 
be  called  upon.  Group  discipline  and  established 
organization  make  it  possible  for  the  school  in 
this  way  to  give  to  the  child  what  is  his  inherent 
right,  the  right  to  grow  in  mental  and  physical 
development.  This  may  sound  a bit  paternalistic, 
but  so  is  the  public  school.  The  school  helps  to 
regulate  physical  health  through  its  gymnasium, 
calling  it  physic^!1  education.  Rest,  its  counterpart, 
is  just  as  much  a part  of  physical  education  and, 
in  all  primary  grades,  should  be  a regular  feature 
of  the  daily  curriculum,  following  the  noonday 
recess. 

Until  this  utopian  condition  becomes  a fact,  the 
under  par  child  at  least  should  be  taken  care  of 


May,  1930 


TUBERCULOSIS — IANNE 


337 


through  the  open  window  school,7  as  is  clone  in 
Chicago,  where  in  twenty-six  schools  there  are 
fifty-six  such  rooms  caring  for  1680  children. 
In  a recent  report  they  find  that  of  1963  open 
window  room  children  compared  to  a like  number 
of  the  normal  group,  the  open  window  group 
gained  3.6  pounds,  as  against  2.5  pounds  of  the 
latter. 

To  overcome  the  defect  in  the  follow-up  work 
in  Berkeley,  Shepard  suggested  that  a centralized 
preventorium  school  be  organized  to  take  care  of 
the  ex-preventorium  and  other  substandard  chil- 
dren. The  school  program  was  modified  to  allow 
supervised  play,  rest  periods,  sun  and  air  baths, 
and  hot  luncheon  under  direction  of  the  school 
dietitian.  Of  seventy-nine  children  cared  for,  73 
per  cent  were  benefited.  Improvement  of  the  ex- 
preventorium children  was  especially  noted.  A 
marked  reduction  in  the  waiting  list  of  children 
for  the  preventorium  occurred.  Better  grades 
resulted  and  a reduction  in  the  percentage  of 
absences  from  18.7  to  9.2  per  cent  resulted.6  Cen- 
tralized preventorium  schools  of  this  type  serve 
as  centers  for  disseminating  health  education  to 
the  teachers  and  parents  in  the  community. 

Hayward  has  a nutrition  class  of  this  type ; 
Oakland  has  recently  started  a preventorium 
school  in  the  better  and  poorer  sections.  Once 
established,  the  need  for  more  of  this  type  of 
school  is  soon  recognized. 

SUMMARY 

In  conclusion,  we  wish  to  emphasize  that  rest 
and  time  are  the  chief  factors  in  the  cure  and  pre- 
vention of  childhood  tuberculosis.  That  the  home 
and  school  are  the  places  where  these  principles 
must  be  put  into  effect.  That  the  preventorium 
should  be  resorted  to  only  when  these  measures 
fail. 

Sunnyholme  Preventorium,  Santa  Clara  County  Hospital. 

REFERENCES 

1.  Meyers,  J.  A.:  Treatment  of  Tuberculosis  in 
Childhood,  Journal  Outdoor  Life,  Vol.  xxvi,  No.  3, 
March  1929. 

2.  Armand  De  Lille,  P.,  Levy,  R.,  et  al.:  Contribu- 
tion to  the  Study  of  Artificial  Pneumothorax  in  Infan- 
tile Tuberculosis,  Bull,  et  Mem.  Soc.  Med.  d.  Hop.  de 
Par.,  Vol.  xli,  pp.  401-404,  March  19,  1925. 

3.  Corneille,  J.  J.:  The  Need  for  a Nutritional  Pro- 
gram for  Mothers  of  Underweight  Children,  Alameda 
County  Public  Health  News. 

4.  Trimble,  H.  G. : The  Prevention  of  Childhood 
Tuberculosis,  Alameda  County  Public  Health  News, 
May  1927. 

5.  Ianne,  Charles  L. : Preventorium  School,  Ala- 
meda County  Public  Health  News,  May  1927. 

6.  Bush,  C.,  and  Shepard,  W.  P. : Transactions  of 
the  National  Tuberculosis  Association,  1928. 

7.  Bulletin  of  the  City  of  Chicago  Municipal  Tuber- 
culosis Sanatorium,  September,  October,  November, 
and  December,  1928. 

DISCUSSION 

Charles  P.  Durney,  M.  D.  (San  Jose). — I take  it 
that  Doctor  Ianne,  in  treating  this  subject,  stresses 
particularly  the  conduct  of  that  type  of  case  falling 
in  the  group  which  has  brought  about  so  much  dis- 
cussion and  dissension  mainly  from  the  standpoint 
of  diagnosis — the  pretuberculous  child,  or  the  tubercu- 
losis suspect,  or,  as  it  is  sometimes  termed,  the 
contact. 

We  all  recognize  the  type,  that  “under  par”  child 
in  which  there  are  suggestive  signs  but  in  which  so 


frequently  we  find  a doubt  as  to  the  actual  presence 
of  active  tuberculous  lesions. 

There  is  no  question  regarding  the  indicated  regi- 
men for  a child  definitely  ill  with  clinically  manifested 
tuberculosis  in  any  of  its  forms.  This  type  of  case 
is  primarily  and  emphatically  an  institutional  charge 
and  should  be  under  the  care  of  those  who  are  trained 
and  experienced  in  order  that  every  phase  of  the 
child’s  condition  may  be  under  observation  and  study 
and  every  advantage  offered  to  forward  what  usually 
are  but  the  slimest  of  chances  in  this  serious  affliction. 

Too  much  stress  cannot  be  given  two  most  impor- 
tant elements  in  this  subject — rest  and  time.  When 
we  say  of  faith,  hope,  and  charity  that  the  greatest 
of  these  is  charity,  we  can  say  of  that  triology — so 
much  a part  of  the  treatment  of  tuberculosis — fresh 
air,  good  food,  and  rest,  that  the  greatest  of  these  is 
rest.  We  should  also  add  that  time  is  a very  marked 
essential.  There  are  no  short  cuts  to  a cure. 

I believe  that  we  have,  however,  one  of  the  most 
splendid  examples  of  what  can  be  done  for  these 
youngsters  that  we  have  in  any  department  of  medi- 
cine. It  answers  every  question  and  needs  only  the 
same  faithful  application  in  a general  way  but  on  a 
greater  scale,  and  it  is  demonstrated  every  day  in  our 
preventorium.  If  the  National  Tuberculosis  Associa- 
tion has  done  nothing  else,  it  has  created  something 
of  which  to  be  justly  proud  in  the  preventoria  which 
have  grown  out  of  the  idea  conceived,  nourished  and 
materialized  under  its  study  and  guidance.  If  any 
physician  desires  to  know  what  is  best  to  do  for  the 
type  of  child  we  are  considering,  let  him  visit  a 
modern  and  up-to-date  preventorium  and  receive  its 
inspiration,  and  borrow  its  book  of  rules. 

Regarding  the  under  par  school  child,  we  are  cer- 
tainly coming  to  the  fresh  air  school.  And  it  is  of 
interest  to  note  the  awarding  of  certain  credits  to 
students  who  are  placed  on  rest  periods.  Our  local 
junior  colleges  and  the  University  of  California  are 
doing  this.  When  they  all  fall  in  line,  much  good  will 
follow,  as  a youngster  will  have  an  incentive  which 
appeals.  To  gain  a credit  by  lying  down  and  relaxing 
for  an  Hour  will  not  be  so  much  like  punishment. 
Verily,  this  thing  we  have  preached  for  so  long  a 
time,  rest,  is  being  accepted. 

* 

Chesley  Bush,  M.  D.  (Arroyo  Sanatorium,  Liver- 
more).—A large  amount  of  work  has  been  done  in 
the  past  ten  years  by  tuberculosis  associations  and 
others  in  “preventive”  work  among  children.  This  work 
has  been  handicapped  by  lack  of  knowledge  and  diffi- 
culty of  interpretation  as  to  just  what  constitutes 
tuberculosis  in  a child.  While  the  broad  principles  of 
prevention  and  care  have  undoubtedly  been  right,  it 
is  also  true  that  a great  deal  of  money  and  effort  has 
been  expended  on  groups  of  children  who  are  eco- 
nomic and  social  problems  rather  than  medical  prob- 
lems. Children  have  largely  been  chosen  for  treat- 
ment from  the  underweight  groups.  The  careful 
studies  of  Opie_  and  McPhedran  and  their  associates 
have  pointed  out  to  us  most  forcibly  that  tubercle 
infection,  and  even  the  tubercle  lesion,  need  not  be 
in  the  underweight  group;  and  therefore  a revision 
in  the  plans  of  selection  of  children  for  preventorium 
and  school  care  is  about  to  take  place. 

We  have  had  an  interesting  opportunity  to  study 
the  development  and  regression  of  tuberculous  lesions 
in  the  lungs  of  children  from  infancy  up  to  adoles- 
cence. We  have  been  impressed  with  the  value  of 
time  in  the  treatment  of  juvenile  tuberculosis  just  as 
in  adult  tuberculosis.  Where  juvenile  infection  exists 
reduction  of  physical  strain  on  a child  must  be  carried 
out  for  a period  of  years.  It  is  obviously  impossible 
to  do  this  in  a preventorium,  it  is  possible  but  gener- 
ally difficult  and  impractical  to  find  parents  who  will 
carry  on  a protracted  regimen  at  home  in  an  appar- 
ently healthy  child,  and  hence  the  problem  falls  back 
upon  the  school.  A course  of  extra  rest  and  nutrition 
becomes  a part  of  the  school  schedule  easily.  And  so 
we  have  ended  just  where  we  started — in  the  school. 
Tuberculosis  prevention  is  a school  problem  because 


338 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


selection  and  treatment  can  be  carried  on  in  the  school 
except  in  a small  percentage  of  cases  where  preven- 
torium or  sanatorium  care  will  always  be  necessary 
to  check  a progressing  lesion. 

In  the  next  decade  a large  part  of  the  work  we 
have  been  doing  with  children  in  clinics  and  pre- 
ventoria  will  be  accepted  and  carried  on  by  school 
departments,  just  as  routinely  as  the  teaching  of  arith- 
metic. For  this  the  present-day  preventoria  have 
pointed  the  way. 

We  have  had  an  opportunity  to  observe  a number 
of  children  who  have  been  hospitalized  for  years  be- 
cause of  extensive  tuberculous  lesions,  and  who  have 
eventually  recovered.  The  wreckage  of  their  bodies 
was  nothing  compared  to  the  wreckage  of  their  minds, 
their  character,  and  their  entire  viewpoint  on  life. 
For  that  reason  I believe  that -the  institutionaliza- 
tion of  children  should  be  avoided  as  a policy  and 
every  effort  made  to  make  a stay  in  an  institution  as 
short  as  possible.  It  is  as  important  that  a child  be 
brought  up  in  a normal  environment  as  it  is  that  he 
has  a normal  body.  Our  present-day  preventoria  are 
operated  with  this  point  in  view,  and  furnish  better 
homes  for  the  children  than  those  from  which  they 
come  in  most  instances;  but  the  health  education 
gained  there  does  not  carry  back  into  the  homes  with 
the  younger  group  of  children  who  quickly  forget. 

Children  with  extensive  pulmonary  lesions  of  the 
juvenile  type  do  get  well;  it  has  been  astonishing 
to  us.  But  in  order  to  achieve  that  end  we  need  all 
our  facilities — sanatorium,  preventorium,  and  school 
care,  in  the  order  named.  We  must  use  all  our  facili- 
ties to  the  best  advantage.  With  a better  selection  of 
children,  a more  extensive  use  of  our  schools  in  treat- 
ment, and  a better  selected  group  in  our  preventoria 
and  sanatoria,  we  should  be  handling  our  problem 
with  great  efficiency. 

Ann  Martin,  M.  D.  (Baby  Hospital,  Oakland). — 
Time  and  rest  are  the  two  most  important  factors  in 
the  treatment  of  the  child  infected  with  tuberculosis. 
Whether  this  care  should  be  given  in  a sanatorium, 
preventorium,  the  home,  or  the  school,  depends  on 
the  extent  and  character  of  the  lesion  found  in  the 
lungs,  and  upon  the  age  of  the  child.  There  is  no 
difference  of  opinion  that  sanatorium  care  is  desirable 
for  the  acutely  ill  child,  though  here,  after  a time,  the 
child  will  do  better,  both  mentally  and  physically,  and 
progress  faster  if  removed  from  the  sanatorium  for 
home  or  school  care. 

In  a series  of  fifty  children  with  pulmonary  infiltra- 
tions, seen  by  me  at  the  Baby  Hospital  contact  clinic, 
thirty-five  were  under  six  years  of  age  when  first 
seen.  This  high  proportion  of  pulmonary  infiltrations 
(which  are  potentially  the  most  serious  lesions)  in  the 
preschool  child  means  that  home,  and  not  school  care, 
must  supplement  sanatorium  treatment. 

Our  problem  here  is  to  work  out  a satisfactory 
routine  which  the  busy  mother  can  carry  out  at  home. 
In  my  experience  this  can  be  done  successfully  in 
most  cases  if  detailed  supervision  is  maintained  over 
a fairly  long  time  by  the  doctor  and  visiting  nurse. 
Most  mothers  are  unwilling  to  send  their  young  chil- 
dren to  an  institution  unless  the  effort  to  care  for 
them  at  home  has  failed  to  give  results.  Home  care 
requires,  first,  cooperative  parents;  second,  a continu- 
ous sympathetic  supervision  of  the  child  by  the 
doctor.  Explicit  directions  as  to  rest,  activity,  and 
diet  are  essential.  Periodic  visits  to  the  doctor  and 
home  visits  by  the  visiting  nurse,  inspire  the  mother 
with  a feeling  of  confidence,  helpfulness,  and  hopeful- 
ness, and  gives  her  the  incentive  to  maintain  the  pre- 
scribed routine  through  the  many  months  necessary 
to  secure  a cure  in  the  child. 

Frequent  x-ray  pictures  must  be  taken,  as  only 
through  serial  pictures  can  we  follow  the  progress 
of  the  lesion;  these  findings  are  a definite  guide  in 
treatment.  The  frequent  taking  of  x-ray  pictures  also 
gives  the  parents  a feeling  of  confidence  and  again 
definitely  helps  them  to  maintain  the  routine. 


I feel  a word  of  warning  should  be  sounded  here 
against  the  too  frequent  acceptance  of  weight  as  the 
sole  measure  of  a child’s  physical  fitness  and  health. 
Lack  of  fatigability  and  irritability,  improvement  in 
the  child’s  school  progress,  are  valuable  criteria  of 
the  child’s  progress  in  his  return  to  normal  health. 

Another  point  probably  of  first  importance  in  the 
treatment  of  the  tuberculous  child  is  to  break  his  con- 
tact with  the  source  of  his  infection.  The  extent  of 
the  disease  and  the  prognosis  depend  upon  avoiding 
repeated  inoculations  with  the  tubercle  bacilli.  In  the 
words  of  McPhedran,  “Experience  suggests  that  the 
determining  factor  (in  the  cure  of  tuberculosis)  even 
after  consolidation  is  extensive,  is  complete  termina- 
tion of  exposure  to  the  infecting  source.” 

& 

Doctor  Ianne  (Closing). — As  Doctor  Durney  pre- 
sumed, I particularly  wish  to  stress  in  this  paper  the 
problem  of  diagnosis  and  care  of  the  substandard  or 
pretuberculous  child.  The  stigma  which  formerly 
rested  on  rest  as  a part  of  health  education  is  being 
broken  down,  as  witness  the  giving  of  credits  for  rest 
by  high  schools  and  colleges. 

I realize  that  weight  is  not  the  sole  or  major  cri- 
terion for  selection  of  the  substandard  child.  It  is 
nevertheless  a good  index  by  which  to  select  and 
study  the  greater  portion  of  substandard  cases.  Then 
with  finer  details  as  to  history,  observation  and  special 
examinations,  such  as  the  tuberculin  test  and  chest 
x-ray  graphs,  only  a few  children  will  be  overlooked. 

Doctor  Bush  mentions  the  impracticability  of  find- 
ing parents  who  will  carry  on  a protracted  rest  regi- 
men in  children  who  are  apparently  well.  This  care, 
then,  devolves  upon  the  state  through  the  school. 

President  Hoover,  in  calling  the  1930  Conference 
on  Child  Welfare,  sounded  the  correct  chord  when  he 
stated:  “It  is  not  the  purpose  of  such  efforts  to  invade 
or  relieve  the  responsibilities  of  parents,  but  to  ad- 
vance those  activities  in  care  and  protection  of  chil- 
dren who  are  beyond  the  control  of  the  individual 
parents.”  


HUMAN  TORULA  INFECTIONS — A REVIEW* 


REPORT  OF  CASES 

By  Howard  A.  Ball,  M.  D. 

Los  Angeles 

Discussion  by  Newton  Evans,  M.  D.,  Los  Angeles; 
Willard  J.  Stone,  M.D.,  Pasadena. 


DEFINITION  AND  CLASSIFICATION 


111- 


npORULA  infections  are  those  infections  i 
volving  chiefly  the  central  nervous  system  and 
lungs,  caused  by  yeast-like  organisms,  belonging 
to  the  group  of  Fungi  imperfecti.  Prominent 
features  have  been  transparent  capsules,  as  seen 
in  tissues  and  to  a less  degree  in  cultures,  and 
in  cultures  reproduction  primarily  by  budding. 
Striking  clinical  features  are  the  absence  of  bone 
lesions  and  the  extreme  rarity  of  skin  lesions, 
one  case  being  reported  in  which  one  skin  lesion 
occurred  when  the  disease  was  disseminated.  The 
classification  given  by  Sheppe  1 is  acceptable  for 
the  present. 

Torula  infection  as  a clinical  entity  is  well 
established.  The  identity  of  the  organisms  in  the 
cases  reported  is  far  from  certain.  A number  of 
cases  have  been  accepted  without  cultural  data, 
the  diagnosis  having  been  based  on  the  histologi- 
cal picture.  The  second  of  the  cases  here  reported 


* Read  before  the  Pathology  and  Bacteriology  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  Coronado,  May  6-9,  1929. 


May,  1930 


TORULA — BALL 


339 


is  identical  histologically  with  a number  of  the 
previously  reported  meningeal  cases,  but  the  cul- 
tural characteristics  of  the  organism  are  at  some 
variance. 

These  infections  have  been  well  classified  by 
McGehee  and  Michelson  2 as  systemic  and  local. 
By  systemic  is  meant  any  involvement  of  a vital 
anatomical  system.  The  central  nervous  system 
and  the  respiratory  system  are  the  ones  chiefly 
concerned.  Local  cases  are  those  in  which  a non- 
vital  system  or  cavity  is  the  site  of  involvement. 
Such  cases  have  involved  the  muscular  system, 
tongue,  soft  palate,  and  pelvic  tissues. 

CASES  IN  THE  LITERATURE 

In  the  years  1906  and  1907,  two  cases  of  so- 
called  blastomycosis  involving  the  central  nervous 
system  were  reported  by  Von  Hansemann  and 
Turck,  respectively,  in  Germany.  In  1911  and 
1912,  Rusk 3 reported  two  similar  cases.  Then 
in  1916,  Stoddard  and  Cutler 4 grouped  these 
four  cases  as  distinct  from  other  reported  blasto- 
mycoses and  added  two  cases,  comparing  the 
lesions  in  theirs  with  those  produced  in  animals 
by  Frothingham’s  torula,  obtained  from  myx- 
omatous lesions  in  a horse,  and  established  torula 
disease  as  a clinical  entity.  It  is  obvious  that  even 
subsequent  to  this  some  cases  would  still  be 
reported,  using  the  older  nomenclature,  and  must 
be  identified  chiefly  from  the  clinical  and  anatomi- 
cal features  in  comparison  with  known  cases, 
together  with  the  cultural  data  when  available. 
Reference  to  Chart  1 will  show  the  cases  in  yearly 
chronological  order  of  publication,  the  months  of 
publication  having  been  disregarded  so  that  there 
are  undoubtedly  some  errors  in  precedence  for 
any  one  year. 

The  cases  of  Goto,5  and  Swift  and  Bull 6 were 
overlooked  from  their  dates  of  publication  until 
Wilhelmj  brought  them  to  notice  in  1925  under 
the  older  terminology  of  blastomycotic  meningi- 
tis. Goto  used  the  same  two  German  cases  in- 
cluded as  torula  by  Stoddard  and  Cutler,  and 
considered  his  case  identical  with  them.  The  case 
of  Wilhelmj  7 is  similar  to  that  of  Goto  which 
he  in  turn  uses  for  comparison.  The  case  of 
Swift  and  Bull,  as  reported,  is  unmistakable,  even 
a special  staining  technique  for  the  demonstration 
of  the  capsules  being  propounded. 


To  date  there  are  twenty-three  systemic  cases 
reported  in  the  English  literature,  including  three 
quoted  cases  from  the  German.  The  two  cases 
here  reported  make  twenty-five.  Two  additional 
cases  to  be  reported  are  known  to  the  author, 
making  the  number  of  cases  twenty-seven.  The 
local  cases  number  four.  Reference  to  Chart  2 
will  reveal  several  items  of  interest  in  these  cases. 

REPORT  OF  CASES 

Case  1. — This  case  occurred  in  1922,  but  was  never 
reported  in  the  literature.  Postmortem  examination 
of  head  by  Dr.  George  D.  Maner. 

Clinical. — The  patient,  a married  white  male  of  fifty- 
five  years,  cement  worker  by  occupation,  entered  the 
hospital  in  a semi-comatose  condition  April  4,  1922. 
He  had  complained  of  headaches  for  a year,  local- 
ized in  the  frontal  regions  and  constant  in  character. 
He  had  had  lumbar  pain  and  a fever  ranging  from 
99  to  101  for  a three  months’  period,  following  which 
he  improved  under  a physician’s  care  for  about  six 
weeks,  when  the  headache  and  backache  returned,  but 
not  the  fever.  He  now  had  difficulty  in  talking.  He 
became  gradually  worse,  and  two  weeks  before  ad- 
mission lost  the  power  of  speech  altogether,  but  was 
not  unconscious.  The  only  past  history  on  record  is 
“rheumatism”  at  sixteen  years,  and  “dropsy”  at  seven 
years. 

Examination  revealed  a semi-comatose,  rigid,  middle- 
aged  white  male,  restive  and  uncooperative.  The  right 
pupil  was  larger  than  the  left,  but  both  reacted  well 
to  light  and  accommodation. 

The  heart  tones  were  weak,  but  there  were  no 
murmurs.  The  blood  pressure  was  90/60.  The  lungs 
expanded  equally.  There  was  slight  impairment  of 
resonance  over  the  right  upper  lobe  posteriorly,  and 
breath  sounds  were  indistinct  in  this  area.  No  rales 
heard.  Abdomen  and  genitalia  negative. 

Both  arms  and  both  legs  were  spastic  and  were 
held  in  a flexed  position.  There  was  some  carpho- 
logia,  especially  when  disturbed.  The  knee-jerks  were 
hyperactive  bilaterally.  Biceps  not  obtainable.  Bab- 
inski  and  ankle  clonus  negative. 

A spinal  puncture  showed  clear  fluid  under  in- 
creased pressure.  Tests  for  globulin  and  albumin 
were  positive.  There  were  ten  cells  per  cubic  milli- 
meter. Blood  findings:  Red  blood  cells,  4,480,000; 
white  blood  cells,  6600  per  cubic  millimeter;  poly- 
morphonuclears,  68  per  cent;  eosinophils,  2 per  cent; 
and  mononuclears,  30  per  cent.  Another  count  nine 
days  later  was:  Hemoglobin,  90  per  cent  (method?); 
red  blood  cells,  4,200,000;  and  white  blood  cells,  7200 
per  cubic  millimeter.  Two  Wassermanns  were  nega- 
tive, three  weeks  apart. 

A neurological  consultant  stated  that  there  were 
no  signs  of  cranial  nerve  involvement.  He  was  not 


Fig.  1. — High  power  magnification  of 
the  organisms  within  the  brain  sub- 
stance in  Case  1.  Gram-Weigert  stain. 
Note  absence  of  tissue  reaction. 


Fig.  2. — Low  power  magnification 
of  a meningeal  tubercle  in  a sul- 
cus of  the  cerebrum,  showing  brain 
substance  on  either  side  (Case  2). 


Fig.  3. — High  power  magnification  of 
the  organisms  within  a giant  cell  in 
the  meninges  (Case  2).  Gram-Weigert 
stain. 


Chart  1. — The  Systemic  Cases  of  Torula  Infection  in  Yearly  Order  of  Publication 


340 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


C D 

s 

be— ; 

fat  a» 

64 

~d  £ 

02  3 

facts 

to 

fcC 

3 

3 ® 

® 

faC 

3 

3 fac 

*^13 

O 

lx 

03 

bC 

3 

3 

bC 

3 

3 

CD 

t-  > 
02  c 

Xm 

c3~ 

,3  3 
a 3 
o 2 

3 

— >> 

43 

bfT3 

23 

— 2= 

® £ 

u 0 

£t3 

0.  C 

-u 

23 

Ml 

+3 

23 

>> 

® 02 
bC  c 

Ctj 

o 

cn 

H E 

03 

ro 

03  t- 
X32 

5 

« 

03 

03 

e^- 

<s- 

e- 

c^. 

c £ 

O a; 

3 

3 

-H> 

3 

Oj 

T3 

Im 

w 

_3 

a 

® 

3 

'a 

E 

-2 

CD 

J3 

'a 

® 

3 

la 

^ >* 
>-JX 

s " 

00 

® 3 

03 

® ,Q 

02  3 

03 

SO 

fc£ 

CD 

Tj 

CD 

CD 

® 

® 

® 

® O 

® 

2)  3 

fa£ 

faC 

faC 

faC 

faC 

faD 

b£ 

H 

fat! 

bC 

faO 

bC 

bC 

.5  3 

3 

3 

•So 

3 

,E  a 

3 

c 

_3 

_3 

.2 

3 

3 

3 

S r 

3 

>; 

3 S( 

3 

3-~ 

3 

3 

3 

3 

3 

3 

3 

3 

03 

® s 

^23 

03 

03 

0,  O 

03 

03 

03 

03 

03 

03 

03 

03 

C3  3 

c u 

gn 

IS 

g 

Sa 

2 

S 

s 

§ 

S 

0 

g 

g 

S 

g 

g 

>> 

a 

T5 

-a 

•+-> 

3 

® 

03 

03 

03 

03 

03 

03 

CD 

03 

® s? 

oi  £ 

CD 

03 

CD 

03 

0 

O 

® 

03 

tn"o 

03  O 

® 

® 

02 

O 

s s 

O 

® 

® 

< 

>< 

>• 

>< 

H 

>*S 

z 

Z 

!>- 

1 ^ 

z 

Z 

3 

o 

6 

d 

o 

d 

d 

o' 

d 

d 

d 

d 

d 

d 

d 

6 

g 

6 

S 

S 

s 

s 

s 

d 

6 

g 

g 

d 

g 

g 

u> 

3 

<«r« 

w\ 

3s: 

3 

% 

2Jt 

Q 

eo\ 

Cl 

cc 

cc 

Cl 

cc 

Cl 

Cl 

Cl 

CC 

lO 

iO 

o 

*03 

> 

O 

O 

O 

2a 

*-> 

0 

og 

gs? 

XH 

XH 

0sS 

o o 
o o 

o 

o 

^0 

00 

A 

fat 

0 

O O 
O O 

OO 

OO 

R6? 

O O 
O O 

S3 

oo 

OTf 

o> 

oco 

^.0 

0*0 

Cl  O 

cc  1 

z 

0 

0 

OO 
o’  P" 

-to 
Cl"  GO 

>00 

CC  Tt 

o'r- 

cT  a 

rHCC 

t-  -H 

t'-  a 

a 

: 

00 

r—  — < 

H d 

-h  a 

h-  a 

« ,3 

T3 

T3 

n3 

-3 

T3 

T3 

T3 

r3 

73 

73 

3 

3 

3 

3 

3 

3 

3 

0 

3 

bt  — 

A A 

5 “ 

>> 

c n 

a 

o 

3 

Spinal  fl 
exam. 

>> 

03 

a 

o 

+3) 

3 

>» 

03 

a 

o 

3 

>> 

03 

a 

o 

3 

>> 

® 

a 

o 

3 

C3 

Is 

■3  55 

C3 

3 3 

'a  g 

CD 

a 

0 

3 

cn 

'S  3 

3 3 

'E  § 

CO 

13  g 

a >< 

CO 

Is 

■3  03 

CD 

a 

0 

XH 

3 

CO 

*3  £ 

3 3 

® 

a 

0 

3 

CC 

xx  43 

2 3 
— ^ 
'a'o 

>» 

® 

a 

0 

3 

CC 

is 

CC 

— 43 

3 b 
.2  2 

® 

a 

0 

*2* 

3 

c 

HjJ 

X'  03 

X 03 

*< 

X 03 

X 03 

X 03 

X 03 

< 

X 03 

< 

x S 

X 0 

*< 

03 

£ 

02  hb 

® 

fab 

o 

3 3 
b£ 
C 3 

o.2 

l'| 

o.2 

!'S 

1 ^ 

1 03 

>>-£ 

-o 

03 

£ ^ 

23 

_ a 

03 

c § 

u 

O 

0.  g 

s 

03 

T3 

® 

■a'l 

-0  3 
02.- 

'If 

•n_3 

11 

"3 

23 

a 

® 

CD 

3 

'£  fe 
s! 

® 

'5b 

3 

*3 

23 

a 

h5 

Sc 

03-3 

a | 

£ £ 

£ 

03  3 

03  03 

03 

03 

03 

dh 

"£ 

03 

3^ 

H S 

3*5 

H 2* 

3 O 

M 03 

o 2 
C3>S 

►£  - 

3:  — 

0 

X 

23  O' 

O £ 

3 

H 

B 0 
P a 

322 

WH 

3 

w 

22 

H 0 

g 

3 

w 

T. 

3 

3 

"s 

3 

O 

0 

2 o> 

v.  A 

n 

® 

® 23 

® 

02 

CD 

® 

CD 

® 

JA 

"a 

E 

1-3 

>>  M Q, 
J3  C3  “• 

Jgg 

u.5 

TJT-2 

•o  P 

03. £ 

® 

3 c3 

13°  g 
23  a 

3 o-  — 

03  3 

22  03  O 

8’!’i 

^ 03  ® 
23  — ® 
03.3  03 

A ® 3 
T3 

^3  e3 

§’§. 
T3  O 

23  > 

to.E 

.£ 

23  3 

03  a 

A C 
T3  3 

03 

23  g 

£ 3 

ir? 

§ S1 

TJ.S 

3.2 

3 ® 

5 a 

3 03 

03  a 

43.5 

3 x-i 
U3 

23 

£ 0 

3 b£ 

'Or, 

S 2 
23  C 
0.3 

3 ® 

"O  ^ 

41.5 

3 *J 

T3'3 

03 

23 

03 

3 

73 

43  ■ — 

23  > 

5 bt) 

•c.S 

33^ 

G ai  £ 

3 CL  3 

c3  O S 

c3  Q. 

3 — 

t- 

3 03 

3 03 

3 — 

3 0 

$ M 

3 O 

3 2 

3 C 

3 

3 r3 

03--  - 

a 

>» 

43  C3 

at  >> 

03  O 

3 

02  O 

02 

02  3 

czK 

K>U 

OH 

OccK 

SQO 

KQQ 

KU 

< 

BC 

KH 

KH 

: 0 

B> 

S> 

K« 

ffitq 

s> 

a 

03 

0 ° 

24 

cj 

3 

3 

24 

O 

O 

c3 

3 

3 

3 

3 

O 

O 

3 

3 

3 

r* 

r* 

Mass. 

A 

3 

lx 

3 

Mass. 

® 

3 

H 

o o 

02(_j 

a 

E 

0) 

o 

| 

03 

O 

s 

o 

z 

£ 

03 

£ 

cO 

a 

e3 
*“ 5 

CD 

3 

c 

O 

N 

3 

O 

Penn 

"5b 

3 

O 

S 

<D 

z 

3 

HH 

Penn 

'S 

3 

HH 

s 

<0 

z 

3 

_o 

3 

3 

3 

3 

3 

3 

3 

3 

o 

3 

u 

3 

3 

£ 

3 

3 

£ 

3 

3 

£ 

3 

3 

£ 

o3 

o 

(x 

03 

cj 

03 

03 

CD 

03 

3 

c3 

03 

® 

03 

3 

oJ 

03 

A 

O 

3 

03 

3 

03 

’lx 

03 

3 

03 

’lx 

03 

3 

03 

lx 

03 

3 

03 

02 

23 

® 

73 

3 

03 

lx 

H 

lx 

03 

03 

03 

E 

E 

a 

r-; 

E 

O 

03 

£ 

S 

£ 

b 

£ 

3 

S 

o 

o 

a 

O 

< 

< 

*-5 

O 

< 

S 

IS 

< 

< 

< 

<3 

*“5 

w 

< 

Age 

Cl 

05 

1 

- I 

I- 

CC 

0 

05 

CC 

0 

»o 

CO 

X 

CO 

-t 

O 

Tt 

to 

»o 

cc 

CO 

" 1 

•O 

Cl 

CC 

-t 

rt 

0 

IO 

Sex 

P*H 

IS 

s 

IS 

s 

S 

s 

IS 

§ 

§ 

g 

g 

L- 

Cl 

CO 

to 

CO 

Cl 

Cl 

cc 

10 

•O 

CO 

3 

Cl 

Cl 

Cl 

(M 

Cl 

CM 

Cl 

Cl 

03 

05 

05 

05 

05 

05 

05 

05 

05 

05 

C5 

05 

05 

_ 

0 

lx 

03 

73 

3 

a 

3 | 

02 

> 

3 

g 

TJ 

T3 

^3 

T3 

3 

23 

X 

3 

3 

3 

3 

3 

3 

X 

cd 

rO 

Q 

® 

3 

3 

3 

O 

> 

Turck 

Rusk 

Rusk 

Stodard  a 
Cutler 

Stodard  a 
Cutler 

Gotto 

S 

X 

Pierson 

Evans 

Evans 

Freeman 

Weidman 

Sheppe 

Bettin 

Hansman 

73 

3 

3 

*3 

02 

Wilhelm  j 

3 

3 

23 

03 

3 

>> 

P 

Rapaport 

Kaplan 

McKendr. 

Cornwall 

1 

o 

cc 

Tt 

to 

cO 

00 

05 

0 

Cl 

CC 

10 

CO 

CC 

05 

O 

Z 

T-H 

i-H 

Cl 

Chart  1. — The  Systemic  Cases  of  Tornla  Infection  in  Yearly  Order  of  Publication — Continued 


May,  1930 


TORULA — BALL 


341 


342 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Fig.  4. — High  power  magnifica- 
tion of  the  yeast-like  organisms 
from  a fibrosed  pulmonary  tuber- 
cle, Case  2.  Gram-Weigert  stain. 


Fig.  5. — Low  power  magnification  of 
peritoneal  surface  of  intestinal  wall 
in  Case  2,  showing  intense  round-cell 
infiltration  and  tubercle  formation. 
Diagonally  at  lower  left  is  intestinal 
musculature. 


Fig.  6. — Low  power  magnification  of 
a tubercle  at  the  base  of  the  intestinal 
ulcer  in  Case  2.  One  organism  is 
clearly  shown  in  the  center.  Gram- 
Weigert  stain. 


able  to  find  definite  evidence  of  an  organic  brain 
lesion.  Examination  of  the  eye-grounds  showed  no 
pathology  in  either  fundus. 

A lumbar  puncture  seven  weeks  after  admission 
produced  clear  fluid,  not  under  increased  tension. 
Further  examination  of  fluid  not  recorded.  A month 
later  his  condition  was  somewhat  worse,  and  he  died 
after  another  four  weeks.  Total  duration,  sixteen 
months. 

Postmortem  examination  limited  to  the  head  was 
performed  the  same  day. 

Pathological. — Weight  of  brain  1500  grams.  No 
meningeal  exudation.  Convolutions  not  flattened. 

In  the  left  lateral  ventricle,  projecting  from  the 
caudate  nucleus,  is  a nodular  mass,  firm  in  consist- 
ency and  having  a gray,  glairy  appearance.  It  extends 
posteriorly  over  the  floor  of  the  ventricle  to  the  lat- 
eral portion  of  the  thalamus.  It  extends  inward  and 
infiltrates  the  anterior  portion  of  the  internal  capsule. 
Section  of  the  mass  presents  a firm,  gray,  gelatinous, 
semi-translucent  surface.  It  is  well  circumscribed. 

The  shape  of  the  right  lateral  ventricle  is  normal, 
but  in  the  deeper  portion  of  the  caudate  nucleus  is 
a definitely  circumscribed  mass,  oval  in  shape  and 
having  dimensions  of  1J4  x 1 x 1 centimeter.  This 
shells  out  easily.  On  gross  section  this  corresponds 
to  the  one  on  the  opposite  side  in  appearance. 

Similar  smaller  lesions  found  in  the  left  mid-portion 
of  the  cerebellum,  the  cortex  of  the  left  temporal 
lobe,  right  frontal  lobe,  and  right  occipital  lobe.  These 
have  a “soapsuds”  appearance. 

The  organisms  are  well  demonstrated  by  Gram- 
Weigert  method.  They  are  present  in  enormous  num- 
bers, with  but  slight  evidence  of  surrounding  tissue 
reaction  except  for  a few  collections  of  lymphocytes. 
There  is  a great  variability  of  the  organisms  in  two 
respects:  their  size,  and  their  staining  reaction. 

The  smaller  organisms  have  an  azure  cytoplasm 
and  a blob  of  strongly  basophilic  matter  always  situ- 
ated eccentrically.  In  some  there  are  a number  of 
globules  circumferentially.  The  largest  organisms 
stain  strongly  and  homogeneously  with  basic  dye, 
thus  tending  to  obscure  these  globules,  but  they  can 
many  times  be  discerned.  Roughly,  they  appear  to 
vary  directly  with  the  size  of  the  organism.  All  varia- 
tions between  the  two  extremes  described  may  be 
observed. 

COMMENT  ON  CASE  I 

There  are  no  cultural  data  to  complete  this 
case,  but  it  is  so  typical  in  gross  and  microscopic 
appearance  of  the  “pseudo-tumor”  type  of  Stod- 
dard and  Cutler  as  to  be  unmistakable.  The  usual 
lesions  present  the  histolytic  phenomenon  with- 


out material  adjacent  tissue  reaction.  The  men- 
inges are  not  affected.  Clinically,  as  in  many  other 
cases,  the  diagnosis  of  encephalitis  was  made. 
Whether  or  not  other  lesions  existed  in  the  body 
is  not  known.  This  will  serve  as  a type-case, 
where  the  involvement  is  limited  to  the  brain  sub- 
stance. It  will  be  noted  in  contradistinction  to  the 
meningeal  type  that  the  spinal  fluid  cell  count  is 
not  altered.  In  the  meningeal  type,  organisms  are 
usually  abundant  in  the  spinal  fluid. 

Case  2. — On  October  5,  1928,  the  patient,  an  Eng- 
lish female  of  fifty  and  one-half  years,  entered  the 
psychopathic  ward  of  the  Los  Angeles  County  Gen- 
eral Hospital,  the  affidavit  stating  that  “this  patient 
is  in  a very  weak  physical  condition  and  at  times 
shows  marked  mental  deterioration.  She  cannot  carry 
on  an  intelligent,  connected  conversation,  but  rambles 
from  one  thing  to  another.  She  has  not  eaten  for 
three  days  and  is  in  such  condition  that  she  needs 
immediate  care  which  cannot  be  provided  at  home.” 

While  on  the  ward  she  slept  a good  deal  of  the 
time,  was  quiet,  orderly,  and  complained  of  no  pain. 
She  was  oriented  as  to  person  but  not  as  to  time  or 
place,  states  she  is  in  a “negro  hospital,”  and  that  her 
husband  will  not  give  her  anything  to  eat.  Talked 
in  a rambling  incoherent  manner.  Answered  ques- 
tions poorly.  Attempts  to  contact  the  husband  for 
more  satisfactory  history  were  unavailing. 

Examination  revealed  a somewhat  emaciated  and 
apparently  exhausted  white  female  of  middle  age, 
lying  in  bed.  A ptosis  of  the  left  eyelid  was  present. 
There  was  noted  a slight  irregularity  of  the  left  pupil, 
and  both  were  sluggish  in  their  reaction  to  light. 
Examination  of  heart,  lungs,  and  abdomen  essentially 
negative.  The  knee-jerks  were  diminished,  extremi- 
ties resistant  and  tonic.  Babinski  negative.  Urin- 
alysis and  blood  Wassermann  negative.  Spinal  punc- 
ture was  not  done.  Two  days  later  she  was  noted  to 
have  a distended  bladder,  and  300  cubic  centimeters 
of  dark  urine  with  abundant  sediment  was  removed. 
Forty-eight  hours  later  800  cubic  centimeters  were 
removed  per  catheter.  The  patient  two  days  later — 
six  days  after  admission — died  an  easy  death  while 
apparently  asleep.  Her  temperature  on  admission  was 
96.8  degrees,  pulse  108,  respiration  28.  The  tempera- 
ture remained  subnormal,  at  no  time  exceeding  98.2 
degrees  and  usually  around  97.6  degrees. 

Pathological  Report. — Autopsy  six  hours  after  death. 
Lungs  free  in  the  pleural  cavities.  In  either  lower 
lobe  was  found  a nodule  one  centimeter  in  diameter 
which  was  not  definitely  caseous,  and  appeared  dry, 
as  though  some  calcification  had  occurred.  Lungs 
otherwise  negative.  Heart  and  aorta  essentially  nega- 


May,  1930 


TORULA — BALL 


343 


live.  Liver  showed  slight 
passive  congestion  and 
beneath  the  capsule  a 
number  of  small  grayish 
white  tubercles.  The  gall 
bladder  contained  one 
large  cholesterin  stone. 
The  mucosa  was  entirely 
eroded.  A loop  of  ileum 
and  adjacent  mesentery 
presented  on  the  serosa 
numerous  small  grayish 
white  miliary  tubercles 
grossly  quite  typical  of 
tuberculous  peritonitis. 
On  opening  this  loop  of 
ileum  an  annular  ulcer 
was  seen  with  small  tu- 
bercles in  the  base.  Both 
kidneys  were  contracted 
from  a chronic  diffuse 
nephritis.  The  spleen  on 
section  showed  one  tu- 
bercle. Bladder:  Hemor- 
rhagic cystitis.  Uterus 
small;  cavity  contained 
thick  mucoid  material 
and  one  endometrial 
polyp. 

The  brain  was  some- 


Fig.  7. — A.  Surface  of  cul- 
ture from  one  of  Evans’ 
cases  reported  in  1922,  hav- 
what  adherent  to  the  ing  a smooth,  moist  yel- 


rranial  vault  nartirnlarlv  >°wish  surface  and  rather 
cranial  vault,  particularly  regular  edges.  B.  Surface 

in  the  posterior  fossa,  of  culture  of  Case  2,  show- 

The  cerebellum  was  ins  scalloped  borders  and  a 

greatly  lacerated  in  re-  dry-  wrinkled  surface. 

moval.  Over  the  surface 

of  either  cerebral  hemisphere  and  following  the 
blood  vessels,  were  seen  numerous  tubercles  hav- 
ing an  average  diameter  of  two  millimeters,  but  not 
as  discrete  and  regular  as  ordinarily  seen  in  tubercu- 
lous meningitis.  There  was  some  yellowish  mucoid 
exudate  on  the  superior  surface  of  the  cerebellum 
taken  for  smears. 


A gross  diagnosis  of  tuberculous  meningitis,  peri- 
tonitis and  enteritis  was  made  and  smears  of  the  cere- 
bellar exudate  examined  for  acid-fast  bacilli.  None 
could  be  found,  but  there  was  noted  in  the  smear 
peculiarly  distorted  retractile  bodies  simulating  yeasts. 
Sodium  hydroxid  preparations  then  revealed  many 
hyaline  encapsulated  yeast-like  organisms,  many  of 
which  were  budding.  A diagnosis  of  torula  lepto- 
meningitis was  made,  later  confirmed  by  Dr.  Newton 
Evans,  who  in  1924  reported  two  cases  from  Los 
Angeles.  Even  at  this  juncture  the  appearance  of  the 
peritoneal  lesion  seemed  so  typical  of  tuberculosis 
that  the  death  certificate  was  signed,  using  tubercu- 
lous enteritis  and  peritonitis  as  a contributory  factor. 
These  lesions  were  histologically  proved  later  to  be 
due  to  the  same  organism  as  invaded  the  meninges. 

Microscopic  examination  of  the  nodule  in  either 
lung  showed  dense  fibrosis  in  which  were  many  re- 
fractile  organisms.  Gram-Weigert  stain  was  found 
satisfactory  for  demonstrating  these,  the  refractile 
membrane  staining  blue  by  this  method.  Similar 
stains  of  the  intestine  showed  organisms  in  the  base 
of  the  ulcer  and  in  the  tubercles  of  the  serosa.  This 
last  section  showed  a very  dense  round-cell  infiltra- 
tion and  many  giant  cells,  many  of  which  could  be 
demonstrated  to  contain  organisms.  Neither  in  this 
location  nor  in  the  lung  nodules  was  a hyaline  cap- 
sule present.  In  the  meninges  the  reaction  was 
granulomatous  in  character,  there  being  many  giant 
cells,  some  very  large,  in  which  the  organisms  could 
be  seen.  The  capsules  were  best  seen  in  sodium  hy- 
droxid mounts  and  in  the  first  few  generations  in 
culture. 


Bacteriology. — With  wet  mount,  using  10  per  cent 
NaOH,  the  material  taken  directly  from  the  menin- 
geal tubercles  showed  small,  definitely  contoured 


organisms  outlined  by  a large  refractile  area,  also 
definitely  contoured.  Some  of  these  were  budding. 

The  organism  grew  readily  on  all  media.  The  first 
plants  made  on  Sabouraud’s  media  showed  a begin- 
ning growth  in  twenty-four  hours.  On  solid  media 
the  growth  has  a grayish  cream-colored  appearance, 
the  surface  being  rather  dry  and  crepe-like.  It  has  a 
tendency  to  begin  as  distinct  cup-like  colonies  which 
later  fuse  and  cover  the  whole  slant  surface.  The 
cultures  present  a yeast-like  odor.  The  colonies  are 
fairly  resistant  to  pressure  with  the  platinum  loop 
and  are  very  adherent  to  the  medium.  Wet  mounts 
show  budding  yeast-like  forms  in  clumps  and  chains, 
the  chains  at  times  presenting,  after  the  budding 
forms,  a mycelium-like  structure;  that  is,  a series  of 
buds  comes  between  the  mycelium  and  the  parent 
organism.  For  the  first  twenty-four  hours  or  more, 
reproduction  is  almost  entirely  by  budding;  after  that 
time  the  mycelia  appear,  and  from  then  on  it  would 
seem,  as  a rough  estimate,  as  though  budding  and 
mycelial  production  occur  in  about  equal  proportions. 
The  mycelia  branch,  but  neither  lateral  conidia  nor 
terminal  sporangia  have  been  observed.  The  mycelia, 
as  well  as  some  of  the  organisms,  contain  small, 
highly  refractile  bodies  exhibiting  brownian  move- 
ment. This  has  been  a constant  finding  in  transplants 
every  fifteen  days  over  a period  of  three  months. 

Growth  was  very  rapid  on  Loeffler's  blood  serum, 
and  on  glucose  agar — a little  slower  on  Sabouraud’s. 
In  a large  flask  of  liquid  medium,  the  growth  begins 
as  small  foci  scattered  through  the  medium,  having 
a very  fluffy  cotton-like  appearance,  radiating  about 
a central  core.  These  grow  to  about  two  centimeters 
in  diameter.  Later  they  sink  to  the  bottom  of  the 
flask,  and  lose  the  characteristic  appearance. 

The  organisms  are  best  studied  in  wet  mounts, 
though  they  stain  positively  by  Gram’s  method,  either 
homogeneously  and  appearing  as  aniline  oil  drop- 
lets, or  with  smaller  circumferential  globules,  similar 
to  those  seen  in  tissues.  The  organisms  are  not  acid- 
fast,  but  counterstain  more  or  less  by  the  meyiylene 
blue.  Their  size  averages  about  one-half  again  that 
of  a red  blood  cell. 

Fermentation  reactions  are  as  follows:  acid  and  gas 
in  maltose,  acid  but  no  gas  in  dextrose,  galactose, 
and  levulose,  and  only  slight  in  saccharose.  Neither 
acid  nor  gas  in  lactose  or  mannite.  This  differs  from 
the  cultures  of  one  of  Evans’  cases,  which  we  had 
for  comparison,  in  that  in  his  case,  acid  but  no  gas 
formed  in  maltose,  and  acid  was  formed  in  mannite. 


Fig;.  8. — Wet  mount  with  10  per  cent  sodium  hydroxid, 
showing  the  chains  of  budding  organisms,  some  contain- 
ing refractile  bodies.  The  lower  portion  shows  two 
mycelia. 


344 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


COMMENT  ON  CASE  2 

This  is  clinically  a case  of  torula ; histologi- 
cally an  infection  with  a yeast-like  organism ; and 
culturally,  distinct  from  any  previously  reported 
case.  It  seems,  for  the  present  at  least,  justifiable 
to  record  this  as  torula,  pending  the  possible 
accumulation  of  like  cases  and  the  establishment 
of  strict  bacteriological  criteria,  and  a more  satis- 
factory classification  of  the  fungi. 

The  unique  features  of  this  case  are  the  in- 
testinal ulceration  and  peritonitis,  never  previ- 
ously reported,  and  the  bacteriological  findings 
including  the  dry  furrowed  growth,  and  the  pro- 
duction of  some  mycelia  after  twenty-four  hours. 
The  fibrosed  nodule  in  either  lung  represents  the 
oldest  lesion  histologically,  and  therefore  the 
probable  atrium  of  infection.  There  was  no  evi- 
dent active  lesion  in  the  lungs  to  account  for  the 
intestinal  ulceration  on  the  same  basis  as  in  tuber- 
culous enteritis.  The  origin  of  the  intestinal 
lesion  is  not  apparent. 

The  cranial  involvement  was  limited  almost 
entirely  to  the  meninges  as  in  other  cases,  only 
slight  superficial  cortical  destruction  occurring 
from  contiguity. 

OBSERVATIONS  ON  COLLECTED  SERIES  OF 
SYSTEMIC  CASES 

Clinical  and  Pathological. — Of  twenty-six  sys- 
temic cases  the  ages  varied  from  thirteen  to  sixty- 
three.  Four  cases  occurred  within  the  second 
decade.  The  majority  of  cases  occurred  in  middle 
life.  The  average  age  was  41.5  years.  There 
were  nineteen  males  and  eight  females.  Two 
cases  have  been  reported  from  Germany,  one 
from  Japan,  one  from  Australia,  and  the  re- 
mainder from  the  United  States.  Racial  extrac- 
tion apparently  is  an  unimportant  factor.  Six 
cases  have  occurred  in  California,  five  in  New 
York,  three  in  Illinois,  and  others  scattered  from 
Florida  to  Massachusetts  and  the  Middle  West. 
(An  attempt  has  been  made  to  credit  the  cases  to 
the  states  from  which  the  patients  came  at  the 
time  symptoms  were  in  evidence,  and  not  neces- 
sarily the  state  from  which  the  author  reported 
them.)  Twenty-one  of  the  twenty-seven  cases 
named  severe  headache  among  their  chief  com- 
plaints. Seven  had  visual  disturbances  (failing 
vision,  diplopia,  or  nystagmus)  while  four  were 
confused  or  completely  disorientated.  Drowsi- 
ness was  mentioned  as  a prominent  symptom  in 
five  cases.  Meningitis  as  a diagnosis  was  con- 
sidered in  nine  cases — thought  to  be  tuberculous 
in  five.  Encephalitis  was  diagnosed  in  five,  ab- 
scess considered  in  four,  and  tumor  considered 
in  four.  Four  cases  were  committed  as  insane, 
in  two  of  which  a tentative  diagnosis  of  paresis 
was  made.  Another  case  (not  committed)  was 
considered  to  have  senile  dementia.  It  is  evident 
that  with  such  a bizarre  clinical  picture,  the  out- 
standing symptom  of  which  is  headache,  the  diag- 
nosis is  not  easy.  Especial  care  should  be  given 
to  spinal  fluid  cytology  in  such  obscure  cases. 
The  white  blood  count  varied  from  normal  to  a 


mild  leukocytosis.  The  polynuclear  percentage  is 
usually-  not  or  but  slightly  raised.  Three  weeks 
is  the  shortest  known  duration,  and  two  years 
the  longest.  The  average  duration  of  twenty-two 
cases  is  four  and  six-tenths  months.  Fifteen 
cases  are  below  the  average,  and  seven  cases 
above.  All  systemic  cases  have  been  fatal.  In 
four  autopsied  cases  there  was  concomitant  tuber- 
culosis of  lungs  or  peribronchial  nodes.  Twenty- 
one  of  the  known  systemic  cases  have  been  autop- 
sied either  partially  or  completely.  Ten  cases  have 
had  material  involvement  of  the  brain  or  cord 
substance;  all  hut  one  of  these  (Maner,  Case  1 
in  this  report)  also  had  meningeal  involvement. 
Ten  had  meningeal  involvement  only.  In  one 
case  (Sheppe)  there  was  no  known  central  nerv- 
ous .system  involvement.  There  were  no  clinical 
signs  and  the  head  was  not  examined.  If  we  add 
those  cases  from  which  a diagnosis  has  been  made 
from  spinal  fluid  examination  or  culture  as  being 
essentially  meningeal  in  character,  of  which  there 
are  four,  we  have  fourteen  meningeal  cases 
against  ten  cases  involving  the  brain  or  cord  sub- 
stance, nine  of  which  also  showed  meningeal  in- 
volvement. In  thirteen  autopsied  cases,  lesions 
have  been  demonstrated  or  the  organism  recov- 
ered from  other  organs  than  the  central  nervous 
system.  Of  these  thirteen  there  have  been  pulmo- 
nary lesions  in  ten,  varying  from  acute  processes 
to  those  of  healing.  The  spleen,  kidneys,  mesen- 
teric and  bronchial  glands,  and  even  the  bone 
marrow  have  been  the  sources  from  which  the 
organisms  have  been  cultured  or  demonstrated 
histologically.  A positive  blood  culture  has  been 
obtained  in  at  least  three  cases,  two  of  these  being 
at  autopsy. 

Of  the  local  cases  three  have  recovered  or  are 
arrested,  and  one  is  dead.  This  case  had  pulmo- 
nary pathology,  probably  torula  infection,  but  it 
was  not  demonstrated  to  be  such. 

There  are  two  distinct  types  of  lesion  histo- 
logically— the  granulomatous  and  the  histolytic, 
the  latter  occurring  only  within  the  brain  sub- 
stance, where  endothelial  reaction  is  minimum. 
The  meningeal  lesions  are  always  granulomatous, 
as  are  also  those  occurring  in  other  organs,  giant 
cells  and  tubercle  formation  being  prominent 
features.  In  several  cases  the  pathologist  has 
temporarily  mistaken  the  meningeal  type  for 
tuberculous  meningitis.  Polymorphonuclear  leu- 
cocytes are  absent  or  but  rarely  present  in  the 
lesions. 

Bacteriological. — In  reviewing  the  cases,  one 
is  struck  by  the  fact  that  many  of  them  are  pre- 
ceded by,  or  have  concomitantly,  an  upper  res- 
piratory infection,  particularly  sinusitis  or  otitis 
media,  but  in  very  few  of  these  cases  has  the 
organism  been  demonstrated  from  these  lesions, 
probably  because  suspicion  is  not  aroused  at  the 
opportune  time.  In  many  cases  lesions  have  been 
demonstrated  in  the  lungs,  both  of  acute  and 
chronic  nature.  At  present  there  is  nothing  to 
indicate  that  the  atrium  of  invasion  is  other  than 


May,  1930 


TORULA — BALI 


345 


respiratory.  Some  cases  of  meningeal  involve- 
ment undoubtedly  come  from  extension  through 
the  cribriform  plate  while  others,  in  all  prob- 
ability, are  hematogenous,  especially  those  like 
Case  1 of  this  report  where  the  involvement  is 
entirely  within  the  brain  substance,  the  meninges 
being  uninvolved. 

One  is  also  struck  with  the  fact  that  there  are 
many  cultural  variations  in  the  reported  cases. 
Some  start  only  on  blood  serum,  others  grow 
readily  on  all  ordinary  media.  Some  are  patho- 
genic for  laboratory  animals,  others  are  not.  A 
detailed  review  of  the  bacteriology  of  the  seven- 
teen reported  cases  is  in  process  of  compila- 
tion, and  will  be  reported  at  a later  date  together 
with  some  comparative  observations  on  available 
cultures. 

SUMMARY 

There  are  twenty-seven  known  cases  of  sys- 
temic torula  infection,  and  four  local  cases,  mak- 
ing a grand  total  of  thirty-one.  The  organisms  in 
these  cases  differ  somewhat  in  cultural  character- 
istics and  in  pathogenicity  for  laboratory  animals. 
The  infection  is  much  more  common  in  middle 
life,  and  the  most  prominent  feature  is  severe 
headache. 

CONCLUSIONS 

1.  The  diagnosis  of  tuberculous  meningitis 
should  not  be  made  by  the  pathologist  without 
the  demonstration  of  acid-fast  bacilli  in  the  men- 
ingeal exudate,  especially  in  adult  cases,  and  even 
though  ulcerative  tuberculosis  of  the  lungs  be 
present.  (Cases  1 and  2.  Chart  1,  had  pulmonary 
tuberculosis.) 

2.  There  are  probably  several  closely  similar 
organisms,  as  suspected  by  Stoddard  and  Cutler, 
which  give  rise  to  the  disease  known  as  torula, 
and  which  have  a predilection  for  the  central 
nervous  system,  and  excite  the  same  or  similar 
histological  pictures. 

3.  The  atrium  of  invasion  is  probably  in  all 
cases  the  respiratory  tract,  either  upper  or  lower. 

4.  Microscopic  study  of  the  spinal  fluid,  with 
the  possibility  of  yeast  infection  in  mind,  should 
be  done  in  obscure  neurological  conditions,  es- 
pecially when  severe  headache  is  a prominent 
symptom. 

Thanks  are  due  Miss  Bertha  Gannon  for  mate- 
rial bacteriological  assistance. 

1100  Mission  Road. 

REFERENCES 

1.  Sheppe,  W.  M. : Torula  Infection  in  Man,  Am. 
J.  M.  Sc.,  167:91-108,  January  1924. 

2.  McGehee,  J.  L.,  and  Michelson,  I.  D.:  Torula 
Infection  in  Man — Report  of  a Case,  Surg.,  Gynec. 
and  Obst.,  42:803-808,  June  1926. 

3.  Rusk,  G.  Y.,  and  Farnell,  F.  J.:  Systemic  Oidio- 
mycosis, University  of  California,  Publications  in 
Pathology,  2:47,  1912. 

4.  Stoddard,  J.  L.,  and  Cutler,  E.  C.:  Torula  Infec- 
tion in  Man,  Monographs  of  the  Rockefeller  Insti- 
tute for  Medical  Research,  No.  6,  January  31,  1916, 
pp.  1-98. 

5.  Goto,  K. : Mitt.  a.  d.  med.  Fak.  d.  k.  Univ.  Tokyo, 
15:75,  1915-1916.  Quoted  in  Wilhelmj,  C.  M.:  The 
Primary  Meningeal  Form  of  Systemic  Blastomycosis, 
Am.  J.  M.  Sc.,  169:712-721,  May  1925. 


6.  Swift,  H.,  and  Bull,  L.  B.:  Systemic  Blastomy- 
cosis, M.  J.  Australia,  2:265-26 7,  1917. 

7.  Wilhelmj,  C.  J.:  The  Primary  Meningeal  Form 
of  Systemic  Blastomycosis,  Am.  J.  M.  Sc.,  169:712-721, 
May  1925. 

DISCUSSION 

Newton  Evans,  M.  D.  (1100  Mission  Road,  Los 
Angeles). — Doctor  Ball  has  rendered  an  important 
service  in  collecting  and  presenting  in  greater  com- 
pleteness than  has  heretofore  been  done,  the  recorded 
cases  of  systemic  infection  with  the  so-called  torula. 
This  is  a group  of  cases  of  peculiar  interest  to  the 
pathologist,  the  mycologist,  and  the  neurologist. 

His  two  new  cases  each  present  features  which  are 
new.  Case  1 is  the  only  autopsied  case  presenting 
lesions  of  the  brain  substance  without  any  meningitis. 
Case  2 has  lesions  of  the  intestinal  canal  resembling 
typical  tubercles,  which  have  not  been  recorded  be- 
fore. In  this  case  also  the  morphology  of  the  organ- 
ism in  the  culture  is  unique  in  that  there  is  both  a 
typical  budding  process  and  a mycelial  formation 
seen.  I understand  that  the  mycologists  would 
classify  such  an  organism  as  Monilia. 

The  peculiar  tendency  of  systemic  torulosis  to  in- 
volve the  central  nervous  system  is  striking  and  of 
great  clinical  interest.  It  is  not  out  of  place  to  call 
attention  again,  as  has  frequently  been  done,  to  the 
importance  of  careful  microscopic  examination  of 
cerebrospinal  fluid  in  cases  of  meningitis  or  obscure 
nervous  symptoms  in  order  to  detect  the  presence  of 
these  characteristic  organisms,  which  have  frequently 
been  mistaken  for  lymphocytes  by  careless  observers. 

To  the  pathologist  and  the  mycologist  the  loosely 
related  group  of  higher  fungi  which  are  capable  of 
invading  the  human  body,  producing  lesions  of  the 
viscera  and  frequently  causing  death,  constitute  an 
important  field  of  investigation.  Among  these  we 
now  recognize  the  Coccidioid.es,  Blastomyces,  Histo- 
plasma  capsulatum  of  Darling,  and  the  Torula  his- 
tolytica of  Stoddard  and  Cutler  and  the  variety  de- 
scribed in  Case  2 of  Doctor  Ball’s  series,  classified  as 
a Monilia. 

Doctor  Ball  has  wisely  emphasized  the  confusion 
which  exists  and  the  many  efforts  at  classification 
which  have  been  made.  It  would  appear  that  Cali- 
fornia is  a fruitful  field  for  collecting  clinical  material 
for  the  study  of  many  of  these  organisms.  It  is  to 
be  hoped  that  an  organized  effort  may  be  initiated  for 
the  prosecution  of  an  extensive  study  of  this  problem 
and  that  funds  for  the  adequate  support  of  such  an 
undertaking  may  be  provided. 

* 

Willard  J.  Stone,  M.  D.  (65  North  Madison  Avenue, 
Pasadena). — I have  been  interested  in  Doctor  Ball’s 
report  of  two  instances  of  torula  infection  and  his 
summary  of  the  literature,  since  Doctor  Sturdivant 
and  I have  recently  reported  the  findings  obtained  in 
a study  of  meningoencephalitis  due  to  torula  which 
occurred  in  one  of  our  colleagues  at  the  Pasadena 
Hospital  ( Archives  of  Internal  Medicine,  October, 
1929).  We  were  not  able  to  find  as  many  authentic 
cases  in  the  literature  as  Doctor  Ball  has  reported, 
but  it  is  apparent  that  many  more  instances  must 
have  occurred  and  not  have  been  recognized  as  such 
due  to  the  absence  of  histologic  or  cultural  studies. 
The  chief  interest  in  differentiating  the  lesions  of 
torulosis  from  those  of  oidiomycosis  lies,  so  far  as 
is  now  known,  in  the  benefit  which  may  be  secured 
from  the  administration  of  iodids  in  oidiomycosis.  In 
torulosis  no  known  therapeutic  agent  has  been  found 
of  value  in  treatment.  In  torulosis  the  organisms 
have  predilection  for  the  central  nervous  system  and 
lungs,  although  the  liver,  spleen,  and  kidneys  may  be 
involved.  The  skin,  or  adjacent  mucous  membranes, 
or  bones  have  rarely  been  affected.  Pathologically, 
nodules  composed  of  giant  and  epithelioid  or  lym- 
phoid cells  with  or  without  caseation  have  been  found. 


346 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  S 


An  important  distinctive  point  has  been  that  poly- 
morphonuclear leukocytes  are  absent  in  the  nodules 
and  in  the  surrounding  exudate.  Torula  organisms 
multiply  by  budding  and  do  not  produce  endospores 
or  fermentation  of  the  sugars  in  culture,  or  mycelia 
in  tissues  or  culture.  Torula  infection  has  shown 
marked  pathogenicity  for  mice  and  rats,  while  guinea- 
pigs,  rabbits,  and  dogs  have  been  only  slightly  sus- 
ceptible. 

In  oidiomycosis  the  lesions  have  been  found  to 
involve  the  skin  and  bones,  but  they  may  involve  all 
organs.  The  central  nervous  system  has  rarely  been 
involved.  The  lesions  likewise  consist  of  nodules, 
with  or  without  caseation  or  abscess  formation,  but 
polymorphonuclear  infiltration  has  been  a more  or 
less  constant  finding.  The  organism  of  oidiomycosis 
has  been  found  but  slightly  pathogenic  for  all  experi- 
mental animals  and,  while  they  likewise  multiply  by 
budding  and  do  not  produce  endospores,  they  do  pro- 
duce fermentation  of  sugars  and  mycelia  are  devel- 
oped in  culture. 

Undoubtedly  many  cases  of  torulosis  and  oidiomy- 
cosis have  been  confused,  since  the  characteristics 
mentioned  are  not  always  distinctive.  Likewise  in 
torulosis  of  the  central  nervous  system  and  lungs 
(the  two  most  common  lesions),  tuberculosis  of  men- 
inges or  lungs,  brain  tumor,  or  epidemic  encephalitis 
must  have  been  frequently  simulated.  It  is  possible 
that  mutation  changes  may  occur  in  torula  and  oidia 
organisms  which  alter  their  cultural  and  tissue  char- 
acteristics in  ways  at  present  unknown.  In  Doctor 
Ball’s  second  case,  which  he  has  classified  as  toru- 
losis, the  organisms  multiplied  by  budding  and  pro- 
duced mycelia  in  culture  which  confuses  the  classifi- 
cation. In  Rappaport  and  Kaplan’s  case  ( Archives  of 
Pathology,  May  1926),  spinal  fluid  and  blood  cultures 
revealed  a yeast-like  organism  which  they  classified 
as  torula.  At  autopsy  repeated  attempts  to  isolate 
torula  organisms  were  unsuccessful,  but  they  then 
obtained  cultures  of  oidium-like  organisms. 

It  will  be  important  in  order  to  further  knowledge 
of  these  organisms,  for  physicians  to  report,  in  future 
cases,  the  results  of  cultural  and  tissue  studies.  A 
lumbar  puncture  should  be  done  for  culture  purposes 
in  all  instances  of  suspected  tuberculous  meningitis 
or  encephalitis.  Among  the  nineteen  cases  which 
Sturdivant  and  I believe  were  authentic  instances  of 
torulosis,  seven  were  from  California. 

’(C' 

Doctor  Ball  (Closing). — It  seems  very  evident  that 
cultural  studies  will  be  a step  forward  in  the  solution 
of  the  problem  of  torulosis.  From  a very  cursory 
examination  of  the  gross  and  wet  mount  appearance 
of  cultures  of  some  previously  reported  cases,  ac- 
quired since  this  presentation,  it  is  evident  that  the 
organisms  are  not  all  identical.  It  is  very  striking 
that  very  similar  histologic  pictures  are  produced  by 
them,  as  judged  from  the  reports. 

Anyone  who  studies  the  literature  with  care  must 
of  necessity  admit  all  cases  included  in  the  chart 
or  consider  the  authors  who  reported  them  as  in- 
capable of  proper  observation.  It  is  evident  that  if 
Stoddard  and  Cutler  include  two  specific  cases  from 
the  German  literature  as  torula,  and  another  author 
uses  the  same  cases  under  a different  name  and  re- 
ports more  like  them,  that  the  cases  are  still  torula 
though  they  may  not  be  called  such  in  the  literature 
and  though  the  decision  must  of  necessity  be  arrived 
at  by  indirect  evidence  and  reasoning. 

I contend  that  at  the  present  time  torula  disease, 
as  reported  by  many  authors  is  the  name  for  a clini- 
cal and  pathological  picture  caused  by  any  yeast-like 
fungus  affecting  the  central  nervous  system  which  is 
distinct  from  oidiomycosis  or  coccidioidal  granuloma, 
and  is  not  a well-defined  bacteriological  or  myco- 
logical  entity.  I hazard  the  opinion  that  probably 
not  more  than  50  per  cent  of  the  cases  reported  in 
the  literature  as  torula  can  be  proved  beyond  doubt 
to  be  due  to  the  Torula  histolytica  of  Stoddard  and 
Cutler.  Herein  lies  the  problem  of  this  disease. 


DUODENAL  ULCER — ITS  SURGICAL 
TREATMENT 

By  Robert  A.  Ostroff,  M.  D. 

San  Francisco 

Discussion  by  P.  K.  Gilman,  M.  D.,  San  Francisco ; 
Gunther  IV.  Nagel,  M.  D.,  San  Francisco. 

¥T  is  not  my  intention  nor  purpose  in  this  paper 

to  discuss  the  merits  or  the  indications  for  the 
medical  or  surgical  treatment  of  duodenal  ulcer, 
one  against  the  other,  nor  to  formulate  indications 
placing  these  cases  in  one  or  the  other  category. 
Given  a patient  with  a duodenal  ulcer  who  is  un- 
doubtedly one  for  surgical  treatment,  what  pro- 
cedure will  the  surgeon  follow  to  guarantee  to 
that  case  the  surest  relief  ? 

OPINIONS  NOTED  IN  THE  LITERATURE 

On  reviewing  the  literature  of  the  last  few 
years  on  the  subject  of  the  surgical  treatment  of 
duodenal  ulcer,  it  is  at  once  apparent  from  the 
voluminous  writings  that  there  exist  diversified 
opinions  as  to  the  proper  line  of  surgical  attack. 
A recent  visit  to  various  surgical  centers  in  this 
country  demonstrated  the  diverse  opinions  and 
the  variety  of  operations  performed.  The  small 
yet  increasing  number  of  American  surgeons  led 
notably  by  the  groups,  Berg  and  Lewisohn  at 
Mount  Sinai  Hospital,  New  York,  and  Strauss  of 
Michael  Reese  Hospital,  Chicago,  who  have  con- 
ducted careful  investigation  in  their  respective 
large  clinics,  shows  that  more  have  swung  into  line 
with  the  European  surgeons,  Haberer,  Finsterer, 
Neuber,  and  others,  who  hold  that  Konjetzney’s 
gastritis  is  found  whether  gastric  or  duodenal 
ulcer  be  the  cause.  In  the  treatment  of  gastric  ulcer 
the  pendulum  has  swung  toward  the  more  radical 
excision  surgery.  Aside  from  the  one  considera- 
tion that  malignancy  is  more  apt  to  develop  in 
the  gastric  ulcer,  there  is  no  reason  for  using  this 
resection  type  of  surgery  to  cure  the  disease  in 
one  case  and  not  in  the  other. 

In  the  examination  of  the  pathologic  speci- 
mens in  their  series  of  primary  subtotal  gastric 
resections  for  duodenal  ulcer,  Strauss  has  shown 
that  the  changes  are  not  confined  to  the  ulcer 
alone,  but  that  the  first  part  of  the  duodenum  and 
stomach  take  part  in  the  inflammatory  process, 
the  more  so  as  the  case  falls  under  the  classifica- 
tion of  acute  attacks,  clinically.  Occasionally  the 
entire  organ  is  involved  in  this  process  and  he 
believes  that  many  surgeons  err  in  rushing  the 
patient  to  operation  in  this  stage.  He  believes  that 
the  placing  of  the  new  stoma  in  case  of  gastro- 
enterostomy in  the  inflamed  zone,  predisposes  the 
patient  to  the  development  of  new  ulcers. 

The  cause  of  gastroduodenal  ulcer  has  been  at- 
tributed in  various  theories  to  the  use  of  non- 
absorbable suture,  the  use  of  clamps  of  crushing 
type,  and  the  inherent  tendency  to  ulcer  forma- 
tion. Operations  designed  to  do  away  with  any. 
clamps  or  use  of  nonabsorbable  sutures  have  been 
elaborately  described.  I doubt  if  these  two  fac- 
tors are  of  great  importance  since  gastrojejunal 
ulcers  are  reported  to  have  developed  in  cases 
where  both  absorbable  and  nonabsorbable  sutures 


Mav,  1930 


ULCER 


OSTROFF 


347 


have  been  used.  Some  men  report  that  they  have 
never  seen  an  ulcer  at  the  site  where  clamps  have 
been  applied.  In  one  patient,  even  two  years  after 
the  operation,  they  found  reaction  resulting  from 
the  clamps  and  marks  in  the  stomach  wall  with- 
out any  ulcers  at  these  sites. 

ETIOLOGY 

The  more  probable  causes  of  gastroduodenal 
ulcer  are  those  put  forward  by  Strauss  as  follows  : 

1.  The  pathologic  changes  not  confined  to  the 
site  of  the  ulcer  alone  but  to  the  adjacent  first 
part  of  the  duodenum  and  stomach. 

2.  Physical  and  chemical  irritation  associated 
with  digestion,  demonstrated  in  cases  where  the 
duodenum  is  found  healed  following  gastro- 
enterostomy. 

3.  Leaving  the  involved  tissue  intact  at  opera- 
tion. 

To  offset  these  causes  of  ulcer  formation  fol- 
lowing gastro-enterostomy,  he  advises,  first,  not 
to  rush  the  patient  to  the  operating  room  after 
admission  to  the  hospital,  but  to  allow  time  for 
the  inflammatory  process  to  subside  in  all  cases 
except  that  of  perforation,  or  at  least  to  allow 
the  surrounding  inflammation  and  edema  of  an 
acute  nature  to  improve  and  in  many  cases  to 
refrain  from  placing  the  new-formed  opening  in 
inflamed  tissue ; second,  to  use  an  operation  which 
will  give  the  stomach  a rapid  emptying  time, 
allowing  for  no  accumulation  and  action  of  acids 
formed ; third,  to  remove  all  involved  tissue. 

The  ideal  surgical  operation  is  the  one  which 
will  give  the  patient  the  most  relief  from  his  dis- 
ease, leaving  the  organs  nearest  their  normal 
anatomic-pathological  state.  Many  factors,  and 
especially  that  of  surgical  risk,  influence  surgeons 
in  their  choice  of  surgical  procedure.  As  Horsley 
says,  it  depends  not  only  on  the  character  of  the 
lesion,  but  to  some  extent  on  the  technical  choice 
of  tae  surgeon.  The  one  who  performs  partial 
gastrectomy  skillfully  may  wisely  lean  more  to 
thici  operation  than  the  surgeon  who  infrequently 
does  a partial  gastrectomy  and  who  prefers  a 
gastro-enterostomy  or  a pyloroplasty.  This  I be- 
lieve is  the  crux  of  the  situation.  Gastro-enteros- 
tomy with  or  without  ulcer  excision,  pyloroplas- 
ties of  this  or  that  type,  plications  and  section  of 
the  pylorus  combined  with  gastro-enterostomy,  all 
have  their  advocates.  Many  surgeons  are  adher- 
ents of  some  special  type  of  operation  because 
their  surgical  abilities  are  limited  to  one  or  the 
other  methods  and  they  have  not  attempted  or 
fear  to  do  radical  or  near  radical  surgery. 

INDICATIONS  FOR  SURGICAL  TREATMENT 

There  are  at  least  four  conclusive  or  definite 
indications  for  surgical  treatment  of  duodenal 
ulcer : continuous  pain ; hemorrhage,  especially 
if  profuse  and  recurrent;  obstruction,  and  per- 
foration. 

And  we  might  add,  no  improvement  in  a rea- 
sonable period  of  medical  regimen,  say  six  to 
eight  weeks. 

In  cases  of  resection  of  the  stomach  for  condi- 
tions other  than  ulcer,  no  matter  what  suture 


material  had  been  used,  whether  absorbable  or 
nonabsorbable;  whether  clamps  had  been  applied; 
whether  low  or  high  resection  had  been  done,  or 
where  the  gastro-enterostomy  had  been  placed, 
there  has  never  been  a gastrojejunal  ulcer  re- 
ported. The  inflammatory  process  in  the  stomach 
and  duodenum  and  the  remaining  acidity  are  ap- 
parently major  factors  in  the  relief  of  peptic 
ulcer.  In  a recent  article  Elman  says  many  ob- 
servers note  the  relief  of  symptoms  usually  in 
those  patients  who  after  operation  persistently 
show  a low  or  absent  gastric  acidity.  In  1909 
Wilcox  showed  that  the  gastric  contents  follow- 
ing simple  gastro-enterostomy  were  far  less  acid 
than  before  and  contained  bile  constantly.  Simi- 
lar occurrences  were  reported  by  Bohmansson. 
He  added,  however,  that  this  anacidity  tends  to 
disappear  in  the  course  of  months  or  years,  which 
may  account  for  the  recurrence  of  symptoms  in 
many  patients.  In  his  analysis  of  cases  of  gastric 
resection,  on  the  other  hand,  he  found  an  almost 
complete  and  permanent  disappearance  of  acid  in 
the  gastric  contents  after  operation.  Klein  re- 
ported similar  findings.  Elman  concludes  that 
reduction  of  gastric  acidity  is  a normal  and,  prob- 
ably, an  essential  phenomenon  which  takes  place 
through  the  reflux  of  the  alkaline  pancreatic  juice 
into  the  stomach.  Bile,  being  acid  rather  than 
alkaline  cannot  be  active  in  causing  this  neutrali- 
zation. In  applying  the  principles  here  stated, 
clinically  it  can  be  seen  that  any  operation  which 
creates  an  opening  large  enough  to  exclude  any 
danger  of  its  narrowing,  and  which  allows  free 
regurgitation  of  duodenal  and  pancreatic  secre- 
tion into  the  stomach,  is  the  logical  procedure  to 
employ.  The  work  of  Olch  showed  that  a Finney 
pyloroplasty  hastens  gastric  neutralization.  There- 
fore any  widening  of  the  pyloric  opening  might 
suffice  if  this  were  the  only  requisite  for  the  relief 
of  duodenal  ulcer.  Patients  with  duodenal  ulcer 
have  been  shown  to  have  a marked  delay  in  neu- 
tralization of  the  test-meal  of  300  cubic  centi- 
meters of  0.5  per  cent  HC1.  Gastric  resection,  on 
the  other  hand,  provides  a wide  communication 
between  the  stomach  and  the  portion  of  the  duo- 
denum or  jejunum  chosen  and  in  addition  re- 
moves the  tissues  involved  in  the  inflammatory 
process  as  well  as  multiple  ulcerations  which  may 
be  present  and  easily  overlooked. 

To  the  younger  surgeon,  away  from  large 
medical  centers  and  without  the  aid  of  consulta- 
tion with  experienced  older  surgeons,  it  is  indeed 
a question  not  easily  solved  to  decide  the  proper 
surgical  procedure  to  follow,  in  order  that  his 
patient  with  duodenal  ulcer  may  have  the  great- 
est chance  for  complete  relief  from  operation. 
Should  he  subject  the  patient  to  a greater  risk 
by  undertaking  more  radical  surgery  of  resection, 
to  give  him  assurance  of  a more  lasting  and  surer 
relief  from  his  symptoms,  as  advocates  of  these 
methods  claim ; or,  on  the  other  hand,  would  it 
be  better  to  do  merely  a gastro-enterostomy  with 
not  so  great  an  immediate  risk  and  take  the  word 
of  its  proponents  that  relief  will  follow  in  a large 
per  cent  of  cases  ? 


348 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


The  advocates  of  extensive  partial  gastric  re- 
section for  nearly  all  types  of  duodenal  ulcer, 
even  small  uncomplicated  ulcers  recurrent  after 
medical  treatment,  seem  to  many  as  perhaps 
overzealous  in  their  attempts  at  cure.  The  inci- 
dence of  development  of  gastroduodenal  ulcers 
following  gastro-enterostomy  is  quoted  by  vari- 
ous workers  as  being  present  in  2 to  34  per 
cent  of  cases,  probably  each  man’s  conclusions 
being  affected  markedly  by  his  argument  for  the 
particular  attitude  he  assumes  as  to  this  type 
of  surgery.  The  percentage  of  cures  following 
gastro-enterostomy  and  similar  procedures  is 
given  variously  at  50  to  85  per  cent. 

Many  prominent  and  able  surgeons  advocate, 
and  rightly  to  a large  degree,  that  each  case  is 
a problem  unto  itself  and  no  operation  should  be 
regarded  as  standard  for  all  cases  of  duodenal 
ulcer. 

Horsley  says  that,  aside  from  malignant  con- 
ditions, the  proper  field  for  partial  gastrectomy 
cannot  be  definitely  laid  down,  and  that  it  de- 
pends not  only  on  the  character  of  the  lesion,  but 
to  some  extent  on  the  technical  choice  of  the  sur- 
geon. The  solution  as  to  the  proper  surgical  treat- 
ment of  duodenal  ulcer  can  only  be  reached  by 
a consideration  of  the  degree  of  success  reached 
by  investigators  in  clinics  that  handle  large  num- 
bers of  cases.  The  increased  number  of  careful 
and  able  surgeons  who  perform  partial  gastric 
resection  for  duodenal  ulcer  would  indicate  the 
worth  of  this  type  of  operation. 

516  Sutter  Street. 

DISCUSSION 

P.  K.  Gilman,  M.  D.  (2000  Van  Ness  Avenue,  San 
Francisco). — The  operative  treatment  of  duodenal 
ulcer  is  not  a routine  matter.  Each  case  must  be  sub- 
jected to  careful  study,  and  the  proper  surgical  treat- 
ment depends  upon  this  study  and 'a  further  study  of 
the  situation  found  when  the  abdomen  is  opened. 

Of  equal  importance  with  the  operative  procedure, 
no  matter  how  limited  or  how  extensive  this  has 
been,  is  the  immediate  and  remote  after-care  and 
medical  supervision  of  the  patient.  Too  often  is  this 
neglected  and  a probable  good  result  is  allowed  to 
become  a poor  one,  bringing  surgery  into  disrepute. 

Surgery  is  indicated  in  cases  of  duodenal  ulcer 
where  there  is  recurring  hemorrhage,  acute  perfora- 
tion, chronic  obstruction,  or  where  medical  treatment 
has  yielded  no  results. 

In  cases  of  ulcer  with  bleeding  I feel  one  should 
be  very  conservative  in  recommending  surgery.  It 
should  be  used  only  in  those  cases  where  proper 
medical  measures  have  failed. 

In  acute  perforation  it  is  a good  rule  to  limit  surgi- 
cal activity  to  the  relief  of  the  immediate  condition. 
If  simple  closure  of  the  perforation  may  be  accom- 
plished without  encroaching  upon  the  lumen  of  the 
duodenum,  this  is  the  procedure  of  choice,  otherwise 
gastro-enterostomy  should  be  added. 

In  certain  clinics  in  this  country,  extensive  resec- 
tion for  duodenal  ulcer  is  practiced  as  against  the 
simpler  procedure  of  gastro-enterostomy,  which  is  in 
more  general  use.  In  Europe  resection  is  even  more 
popular  than  in  America.  What  is  accomplished  by 
any  form  of  treatment  in  ulcer  of  the  duodenum  will 
not  be  clear  until  the  etiology  is  known. 

In  general  the  least  surgery  that  will  accomplish 
certain  results  is  best.  Adequate  drainage  of  the 
stomach  is  important.  This  may  be  accomplished  by 
a properly  placed  and  formed  gastro-enterostomy.  In 
cases  of  pyloric  stenosis  this  alone  is  usually  suffi- 
cient. A certain  percentage  of  secondary  ulcers  form 


following  gastro-enterostomy,  especially  in  high- 
strung  patients.  Removal  of  a duodenal  ulcer  and 
placing  the  pyloric  sphincter  at  rest  is  followed  by 
excellent  results  in  those  cases  with  the  ulcer  readily 
presenting.  ^ 

Gunther  W.  Nagel,  M.  D.  (2000  Van  Ness  Avenue, 
San  Francisco). — The  cause  of  duodenal  ulcer  is  not 
known  and,  therefore,  the  treatment  has  not  been 
placed  upon  an  absolutely  sound  basis.  As  Doctor 
Ostroff  states,  there  are  various  methods  of  pro- 
cedure in  the  treatment  of  duodenal  ulcer,  each  with 
its  own  strong  adherents. 

Duodenal  ulcer  is  a combined  medical  and  surgical 
problem.  Medical  treatment  is  effective  in  many  cases, 
but  is  not  entirely  without  danger.  Hemorrhage  and 
perforation  occasionally  occur  while  the  patient  is 
under  medical  treatment. 

Radical  resection  in  cases  of  duodenal  ulcer  has 
not  gained  in  popularity  during  the  last  few  years. 
Gastrojejunal  ulceration  occasionally  follows  gastric 
resection  for  duodenal  ulcer.  The  mortality  follow- 
ing resection  even  in  the  best  hands  is  greater  than 
that  of  conservative  procedures. 

A properly  placed  gastro-enterostomy  gives  excel- 
lent results  especially  when  there  is  obstruction  at 
the  pylorus.  Were  it  not  for  the  occasional  occur- 
rence of  gastrojejunal  ulceration  following  gastro- 
enterostomy, this  operation  would  leave  little  to  be 
desired.  The  various  forms  of  pyloric  exclusion  are 
not  satisfactory  and  are  followed  by  an  increase  in 
the  occurrence  of  jejunal  ulcers. 

Partial  duodenectomy  together  with  excision  of  the 
anterior  portion  of  the  pyloric  sphincter  muscle  gives 
excellent  results  in  properly  selected  cases,  and  is  an 
absolute  protection  against  the  occurrence  of  jejunal 
ulceration.  It  is  the  operation  of  choice  in  cases  com- 
plicated by  hemorrhage.  Its  application  is  limited 
for  technical  reasons;  it  should  be  done  only  in  those 
cases  where  the  lesion  is  readily  accessible  and  the 
tissues  can  be  united  without  tension. 

* 

Doctor  Ostroff  (Closing). — I wish  to  express  my 
appreciation  to  Doctors  Gilman  and  Nagel  for  their 
constructive  criticism  and  discussion  of  the  salient 
features  of  this  paper. 

Until  the  etiology  of  this  disease  is  known  no  pro- 
cedure will  have  a scientific  basis,  but  its  value  can 
only  be  judged  by  its  effectiveness  in  giving  the 
greatest  amount  of  relief  or  cure.  We  have  the  re- 
sults achieved  by  surgical  clinics  in  which  large  num- 
bers of  duodenal  ulcers  are  operated,  and  it  is  upon 
these  statistics  that  surgeons  may  judge  the  relative 
worth  of  the  many  operations  devised  for  this  disease. 

Doctor  Nagel  says  that  the  occasional  occurrence 
of  gastrojejunal  ulcer  is  all  that  stands  in  the  way 
of  gastro-enterostomy.  Many  large  clinics  report  this 
occurrence  in  as  many  as  30  to  34  per  cent  of  cases 
and  this  Is  undoubtedly  too  high  to  give  this  opera- 
tion choice  over  most  other  procedures.  The  cure  of 
the  disease  by  the  simpler  operation  of  gastro-enteros- 
tomy has  not  achieved  the  pinnacle  of  success  when 
this  is  quoted  by  various  authorities  as  ranging  from 
50  to  85  per  cent.  This  is  a wide  variance  of  results 
and  indicates  that  gastro-enterostomy  has  fallen  far 
short  of  its  goal  since  it  has  had  the  greatest  test  of 
all  operations,  particularly  in  America,  where  it  has 
been  more  widely  used.  How  much  larger  the  per- 
centage of  occurrence  of  jejunal  ulcer  would  be  or 
the  development  of  a vicious  circle  or  the  number 
of  cases  in  which  relief  of  the  ulcer  by  gastro-enteros- 
tomy failed,  we  can  only  surmise.  If  the  results  of 
cases  operated  at  large  by  the  army  of  surgeons  in 
America  could  be  obtained  instead  of  simply  those 
of  well-trained  surgeons  in  the  larger  clinics,  our 
knowledge  of  the  subject  would  be  more  complete. 

In  a recent  report,  Elman  is  attempting  to  study 
the  success  attained  in  various  types  of  operations 
for  the  relief  of  duodenal  ulcer  by  measuring  the  rate 
of  acid  neutralization,  the  principle  upon  which  the 
success  of  such  operations  depends.  He  contends  that 
the  rate  of  neutralization  is  the  important  factor. 


May,  1930 


GASES — BAXTER 


349 


ANESTHETIC  GASES* 

THEIR  PURIFICATION  AND  STANDARDIZATION 

By  Donald  E.  Baxter,  M.D. 

Glendale 

HTHE  savant,  Dr.  Horace  Wells,  if  permitted 

to  view  present-day  methods  of  gas  manufac- 
ture, would  be  appalled  at  his  own  audacity  in 
foisting  so  crude  an  anesthetic  on  an  unsuspect- 
ing public;  and  yet  a full  half  century  elapsed 
before  any  real  improvements  had  been  made  in 
the  method  of  gas  manufacture. 

It  is  a well-known  fact  that  the  essential  prob- 
lems of  purification  were  not  considered  of  suffi- 
cient moment  to  attract  the  attention  of  chemists 
or  research  men,  but  were  solved,  or  partially 
solved,  in  a practical  way  by  the  various  manu- 
facturers. 

Such  men  as  Slides,  French,  Clark,  Francis 
Cheney  and  Johnson  have  been,  in  the  main,  re- 
sponsible for  many  of  the  refinements  which  have 
made  nitrous  oxid  a safe  and  sane  anesthetic. 

MANUFACTURING  METHODS  AND  PRODUCTS 

The  conversion  of  raw  materials  into  a finished 
anesthetic  gas  embraces  many  and  varied  compli- 
cated procedures  and  each  manufacturer  employs 
methods  in  which  modesty  seemingly  plays  but 
a small  part  when  it  comes  to  advertising  his 
wares.  However,  be  that  as  it  may,  the  gas  which 
you  use  today  is  to  all  practical  intents  and  pur- 
poses a good  product,  and  great  credit  is  due  the 
manufacturers  for  their  work  during  the  last 
decade. 

In  order  to  thoroughly  appreciate  the  gradual 
improvement  in  medical  gases,  one  has  only  to 
go  back  a short  ten  years.  It  was  a common  ex- 
perience at  that  time  to  open  a valve  and  be 
greeted  with  a dense  cloud  of  white  fumes,  or 
possibly  the  brown  fumes  of  nitric  acid,  which 
brought  offense  to  all  within  its  reach.  All  gas 
was  wet,  and  to  a point  where  no  one  expected  a 
smooth  flow  without  the  addition  of  electric  heat- 
ers or  hot-water  bags  to  thaw  out  the  cylinders. 

Toxic  by-products,  accumulative  in  nature,  pro- 
hibited extended  anesthesia.  It  was  a brave  per- 
son who  dared  give  straight  gas  throughout  a long 
operation.  As  late  as  1920,  a prominent  eastern 
physician  and  hospital  executive,  who  operated  a 
small  institution,  informed  me  that  at  frequent 
intervals  they  had  experienced  anesthetic  difficul- 
ties due  to  some  unknown  by-products.  Their 
patients,  after  a brief  time,  exhibited  an  ashen 
pallor,  the  respiration  was  shallow  and  then  im- 
perceptible, and  death  would  have  resulted  if  the 
gas  had  been  continued.  Forced  oxygen,  respira- 
tory or  heart  stimulants  showed  no  beneficial  re- 
sults. Later  it  was  found  the  trouble  was  caused 
by  hydrazines  which  had  not  been  removed,  due 
to  inefficient  purifying  solutions.  Today  modern 
methods  of  production  have  entirely  eliminated 
the  possibility  of  such  contamination. 

Nitrous  pentoxid  was  frequently  encountered, 
and  I have  had  the  unique  experience  of  actually 

* Read  before  the  Anesthesiology  Section  of  the  Cali- 
fornia Medical  Association  at  the  Fifty-Eighth  Annual 
Session,  at  Coronado,  May  6-9,  1929. 


photographing  the  brown  fumes  as  they  were  re- 
leased from  the  cylinder.  Fortunately  the  fumes 
from  such  cylinders  were  so  acrid  and  irritating 
that  they  could  not  be  inhaled  and  were  recog- 
nized before  causing  serious  complications. 

A careful  analysis  of  the  manufacturers’  prob- 
lems proved  conclusively  the  need  of  adequate 
laboratory  facilities,  not  only  for  plant  control 
but  as  a factor  in  the  solution  of  the  many  prob- 
lems connected  with  gas  purification.  The  need 
for  standard  specifications  of  raw  products  was 
also  necessary.  With  the  advent  of  scientific 
methods  came  the  demand  for  well-trained,  intelli- 
gent, and  conscientious  employees,  who  are  now 
an  important  factor  of  gas  production,  sales,  and 
service. 

OBLIGATION  OF  CARE  IN  MANUFACTURE 

It  is  logical  to  suppose  that  all  medical  gases, 
including  nitrous  oxid,  ethylene,  oxygen  and  car- 
bon dioxid,  are  as  important  to  the  patient,  to  the 
surgeon,  and  the  anesthetist,  as  any  potent  drug 
or  chemical  used  in  the  hospital  or  laboratory. 
Not  only  are  the  reputations  of  the  operator  and 
the  anesthetist  at  stake,  but  the  life  of  the  patient, 
which  is  of  a greater  importance,  must  be  taken 
into  consideration.  Therefore  it  behooves  the 
medical  fraternity  to  demand  the  highest  possible 
standards  from  the  manufacturers. 

It  is  not  enough  to  know  that  an  anesthetic  gas 
is  usually  good,  or  is  fairly  consistent  in  its 
purity.  The  surgeon  must  at  all  times  be  assured 
of  a standard  product,  a product  that  will  give 
consistent  results  and  never  vary  in  any  way.  To 
this  end  the  profession  must  demand  a chemical 
analysis  covering  the  content  of  each  and  every 
cylinder.  Such  an  analysis  should  specifically 
state  the  exact  purity  of  the  gas,  the  percentage 
of  moisture  present,  and  in  addition  a statement 
covering  each  individual  impurity  common  to  the 
gas  in  question.  This  procedure  does  not,  in  the 
long  run,  work  a hardship  on  the  manufacturer, 
but  serves  to  create  additional  confidence  in  his 
product,  and  consequently  greater  sales. 

Such  a procedure  may  be  considered  by  many 
to  be  an  unnecessary  refinement,  inasmuch  as 
there  is  no  record  of  a single  fatality  directly 
traceable  to  nitrous  oxid  gas  produced  by  either 
of  the  two  companies  now  operating  on  the  Pa- 
cific Coast.  One  cannot  say  as  much  for  the  “fly 
by  night,  stock-selling  institutions”  that  have  in- 
vaded the  field  in  past  years. 

There  are  several  obvious  reasons  why  a chemi- 
cal analysis  is  most  necessary.  Whenever  per- 
sonal equation  enters  into  production  work  there 
is  always  the  liability  of  failure — a leaky  or  acid- 
corroded  tower  pipe  which  would  permit  the  raw 
gas  to  escape  directly  into  the  storage  tanks ; an 
error  of  one  decimal  point  in  the  calculations  of 
acid  or  lye  strength  might,  if  not  checked  up  by 
the  plant  control  laboratory,  result  disastrously  to 
every  one  concerned.  It  is  true  that  most  acci- 
dents of  the  kind  are  discovered  at  once.  How- 
ever, without  proper  chemical  control,  there  is 
always  the  possibility  of  a coroner’s  verdict  being 
the  first  indication  of  plant  failure  to  live  up  to 


350 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


proper  standards.  All  medical  gases  should  be 
included,  but  more  especially  nitrous  oxid,  and 
ethylene.  Oxygen  should  be  certified  as  to  purity, 
inasmuch  as  a slight  air  or  nitrogen  dilution  is 
productive  of  inconsistent  results.  In  addition 
moisture  tests  are  very  important,  inasmuch  as 
this  gas  is  compressed  with  soap  water  as  a lubri- 
cant. Frequently  the  cylinders  will  contain  a 
quantity  of  accumulated  rancid  soap  water,  which 
has  in  many  instances  produced  an  acute  per- 
sistent nausea. 

SPECIFIC  RECOMMENDATIONS 

Much  could  be  written  on  medical  gas  purifi- 
cation and  plant  management.  I shall  mention 
only  those  points  which  are  of  interest  to  anes- 
thetists, and  which  in  the  main  should  apply  to 
the  production  of  all  gases. 

The  progressive  producer  exerts  constant  vigi- 
lance and  keeps  close  tab  on  cylinders,  as  they 
represent  not  only  a huge  investment,  but  their 
condition  as  regards  cleanliness  and  appearance 
is  indicative  of  either  good  or  poor  management. 
Cylinders  should  be  washed,  steam-cleaned,  and 
repainted  on  each  return  to  the  factory.  Espe- 
cially during  the  past  few  years  during  which 
ethylene  has  come  into  general  use,  as  there  is 
always  a real  danger  due  to  back  pressures 
causing  an  interchange  of  gas  from  one  cylinder 
to  another. 

Routine  washing  and  steaming  removes  all  gas, 
traces  of  grease,  soap  water  and  scale,  leaving  the 
container  absolutely  clean  and  dry.  The  removal 
of  the  iron  scale  and  rust  is  in  itself  of  great 
value,  inasmuch  as  fully  90  per  cent  of  all  valve 
trouble  on  gas-oxygen  machines  was  caused  from 
that  source. 

Cylinder  valves,  on  each  return  to  the  factory, 
should  be  removed  from  the  cylinder,  taken  apart, 
repaired  and  inspected  before  replacing,  thus 
avoiding  the  inconvenience  and  expense  of  leak- 
age. 

All  raw  products  used  in  the  preparation  of 
medical  gases  should  be  produced  or  purchased 
under  the  most  rigid  chemical  and  physical  specifi- 
cations, and  price  should  not  be  a deciding  factor. 

In  the  case  of  nitrous  oxid,  only  the  best  grades 
of  ammonium  nitrate  should  be  used.  Low  grade, 
cheap  nitrates  are  always  a source  of  danger,  not 
only  to  the  manufacturer  but  to  the  consumer. 

All  chemicals  entering  into  neutralizing  washes 
should  be  of  standard  grade,  the  solutions  should 
be  titrated  to  a definite  standard  which  will  create 
a safety  factor  that  will  be  ample  to  remove  all 
impurities.  These  solutions  should  receive  rou- 
tine analysis  and  a definite  strength  should  be 
maintained. 

Moisture  content  plays  an  important  role  and 
the  modern  plant  must  be  equipped  with  appa- 
ratus which  will  efficiently  reduce  the  moisture  to 
a point  where  the  gas  will  flow  smoothly  and  with- 
out freezing.  The  plant  chemist  is  indispensable, 
as  every  run  of  gas  necessitates  not  only  careful 
supervision,  but  an  exact  moisture  determina- 
tion. The  moisture  content  of  medical  gases  under 
ordinary  conditions  of  temperature  and  pressure 


within  the  cylinder  should  not  contain  over  .009 
per  cent  of  water,  consequently  the  driers  must 
receive  careful  and  costly  attention. 

Chemical  analysis  is  the  last  and  most  impor- 
tant procedure  in  the  manufacture  of  all  medical 
gases.  It  is  true  that  there  are  many  successful 
manufacturers  throughout  the  country  who  rely 
upon  physical  findings  of  their  gas,  such  as  odor 
and  color  tests.  However,  I feel  that  the  personal 
satisfaction  derived  from  routine  laboratory  find- 
ings is  well  worth  the  time  and  expense  involved. 

With  the  advent  of  higher  standards  of  produc- 
tion an  adequate  method  of  gas  analysis  covering 
the  entire  field  in  question  has  been  gradually  per- 
fected. The  necessary  apparatus  has  been  com- 
bined into  a single  unit,  thus  increasing  the  accu- 
racy and  decreasing  the  time  factor  for  complete 
determinations. 

In  conclusion,  I wish  to  impress  the  advis- 
ability of  demanding  higher  standards  in  the 
manufacture  of  anesthetics  as  well  as  a routine 
analysis  of  each  and  every  cylinder. 

Box  577,  Glendale. 


THE  LURE  OF  MEDICAL  HISTORY 


HIPPOCRATIC  MEDICINE* 

PART  III 

By  Lancley  Porter,  M.  D. 

San  Francisco 

HPHAT  surgery,  even  among  primitive  men, 
should  have  been  practical  and  rational,  is  not 
to  be  wondered  at.  A combatant  drops  a rock  on 
the  head  of  his  enemy ; on  the  hunting  field  a 
wild  boar  or  an  angry  stag  gores  the  hunter ; 
among  the  hazards  of  daily  life  are  sprains, 
bruises  and  fractures  from  numerous  causes. 
Such  injuries,  it  was  apparent  to  the  simplest 
mind,  were  caused  by  calculable  forces.  Equally 
apparent  was  the  fact  that  cleanliness,  soothing 
applications  and  manipulative  measures  were 
helpful. 

Up  to  the  fifties  of  the  nineteenth  century,  when 
Astley  Cooper  restudied  the  subject  of  fractures 
and  dislocations,  there  was  no  guide  for  their 
treatment  other  than  the  Hippocratic  directions 
and  these  had  been  in  effective  use  for  nearly 
twenty  centuries.  And  in  spite  of  x-rays  and 
modern  ingenuities,  even  orthopedic  surgeons 
might  be  stimulated  to  thought  by  a study  of  the 
Hippocratic  methods  of  reducing  dislocations. 
The  treatment  of  shoulder  dislocations  is  among 
the  most  interesting  to  read. 

In  Hippocratic  times,  dislocations  were  com- 
mon ; in  those  days  athletic  games  were  generally 
indulged  in,  because  bodily  development  through 
gymnastics,  particularly  wrestling,  and  its  care 
through  the  free  use  of  water  and  sun  baths,  was 
considered  the  major  prophylaxis  against  disease. 
The  centers  for  athletics  were  called  palaestrae 
and  each  palaestra  had  its  own  physician-director 
who  soon  became  skilled  in  the  treatment  of  frac- 
tures and  dislocations. 

*Read  before  the  San  Francisco  County  Medical  Society, 
January  14,  1930. 

Part  II  was  printed  in  the  April  issue. 


May,  1930 


1 1 1 PPOCRATIC  MEDICI  N E — PORTER 


351 


Other  physicians,  attached  to  armies,  became 
adept  in  the  care  of  wounds,  and  the  fact  that 
Greeks  were  adventurous,  given  to  following  the 
sea  and  to  voyaging  into  far  countries,  as  well 
as  the  custom  of  slave-holding,  brought  about  the 
development  of  industrial  surgery  on  a scale  that 
would  gladden  some  of  our  present-day  accident 
hounds.  I shall  quote  from  some  of  tbe  Hippo- 
cratic writings  on  surgery  rendered  in  the  third 
volume  of  W.  H.  S.  Jones’  edition  of  the  Corpus. 
The  mode  of  thought  used  by  the  writers  is  strik- 
ingly like  our  own — allowing  for  the  fact  that 
the  impossibility  of  human  dissection  robbed  them 
of  any  chance  of  acquaintance  with  the  details 
of  intermediate  anatomy.  That  the  Greeks  of 
those  days  were  thorough  masters  of  surface 
anatomy  is  testified  to  by  their  wonderful  sculp- 
tures of  the  human  body  as  well  as  by  tbe  vase 
paintings  showing  the  activities  of  warriors  and 
revelers.  The  following  fragment  illustrates  their 
teaching  in  regard  to  dislocations  of  the  shoulder : 

“Those  who  have  frequent  dislocation  of  the  shoul- 
der are  usually  able  to  put  it  in  for  themselves.  For 
by  inserting  the  fist  of  the  other  hand  into  the  arm- 
pit  they'  forcibly  push  up  the  head  of  the  bone,  while 
they  draw  the  elbow  to  the  chest.  And  a practitioner 
would  reduce  it  in  the  same  way  if,  after  putting  his 
fingers  under  the  armpit  inside  the  head  of  the  dis- 
located bone,  he  should  force  it  away  from  the  ribs, 
thrusting  his  head  against  the  top  of  the  shoulder  to 
get  a point  of  resistance,  and  with  his  knees  thrusting 
against  the  arm  at  the  elbow,  should  make  counter- 
pressure towards  the  ribs— — it  is  well  for  the  operator 
to  have  strong  hands — or,  while  he  uses  his  hands 
and  head  in  this  way,  an  assistant  might  draw  the 
elbow  to  the  chest.”  . . . 

“There  is  also  a way  of  putting  in  the  shoulder  by 
bringing  the  forearm  on  to  the  spine,  then  with  one 
hand  turn  upwards  the  part  at  the  elbow,  and  with 
the  other  make  pressure  from  behind  the  joint.  This 
method  and  the  one  described  above,  though  not  in 
conformity  with  nature,  nevertheless,  by  bringing 
round  the  head  of  the  bone,  force  it  into  place.” 

The  writer  goes  on  with  the  following  criticism : 

“The  theorizing  practitioners  are  just  the  ones  who 
go  wrong.  In  fact  the  treatment  of  a fractured  arm 
is  not  difficult,  and  is  almost  any  practitioner’s  job, 
but  I have  to  write  a good  deal  about  it  because  I 
know  practitioners  who  have  got  credit  for  wisdom 
by  putting  up  arms  in  positions  which  ought  rather 
to  have  given  them  a name  for  ignorance.  And  many 
other  parts  of  the  art  are  judged  thus:  for  they  praise 
what  seems  outlandish  before  they  know  whether  it 
is  good  rather  than  the  customary  which  they  already 
know  to  be  good;  the  bizarre  rather  than  the  obvious. 
One  must  mention  then  those  errors  of  practitioners 
as  to  the  nature  of  the  arm  on  which  I want  to  give 
positive  and  negative  instruction,  for  this  discourse 
is  an  instruction  on  other  bones  of  the  body  also. 

“To  come  to  our  subject,  a patient  presented  his 
arm  to  be  dressed  in  the  attitude  of  pronation,  but 
the  practitioner  made  him  hold  it  as  the  archers  do 
when  they  bring  forward  the  shoulder,  and  he  put  it 
up  in  this  posture,  persuading  himself  that  this  was  its 
natural  position.  He  adduced  as  evidence  the  paral- 
lelism of  the  forearm  bones,  and  the  surface  also, 
how  that  it  has  its  outer  and  inner  parts  in  a direct 
line,  declaring  this  to  be  the  natural  disposition  of  the 
flesh  and  tendons,  and  he  brought  in  the  art  of  the 
archer  as  evidence.  This  gave  an  appearance  of 
wisdom  to  his  discourse  and  practice,  but  he  had  for- 
gotten the  other  arts  and  all  those  things  which  are 
executed  by  strength  or  artifice,  not  knowing  that  the 
natural  position  varies  in  one  and  another,  and  that 
in  doing  the  same  work  it  may  be  that  the  right  arm 
has  one  natural  position  and  the»left  another.  For 


there  is  one  natural  position  in  throwing  the  javelin, 
another  in  using  the  sling,  another  in  casting  a stone, 
another  in  boxing,  another  in  repose.  How  many 
arts  might  one  find  in  which  the  natural  position  of 
the  arms  is  not  the  same,  but  they  assume  postures 
in  accordance  with  the  apparatus  each  man  uses  and 
the  work  he  wants  to  accomplish.” 

Not  merely  the  technical  side  of  the  profession 
interested  the  writers  of  the  Corpus ; to  them,  mat- 
ters of  deportment  and  ethics  were  of  paramount 
importance.  A gem  worthy  to  be  considered  and 
cherished  by  those  of  us  who  have  to  meet  one 
another  on  our  daily  rounds  reads  in  this  way : 

“Wherever  there  is  the  love  of  man  there  also  is 
the  love  of  the  art.  There  is  nothing  wrong  if  a phy- 
sician finds  himself  embarrassed  in  the  presence  of 
a patient.  If  on  account  of  his  inexperience  he  fails 
to  comprehend  the  situation  clearly,  he  should  call  in 
other  medical  men  in  consultation,  so  that  after  a 
common  study  it  will  be  possible  to  be  certain  about 
the  condition  of  the  patient  and  to  help  him.  The 
physicians  who  come  together  for  consultation  should 
never  dispute  among  themselves  or  ridicule  one 
another.” 

THE  DEPORTMENT  OF  THE  PHYSICIAN 

Among  the  writings  is  one  entitled : “Concern- 
ing the  physician.”  It  contains  a number  of  inter- 
esting precepts  governing  the  deportment  of  the 
physician,  admonitions  about  his  working  place 
and  his  instruments,  and  some  advice  in  regard 
to  minor  surgery.  Somewhat  resembling  this  is 
another  book  entitled  “Decorum.”  In  it  there  is 
taught  that  philosophy  and  medicine  are  inter- 
dependent ; it  contains  precepts  instructing  the 
physician  how  he  should  enter  the  sickroom, 
how  he  should  conduct  the  examination  of  the 
patient,  and  directions  as  to  the  mode  of  his 
speech.  In  this  book  “Decorum”  there  are  ex- 
pressions so  apt  that  it  seems  impossible  that  they 
were  written  twenty  centuries  ago : 

“It  is  necessary  to  keep  simple  remedies  ready  for 
use  and  to  take  them  along  on  going  abroad,  for  it  is 
impossible  for  the  physician,  at  the  last  minute,  to 
choose  the  things  that  he  needs  from  amongst  many 
others. 

“From  the  moment  that  the  physician  enters 
the  sickroom  he  must  pay  attention  to  the  way  in 
which  he  seats  himself,  to  his  behavior,  see  that  he 
is  properly  dressed,  remain  serene  in  his  facial  ex- 
pression, and  in  his  actions,  pay  careful  attention  to 
the  patient,  responding  tranquilly  to  the  latter’s  objec- 
tions and  not  to  lose  patience  or  calmness  when  diffi- 
culties present  themselves.  The  most  important  rule 
is  to  repeat  the  examination  frequently  in  order  to 
avoid  the  chance  of  deceiving  himself.  It  is  necessary 
to  remember  that  patients  often  lie  about  having  taken 
the  remedies  prescribed.  ...  It  is  necessary  to  study 
the  position  of  the  patient  in  bed,  to  note  the  reaction 
to  noises  and  to  odors.  All  the  physician’s  directions 
should  be  given  in  a quiet  and  friendly  way;  nothing 
should  be  revealed  to  the  patient  of  the  things  that 
may  happen  to  him  or  threaten  him  in  the  future, 
because  through  such  knowledge  many  sick  have  been 
pushed  to  extremity.” 

Again  the  ever  recurring  appeal  to  reality  is 
found  in  a paragraph  which  runs  as  follows ; 

“One  must  attend  in  medical  practice,  not  primarily 
to  plausible  theories,  but  to  experiences  combined 
with  reason.  If  the  mind  begins  to  act,  not  from  a 
clear  impression,  but  from  a plausible  fiction,  it  often 
induces  uncertainty  and  trouble.  No  harm  would  be 
done  if  bad  practitioners  received  their  due  wages, 
but  as  it  is,  their  innocent  patients  suffer.  Affirmation 
and  talk  are  deceptive  and  treacherous,  therefore  one 
must  hold  fast  to  facts,  occupy  oneself  with  facts  per- 


352 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


sistent'y,  if  one  is  to  acquire  that  ready  and  infallible 
habit  which  we  call  the  “art  of  medicine.”' 

From  the  Hippocratic  writings  it  is  clear  that, 
although  some  Greek  citizens  were  given  to  the 
support  of  medicine  as  it  was  practiced  in  the 
temples,  and  while  others — probably  the  great 
mass  of  the  population — were  the  victims  of 
magicians  and  sorcerers  and  of  the  venders  of 
amulets  and  charms,  there  were  still  enough 
clients,  especially  on  the  Ionian  shores  of  Asia 
Minor  and  in  the  colonies  in  southern  Italy  and 
Sicily,  to  support  a great  and  well-organized 
group  of  scientific-minded  physicians.  It  is  equally 
clear  that  this  group  of  practitioners  was  un- 
influenced by  magic  or  philosophy  or  theology, 
and  that  the  relations  of  its  members  to  one  an- 
other and  to  those  they  served  were  guided  by 
one  of  the  highest  ethical  conceptions  that  the 
human  spirit  has  yet  accomplished. 

THE  OATH 

The  fact  that  the  Asklepiads,  of  whom  Hippo- 
cratec  provides  the  outstanding  example,  were 
bound  to  their  craft  and  their  clan  by  an  oath 
strongly  testifies  to  some  past  affiliation  with  the 
priests  of  Apollo.  Furthermore  there  are  many 
passages  in  other  books — “Aphorisms,”  “On  the 
Physician,”  “Precepts,”  “On  Decent  Habits” — 
which  show  that  the  physician  was  called  to  hold 
himself  to  a life  of  dignity,  order,  morality  and 
leadership — to  be  guided  by  a philosophy  of  high 
purpose  and  of  personal  detachment,  akin  to  the 
philosophy  that  guides  the  best  of  theologians. 
And  yet,  no  trace  of  the  supernatural,  tinctures 
the  Asklepiad  principles  insofar  as  they  touch  his 
art.  The  oath,  which  is  familiar  to  every  medical 
man,  was  sworn  to  by  Apollo  the  physician, 
Aesculepius,  Hygeia,  Panacea,  and  all  the  gods 
and  goddesses. 

The  oath  divides  into  two  groups  of  promises : 
the  first  group  recited  the  novitiate’s  duties  to  the 
guild  and  to  his  teachers,  binding  him  to  treat 
the  children  of  his  teacher  as  brothers,  to  teach 
them  without  fee,  to  instruct  them  fully,  and  as 
well  those,  and  only  those,  other  students  who 
have  taken  the  oath.  If  circumstances  made  it 
necessary,  he  was  bound  to  relieve  his  teacher’s 
financial  distress  and  to  supply  him  with  the 
means  of  livelihood. 

The  second  part  of  the  oath  was  a statement 
of  the  physician’s  duties  to  his  patient.  He  bound 
himself  to  do  all  good  and  no  harm  to  those  in  his 
charge.  To  give  no  poison,  to  produce  no  abor- 
tion ; to  live  a life  of  rigid  morality,  holding 
sacred  the  homes  to  which  his  profession  admitted 
him,  and  not  to  talk  about  his  patients’  affairs, 
no  matter  how  the  information  had  reached  him, 
whether  in  the  course  of  professional  attendance 
or  outside  of  it. 

One  passage  of  the  oath  which  constitutes  a 
promise : “not  to  operate,  not  even  for  stone,”  has 
puzzled  many  a commentator,  as  the  Hippocratic 
writings  clearly  show  that  Greek  physicians  did 
operate  freely  for  many  things,  among  them  quite 
often  to  relieve  patients  of  cystic  calculi ; there  is 
little  doubt  that  this  passage  was  written  in  at  a 


later  date.  This  interpolation  occurred  probably 
in  medieval  times,  when  medical  practice  had  de- 
generated and  its  practitioners  become  so  haughty 
that  they  would  condescend  to  do  no  more  than 
to  indicate  with  the  point  of  a wand  the  site  for 
incision  of  an  abscess,  or  the  place  for  the  open- 
ing of  a vein.  The  dignity  of  the  great  man  of 
the  Middle  Ages  could  not  be  degraded  by  manual 
labor ; a barber  or  some  other  base-born  attendant 
must  do  the  actual  work. 

THE  HERITAGE  FROM  GREEK  MEDICINE 

Out  of  the  records  left  by  the  lay  medicine  of 
Greece  have  come  two  immortal  things : one  a 
philosophy,  the  other  a portrait  of  the  imagined 
Hippocrates ; of  the  ideal  physician.  That  phil- 
osophy is  summed  up  in  the  magnificent  first 
aphorism : 

“The  art  is  long;  life  is  short.  The  opportune 
moment  passes  quickly.  Experience  is  fallacious, 
decision  is  difficult.  Not  only  must  the  physician 
be  prepared  to  do  his  duty,  but  he  must  be  able 
to  make  the  patient,  the  attendants,  the  external 
circumstances  conduce  to  the  cure.” 

singer’s  WORD  FICTURE  OF  HIPPOCRATES 

Of  the  portrait  of  the  idealized  Hippocrates, 
exemplar  of  what  a true  physician  should  be,  no 
one  ever  has  or  probably  ever  will  draw  a more 
eloquent  word  picture  than  Charles  Singer  when 
he  wrote  that : 

“The  figure  of  Hippocrates — physician — has  been  of 
incalculable  value  to  the  medical  profession  in  the 
twenty-three  centuries  that  have  passed  since  his 
death.  Calm  and  effective,  humane  and  observant, 
prompt  and  cautious,  at  once  learned  and  willing  to 
learn,  eager  alike  to  get  and  give  knowledge,  unmoved 
save  by  the  fear  lest  his  knowledge  may  fail  to 
benefit  others — both  the  sick  and  their  servants  the 
physicians — incorruptible  and  pure  in  mind  and  body, 
the  figure  of  the  greatest  of  physicians  has  gained, 
not  lost,  by  time.  In  all  ages  he  has  been  held  by 
medical  men  in  a reverence  comparable  only  to  that 
which  has  been  felt  toward  the  founders  of  the  great 
religions  by  their  followers.” 

University  of  California  Medical  School. 


CLINICAL  NOTES  AND  CASE 
REPORTS 


BACILLUS  PYOCYANEUS  SEPTICEMIA* 


REPORT  OF  CASE 

WITH  UNUSUAL  BLOOD  FINDINGS 

By  John  Martin  Asket,  M.  D. 

Los  Angeles 

1DACILLUS  pyocyaneus  has  been  reported  fre- 
^ quently  as  the  causative  culprit  in  localized 
infections.  Cases  of  septicemia  are  relatively  few. 

The  tendency  in  both  localized  and  blood  stream 
infection  toward  a normal  or  low  white  cell  count 
long  has  been  recognized.  Brill  and  Libman,1  in 
reporting  two  cases  of  Pyocyaneus  bacillemia  in 

* Thanks  are  expressed  to  Dr.  S.  W.  Imerman  and  Dr. 
Francis  E.  Browne  for  permission  to  report  this  case. 


May,  1930 


CASE  REPORTS 


353 


Table  1. — Blood  Changes 


(9-11)  9/12  9/25  9/2G  9/27  9/28  9/30  9/30  10/4 


Red  Blood  Cells  (In  millions) 

3.9 

HYSTERECTOMY 

2.5 

2.8 

2.5 

BLOOD  TRANSFUSION 

2.2 

BLOOD  TRANSFUSION 

2.5 

Hemoglobin 

57 

36 

40 

37 

34 

36 

White  Blood  Cells  (in  thousands) 

4.0 

2.0 

1.6 

1.5 

1.3 

1.2 

Lymphocytes 

28 

66 

69 

66 

71 

94 

Polymorphonuclear  Leukocytes 

72 

34 

28 

31 

24 

10 

1899,  remarked  on  the  “absence  of  any  leuko- 
cytosis,” despite  a fulminating  infection. 

More  recently  Bacillus  pyocyaneus  has  been 
found  in  the  lesions  of  agranulocytic  angina  in 
several  cases,  but  blood  cultures  when  taken  have 
been  negative. 

The  relative  paucity  of  reported  cases  of  Bacil- 
lus pyocyaneus  septicemia  and  the  unusual  blood 
findings  prompt  us  to  report  the  case  outlined 
below. 

REPORT  OF  CASE 

The  patient,  age  forty-two,  had  had  menorrhagia 
for  over  a year.  Between  periods  there  had  been  a 
moderate  but  persistent  malodorous  discharge.  The 
last  three  periods  prior  to  admission  had  lasted  over 
a week.  Her  average  duration  was  always  three  to 
five  days.  There  had  been  no  associated  cramps  or 
pain. 

Her  one  child,  eight  years  old,  had  caused  her  no 
trouble  at  delivery.  The  past  medical  history  was 
irrelevant. 

Physically  she  was  fairly  well  nourished,  with  color 
suggesting  a moderate  anemia.  There  were  no  rele- 
vant findings  in  the  chest.  The  blood  pressure  was 
100  systolic,  60  diastolic.  The  heart  sounds  were  rela- 
tively weak  but  regular  without  murmurs. 

Pelvic  examination  showed  an  eroded  and  cystic 
cervix.  The  uterus  was  enlarged  and  irregular,  retro- 
verted  and  not  movable,  apparently  adherent. 

On  September  12  a total  hysterectomy  was  done. 
Immediately  after  the  operation,  fever  developed 
which  continued  until  death;  ranging  from  100  to  105 
degrees.  On  September  25  the  white  count  was  2000, 
with  66  per  cent  lymphocytic  cells.  The  leukopenia 
progressively  increased  until  death,  1200  being  the  last 
count,  with  90  per  cent  lymphocytes.  The  red  cells 
dropped  to  2.5  million,  the  hemoglobin  was  36.  Study 
of  the  blood  smear  revealed  moderate  variation  in 
size  and  shape  of  the  red  cells.  A marked  reduction 
in  platelets  was  observed  and  a determination  of  the 
bleeding  time  showed  prolongation  to  twenty  minutes. 
The  clotting  time  was  seven  minutes,  but  there  was 
no  retractility  of  the  clot  after  twenty-four  hours. 

Despite  the  thrombocytopenia  and  increased  bleed- 
ing time,  no  purpuric  spots,  petechiae  or  other  hemor- 
rhagic manifestations  appeared. 

On  October  3,  a blood  culture  was  positive  for 
Bacillus  pyocyaneus.  Culture  from  the  wound  devel- 
oped a growth  of  Bacillus  pyocyaneus ; also  a bile  solu- 
ble, Gram-positive  diplococcus.  Blood  transfusions  on 
September  28  and  30  failed  to  improve  the  patient. 
Mercurochrome,  intravenously,  on  September  3 was 
futile.  The  patient  died  October  3,  1929.  An  autopsy 
was  refused. 


Pathologic  Report. — 1.  Fibromyoma  of  uterus  (in- 
fected). 2.  Chronic  proliferative  endometritis.  3.  Ulcer 
in  cervix. 

COMMENT 

The  site  of  action  of  the  Bacillus  pyocyaneus 
by  which  leukopenia  is  produced  has  not  been 
determined  definitely.  Whether  it  be  due  to  the 
direct  depressant  action  of  the  bacterial  toxin  on 
the  leukopoietic  centers  of  the  bone  marrow,  simi- 
lar to  that  of  arsenic  poisoning,  or  to  a destruc- 
tion of  circulating  leukocytes  in  the  peripheral 
blood,  or  both,  has  not  been  established.  It  is  true 
a direct  lytic  action  on  white  cells  was  demon- 
strated by  Lovett 2 in  her  experiments  on  artifi- 
cially produced  exudates  in  guinea  pigs.  Con- 
versely, however,  the  bone  marrow  of  the  patient 
reported  showed  an  absence  of  active  white  cen- 
ters. Other  cases  reported  have  shown  similar 
aplasia.  Lovett  further  produced  a marked  drop 
in  the  white  cell  count  in  the  peripheral  blood 
of  the  guinea  pig  by  injection  of  cultures.  Lin- 
thicum  3 corroborated  this  work  and  found  that 
sublethal  doses  caused  leukocytosis,  and  lethal 
doses  leukopenia. 

Although  unsupported  by  necropsy  findings, 
the  clinical  data  in  the  above  reported  case,  that  of 
granulocytic  leukopenia,  thrombocytopenia,  and  a 
progressive  anemia,  point  toward  a toxic  depres- 
sion of  the  whole  bone  marrow,  or  beginning  pan- 
myelophthisis. The  prolonged  bleeding  time  and 
nonretractility  of  the  clot  are  sequelae  of  the 
lowered  platelet  count.  It  is  interesting  to  note 
that  the  patient  showed  no  petechiae,  purpuric 
spots,  or  other  hemorrhagic  lesions,  despite  these 
findings. 

CONCLUSIONS 

Bacillus  pyocyaneus  septicemia  is  capable  of 
producing  a marked  granulocytic  leukopenia  with 
reduction  of  platelets  and  red  blood  cells.  The 
site  of  action  probably  is  in  the  bone  marrow. 

1930  Wilshire  Blvd. 

REFERENCES 

1.  Brill,  N.  E.,  and  Ligman,  E.:  Pyocyaneus  bacil- 
lemia,  Am.  J.  M.  Sc.,  118,  153,  August  1899. 

2.  Lovett,  B.  R. : Agranulocytic  Angina,  J.  A.  M.A., 
83,  1498,  November  8,  1924. 

3.  Linthicum,  F.  H.:  Experimental  Work  with  the 
Bacillus  pyocyaneus,  Ann.  Otol.  Rhin.  and  Laryng., 
36,  1093-1103,  December  1927. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 


POSTOPERATIVE  TREATMENT  FOLLOW- 
ING ABDOMINAL  OPERATIONS 

Le  Roy  Brooks,  San  Francisco.— In  the  light 
of  advances  in  psysiology  of  the  gastro-intestinal 
tract  and  the  practical  contributions  of  biochem- 
istry, postoperative  treatment  is  coming  more  and 
more  to  occupy  the  position  it  has  long  merited. 
Proper  postoperative  treatment  is  begun  by  pre- 
operative preparation  of  the  patients.  Except 
when  emergencies  exist,  all  patients  should  have 
rest  in  bed  eighteen  to  twenty-four  hours  before 
operation,  adequate  supply  of  food,  an  abundance 
of  carbohydrates  in  order  that  the  liver  may  store 
up  glycogen  for  the  pending  call,  fluids  plentifully 
for  several  days  and  no  cathartics.  When  obstruc- 
tion to  hollow  viscera  exists,  good  judgment  often 
dictates  that  the  operation  be  done  in  two  or  more 
stages.  Modern  surgery  does  not  admit  of  a mul- 
tiplicity of  major  procedures  at  one  sitting, 
regardless  of  the  deftness  of  the  surgeon. 

The  type  of  anesthetic  administered  also  influ- 
ences the  convalescence.  Nitrous  oxid  and  oxy- 
gen supplemented  by  nerve  block  or  local  infil- 
tration with  y2  per  cent  novocain  solution  without 
adrenalin,  is  the  present  choice  if  great  relaxation 
is  not  required.  Ether  may  be  added  for  relaxa- 
tion, but  is  borne  poorly  by  patients  suffering 
from  intestinal  ileus,  obstruction  to  the  bile  tract 
with  hepatitis,  starvation  or  prolonged  general 
sepsis.  This  latter  group  of  patients  will  be  given 
a much  better  chance  of  recovery  with  spinal 
anesthesia  with  the  small  needles  as  advocated  by 
Pitkin  and  others,  and  with  attention  to  physio- 
logical details  in  controlling  blood  pressure. 
Finally,  an  a-traumatic  technique  is  always  im- 
perative and  consistent  with  finished  and  gentle 
work— the  shorter  the  operation,  the  better  for 
the  patient. 

Following  any  opening  of  the  peritoneal  cavity 
with  a minimum  of  trauma,  enough  irritation  to 
the  peritoneum  is  produced  to  cause  nature, 
to  attempt  to  put  the  gastro-intestinal  tract  at  rest. 
Therefore,  nothing  should  be  given  by  mouth  for 
the  first  twenty-four  hours — or  better,  forty-eight 
hours — after  the  simplest  abdominal  operation.  If 
the  patient  has  had  sufficient  amount  of  carbohy- 
drates and  fluids  preoperatively,  further  fluids  are 
not  required  in  the  average  case  for  forty-eight 
hours.  In  an  uncomplicated  case,  after  thirty-six 
hours,  tap  water  may  be  allowed  by  mouth  in  spar- 
ing quantities;  fruit  juices,  etc.,  on  the  third  or 
fourth  day.  If  nausea  occurs  it  usually  means  that 
fluids  have  been  given  too  soon  or  in  too  large 
quantities,  and  all  fluids  by  mouth  should  be  im- 
mediately discontinued  and,  if  vomiting  persists, 
the  stomach  should  be  washed  with  sodium  chlo- 
rid  solution.  Giving  chipped  ice  for  the  first  few 
354 


days  following  an  operation  is  mentioned  here 
only  to  condemn  it  as  it  leads  to  more  discomfort 
than  relief  to  the  patient.  When  enemata  or  colon 
flushes  return  liquid  feces  containing  bile,  then — 
and  not  until  then — is  the  patient’s  gastro- 
intestinal tract  ready  for  semisolid  or  solid  foods. 
Morphin  should  be  used  to  control  pain,  but  not 
every  three  or  four  hours  regardless  of  pain,  and 
is  not  indicated  when  pain  is  due  to  distension. 

If,  however,  the  operation  is  done  as  an  emer- 
gency, fluids  may  be  furnished  by  injection  of 
normal  salt  solution,  both  during  the  operation 
and  for  the  required  time  afterwards.  Glucose 
in  10  per  cent  solution  may  be  injected  intraven- 
ously if  proper  precautions  are  exercised.  The 
10  per  cent  glucose  can  be  made  up  in  normal  salt 
solution  if  the  solution  is  not  heated  after  mixing 
and  the  added  advantage  of  the  sodium  chlorid  is 
secured.  Five  per  cent  glucose  in  normal  salt 
solution  may  be  injected  subcutaneously  or  into 
the  muscles  of  the  outside  of  the  thigh  without 
fear  of  necrosis  or  more  than  the  usual  amount 
of  irritation  caused  by  normal  salt.  Normal  salt 
solution  may  be  given  by  rectal  instillation  or  a 
rectal  drip,  but  there  is  a difference  of  opinion 
as  to  the  amount  of  glucose  absorbed  and  utilized 
from  such  practice. 

In  peritonitis  or  intestinal  obstruction  often 
the  stomach  must  be  washed  frequently  and  a life- 
saving procedure  consists  of  passing  a duodenal— 
or  some  other  small  tube — into  the  stomach  and 
bringing  the  upper  end  through  the  nose,  con- 
necting it  with  other  tubing  which  leads  into  a 
basin  at  the  side  of  the  bed.  The  patient  may  then 
drink  water  at  will,  which  will,  by  siphonage, 
return  through  the  tube  and  automatically  wash 
the  stomach.  Doctor  Ward  has  described  an 
ingenious  tube  for  this  purpose  with  a Connell 
suction  principle,  but  if  such  a tube  is  not  avail- 
able, a Rehfus  tube  is  adequate.  From  3000  to 
5000  cubic  centimeters  of  glucose  and  salt  solu- 
tion must  be  injected  daily  to  meet  the  tissue  and 
blood  chemistry  requirements  in  these  cases  until 
the  intestinal  tract  resumes  its  function.  There  is 
a tendency  in  such  patients  to  develop  acidosis  or 
alkalosis,  retention  of  urea  and  nonprotein  nitro- 
gen, a hypochloremia  and  dehydration.  Fortu- 
nately all  of  these  indications  may  be  properly 
met  by  the  injection  of  a sufficient  quantity  of 
glucose  and  normal  or  2 per  cent  salt  solution. 
These  solutions  may  be  injected  subcutaneously, 
intramuscularly  and  intravenously,  and  it  is  desir- 
able, but  not  obligatory,  to  have  reports  from  the 
blood  chemistry  laboratory  to  give  the  solutions. 

The  time  for  the  removal  of  drains  depends 
upon  the  type  of  case.  If  drainage  is  direct  and 
the  abscess  is  not  far  removed  from  the  surface 


May,  1930 


BEDSIDE  MEDICINE 


355 


with  large  enough  external  opening  not  to  inter- 
fere with  the  escape  of  pus  and  debris,  the  drain 
should  be  removed  not  later  than  the  third  or 
fourth  day.  Drains  in  nonlocalized  peritonitis  are 
of  questionable  value,  and  if  used  at  all  should  be 
removed  at  the  end  of  twelve  to  twenty- four 
hours.  Undressed  hard  rubber  tubes  should  not 
be  used  as  drains  because  they  cause  hemorrhage 
and  intestinal  fistulae  from  pressure  necrosis. 
As  a general  rule  the  tendency  in  regard  to  drain- 
age in  peritonitis  is  to  leave  the  drains  within  the 
peritoneal  cavity  too  long,  rather  than  to  take 
them  out  too  soon. 

If  silkworm  gut  tension  stitches  are  used  the 
deep  layers  of  a suppurating  wound  may  slough 
and  separate  and  the  pressure  upon  these  stitches 
by  the  bulging  distended  intestine  will  lead  to 
pressure  necrosis  and  intestinal  fistula.  All  such 
stitches,  if  used,  should  be  removed  within  the 
first  few  days  when  infection  exists.  The  wound 
may  be  held  together  by  adhesive. 

Secondary  abscesses  within  the  peritoneal  cav- 
ity rarely  develop  and  will  often  break  into  the 
drainage  channel  or  can  be  reached  with  a curved 
Mayo  hemostat  without  the  necessity  of  a second 
operation  if  the  surgeon  does  not  become  im- 
patient. The  exception  to  this  is  extremely  rare. 

Abdominal  distension  in  peritonitis  is  distress- 
ing to  both  patient  and  surgeon  and  the  latter  may 
get  panicky  and  give  irritating  enemata,  pituitrin, 
spinal  anesthesia,  etc.,  in  an  attempt  to  get  relief. 
He  may  obtain  temporary  relief,  but  will  find  his 
patient  in  a worse  condition  a few  hours  later 
because  of  having  stirred  up  the  sick  intestines. 
In  peritonitis  if  the  distension  cannot  be  relieved 
by  colon  flushes,  mild  enemata  and  hot  compresses 
to  the  abdomen,  the  more  drastic  measures  are  not 
indicated.  These  patients  occasionally  present  a 
duplex  obstruction — one  in  the  sigmoid  and  the 
other  in  the  small  intestine,  when  the  bowels  are 
adherent  together  in  the  pelvis.  When  this  occurs, 
a simple  jej  unostomy  done  early  under  local 
anesthesia  in  the  patient’s  bed  will  drain  the  upper 
small  intestine,  but  the  patient  may  succumb  to 
the  second  obstruction  unless  a cecostomy  is  done 
to  drain  the  lower  loops  of  small  intestine  and 
the  colon. 

These  remarks  are  concluded  with  an  appeal 
for  rest  of  the  gastro-intestinal  tract  to  aid  the 
natural  processes  of  repair  following  abdominal 
surgery.  + + 

Thomas  O.  Burger,  San  Diego. — Doctor 
Brook’s  article  seems  to  call  for  the  old  stereo- 
typed beginning  of  a discussion,  namely,  "I  want 
to  approve  most  heartily  of  all  the  doctor  has 
said,  and  only  wish  to  emphasize  the  points  he  has 
made  in  his  discussion.” 

He  has  very  properly  started  the  discussion  of 
postoperative  complications  or  conditions  by 
beginning  with  preoperative  preparation,  which 
is  now  admitted  to  be  the  greatest  benefit  we  have 
toward  preventing  postoperative  distress  or  com- 
plications. 

There  is  no  question  but  that  the  improved  con- 
ditions and  the  preparatory  treatment  at  the 


present  time,  or,  you  might  say  the  lack  of  it, 
has  had  a great  deal  to  do  with  helping  to  keep 
the  physiological  function  of  the  gastro-intestinal 
tract  in  a better  or  worse  condition  for  surgical 
onslaught. 

The  other  emphasis  I should  like  to  mention  is 
the  use  of  spinal  anesthesia,  which  has  been  found 
to  be,  more  than  any  other  single  procedure,  the 
greatest  blessing  to  the  patient  following  abdom- 
inal surgery.  We  have  found  during  the  past  few 
years  that  it  lessens  the  discomfort,  the  pain,  and 
the  various  complications  following'  abdominal 
operations.  It  means  that  nontraumatic  proced- 
ures to  the  abdominal  contents  can  be  carried  out 
as  they  have  never  been  done  before  with  a gen- 
eral anesthesia.  There  is  less  gas,  less  possibility 
of  ileus,  fewer  adhesions  in  the  future,  and  many 
other  features  that  might  be  noted. 

I am  also  and  have  been  making  for  quite  a 
few  years  an  effort  to  lessen  the  disaster  of 
embolus,  which  is  an  ever-present  danger,  and 
I have  carried  out  the  procedure  to  some  extent 
that  Walters  has  been  having  good  results  with, 
and  regarding  which  he  has  recently  written  a 
number  of  articles,  i.  e.,  keeping  the  blood  pres- 
sure up  and  preventing  stagnating  blood  currents 
by  improving  the  force  and  activity  of  the  circu- 
lation by  the  moving  of  the  body,  particularly  the 
limbs  at  frequent  intervals.  Also  keeping  up  the 
circulation  if  necessary  by  giving  ephedrin  occa- 
sionally, and  possibly  by  giving  a full  tolerance 
of  thyroid  extract,  and  doing  everything  that  is 
possible  to  keep  the  circulation  active. 

We  do  not  put  adhesive  or  tight  binders  about 
the  upper  abdomen  which  may  interfere  with  free 
and  full  respiration,  and  insist  that  the  nurse  make 
the  patient  breathe  fully  at  very  frequent  inter- 
vals. I his  also  probably  helps  to  prevent  occa- 
sional atelectasis. 

A small  point  that  we  insist  upon  (which  makes 
the  patient  and  some  of  the  profession  smile) 
is  that  all  postoperative  patients  regularly 
chew  gum.  We  believe  that  it  has  a benefit  in 
keeping  the  mouth  in  a better  condition.  Patients 
swallow  the  saliva  and  a slight  amount  of  secre- 
tion. It  is  not  an  objectionable  feature,  and  we 
believe  particularly  that  it  will  have  a beneficial 
effect  in  preventing  that  occasional  and  distress- 
ing complication,  namely,  parotiditis. 

We  do  not  give  purgatives  following  surgery; 
but  as  soon  as  the  patient  will  tolerate  it,  gen- 
erally the  second  or  third  day,  we  administer  large 
doses  of  paraffin  oil  or  some  of  the  combinations 
of  paraffin  oil.  We  believe  the  oil  aids  in  estab- 
lishing a quicker  physiologic  function  of  the 
bowel  by  lubrication. 

I think  that  morphin  is  a godsend  to  the 
majority  of  these  patients,  but  its  use  should  not 
be  abused.  If  a sufficient  amount  is  given,  I do 
not  believe  that  any  serious  injury  results. 

Hiccough  is  a distressing  condition,  particularly 
so  following  semi-infectious  or  peritonitis  cases. 
For  this  there  are  many  treatments  used,,  but  we 
have  found  the  most  effective  method  for  the  con- 
trol of  this  distressing  condition  to  be  the  inhala- 
tion of  carbon  dioxid  gas. 


356 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Too  little  attention  has  been  given  in  the  past 
to  those  increasing  numbers  of  patients  who 
unnecessarily  complain  of  “adhesions”  as  a cause 
for  their  numerous  and  varied  complaints  which 
develop  postoperatively. 

Proper  cooperation  on  the  part  of  the  surgeon 
and  internist  in  treatment,  both  physical  and 
in  the  restitution  of  normal  physiologic  func- 
tions, will  certainly  do  much  toward  eliminating 
this  complaint,  or  at  least  it  will  keep  many  of 
those  seeking  relief  from  this  complaint  out  of 
the  hands  of  quacks. 

* * * 

George  H.  Sanderson,  Stockton. — Doctor 
Brooks’  paper  presents  a brief  review  of  post- 
operative treatment  following  abdominal  opera- 
tions which  embodies  a most  modern  viewpoint 
and  a most  rational  method.  In  discussing  it, 
I can  only  emphasize  certain  points,  and  add  but 
little. 

Postoperative  treatment  to  be  rational  must  be 
simple — I can  see  no  need  of  too  complicated  or 
too  stereotyped  a regime.  Rest  is  the  keynote 
in  the  treatment,  and  disturbing  elements  should 
be  as  easily  and  simply  combated  as  possible  in 
order  that  the  keynote  may  be  struck  and  main- 
tained. A patient  has  often  about  all  the  treat- 
ment he  can  stand  on  the  operating  table — he 
should  therefore  not  be  overtreated  postopera- 
tively, and  especially  during  the  first  few  days 
should  be  disturbed  as  little  as  possible. 

I am  giving  morphin  in  much  smaller  doses 
than  formerly,  and  find  that  the  tolerance  of 
different  individuals  for  this  drug  varies  enor- 
mously— the  only  safe  way,  then,  is  to  use  small 
doses  first  and  then  increase  if  necessary.  Very 
often  the  preoperative  hypodermic  may  be  omitted 
entirely. 

I have  gotten  used  to  digitalizing  patients 
before  goiter  operations,  and  I think  this  could 
also  be  done  more  in  abdominal  surgery  than  it  is. 
It  would  be  an  advantage,  especially  in  the 
flabby-obese,  biliary  and  pancreatic  cases,  who 
often  have  a myocardial  impairment  which  stands 
the  operation  but  which  is  a factor  in  postopera- 
tive distension  and  complications  dependent  in 
part  on  circulation,  such  as  pneumonia  and  em- 
bolism. If  there  has  been  no  opportunity  to  do 
this  preoperatively,  a dram  of  the  tincture  may  be 
given  by  rectum  in  four  ounces  of  tap  water  just 
following  operation. 

Both  dehydration  and  alkalosis  are  best  com- 
bated by  the  administration  of  salt  solution  either 
by  hypodermoclysis  or  intravenously,  and  where 
much  blood  is  lost,  this  is  best  done  on  the  table 
during  the  anesthetic.  When  done  afterwards  it 
disturbs  the  patient  both  physically  and  psy- 
chically to  some  extent,  although  this  should  not 
discourage  its  use  where  it  is  really  necessary. 
Except  in  operations  on  the  stomach  or  duode- 
num, I can  see  no  objection  after  a few  hours 
in  giving  small  amounts  of  water  by  mouth  when 
it  is  tolerated,  but  it  should  not  be  either  hot  or 
cold.  At  moderate  temperatures,  it  does  not  seem 
to  cause  peristalsis,  and  is  rapidly  absorbed  if  the 
stomach  is  not  upset.  The  Murphy  drip  method  is 


irritating  to  many  patients  and  interferes  with 
their  rest.  Normal  salt  solution  may  be  given  by 
rectum  as  a retention  enema  of  four  to  six  ounces 
every  few  hours  with  very  little  disturbance  to 
the  patient. 

Where  there  is  any  tendency  to  gastric  dilata- 
tion, lavage  should  be  performed,  and  in  extreme 
cases,  continuous  drainage,  as  advocated  by  Dr. 
Robertson  Ward.  Gas  enemas  and  pituitrin 
should  be  used  only  rarely,  but  are  effective  occa- 
sionally in  selected  cases.  More  often  the  rectal 
tube  alone  will  suffice. 

Drains  should  be  soft,  and  used  only  when 
definitely  indicated.  If  intended  to  remove  post- 
operative blood  or  tissue  fluid  oozing,  they  should 
be  removed  in  from  twenty-four  to  forty-eight 
hours.  If  there  is  positive  infection,  they  often 
save  the  incision  from  breaking  down,  and  less 
frequently  actually  drain  any  considerable  amount 
of  pus  from  the  depths  of  the  peritoneal  cavity 
where  it  usually  occurs.  Where  there  is  doubt, 
the  drain  may  be  removed  slowly,  a small  piece 
being  cut  off  once  a day  until  the  whole  drain  is 
removed.  The  majority  of  even  badly  infected 
cases  will  get  along  without  any  drainage  at  all, 
but  a safety-valve  is  certainly  more  of  a boon 
than  a menace. 


Another  Experiment  in  Middle-Class  Medical  Care. 
In  February  1930,  the  trustees  of  the  Massachusetts 
General  Hospital  will  open  a new  unit  called  the 
Baker  Memorial.  The  Rosenwald  Fund  Committee 
has  agreed  to  underwrite  one-half  of  the  deficit  in 
operation  of  this  hospital  during  its  first  three  years 
up  to  a maximum  of  $150,000,  with  the  understanding 
that  the  deficit  will  not  exceed  $75,000  in  any  one 
year.  The  Baker  Memorial  has  been  designed  for  the 
care  of  sick  people  of  moderate  means.  It  is  pointed 
out  in  the  Massachusetts  General  Hospital  News  that 
the  care  of  the  sick  in  this  unit  will  include  voluntary 
curtailment  of  the  physicians’  fees  so  that  those  enter- 
ing the  institution  will  pay  a maximum  fee  of  $150 
for  any  illness  or  operative  care  and  that  the  maxi- 
mum fee  for  uncomplicated  obstetric  service  and  hos- 
pital care  will  be  $100.  Only  members  of  the  staff 
of  the  Massachusetts  General  Hospital  and  of  the 
Charitable  Eye  and  Ear  Infirmary  and  the  obstetric 
staff  will  be  permitted  to  practice  in  this  institution. 
This  hospital  has  been  definitely  planned  and  con- 
structed, and  is  to  be  quite  definitely  operated,  as  a 
middle-class  institution.  The  employment  of  special 
nurses  will  be  discouraged.  Ward  maids,  nurses’ 
helpers,  and  floor  clerks  will  be  utilized  so  that  nurses 
will  devote  all  their  time  to  actual  bedside  nursing. 
A special  social  service  department  will  control  the 
class  of  patients  to  be  admitted.  The  institution  will 
have  333  beds,  part  of  which  will  be  used  at  first  for 
the  interns  and  nurses,  since  special  buildings  for  this 
purpose  have  not  yet  been  provided.  There  are  to  be 
eighty-eight  beds  in  single  rooms,  twenty-four  beds 
in  two-bed  wards,  twenty-eight  beds  in  four-bed 
wards,  and  eighteen  beds  in  cubicles.  For  obstetric 
patients  there  will  be  twelve  beds  in  single  rooms, 
six  beds  in  two-bed  wards,  and  eight  beds  in  four-bed 
wards.  Private  rooms  will  cost  $6  a day,  cubicle  beds 
$4  a day,  and  the  two-bed  and  four-bed  wards  will 
vary  between  these  figures.  Nursing,  food,  and  ordi- 
nary drugs  are  included  in  this  price.  Special  fees 
will  be  charged  for  laboratory  work  and  for  roentgen- 
ray  work.  It  will  be  interesting  to  see  whether  this 
experiment  can  operate  successfully  and  pay  its  own 
way.  The  fees  are  not  apparently  much  greater  or 
much  less  than  those  charged  today  in  most  of  the 
hospitals  in  the  United  States. — Journal  of  the  American 
Medical  Association. 


May,  1930 


EDITORIALS 


357 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Official  Organ  of  the  California,  Utah  and  cNjrvada  l Medical  ^Associations 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 

Telephone ‘Douglas  0062 


Editors 

Associate  Editor  for  Nevada  . 
Associate  Editor  for  Utah 


j GEORGE  H.  KRESS 
* } EMMA  W.  POPE 
. HORACE  J.  BROWN 
. . . . J.  U.  GIESY 


Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 
single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  A.ddress. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects.  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 


Contributions — Exclusive  Publication. — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


EDITORIALS 


THE  DEL  MONTE  “PRE-CONVENTION 
BULLETIN”— COMMENTS  ON  SOME 
OF  ITS  SUGGESTIONS 

Volume  One  of  the  California  Medical  Asso- 
ciation Pre-Convention  Bulletin. — Last  year,  at 
San  Diego,  the  House  of  Delegates  revised  the 
constitution  of  the  California  Medical  Association 
and  among  other  things  provided  for  a Pre- 
Convention  Bulletin,  to  be  printed  and  distributed 
to  members  of  the  House  of  Delegates  at  each 
annual  session.  The  reports  and  suggestions  of 
the  officers  and  committees  which  are  printed 
therein  open  up  vistas  of  many  alluring  fields  of 
medical  organization  work. 

The  members  of  the  House  of  Delegates,  when 
the  Fifty-ninth  Annual  Session  of  the  California 
Medical  Association  convenes  at  Del  Monte,  will 
have  opportunity  to  study  and  take  such  action 
on  these  various  reports  and  recommendations 
as  in  their  judgment  may  be  deemed  best.  What 
that  action  will  be  we  are  not  in  a position  to 
forecast,  but  whatever  it  is,  the  instructions  will 
be  carried  out  by  the  administrative  officers  of 
the  Association.  What  is  here  written,  before 
the  House  of  Delegates  convenes,  is  intended  only 
as  a running  or  an  informal  comment  so  that  the 
many  members  of  the  Association  who  will  not 
be  able  to  attend  the  Del  Monte  meeting  and  who 
will  not  receive  copies  of  the  Pre-Convention 
Bulletin  may  have  an  opportunity  to  know  some- 
what of  some  of  the  matters  which  will  be 
brought  before  the  House  of  Delegates.  Full 


reports  of  the  proceedings  of  the  House  of  Dele- 
gates will  be  printed  in  the  June  issue  of  Cali- 
fornia and  Western  Medicine. 

♦ * * 

Reports  of  General  Officers. — The  annual  ad- 
dress of  President  Morton  R.  Gibbons  is  printed 
in  this  issue  of  California  and  Western 
Medicine  and  is  commended  to  the  considera- 
tion of  all  who  wish  to  be  alert  to  modern  day 
trends  in  medieal  practice.  His  address  is  worthy 
of  perusal  and  serious  thought  by  every  member 
of  the  California  Medical  Association. 

The  Report  of  the  Council  took  up  topics 
such  as  the  funds  of  the  Association,  its  incorpo- 
ration, the  new  constitution  and  by-laws,  the 
clinical  and  research  prizes,  membership,  and  the 
Woman’s  Auxiliary. 

The  Report  of  Secretary  Pope  discussed  sev- 
eral organization  and  membership  problems  and 
was  also  given  in  more  detail  in  verbal  form. 

The  Report  of  Editors  Kress  and  Pope  con- 
tained the  interesting  statement  that  California 
and  Western  Medicine,  through  its  increase 
in  advertising  rates,  had  added  to  its  income  re- 
sources something  over  $6000  in  the  year  just 
closed,  and  that  the  journal  now  had  an  income 
sufficient  to  meet  its  expenses. 

* * * 

Reports  of  individual  district  councilors  indi- 
cated continued  progress  in  the  nine  geographical 
districts  into  which  the  Association  is  divided. 

As  yet  no  District  Association  has  come  into 
existence.  It  will  be  interesting  to  note  how  long 
California  will  refrain  from  organizing  such  dis- 
trict societies  which  in  other  states  of  the  Union 
have  been  found  to  be  efficient  elements  in  better 
organization.  * * * 

The  Value  of  Standing  Committees. — Of  spe- 
cial interest  were  the  reports  of  the  standing 
committees,  which  committees  came  into  existence 
when  the  new  constitution  and  by-laws  were 
adopted. 

Through  such  committees  the  various  activities 
having  to  do  with  scientific  and  organized  medi- 
cine are  under  more  or  less  constant  consideration 
by  workers  in  the  Association,  contact  being 
maintained  with  the  central  administrative  body 
of  the  Association  by  the  placement  of  one  coun- 
cilor on  each  such  committee.  In  this  manner 
individual  committees  are  able  to  pursue  their  in- 
vestigations and  studies  of  problems  within  their 
respective  domains  and  present  their  viewpoints 
and  recommendations  to  the  Council  for  further 
consideration.  The  value  of  having  such  stand- 
ing committees  is  evidenced  in  the  reports  sub- 
mitted by  them.  These  first  standing  committees 
were  all  appointed  after  the  close  of  the  San 
Diego  session,  so  that,  with  the  exception  of  one 
or  two  committees,  most  of  the  exchange  of 
opinion  between  members  had  to  be  by  letter 
instead  of  through  personal  conference. 

Reports  of  Individual  Committees. — The  Com- 
mittee on  Associated  Societies  reported  that  seven 
county  woman’s  auxiliaries  had  been  organized, 


358 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


the  Los  Angeles  County  auxiliary  reporting  a 
paid-up  membership  in  excess  of  four  hundred. 

The  value  of  cooperation  with  the  medical  and 
dental  professions  in  securing  the  passage  of  a 
“basic  science”  or  “qualifying  certificate”  act  was 
also  mentioned. 

The  desirability  of  having  the  California  Medi- 
cal Association  appoint  fraternal  delegates  to  at- 
tend the  annual  sessions  of  neighboring  state 
medical  societies,  such  as  Nevada,  Utah,  Oregon, 
Washington,  Arizona,  and  New  Mexico,  and  so 
aiding  in  the  promotion  of  kindly  sectional  out- 
look, was  also  suggested. 

The  Committee  on  Extension  Lectures  made 
mention  of  the  desirability  of  keeping  the  central 
office  of  the  Association  and  the  committee  in 
touch  with  the  expected  visits  of  prominent  mem- 
bers of  the  medical  profession  of  our  own  and 
foreign  countries,  in  order  that  different  county 
associations  in  California  might  avail  themselves, 
if  possible,  of  addresses  by  such  prominent  visit- 
ing colleagues. 

The  Committee  on  Health  and  Public  Instruc- 
tion commented  briefly  on  radio  health  talks, 
newspaper  health  columns,  and  among  other  items 
suggested  the  value  to  be  derived  by  having  short 
items  on  health  matters  which  could  be  printed 
on  the  wrappers  used  by  drug  stores. 

The  Committee  on  History  and  Obituaries 
reported  that  in  our  State  Association  member- 
ship of  4854,  there  had  been  a total  of  eighty-one 
deaths  during  the  preceding  year. 

This  committee  also  recommended  that  every 
county  society  make  an  effort  to  begin  the  com- 
pilation of  a history  of  its  unit,  and  that  the  Cali- 
fornia Medical  Association  also  make  an  effort 
to  compile  such  a history  of  its  own  past. 

The  Committee  on  Hospitals,  Dispensaries,  and 
Clinics,  through  its  Subcommittee  on  Clinics,  gave 
in  considerable  detail  an  analysis  of  the  clinic 
situation  existing  at  this  time  in  California.  The 
report  is  worthy  of  perusal  by  every  member  of 
the  California  Medical  Association.  Some  of  the 
figures  presented  cannot  be  other  than  be  a sur- 
prise to  most  of  the  members  of  the  California 
Medical  Association.  The  survey  thus  far  made 
is  only  a beginning  and  indicates  how  large  a 
field  for  further  work  and  study  lies  in  a con- 
sideration of  these  clinic  and  dispensary  problems. 

The  Committee  on  Medical  Economics  pre- 
sented a digest  of  some  of  the  studies  which  it 
had  made  in  connection  with  the  tentative  plans 
to  give  better  medical  and  surgical  care  to  citizens 
of  moderate  financial  resources.  Here  also  a large 
amount  of  work  was  done  by  certain  committee 
members  and  the  facts  and  figures  presented  are 
worthy  of  the  careful  thought  and  consideration 
of  all  members  of  the  California  Medical  Asso- 
ciation. The  studies  thus  far  made  indicate  the 
great  scope  of  these  problems  and  how  necessary 
it  is  that  adequate  knowledge  should  be  had  of 
these  matters. 

The  Committee  on  Medical  Defense  presented 
a short  report  which  also  should  be  read  by  all 
members  of  the  Association.  A malpractice  suit 


usually  comes  out  of  a clear  sky.  When  it  does 
come  it  makes  a tremendous  difference  if  pro- 
tection has  been  previously  obtained.  The  bene- 
fits of  the  coverage  known  as  “Optional  Defense,” 
as  carried  out  through  the  California  Medical 
Association,  are  explained.  Any  members  wish- 
ing additional  information  can  obtain  the  same 
through  the  central  office  of  the  Association.  If 
you  do  not  carry  such  insurance,  you  are  urged 
to  send  in  a letter  asking  for  more  information. 

I he  Committee  on  Membership  and  Organi- 
sation again  called  attention  to  the  figures  show- 
ing a total  number  of  California  licentiates  who 
had  M.  D.  degrees  (8974)  ; and  that  of  these 
licentiates,  4854  were  members  of  the  California 
Medical  Association  and  5840  were  nonmembers. 
I he  importance  and  desirability  of  each  county 
unit  making  a careful  survey  of  nonmembers  in 
its  county,  to  the  end  of  securing  affiliation  of 
those  physicians  in  such  groups  who  were  eligible 
and  desirable  as  members,  was  stressed. 

I he  Committee  on  Publications  made  several 
suggestions  of  additions  to  the  annual  directory, 
such  as  the  code  of  ethics,  digest  of  malpractice 
laws,  and  Woman’s  Auxiliary  information. 

The  Committee  on  Public  Policy  and  Legisla- 
tion, which  has  always  been  one  of  the  hard- 
working committees,  brought  in  a report  on  some 
of  its  work,  emphasizing  the  necessity  of  all  mem- 
bers of  the  Association  being  alert  in  the  forth- 
coming primary  and  final  elections,  so  that  only 
candidates  in  favor  of  proper  protection  of  the 
public  health  would  receive  the  support  of  mem- 
bers of  the  medical  profession. 

The  Committee  on  Scientific  Work  submitted 
as  its  report  the  scientific  program  of  the  Del 
Monte  session,  as  printed  in  the  April  issue  of 
California  and  Western  Medicine.  Members 
of  the  Association  were  urged  to  send  in  sugges- 
tions and  constructive  criticisms  so  that  members 
of  the  committee  might  be  able  to  eliminate  un- 
desirable features  and  to  make  desirable  changes. 

* * * 

Report  of  Special  Committees. — The  last  of  the 
committee  reports  included  in  the  Pre-Convention 
Bulletin  was  that  of  a special  committee — the 
Special  Committee  on  Revision  of  the  Medical 
Practice  Act  and  of  a Possible  Basic  Science  Act. 
The  report  recommended  no  changes  in  the  Medi- 
cal Practice  Act  as  now  existing  in  California 
other  than  to  insert  a provision  that  would  give 
graduates  of  California  medical  schools  the  same 
advantages  as  those  of  eastern  schools  who  sought 
licensure  in  California. 

The  important  matter  of  a possible  basic  science 
act  was  considered,  in  connection  with  two  drafts, 
one  of  which  was  submitted  by  the  Southern  Cali- 
fornia subgroup  and  the  other  by  the  secretary 
of  the  California  Board  of  Medical  Examiners. 
The  value  of  calling  such  a “basic  science”  act 
by  the  name  “qualifying  certificate”  act  was 
pointed  out,  especially  if  such  nonmedical  subjects 
as  English,  physics,  chemistry,  and  biology  were 
decided  upon  as  the  preferable  subjects  for  such 
“qualifying  certificates.” 


May,  1930 


EDITORIALS 


359 


“Pre-Convention  Palletin'’  a Desirable  Innova- 
tion.— As  stated  at  the  outset  of  these  comments, 
these  various  reports  will  he  submitted  to  the 
House  of  Delegates  to  be  referred  to  its  proper 
committees  and  then  acted  upon  by  the  House. 
The  report  of  the  proceedings  of  the  House  of 
Delegates  will  appear  in  next  month’s  issue  of 
California  and  Western  Medicine.  It  is  our 
impression  that  the  members  of  the  House  of 
Delegates,  after  this  first  experience  with  such  a 
printed  outline  and  survey  of  past  and  future 
work,  will  look  with  favor  on  this  Pre-Convention 
Bulletin.  

WILLIAM  HENRY  WELCH 

The  Eightieth  Birthday  of  William  H.  Welch 
of  Johns  Hopkins.- — William  H.  Welch,  whose 
eightieth  birthday  occurred  on  April  8,  was  hon- 
ored in  many  cities  throughout  the  country  by 
meetings  held  in  his  honor.  These  meetings  were 
an  expression  of  the  high  regard  in  which  are 
held  the  contributions  which  he  had  made  to  scien- 
tific medicine  and  to  humanity  in  the  many  years 
it  has  been  his  privilege  to  serve  at  the  shrine  of 
the  healing  art.  Where  formal  meetings  wrere  not 
held,  members  of  the  profession  who  were  aware 
of  the  celebration  of  his  natal  day  gave  him  silent 
good  wishes,  in  their  pride  at  his  notable  achieve- 
ments on  behalf  of  modern  scientific  medicine. 
* * * 

The  Life  and  Work  of  Doctor  Welch  an 
Inspiration. — Both  the  lay  world  and  the  medical 
profession  have  reasons  to  be  grateful  for  the 
existence  of  men  like  Doctor  Welch.  Modest,  gra- 
cious, hard-working,  clear-thinking — with  vision 
and  devotion  he  has  carried  on  his  work  from 
the  time  bacteriology  first  came  into  real  being 
through  the  researches  of  Pasteur,  bringing  forth 
from  his  laboratories  from  time  to  time,  this,  that 
or  the  other  study  on  some  medical  problem, 
which  would  make  it  possible  for  his  colleagues 
to  do  to  better  advantage  their  work  in  the  con- 
servation of  human  health  and  life. 

Even  at  the  age  of  eighty,  he  is  still  an  active 
force  in  medical  advancement,  as  witness  the  in- 
stitution of  the  new  department  of  the  history 
of  medicine  which,  largely  through  his  urging 
and  efforts,  has  been  organized  at  Johns  Hopkins 
University. 

That  he  may  live  for  many  days  to  come,  to 
see  the  further  fruition  of  his  past  efforts  and 
to  receive  the  esteem  and  honor  in  which  he  is 
held  by  his  colleagues  from  one  end  of  the  coun- 
try to  the  other,  is  the  wish  not  only  of  those 
who  have  had  the  privilege  of  working  under  him 
or  of  personally  knowing  him,  but  also  of  that 
great  host  of  medical  men  who  give  him  their 
meed  of  praise  and  recognition  because,  through 
the  literature,  they  have  learned  to  appreciate  his 
splendid  services  to  the  medical  profession  and 
to  the  human  family.  His  life  is  an  inspiration 
to  every  medical  man  or  woman  desirous  of  per- 
forming real  service. 


EPIDEMIC  CEREBROSPINAL  FEVER 

Recent  Articles  in  California  and  Western 
Medicine. — Among  the  special  articles  of  this 
issue  is  an  article  on  epidemic  cerebrospinal 
fever  on  the  Pacific  Coast  by  Dr.  J.  D.  Geiger, 
who  is  the  epidemiologist  for  the  Hooper  Founda- 
tion of  the  University  of  California.  In  the  Mis- 
cellany department,  in  the  “Clippings  From  the 
Fay  Press”  column,  is  reprinted  a Washington 
dispatch  concerning  cerebrospinal  meningitis, 
based  on  recent  reports  of  the  United  States 
Public  Health  Service.  A very  interesting  article, 
giving  a report  by  Dr.  Barnet  E.  Bonar  on 
seventy-one  Utah  cases,  was  also  printed  in  the 
November  issue  of  California  and  Western 
Medicine,  page  316.  The  attention  of  readers 
of  this  journal  is  called  to  these  articles,  not  only 
because  of  their  general  public  health  importance, 
but  because  the  sequelae  of  this  disease  so  often 
are  little  less  than  tragic. 

* * * 

Outbreaks  Aboard  Ship. — Of  special  interest  to 
Californians  are  the  facts  brought  out  by  Doctor 
Geiger  concerning  epidemics  on  Pacific  Ocean 
ships  which  dock  at  ports  on  the  west  coast  of  the 
United  States.  The  recurring  outbreaks  aboard 
certain  ships  trading  with  the  Orient  indicate  how 
rigid  must  be  the  port  quarantines  if  infected 
persons  are  to  be  kept  from  shore  entrance  to 
Pacific  Coast  states.  Fack  of  such  stringent 
quarantine  regulations  might  make  possible  the 
entrance  of  one  or  more  infected  persons  or 
carriers,  with  possibilities  of  untold  horror  to 
those  who  might  subsequently  become  infected. 

* * * 

Report  Suspicious  Cases  to  Health  Depart- 
ments.— Cerebrospinal  fever  is  one  of  the  dis- 
eases which  menace  human  health  and  happiness, 
and  life  as  well,  and  all  practitioners  should  be  on 
the  alert  to  recognize  the  disease  when  and  where- 
ever  met.  Suspicious  cases  should  be  promptly 
reported  to  local  and  to  state  health  officers. 


BACK  TO  NATURE  FOR  DISCOVERIES 
IN  SCIENCE 

“ There  Is  Nothing  New  Under  the  Sun.” — 
Certainly  when  one  considers  the  universe— inso- 
far as  our  feeble  vision  will  permit — and  to  think 
of  the  earthly  planet  on  which  we  human  beings 
have  our  existence,  and  to  note  the  infallible  and 
never-varying  laws  under  which  nature  guides  it 
and  all  things  upon  it,  we  cannot  do  other  than  to 
acknowledge — as  we  note  the  phenomena  evi- 
denced in  the  mineral,  plant  and  animal  king- 
doms— that  probably  nothing  that  man  has  or 
will  discover  in  relation  to  physical  forces  but 
has  had  an  application  in  nature  for  ages  and  ages 
past,  in  manner  manifold  and  almost  beyond  the 
comprehension  of  most  humans. 

* * * 

An  Interesting  Contribution  From  Peru  on 
Wound  Care. — The  general  observations,  as  just 
given,  come  to  us  as  we  consider  a newspaper 
clipping  of  a few  days  ago.  The  item  had  to  do 
with  a recent  report  by  the  Field  Museum  of 


360 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Natural  History  of  Chicago,  in  which  Llewellyn 
Williams,  leader  of  the  Peruvian  expedition  into 
the  Amazon  country,  tells  how  the  Peruvian  In- 
dians long  antedated  the  use  of  metal  suture  clips 
brought  out  a few  years  ago,  by  using  the  power- 
ful jaws  of  certain  ants  to  hold  opposing  wound 
surfaces  in  proper  apposition.  More  concerning 
this  will  be  found  in  the  “Clippings  From  the  Lay 
Press”  column  of  this  issue. 

* * * 

The  foregoing  shows  at  least  that  even  though 
one  may  have  an  unusual  fund  of  general  or 
special  knowledge  and  skill  that  it  is  wise  to  go 
through  life  in  quite  humble  spirit.  That  which 
appears  as  a strange  theory  or  idle  fancy  today, 
in  the  light  of  better  knowledge  not  infrequently 
is  found  on  the  morrow  to  be  either  a veritable 
fact  or  based  on  such. 

CALIFORNIA  ACQUIRES  TWO  FOUNDA- 
TIONS FOR  CANCER  RESEARCH— THE 
FIRST  AT  LOS  ANGELES  AND  THE 
SECOND  AT  SAN  FRANCISCO 

Two  foundations,  or  organizations,  for  the 
study  of  cancer  and  kindred  problems  were  an- 
nounced at  the  Fifty-ninth  Annual  Session  of  the 
California  Medical  Association  held  at  Del  Monte 
April  28  to  May  1.  The  announcement  of  this 
expression  of  confidence  by  lay  fellow  citizens  in 
the  work  of  members  of  the  medical  profession 
who  were  carrying  on  cancer  studies  was  received 
with  much  approval.  In  the  name  of  the  Cali- 
fornia Medical  Association,  the  House  of  Dele- 
gates at  its  meeting  on  Wednesday,  April  30, 
passed  resolutions  congratulating  the  donors 
whose  contributions  made  these  benefactions 
possible  and  expressing  good  wishes  to  the  two 
California  colleagues,  I3r.  Walter  B.  Coffey  and 
John  D.  Humber,  whose  experimental  studies  on 
cancer  excited  such  widespread  interest  in  the 
cancer  problem  because  of  the  publicity  which  lay 
newspapers  and  publications  gave  to  the  cancer 
clinics  established  after  their  paper  had  been  pre- 
sented before  the  San  Francisco  Pathological  So- 
ciety. The  comments  made  in  this  column  in  the 
March  1930  issue  of  California  and  Western 
Medicine,  page  190,  told  the  story  of  that  pres- 
entation, and  it  is  not  necessary  to  repeat  what 
was  there  stated  other  than  to  add  that  through 
the  clinics  in  San  Francisco,  Los  Angeles,  and 
other  places  in  California,  a total  of  almost  two 
thousand  inoperable  patients  are  now  receiving  in- 
jections of  the  Coffey-Humber  suprarenal  cortex 
extract.  Practically  all  of  these  patients  who  re- 
quest treatment,  prior  to  receiving  the  injections, 
without  cost  or  fee,  state  their  willingness  to  have 
autopsies  performed  in  the  event  of  death.  Cali- 
fornia, therefore,  through  the  wide  publicity  given 
by  the  lay  press,  overnight  has  developed  what  are 
probably  the  largest  cancer  clinics  in  the  entire 
world. 

The  first  gift  for  the  further  promotion  of 
these  cancer  studies  was  made  at  Los  Angeles, 
through  the  generosity  of  W.  K.  Kellogg  of 
Battle  Creek,  Michigan  and  Pomona,  California, 
who  set  aside  the  sum  of  $2,000,000.  The  income 


is  to  be  used  through  the  Kellogg  Foundation, 
the  experiments  to  be  carried  on  by  the  White 
Memorial  Hospital  of  the  College  of  Medical 
Evangelists. 

The  second  donation  was  made  by  a group  of 
well-known  Californians  headed  by  Herbert 
Fleishhacker,  Paul  Shoup,  Stanley  Dollar,  and 
other  citizens  who  underwrote  a subscription  for 
the  sum  of  $500,000  to  be  used  in  this  and  asso- 
ciated research  work. 

California  as  a whole  may  well  feel  proud  of 
these  public-spirited  citizens  who  have  thus  given 
expression  of  their  love  of  their  fellows  and  their 
regard  and  faith  in  Doctors  Coffey  and  Humber 
and  of  the  medical  profession. 

The  resolutions  which  were  unanimously 
adopted  by  the  House  of  Delegates  read  as 
follows : 

Whereas,  The  dread  scourge  of  cancer,  in  an  ever- 
mounting  toll,  is  decimating  the  population  of  our 
country  so  that  today  its  dire  death  roll  accounts  for 
the  life,  in  those  of  forty  years  of  age  and  upward, 
of  one  woman  out  of  every  eight  and  one  man  out 
of  approximately  every  twelve,  thus  making  it  a 
sacred  duty  incumbent  upon  all  members  of  our  be- 
loved profession  to  combat  its  ravages  with  every 
arrow  in  the  armamentarium  of  the  science  and  skill 
at  our  command,  and  to  shrink  from  no  sacrifice, 
however  great,  in  order  to  halt  its  forward  march  and 
bring  to  an  end  its  almost  unveiled  threat  to  annihi- 
late mankind;  and 

Whereas,  Many  agencies  and  investigators  are  mak- 
ing researches  designed  to  add  to  man’s  knowledge 
of  this  disease  which  causes  so  much  illness,  pain, 
death,  and  other  loss  to  individual  citizens  and  to  the 
nation;  and 

Whereas,  Some  recent  studies  by  two  members  of 
the  California  Medical  Association,  Dr.  Walter  B. 
Coffey  and  Dr.  John  D.  Humber,  are,  in  the  opinion 
of  many  of  the  leaders  of  our  profession  who  have 
had  the  opportunity  to  observe  this  work,  of  such 
nature  as  to  give  aid  in  the  solution  of  the  cancer 
problem;  and  which  work  and  investigations  of  our 
California  colleagues  are,  as  stated  by  them,  and  will 
remain  for  some  time  in  the  research  period,  and  no 
scientific  or  definite  pronouncement  can  or  should 
now  be  made  of  the  results  thereof;  and 

Whereas,  In  the  city  of  San  Francisco  Herbert 
Fleishhacker,  Paul  Shoup,  and  Stanley  Dollar,  act- 
ing for  themselves  and  for  other  public-spirited  citi- 
zens, have  arranged  to  place  the  sum  of  $500,000  at 
the  disposal  of  the  Better  Health  Foundation  of 
California  to  carry  on  these  investigations  and  kin- 
dred studies;  and  in  the  city  of  Los  Angeles  W.  K. 
Kellogg  has  given  the  Kellogg  Foundation  the  income 
from  an  endowment  of  $2,000,000  for  similar  pur- 
poses; and 

Whereas,  This  Association,  by  its  constitution  and 
membership,  is  irrevocably  committed  to  the  princi- 
ples of  the  progress  of  medical  science  and  the  un- 
prejudiced pursuit  of  truth  and  fact;  now,  therefore, 
be  it 

Resolved,  That  the  California  Medical  Association, 
acting  through  its  House  of  Delegates  in  its  fifty- 
ninth  annual  session  assembled  at  Del  Monte,  cor- 
dially approves  and  commends  this  generous  and 
humane  action  of  Paul  Shoup,  Herbert  Fleishhacker, 
Stanley  Dollar  and  their  associates,  and  W.  K.  Kel- 
logg that  affords  the  necessary  means,  administered 
by  competent  authority,  to  enable  the  investigations 
to  properly  proceed,  adds  greatly  to  the  resources  of 
scientific  research  in  the  State  of  California  and 
encourages  others  to  emulate  the  good  deeds  of  these 
men;  and  be  it  further 

Resolved,  That  a copy  of  this  resolution  be  sent  to 
each  of  the  donors  with  a suitable  letter  of  transmittal 
by  this  Association. 


MEDICINE  TODAY 

Current  comment  on  medical  progress,  discussion  of  selected  topics  from  recent  books  or  periodic  literature,  by 
contributing  members.  Every  member  of  the  California  Medical  Association  is  invited  to  submit  discussion 
suitable  for  publication  in  this  department.  No  discussion  should  be  over  five  hundred  words  in  length. 


Syphilology 

Modern  Advances  in  the  Therapy  of  Syphi- 
lis.— On  August  23,  1929,  Dr.  Jay  Frank 
Schamberg,  professor  of  dermatology  and  syphi- 
lology at  the  University  of  Pennsylvania,  spoke 
before  the  Alameda  County  Medical  Society  on 
“Modern  Advances  in  the  Therapy  of  Syphilis.” 

The  main  theme  of  his  address  was  a plea  for 
conservatism  in  the  dosage  of  the  antisyphilitic 
drugs.  Instead  of  the  formerly  used  maximum 
dose  of  .9  gram  neoarsphenamin,  he  urged  that 
the  maximum  dose  of  this  drug  be  .6  of  a gram. 
To  offset  the  lower  therapeutic  efficiency  of  this 
smaller  dose,  he  advocated  the  concomitant  ad- 
ministration of  small  doses  of  bismuth. 

Of  the  arsenicals,  he  favored  neoarsphenamin 
instead  of  arsphenamin  because  of  the  fact  that 
it  is  the  less  toxic  and  because  it  is  better  borne 
by  the  patient  when  given  over  the  long  periods 
of  time  required  by  the  modern  treatment  of 
syphilis.  He  recognized  that  arsphenamin  is 
therapeutically  slightly  more  active  than  neo- 
arsphenamin, but  felt  that  this  could  be  offset 
by  giving  a few  more  injections  of  neoarsphena- 
min in  a series;  for  instance,  eight  injections  of 
neoarsphenamin  would  be  comparable  with  six 
injections  of  old  arsphenamin. 

In  his  opinion  the  failure  of  certain  investiga- 
tors to  obtain  results  with  neoarsphenamin  was 
due  to  their  use  of  inferior  brands ; it  being  well 
known  that  various  batches  of  neoarsphenamin 
are  subject  to  greater  variations  therapeutically 
than  the  older  product.  To  eliminate  this  diffi- 
culty only  brands  of  proved  value  should  be  used. 
Doctor  Schamberg  urged  that  the  United  States 
Public  Health  Service  or  some  similar  agency 
test  all  lots  of  the  arsenicals  for  their  therapeutic 
activity  (therapeutic  index)  as  well  as  for  their 
toxicity  which  latter  is  the  only  test  made  at 
present. 

He  believed  that  the  use  of  bismuth  was  a great 
step  forward,  his  choice  being  potassium  bismuth 
tartrate.  It  should  be  used  along  with  the  ars- 
phenamins  in  early  syphilis  and,  when  thus  given, 
the  dosage  should  be  conservative,  say  one-tenth 
of  a gram  per  week.  Work  done  by  Wright  in 
his  clinic  made  him  feel  that  it  was  of  especial 
value  in  congenital  syphilis ; also  in  those  cases 
where  the  Wassermann  had  remained  persistently 
positive  in  spite  of  treatment  with  the  arsphena- 
mins  and  mercury. 

This  class  of  patients,  i.  e.,  the  Wassermann- 
fast  group,  should  be  investigated  most  thor- 
oughly in  regard  to  the  condition  of  their  cardio- 
vascular and  central  nervous  systems.  X-rays  of 


the  aortic  arch  and  spinal  fluid  examinations  are 
imperative.  He  had  found  that  this  group  reacted 
best  to  silver  arsphenamin. 

He  would  not  abandon  mercury,  although  he 
felt  that  it  was  inferior  to  bismuth.  It  is  desir- 
able to  have  several  drugs  with  which  to  attack 
the  spirochetes.  Courses  of  bismuth  and  mercury 
can  be  alternated  with  courses  of  the  arsphena- 
mins,  thus  attacking  the  spirochetes  through  dif- 
ferent chemoreceptors. 

In  his  opinion,  the  iodids  were  of  less  impor- 
tance than  they  were  prior  to  the  advent  of  the 
arsphenamins.  However,  they  are  of  distinct 
value  in  late  gummatous  lesions,  especially  when 
treatment  with  bismuth  and  mercury  is  also  used. 
In  certain  phases  of  neurosyphilis,  iodids  are 
valuable. 

He  reviewed  his  experiments  on  rabbits  in 
which  he  demonstrated  that  hot  baths  would  pre- 
vent and  would  cure  experimental  rabbit  syphilis. 
Reasoning  from  these  results,  he  felt  that  the 
application  of  hot  baths  in  human  syphilis  should 
be  studied  further. 

He  spoke  of  the  value  of  malarial  inoculation 
in  the  treatment  of  paresis  and  expressed  the  view 
that  paresis  was  no  longer  a hopeless  condition 
in  view  of  the  new  treatment  that  had  been  intro- 
duced. At  least  one-third  of  the  cases  are  im- 
proved to  such  an  extent  that  the  patients  are 
able  to  leave  institutions  and  return  to  work. 

H.  J.  Templeton,  Oakland. 


Esophagoscopy 

Radon  in  Cancer  of  the  Esophagus. — Up  to 

. the  present  time  the  mortality  from  cancer 
of  the  esophagus  has  been  100  per  cent.  Experi- 
ence has  shown  that  surgical  removal  of  the 
growth  has  invariably  ended  in  death.  Radium 
has  been  tried  but,  for  obvious  reasons,  found 
wanting. 

In  recent  months  English  workers  have  intro- 
duced the  use  of  radon  seeds  in  treatment  of 
esophageal  cancer.  It  seems  to  be  based  on  logical 
foundation  and  merits  serious  consideration. 

F.  J.  Cleminson1  reported  four  cases  of  esopha- 
geal carcinoma  in  whom  artificial  pneumothorax 
was  performed,  and  a week  or  ten  days  later 
followed  with  thoracotomy  and  implantation  of 
radon  seeds  of  various  strength  in  front,  behind, 
and  at  the  proximal  side  of  the  growth  on  which 
the  chest  was  opened.  The  distal  side  was  treated 
by  means  of  radon  seeds  strapped  to  the  Souttars 
tube  and  introduced  by  means  of  esophagoscopy. 

Musgrave  Woodman  2 has  treated  some  thirty- 
five  cases  of  cancer  of  the  gut  by  implantation  of 
radon  seeds  into  the  growth  through  the  esophag- 

361 


362 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


oscope.  He  considers  the  para-esophageal  route 
too  serious  a risk  to  take,  particularly  in  those 
who  have  advanced  lesions  and  whose  vitality  is 
already  greatly  reduced. 

As  might  be  expected,  the  method  is  still  in  a 
stage  of  development.  Much  work  must  be  done 
before  it  even  approximates  finality.  But  with 
improved  technique,  coupled  with  early  recogni- 
tion of  the  presence  of  the  disease,  the  judicial 
use  of  radon  in  the  skilled  hand  ofifers  a hope  of 
effecting  a resolution  of  the  growth  in  at  least  a 

few  instances.  TT  T TT 

H.  J.-  Hara, 

Los  Angeles. 

REFERENCES 


1.  Cleminson,  F.  J.:  J.  Laryng.  and  Otol.,  Vol.  xliv, 
No.  9,  1929,  577. 

2.  Woodman,  Musgrave:  J.  Laryng.  and  Otol.,  Vol. 
xliv,  No.  9,  1929,  584. 


Bacteriology 

Paradoxical  Culture  Media. — The  observation 
of  Mesnil  during  the  closing  years  of  the 
nineteenth  century  that  pathogenic  microorgan- 
isms multiply  in  the  serum  of  animals  artifici- 
ally immunized  against  these  microorganisms, 
and  the  later  demonstration  by  Bridre  and  Jouan 
(1914)  that  the  microorganisms  not  only  multiply 
but  proliferate  at  an  accelerated  rate  in  such  spe- 
cific antisera,  were  paradoxical  to  nineteenth 
century  orthodox  immunology,  which  assumed 
that  all  serum  “antibodies”  are  of  necessity  pur- 
poseful specific  defensive  or  antiseptic  substances. 
Current  immunology,  however,  which  assigns  no 
necessary  defensive  or  antiseptic  function  to  such 
humoral  colloids,1  which  regards  the  basic 
mechanism  of  acquired  antimicrobic  immunity 
as  still  beyond  the  horizon  of  adequate  biochem- 
ical hypotheses,  finds  no  paradox  in  such  alleged 
specific  growth  stimulation. 

Emboldened  by  these  newer  immunologic  con- 
cepts, Nicolle  and  Cesari 2 of  the  Pasteur  Insti- 
tute, Paris,  have  recently  extended  the  currently 
forgotten  historic  observation  to  a wide  variety 
of  pathogenic  microorganisms.  They  report  such 
a marked  growth  stimulation  with  specific  antisera 
as  to  lead  them  to  suggest  the  employment  of  such 
immunesera  as  the  routine  culture  medium  of 
choice  for  pathogenic  microorganisms.  They 
believe  that  the  employment  of  such  specific 
growth  stimulants  may  in  time  lead  to  the  test- 
tube  cultivation  of  filterable  viruses  and  to  the 
preparation  of  successful  vaccines  with  many 
microorganisms  “thus  far  unculturable.” 

W.  H.  Manwaring,  Stanford  University. 

REFERENCES 

1.  The  Newer  Knowledge  of  Bacteriology  and  Im- 
munology, University  of  Chicago  Press,  Chapter  81, 
pp.  1078-1085,  1928. 

2.  Nicolle,  M.,  and  Cesari,  E.:  Influence  des  Im- 
munserums  Specifiques  Sur  la  Culture  des  Microbes 
Pathogenes,  Annales  de  l’lnstitut  Pasteur,  40,  41. 
January  1926. 


Surgery 

Sodium  Amytal  in  Thyroid  Surgery. — The 

surgery  of  the  thyroid  gland  presents  many 
unique  problems.  Among  them  not  the  least  to 
be  reckoned  with  is  the  choice  of  the  anesthetic. 
In  the  majority  of  toxic  cases  the  threshold  of 
safety  for  surgical  attack  is  greatly  reduced  both 
by  the  conditions  inherent  in  the  malady  itself, 
as  well  as  by  the  secondary  pathology  affecting 
the  vital  organs.  Imbalance  of  the  emotional  cen- 
ters, abnormal  reaction  to  the  stimuli  received 
through  the  special  senses,  render  the  sights  and 
sounds  of  the  operating  room  peculiarly  hazard- 
ous to  the  hyperthyroid  patient. 

Sodium  amytal  promises  much  toward  safe- 
guarding these  patients.  By  its  use,  intrave- 
nously, a profound  and  apparently  normal  sleep 
is  promptly  induced  and  the  patient  comes  to  the 
surgical  ordeal  unconscious,  relaxed,  and  with 
pulse  and  heart  action  unchanged.  If  the  supple- 
mentary anesthetic  is  carefully  chosen  and  ad- 
ministered and  due  gentleness  employed  in  all 
manipulations,  it  is  not  at  all  unusual  to  find  pulse 
and  general  condition  as  favorable  at  the  end  as 
at  the  beginning  of  the  operation. 

This  new  agent  is  not  an  analgesic.  It  is  most 
important  that  this  fact  be  clearly  understood  by 
those  who  would  employ  it.  True,  a few  have 
reported  success  with  it  alone  in  a variety  of 
operations.  But  within  the  limits  of  safe  dosage 
such  result  is  not  to  be  anticipated  or  sought. 

The  writer  has  employed  it  in  a series  of  thy- 
roidectomies during  the  past  year,  both  with  gen- 
eral and  with  local  anesthesia,  and  feels  justified 
in  stating  that  it  is  a valuable  addition  to  our 
armamentarium.  Particularly  is  this  true  in  the 
type  of  case  in  which  it  is  desirable  to  use  local 
anesthesia.  It  should  be  stressed  in  this  connec- 
tion, however,  that  a satisfactory  result  is  even 
more  dependent  upon  the  care  and  skill  which 
characterize  the  local  anesthesia  technique  than 
when  the  latter  alone  is  employed,  since  the  co- 
operation of  the  unconscious  patient  cannot  be 
enlisted. 

Sodium  amytal  is  put  up  in  ampoules  of  one 
cubic  centimeter.  This  is  the  ordinary  dose.  It  is 
used  only  intravenously,  and  the  patient  falls  into 
sound  sleep  while  it  is  being  administered.  In  the 
writer’s  personal  experience,  no  disturbance  of 
heart  action,  blood  pressure,  or  other  untoward 
effect  has  been  observed. 

A.  B.  Cooke,  Los  Angeles. 


What  are  the  attractions  of  a career  in  life?  They 
lie,  do  they  not,  in  the  opportunities  the  career  offers 
for  service  to  mankind,  in  the  congeniality  of  the  work 
and  in  its  rewards.  The  profession  of  medicine  sur- 
passes all  others  in  its  opportunities  for  service  to 
our  fellow  men.  Besides  this  there  are  manifold  fields 
of  activity,  appealing  to  the  most  varied  personal  in- 
clinations and  aptitudes,  be  these  practical  or  scien- 
tific. The  rewards  of  success  in  medicine,  even  of  the 
highest  success,  lie  not  in  money;  they  lie  in  the 
intellectual  pleasure  which  one  gets  from  his  work  as 
a physician,  in  the  consciousness  of  service,  in  the 
relief  of  suffering,  and  in  the  cure  and  prevention  of 
disease. — William  Henry  Welch  of  Baltimore. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION* 


MORTON  R.  GIBBONS President 

LYELL  C.  KINNEY President-Elect 

EMMA  W.  POPE Secretary 


COMPONENT  COUNTY  SOCIETIES 

ALAMEDA  COUNTY 

Tiie  regular  meeting  of  the  Alameda  County  Medi- 
cal Association  which  was  held  at  Hunter  Hall  on 
March  17  was  devoted  entirely  to  the  subject  of 
medical  economics.  Dr.  Daniel  Crosby,  the  chief 
speaker  of  the  evening,  spoke  with  the  authority  of 
information  amassed  from  innumerable  sources  both 
in  this  country  and  in  Europe.  The  doctor  painted  a 
clear  and  concise  picture  of  the  situation  as  it  actually 
exists  in  the  principal  countries  of  Europe  as  well  as 
in  various  parts  of  the  United  States.  In  closing  the 
discussion  Doctor  Crosby  offered  a motion  that  the 
president  appoint  a committee  to  continue  the  work 
of  investigation  and  after  mature  study  to  map  out 
a plan  or  plans  for  betterment  of  the  existing  condi- 
tion. General  discussion  was  opened  by  Dr.  O.  D. 
Hamlin,  who  told  of  some  of  the  plans  of  the  Cali- 
fornia Medical  Association  in  regard  to  this  matter. 
The  president  then  appointed  Doctor  Crosby  as  chair- 
man of  a committee  to  be  selected. 

Gertrude  Moore,  Secretary. 

* 

CONTRA  COSTA  COUNTY 

The  Contra  Costa  County  Medical  Society  met  at 
the  nurses’  home  of  the  County  Hospital  at  Martinez 
on  April  8. 

Dr.  O.  D.  Hamlin  of  Oakland,  councilor  of  the 
California  Medical  Association  for  this  district,  paid 
us  an  official  visit.  Doctor  Hamlin  presented  a survey 
of  the  work  being  done  on  the  cost  of  medical  care. 
He  discussed  the  economic  situation  of  the  physicians 
in  various  counties,  and  showed  how  irregular  prac- 
tices are  carried  out  in  certain  county  hospitals,  to  the 
detriment  of  the  medical  profession  as  a whole  and 
the  individual  practitioner  in  particular.  The  various 
remedies  proposed  to  lower  the  medical  cost  to  the 
patient  were  described.  The  speaker  explained  the 
plan  which  the  State  Association  has  been  consider- 
ing for  some  time  in  the  solution  of  this  vital  eco- 
nomic problem.  Doctor  Hamlin’s  talk  brought  out 
much  instructive  discussion. 

The  scientific  paper  was  presented  by  Dr.  Eugene 
S.  Kilgore  of  San  Francisco,  who  spoke  on  “The 
Practical  Assessment  of  Cardiac  Condition.”  The 
speaker  explained  how  the  practical  interpretation  of 
the  clinical  signs  and  symptoms  of  heart  disease  will 
guide  the  prognosis  of  the  case.  Particular  emphasis 
was  laid  on  the  value  of  careful  and  detailed  history 
in  these  cases.  The  estimate  of  what  a heart  can 
stand  and  its  future  possibilities  depends  on  stability 
and  integrity  of  the  myocardium.  Doctor  Kilgore 
illustrated  by  well-chosen  cases  the  common  pitfalls 
of  erroneous  prognosis  in  the  diseased  heart.  A con- 
cise but  thorough  differential  diagnosis  between  coro- 
nary block  and  angina  pectoris  was  presented.  Vari- 


*  For  a complete  list  of  general  officers,  of  standing 
committees,  of  section  officers,  and  of  executive  officers 
of  the  component  county  societies,  see  index  reference  on 
the  front  cover,  under  Miscellany. 


ous  types  of  pain  in  heart  disease  were  interpreted 
by  the  speaker.  The  practical  value  of  Doctor  Kil- 
gore’s paper  was  much  appreciated  by  his  audience, 
as  shown  by  the  lengthy  discussion  which  followed. 

Dr.  Clara  H.  Spalding  of  Richmond  was  unani- 
mously voted  a member  of  the  society. 

This  meeting  was  the  first  held  in  Martinez  this 
year  and  drew  a large  attendance  from  the  surround- 
ing communities. 

The  Woman’s  Auxiliary  held  a business  and  social 
meeting  at  the  First  Congregational  Church,  Mar- 
tinez, on  the  same  evening  and  were  hostesses  to  the 
members  at  a well-appointed  supper. 

Those  present  at  the  society  meeting  were:  Doctors 
J.  L.  Beard,  E.  Merrithew,  G.  W.  Sweetzer,  and  I.  O. 
Church,  all  of  Martinez;  H.  D.  Neufeld,  Bay  Point; 
M.  C.  McLafferty,  Brentwood;  H.  C.  Gifford,  Dan- 
ville; C.  R.  Leech,  Walnut  Creek;  S.  V.  Weil,  Selby; 
J.  M.  McCullough  and  W.  G.  Rowell,  Crockett;  Rosa 
Powell,  M.  Deininger-Keser,  J.  W.  Bumgarner,  F.  W. 
Overdahl  and  L.  H.  Fraser,  all  of  Richmond;  Eugene 
S.  Kilgore  of  San  Francisco;  O.  D.  Hamlin  and  C.  L. 

Abbott,  Oakland.  T m t-  o 

L.  H.  Fraser,  Secretary. 


FRESNO  COUNTY 

The  regular  meeting  of  the  Fresno  County  Medical 
Society  was  held  after  dinner  at  the  University 
Sequoia  Club,  April  1. 

Miss  Foster,  representative  of  the  Red  Cross  Visit- 
ing Nurses’  Association,  spoke  of  a plan  whereby 
nurses  will  visit  patients  where  the  services  of  a full- 
time nurse  are  not  required.  The  fee  for  this  service 
will  be  $1  per  hour. 

Dr.  D.  I.  Aller,  chairman  of  the  Welfare  Com- 
mittee, submitted  his  report.  It  was  moved,  seconded, 
and  carried  that  this  report  endorsing  the  rules  and 
regulations  of  the  Red  Cross  Visiting  Nurses’  Asso- 
ciation be  adopted. 

It  was  moved,  seconded,  and  carried  that  the  presi- 
dent appoint  a committee  of  three  to  report  on  the 
County  Hospital  situation  in  Fresno  County.  That 
they  have  the  power  of  employing  expert  help  in 
obtaining  all  needed  data.  The  president  appointed 
the  following  committee:  Doctors  D.  H.  Trowbridge 
(chairman),  T.  N.  Sample,  and  C.  O.  Mitchell. 

Dr.  F.  D.  DeLappe  of  Modesto,  councilor  for  this 
district,  gave  an  outline  of  the  work  being  done  by 
the  council  of  the  state  society.  They  recommend: 
(1)  That  a Woman’s  Auxiliary  be  organized  in  every 
county  society.  (2)  That  members  of  the  society  ap- 
point a committee  to  solicit  members  for  optional 
medical  defense. 

Dr.  E.  B.  Towne  of  Stanford  University  gave  a 
very  interesting  talk  illustrated  by  many  lantern 
slides.  The  subject  was  “The  Diagnosis  and  Locali- 
zation of  Tumor  of  the  Brain.” 

J.  M.  Frawley,  Secretary. 

* 

LOS  ANGELES  COUNTY 

Industrial  Accident  Section. — One  hundred  and 
sixty  doctors,  representative  of  all  parts  of  southern 
California,  attended  the  regular  March  meeting  of  the 
Industrial  Accident  Section  of  the  Los  Angeles 
County  Medical  Association  as  guests  of  the  Golden 
State  Hospital,  Los  Angeles,  through  the  courtesy  of 
Dr.  J.  Rollin  French.  Inspection  of  modern  hospi- 

363 


36+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


talization  of  traumatic  injury  cases  and  demonstra- 
tion of  hospital  fracture  apparatus  began  at  5:30  p.  m., 
following  which  an  excellent  buffet  supper  was  served 
for  all  those  attending.  At  7 p.  m.  the  regular  meet- 
ing was  called  to  order,  with  Dr.  John  W.  Crossan 
presiding,  and  the  following  scientific  papers  were 
presented:  “Fracture  Dislocation  of  the  Fourth  Lum- 
bar Vertebra  with  Paralysis,  and  the  Presentation  of 
the  Case  with  Recovery,”  S.  Herzikoff;  “Bursitis  of 
the  Shoulder  Joint  as  Related  to  Industrial  Injuries,’' 
I.  D.  Tiedemann.  Doctors  John  C.  Wilson,  John 
Dunlop,  H.  W.  Chappel,  William  B.  Bowman,  I.  Leon 
Myers,  and  others  carried  on  the  enthusiastic  dis- 
cussion which  followed.  A unique  feature  of  the  In- 
dustrial Accident  Section  is  that  all  scientific  papers 
presented  at  its  meetings  are  subsequently  supplied 
to  members  in  printed  abstract  form.  All  doctors 
eligible  to  membership  in  the  American  Medical  As- 
sociation are  eligible  to  apply  for  membership  in  this 
section.  Floyd  Thurber, 

Secretary,  Industrial  Accident  Section. 

MARIN  COUNTY 

The  Marin  County  Medical  Society  held  its  monthly 
meeting  on  the  evening  of  March  27  at  the  Cottage 
Hospital  in  San  Rafael.  There  were  nine  members 
present.  , 

The  minutes  of  the  previous  meeting,  February  5, 
were  read  and  approved.  A communication  from  the 
State  Association  regarding  the  present  status  of  the 
Porter  Bill,  No.  H.  R.  9054  and  also  No.  H.  R.  10561, 
were  read  and  placed  on  file.  In  keeping  with  the  re- 
quest of  the  State  Association,  it  was  decided  that 
no  action  be  taken  regarding  the  above  measure  until 
further  word  from  the  State  Association  be  received. 

Following  the  business  meeting,  Dr.  Alfred  C.  Reed 
of  San  Francisco  gave  an  interesting  talk  on  “Oriental 
and  Tropical  Diseases.”  His  lecture  was  illustrated 
by  a number  of  lantern  slides. 

L.  L.  Robinson,  Secretary. 

* 

MONTEREY  COUNTY 

The  regular  monthly  meeting  of  the  Monterey 
County  Medical  Society  was  held  at  the  Hotel  Jeffery 
in  Salinas  March  7.  Seventeen  members  were  present. 

Following  dinner  there  was  a short  business  meet- 
ing at  which  time  Dr.  F.  E.  Wiebe  of  Soledad  was 
elected  to  membership  in  the  society. 

The  meeting  was  then  turned  over  to  Dr.  Edmund 
Butler  of  San  Francisco,  who  gave  an  interesting  talk 
on  “Spinal  Anesthesia  and  Its  Practicability  in  Ab- 
dominal Surgery”  which  was  greatly  enjoyed  by  the 
members  present. 

On  April  4 the  regular  monthly  meeting  was  held 
at  the  Hotel  San  Carlos  in  Monterey. 

The  wives  of  members  were  invited  to  be  present 
to  consider  the  organization  of  a Woman’s  Auxiliary. 
Following  dinner  the  ladies  held  a meeting  at  which 
time  Mrs.  C.  H.  Lowell  of  Carmel  was  elected  presi- 
dent and  Mrs.  A.  A.  Arehart  of  Pacific  Grove  was 
elected  secretary  of  the  new  organization. 

Dr.  P.  T.  Phillips  and  Dr.  A.  L.  Phillips  of  Santa 
Cruz  were  present  as  guests  and  both  gave  brief  but 
interesting  talks  which  were  enjoyed  by  those  present. 

J.  A.  Merrill,  Secretary. 

NAPA  COUNTY 

The  regular  monthly  meeting  of  the  Napa  County 
Medical  Society  was  held  Wednesday,  April  2,  at 
7 p.  m.  at  the  Ramona  Gardens,  Napa.  Members  and 
their  wives  enjoyed  a well-appointed  banquet  which 
was  followed  by  a musical  program  by  artists  espe- 
cially selected  for  this  occasion.  The  first  meeting 
of  the  ladies  interested  in  the  formation  of  a Woman’s 
Auxiliary  was  held  also.  Mrs.  Jean  F.  Rogers,  state 
president  of  the  auxiliary,  addressed  the  ladies  on  the 
purpose  of  such  an  organization. 

The  medical  society  members  met  in  regular  session 
and  were  addressed  by  Mr.  Celestine  Sullivan,  who 


clearly  and  concisely  portrayed  the  present  trend  of 
medical  practice  as  compared  to  other  businesses. 
Mr.  Heartly  Peart,  legal  counsel  for  the  California 
State  Medical  Association,  spoke  most  entertainingly 
and  instructively  concerning  the  legal  aspect  as  re- 
gards the  practice  of  medicine. 

This  first  joint  meeting  was  an  enthusiastic  gather- 
ing, and  others  to  come  are  anticipated. 

It  was  moved  and  carried  that  the  society  should 
bear  the  expense  of  entertaining  the  ladies. 

Those  present  were: 

Members — W.  L.  Blodgett,  M.  M.  Booth,  C.  H. 
Bulson,  H.  R.  Coleman,  G.  I.  Dawson,  C.  A.  Johnson, 
Edward  Love,  D.  H.  Murray,  A.  K.  McGrath,  C.  E. 
Nelson,  Robert  Northrop,  J.  B.  Rogers,  J.  Robertson, 
C.  E.  Sisson,  and  L.  Welti. 

Mesdames  C.  H.  Bulson,  W.  L.  Blodgett,  H.  R. 
Coleman,  G.  I.  Dawson,  C.  A.  Johnson,  M.  L.  Lewis, 
A.  K.  McGrath,  Edward  Love,  D.  H.  Murray,  C.  E. 
Nelson,  Robert  Northrop,  S.  Z.  Peoples,  H.  Peart, 
J.  B.  Rogers,  H.  R.  Rogers,  C.  E.  Sisson,  C.  Sullivan, 
and  L.  Welti. 

Visitors — M.  L.  Lewis,  S.  Z.  Peoples,  H.  R.  Rogers 
of  Petaluma  and  F.  R.  Moore,  H.  A.  Keener,  L.  J. 
Roberts,  W.  M.  Kerr  of  Mare  Island. 

C.  A.  Johnson,  Secretary. 

ORANGE  COUNTY 

The  regular  monthly  meeting  of  the  Orange  County 
Medical  Association  was  held  in  the  staff  room  of  the 
County  Hospital  Tuesday,  April  1.  The  minutes  of 
the  last  meeting  were  read  and  approved.  The  second 
reading  on  Dr.  H.  F.  Gramlich’s  application  for  mem- 
bership was  heard  and.  by  vote,  he  was  unanimously 
admitted  into  the  society. 

An  interesting  talk  on  “Collections”  was  given  by 
Mr.  Lynn  Chuninc,  who  proposed  to  the  society  that 
the  members  form  their  own  collection  agency  by 
incorporating  and  working  on  a nonprofit  basis.  The 
president  appointed  a committee  to  investigate  the 
proposition.  This  committee  is  composed  of:  G.  M. 
Tralle,  R.  A.  Cushman,  and  H.  G.  Huffman. 

Biographical  sketches  of  two  of  our  deceased  mem- 
bers, Daniel  Franklin  Royer  and  Walter  Watkins 
Davis,  were  read  by  the  secretary.  It  was  moved  and 
seconded  that  a copy  be  sent  to  Mrs.  Davis.  This  was 
unanimously  carried. 

Due  to  the  fact  that  many  of  our  members  have 
office  hours  in  the  evening  from  7 to  8 o’clock,  it  was 
suggested  that  the  time  of  meetings  be  changed  to 
8:15  o’clock.  By  vote  this  change  was  adopted.  The 
president  stressed  the  point  that  he  was  to  call  all 
meetings  promptly  at  this  specified  time. 

Case  reports  were  given  by  Harold  Gobar,  “Imper- 
forate Anus”;  E.  D.  Kilbourne,  “Liver  Abscess”; 
and  R.  S.  Wade,  “Prostatic  Hypertrophy.”  These 
cases  were  fully  discussed.  Doctor  Brunemeier  de- 
scribed a similar  case  of  imperforate  anus  that  he 
treated  in  China. 

The  speaker  of  the  evening  was  Dr.  D.  A.  Har- 
wood of  Santa  Ana.  His  subject  was  “Uterine  Fibro- 
myomata — Their  Diagnosis  and  Various  Methods  of 
Treatment.”  A very  complete  discussion  of  the  sub- 
ject was  given  by  the  speaker,  who  outlined  the 
advantages  of  radium  in  some  cases  over  x-ray  or 
surgery.  He  also  stressed  the  probable  etiology  in  a 
number  of  these  cases  as  being  due  to  a local 
hyperemia. 

There  being  no  more  business  the  meeting  ad- 
journed. 

On  April  4 and  5 the  Orange  County  Medical  As- 
sociation and  the  Orange  County  Woman’s  Auxiliary 
acted  as  hosts  to  the  Southern  California  Medical  As- 
sociation during  its  meeting  in  Santa  Ana.  An  elabo- 
rate program  and  entertainment  for  both  members 
and  their  wives,  in  addition  to  the  scientific  part  of 
the  session,  served  to  make  this  meeting  a very  de- 
cided success.  A detailed  report  of  this  session  will 
be  given  by  the  secretary  of  the  Southern  California 
Medical  Association. 

Harry  G.  Huffman,  Secretary. 


May,  1930 


STATE  MEDICAL  ASSOCIATIONS 


365 


SAN  DIEGO  COUNTY 

Dr.  H.  E.  Robertson  of  the  Mayo  Clinic  talked 
before  the  Mercy  Hospital  staff  March  18  on  the  sub- 
ject, “Postmortem  Examinations  and  Means  for  Ex- 
pansion of  Their  Usefulness.”  Doctor  Robertson 
stressed  the  importance  of  postmortem  examinations 
and  gave  his  hearers  some  good,  practical  advice.  In 
his  remarks  he  made  a plea  for  more  dignity  in  con- 
ducting the  autopsy,  a better  understanding  between 
physician  and  undertaker,  and  the  need  of  informing 
relatives  as  to  the  findings  of  the  examination.  The 
most  important  point  brought  out  by  Doctor  Robert- 
son was  the  need  for  wider  dissemination  of  the  infor- 
mation of  postmortem  findings  among  the  members 
of  the  profession,  either  at  staff  meetings  or  by  mak- 
ing the  reports  in  the  form  of  a letter. 

The  regular  monthly  meeting  of  the  staff  of  the 
Scripps  Memorial  Hospital  was  held  March  17,  at 
8 p.  m.  Dr.  Hall  G.  Holder  gave  a very  interesting 
paper  on  “The  Modern  Treatment  of  Malignant  Dis- 
eases.” Several  members  of  the  staff  closed  the  meet- 
ing with  a very  lively  discussion. 

A number  of  the  members  of  the  county  society 
motored  to  Santa  Ana  to  attend  the  sessions  of  the 
Southern  California  Medical  Association  meeting. 
Dr.  May  T.  Riach  gave  an  interesting  paper  on 
“A  Plea  for  a Closer  Cooperation  Between  the  Oph- 
thalmologist and  the  Internist.”  Dr.  Hall  G.  Holder 
and  Dr.  M.  W.  McDougall  gave  a paper  entitled 
“Circulatory  Diseases  of  the  Extremities,  with  Special 
Reference  to  Test  of  Capillary  Circulation.” 

On  Tuesday  evening,  April  8,  the  regular  monthly 
meeting  and  dinner  of  the  San  Diego  County  Medical 
Society  was  held  in  the  Don  Room  of  the  Hotel 
El  Cortez.  Dr.  Samuel  Ingham,  neurologist  of  Los 
Angeles,  was  the  speaker  of  the  evening,  and  gave  a 
very  interesting  talk  on  “How  to  Make  a Neuro- 
logical Examination  and  How  to  Interpret  Your 
Findings.”  Robert  Pollock. 

# 

SAN  JOAQUIN  COUNTY 

The  stated  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  Thursday  evening  at  eight 
o’clock,  April  3,  in  the  Medico-Dental  Club  rooms, 
242  North  Sutter  Street,  Stockton. 

The  meeting  was  called  to  order  by  Dr.  Harry  E. 
Kaplan,  president.  The  minutes  of  the  previous  stated 
meeting  and  of  a special  meeting  of  the  board  of 
directors  held  March  31  were  read  and  approved. 

Dr.  J.  J.  Sippy  reported  that  the  medical  society 
had  sponsored  a loge  of  forty-five  tickets  for  the 
Amateur  Boxing  Match  being  given  by  the  Amblers’ 
Club  for  the  benefit  of  crippled  children.  Of  these, 
thirty-six  tickets  were  already  sold.  Eighty-five  per 
cent  of  all  funds  received  are  to  be  devoted  to  the 
charitable  purposes. 

Dr.  Dewey  R.  Powell  reported  for  the  committee 
cooperating  with  the  Committee  on  the  Cost  of  Medi- 
cal Care.  They  met  with  Doctor  Sinai  to  go  over  the 
details  of  the  work,  approving  and  modifying  the 
plans  for  local  conditions. 

Dr.  R.  V.  Looser  moved  that  “the  time  of  at  least 
fifteen  minutes  be  set  aside  at  each  stated  meeting  for 
discussion  of  problems  for  the  good  of  the  county 
society  and  its  members.”  Seconded. 

Dr.  Dewey  R.  Powell  moved  to  amend  the  motion, 
inserting  the  words,  “sufficient  time  be  allotted,” 
instead  of  “fifteen  minutes.”  Seconded. 

Both  the  amendment  and  the  original  motion  were 
carried. 

Dr.  Fred  R.  De  Lappe  of  Modesto,  the  district 
councilor,  was  present  and  spoke  to  the  society  on 
several  matters.  He  called  attention  to  the  benefits 
to  be  derived  from  an  active  Woman’s  Auxiliary;  he 
urged  the  importance  of  the  Optional  Medical  De- 
fense; the  solicitation  of  new  members;  more  atten- 
tion to  the  careful  writing  of  narcotic  prescriptions; 
and  attendance  at  the  state  convention  this  year. 


Dr.  Dewey  R.  Powell  moved  that,  as  a compliment 
to  our  member,  Dr.  George  Sanderson,  who  is  secre- 
tary of  the  Northern  District  Medical  Society,  our 
own  society  should  entertain  the  visiting  members  at 
luncheon  when  they  come  here  for  the  convention  on 
Tuesday,  April  8.  Seconded  and  carried. 

There  being  no  further  business,  Doctor  Kaplan 
introduced  Dr.  William  W.  Newman  of  San  Fran- 
cisco for  an  address  on  “The  Sweaney  Method  of 
Examining  Sputum  for  Acid-Fast  Bacilli  Often  Found 
in  Patients  with  no  Physical  and  no  X-ray  Evidence 
of  Tuberculosis.”  He  said  that  prior  to  using  the 
concentration  method  it  was  seldom  that  acid-fast 
organisms  were  found  in  the  sputum.  During  the 
past  ten  months  eighty-six  specimens  had  been  ex- 
amined by  the  Sweaney  method  with  20  per  cent 
showing  positive,  whereas  only  two  cases  were  posi- 
tive by  the  direct  method.  The  unique  point  in  this 
method  is  that  after  the  sputum  has  been  collected 
in  a clean,  rubber-stoppered  bottle,  it  is  first  incu- 
bated for  twenty-four  hours.  It  is  then  digested  with 
sodium  hydroxid,  centrifuged,  the  supernatent  fluid 
decanted  and  specimens  from  the  upper  layer  of 
sediment  stained  and  examined  in  the  usual  manner 
by  the  Ziehl-Neelson  technique.  He  named  as  possi- 
ble sources  of  error  the  following:  (1)  Scratches  on 
slides.  (2)  Saprophytic  bacteria  from  ordinary  cork. 
(3)  Presence  of  other  acid-fast  bacteria  such  as 
Smegma  and  Timothy.  (4)  Tuberculous  bacilli  as 
saprophytes.  He  went  into  detail  to  show  that  pre- 
cautions had  been  taken  to  avoid  such  errors. 

All  of  the  doctor’s  patients  had  originally  presented 
themselves  for  heart  examination  because  of  pain  in 
the  chest,  usually  about  the  heart.  He  presented  an 
analysis  of  the  seventeen  positive  cases.  Six  of  these 
had  no  cardiovascular  pathology.  Of  these,  five  com- 
plained of  pain  in  the  chest  and  the  other  was  short 
of  breath.  Four  of  them  showed  no  pathology  in  the 
chest  by  x-ray  or  physical  examination,  but  two  had 
positive  pathology  on  x-ray.  Four  of  the  six  he  be- 
lieves were  tuberculous  because  of  history,  under- 
weight, or  afternoon  temperatures.  Of  the  other 
nineteen,  eleven  had  definite  cardiovascular  pathology, 
but  three  also  had  positive  tuberculous  symptoms  for 
conditions.  With  the  remaining  eight,  as  their  cardio- 
vascular symptoms  disappeared,  the  acid-fast  bacilli 
also  disappeared  from  the  sputum.  In  conclusion,  the 
doctor  said:  “We  have  seventeen  patients  having  acid- 
fast  bacilli  in  their  sputum.  Of  these  only  four  have 
confirmatory  evidence  of  tuberculosis  in  their  x-ray 
and  only  nine  can  on  any  account  be  suspected  of 
tuberculosis.  What  is  the  significance  of  the  remain- 
ing eight?” 

The  discussion  was  led  by  Dr.  N.  E.  Williamson, 
who  said  that  there  had  been  many  concentration 
methods  used.  A Doctor  Bean  used  one  for  tubercle 
bacilli  in  the  blood  and  was  amazed  at  the  large  num- 
ber he  found  until  it  was  discovered  that  the  distilled 
water  used  for  dilution  was  contaminated.  He  men- 
tioned the  large  number  of  acid-fast  bacilli  which  are 
found  in  nature.  He  feels  conservative  about  results 
and  pays  more  attention  to  cultures. 

Dr.  J.  W.  Barnes  next  presented  a paper  on  “Com- 
plications of  Some  of  the  Acute  Infections.”  He 
called  attention  particularly  to  the  grave  danger  to 
the  heart  of  a child  in  such  conditions  as  acute  rheu- 
matism, chorea,  acute  tonsillitis,  quinsy,  and  even  at- 
tacks of  growing  pains.  He  mentioned  that  too  often 
no  attention  is  paid  to  the  heart  in  the  examination, 
although  it  is  the  one  organ  most  often  affected.  In 
the  matter  of  treatment  he  said  that  rest  is  the  one 
great  factor  over  a long  period — at  least  six  months 
and  better  upward  of  a year. 

Following  this  paper,  Doctor  Newman  presented 
moving  pictures  showing  the  heart  action  under  nor- 
mal conditions  and  following  stimulation  of  nerves. 
He  demonstrated  that  the  heart  ventricles  are  filled, 
not  by  auricular  contraction,  but  by  venous  pressure. 
Also,  he  pointed  out  in  the  pictures  that  auricular 


366 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


fibrillation  tends  to  recover,  whereas  ventricular  fibril- 
lation ends  in  death. 

The  president  appointed  Doctors  Gallegos,  Dozier, 
Foard,  and  Van  Meter  to  arrange  for  a smoker  for 
the  society. 

The  meeting  was  well  attended,  there  being  Drs, 
Newman,  De  Lappe,  Sutton,  Barton  Powell  Jr.,  and 
Mr.  Curtis  as  visitors;  also  two  nurses  from  the 
Health  Center.  The  members  present  were:  Drs. 
E.  A.  Arthur,  Barnes,  Blackmun,  Blinn,  Broaddus, 
Conzelmann,  Dozier,  Foard,  Gallegos,  Goodman, 
Haight,  Hanson,  Kaplan,  Krout,  Looser,  McCoskey, 
B.  J.  Powell,  D.  R.  Powell,  Priestley,  Rohrbacher, 
Sanderson,  Sheldon,  Sippy,  Smyth,  Thompson,  and 
Williamson. 

There  being  no  further  business  the  meeting  ad- 
journed for  refreshments. 

C.  A.  Broaddus,  Secretary. 


SAN  LUIS  OBISPO  COUNTY 

The  regular  monthly  meeting  of  the  San  Luis 
Obispo  County  Medical  Society  was  held  Saturday 
night,  March  22,  at  the  Atascadero  Inn.  Eleven 
members  were  present. 

The  minutes  of  the  two  previous  meetings  were 
read  and  approved. 

Dr.  Gifford  L.  Sobey  of  Paso  Robles  was  elected 
delegate  and  Dr.  H.  S.  Walters  of  San  Luis  Obispo 
was  elected  alternate  for  the  next  meeting  of  the  state 
medical  society. 

A discussion  was  held  upon  the  federal  Porter  nar- 
cotic bills  now  before  Congress,  and  it  was  decided 
to  forward  a resolution  to  the  members  of  Congress 
informing  them  that  the  County  Medical  Association, 
while  in  favor  of  the  regulation  of  narcotics,  was 
opposed  to  the  Porter  bill. 

After  discussion  it  was  decided  that  the  secretary 
forward  to  the  State  Medical  Association  a brief 
summary  of  each  monthly  meeting  for  inclusion  in 
the  state  medical  journal.  A general  discussion  was 
held  relative  to  revision  of  the  county  fee  schedule, 
and  to  formulation  of  some  plan  whereby  collections 
could  be  made  more  promptly. 

The  meeting  adjourned  at  10:50  o’clock. 

Those  present  were  Doctors  Gallup,  McGarvey, 
Sobey,  Butler,  Larsen,  Bartle,  Mills,  Law,  Walters, 
Mugler,  and  Gillihan. 

Allen  F.  Gillihan,  Secretary. 

# 

SANTA  BARBARA  COUNTY 

The  regular  meeting  of  the  Santa  Barbara  County 
Medical  Society  was  held  on  Monday,  April  14,  at 
8 p.  m.  in  the  new  Bissell  Auditorium  of  the  Cottage 
Hospital. 

The  meeting  was  called  to  order  by  President  Frei- 
dell,  and  the  minutes  of  the  last  meeting  were  read 
and  approved. 

Doctor  Freidell  then  introduced  Dr.  Elmer  Bissell, 
who  stated  that  he  and  Mrs.  Bissell  fully  appreciated 
the  fact  that  the  best  must  be  given  to  the  patient, 
but  at  the  same  time  they  felt  that  the  doctors  them- 
selves should  not  be  slighted,  and  to  this  end  it  was 
their  great  pleasure  to  endow  this  Bissell  Auditorium 
for  the  use  of  the  medical  profession,  together  with 
a lounging  room  and  library,  with  a librarian  in 
charge.  Doctor  Bissell  also  expressed  the  keen 
pleasure  of  Mrs.  Bissell  in  selecting  the  draperies  and 
furniture  for  the  rooms,  and  hoped  that  the  joy  of 
the  medical  profession  in  the  gift  would  be  com- 
mensurate to  that  of  the  donors. 

It  was  then  moved  by  Doctor  Bakewell,  and  sec- 
onded by  Doctor  Brush,  that  a rising  vote  of  thanks 
be  given  to  Dr.  and  Mrs.  Bissell  for  their  wonderful 
contribution  to  the  Cottage  Hospital  for  the  benefit 
of  the  medical  profession. 

The  scientific  program  was  opened  by  Doctor  Pro- 
fant,  who  gave  a paper,  illustrated  with  lantern  slides, 


on  “Gradenigo’s  Syndrome,  with  a Consideration  of 
Petrositis.”  This  paper  was  discussed  by  Doctors 
Geyman,  Hunt,  and  Thorner. 

Doctor  Wills  then  followed  with  a presentation  on 
“Conservatism  in  Prostatic  Enlargement.”  This  was 
discussed  by  Doctor  Pierce. 

Both  papers  were  enthusiastically  received  and  en- 
joyed by  all. 

The  president  then  introduced  Mr.  McMann,  who 
spoke  briefly  on  the  coming  convention  in  Santa  Bar- 
bara of  the  California  Social  Service  Conference. 
Favorable  comments  were  made  by  Doctors  Lamb 
and  Markthaler,  and  it  was  moved,  seconded,  and 
carried  that  the  Santa  Barbara  County  Medical  Society 
pay  $10  for  a yearly  membership  in  this  conference. 

There  being  no  further  business  the  meeting  ad- 
journed. W.  H.  Eaton,  Secretary. 

VENTURA  COUNTY 

The  April  meeting  of  the  Ventura  County  Medical 
Society  was  held  Tuesday  evening,  April  8 at  the 
clinic  of  the  Ventura  County  Hospital.  Dr.  D.  G. 
Clark  opened  the  meeting.  Members  present  were: 
D.  G.  Clark,  Smolt,  W.  S.  Clark,  Hill,  Homer,  Patton, 
Achenbach,  Tillim,  Welsh,  Armitstead,  Shore,  Schultz, 
Jones,  Felberbaum,  and  Bardill.  Guests  were:  Dr. 
H.  J.  Ullmann  and  Dr.  and  Mrs.  Richard  Evans  of 
Santa  Barbara,  and  Drs.  Mosher  and  Rhymes  of 
Ventura. 

The  meeting  adjourned  to  the  County  Hospital, 
where  Dr.  R.  W.  Homer  demonstrated  several  cases 
of  malignant  disease.  Upon  return  to  the  clinic  build- 
ing, Doctor  Evans  read  a paper  on  the  “Histo- 
pathology  of  Diseases  of  the  Breast.”  This  paper  was 
accompanied  by  a series  of  very  fine  microscopic  sec- 
tions, shown  by  means  of  a projecting  microscope. 

Doctor  Ullmann  then  presented,  by  means  of  a 
motion  picture  projector,  a marvelous  film  showing 
the  growth  and  reproduction  of  living  cells  in  normal 
and  malignant  tissues  and  the  effects  of  radium 
thereon. 

A short  business  meeting  followed.  The  secretary 
was  instructed  to  refer  Doctor  Cornman’s  request  for 
nonresident  membership  to  the  state  secretary. 

Charles  A.  Smolt,  Secretary. 

* 

CHANGES  IN  MEMBERSHIP 
New  Members 

Alameda  County— Frank  S.  Bissell,  Edwin  Daniel 
Greer,  Oliver  Brinton  Jensen,  Theodore  E.  Schwarz, 
and  Anah  Cecelia  Wineberg. 

Butte  County — Frank  Moore  Whiting. 

Contra  Costa  County — Ira  Otis  Church  and  Clara  H. 
Spalding. 

Fresno  County — A.  A.  Arehart. 

Imperial  County — T.  E.  Bartholomew  and  Oran  L. 
Webster. 

Kern  County — Harrison  M.  Hawkins. 

Los  Angeles  County — David  George  Azadian,  Charles 
Hall  Cowgill,  William  Edward  Hunter,  Hugh  Toland 
Jones,  Theodore  Spalding  Kimball,  Angus  Cameron 
McDonald,  Susanne  Ring  Parsons,  Marvin  K.  Paup, 
Rankin  Reiff,  Monte  Salvin,  James  Robert  Sanford, 
and  Fred  Cecil  Watson. 

Merced  County — Amzi  Martin  Gregory. 

Orange  County  — Henry  Frank  Gramlich,  Henry 
MacVicker  Smith,  and  Robert  Simpson  Wade. 

Sacramento  County — Ernest  Sevier. 

San  Benito  County — Rosewell  Hull  and  Fred  Fellows 
Sprague. 

San  Bernardino  County — Samuel  Andrew  Crooks, 
Franklin  Hunter  Garrett,  and  Charles  William  Moots. 

San  Diego  County — John  Carl  Schleppi,  Rudolph 
Herbert  Sundberg,  Oril  Stone  Harbaugh,  and  Mal- 
colm Y.  Marshall. 


May,  1930 


STATE  MEDICAL  ASSOCIATIONS 


367 


San  Francisco  County — Jessie  Marguerite  Bierman, 
Charlotte  A.  Boehm,  Donald  Alfonso  Carson,  Chester 
L.  Cooley,  William  Amos  Key,  and  Helen  Hopkins 
Detrick. 

San  Luis  Obispo  County — Harry  Seth  Walters. 

San  Mateo  County — Augustus  A.  Gerlach,  R.  J. 
Gerlough,  Ralph  E.  Scovel,  and  Ralph  D.  Howe. 

Santa  Clara  County — Lucas  W.  Empey. 

Santa  Cruz  County — Frederick  P.  Shenk. 

Siskiyou  County — Daniel  F.  McCann  and  Albert  H. 
Newton. 

Solano  County — Warren  Corned  Jenney. 

Sonoma  County — Byron  Lee  Baldwin,  H.  Julian 
Wright,  M.  H.  Hamelink,  and  Hiriam  A.  Haskell. 

Tulare  County — Elmer  C.  Bond,  Reuben  C.  Hill, 
H.  A.  Todd,  and  Karl  F.  Weiss. 

Ventura  County — Fred  A.  Shore  and  Charles  Ray- 
mond Illick. 

Transferred  Members 

Edwin  D.  Kilbourne,  from  Los  Angeles  to  Orange 
County. 

Arthur  E.  Dart,  from  San  Francisco  to  Alameda 
County. 

Delta  Ross  Olsen,  from  San  Francisco  to  Alameda 
County. 

John  L.  Fanning,  from  Placer  to  Sacramento 
County. 

Owen  W.  E.  Nowlin,  from  Los  Angeles  to  Illinois 
Medical  Association. 

William  M.  Maloney,  from  Los  Angeles  to  Arizona 
Medical  Association. 

Blake  C.  Wilbur,  from  San  Francisco  to  Santa 
Clara  County. 

Willis  E.  King,  from  San  Francisco  to  Sacramento 
County. 

Frederick  P.  Shafer,  from  San  Francisco  to  Los 
Angeles  County. 

Ira  B.  Bartle,  from  Imperial  to  San  Luis  Obispo 
County. 

Jens  W.  Larsen,  from  Yolo-Colusa  to  San  Luis 
Obispo  County. 

Edith  Harrison,  from  Santa  Cruz  to  Humboldt 
County. 

Iner  Sheld  Ritchie,  from  Imperial  to  San  Bernar- 
dino County. 

Walter  B.  Felger,  from  Yolo-Colusa  to  Sacramento 
Count}'. 

Resignations 

San  Francisco  County — Ethan  H.  Smith,  Hajo  P. 
Plagge,  and  Edward  P.  Driscoll. 

San  Diego  County — Frank  A.  Lee. 

Santa  Cruz  County — Thomas  F.  Conroy. 

Deaths 

Edie,  Guy  Lewis.  Died  at  San  Francisco,  April  8, 
1930,  age  72  years.  Graduate  of  the  University  of 
Virginia  Department  of  Medicine,  1879.  Licensed  in 
California,  1901.  Doctor  Edie  was  a member  of  the 
San  Francisco  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

Franklin,  James  William.  Died  January  4,  1930,  age 
50  years.  Graduate  of  the  University  of  Texas  School 
of  Medicine,  Galveston,  1909.  Licensed  in  California, 
1914.  Doctor  Franklin  was  a member  of  the  Los 
Angeles  County  Medical  Association,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

Gatchell,  Ella  Frances.  Died  at  Chico,  April  9, 
1930,  age  77  years.  Graduate  of  the  College  of  Phy- 
sicians and  Surgeons,  Boston,  1889.  Licensed  in  Cali- 
fornia, 1895.  Doctor  Gatchell  was  a member  of  the 
Butte  County  Medical  Society,  the  California  Medical 
Association,  and  a Fellow  of  the  American  Medical 
Association. 


Guy,  Walter  Parry.  Died  at  Los  Angeles,  April  3, 
1930,  age  47  years.  Graduate  of  Rush  Medical  College, 
Chicago,  1909.  Licensed  in  California,  1920.  Doctor 
Guy  was  a member  of  the  Los  Angeles  County  Medi- 
cal Association,  the  California  Medical  Association, 
and  the  American  Medical  Association. 

Harbinson,  James  Edward.  Died  at  Woodland, 
March  9,  1930,  age  36  years.  Graduate  of  University 
of  California  Medical  School,  Berkeley,  1922.  Licensed 
in  California,  1922.  Doctor  Harbinson  was  a member 
of  the  Yolo  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

Henrikson,  Gustav.  Died  at  Sacramento,  Febru- 
ary 18,  1930,  age  72  years.  Graduate  of  California 
Eclectic  Medical  College,  Los  Angeles,  1894.  Licensed 
in  California,  1894.  Doctor  Henrikson  was  a member 
of  the  Sacramento  Society  for  Medical  Improvement, 
the  California  Medical  Association,  and  a Fellow  of 
the  American  Medical  Association. 

McDowell,  Anderson  Eddie.  Died  at  Los  Angeles, 
March  20,  1930,  age  49  years.  Graduate  of  North- 
western University  Medical  School,  Chicago,  1909. 
Licensed  in  California,  1909.  Doctor  McDowell  was 
a member  of  the  Los  Angeles  County  Medical  As- 
sociation, the  California  Medical  Association,  and  a 
Fellow  of  the  American  Medical  Association. 

Muchnic,  Adolph  Maurice.  Died  at  Los  Angeles, 
March  29,  1930,  age  54  years.  Graduate  of  Univer- 
sity of  Illinois  College  of  Medicine,  Chicago,  1911. 
Licensed  in  California,  1911.  Doctor  Muchnic  was 
a member  of  the  Los  Angeles  County  Medical  As- 
sociation, the  California  Medical  Association,  and  a 
Fellow  of  the  American  Medical  Association. 

Read,  William  Parsons.  Died  at  San  Francisco, 
April  12,  1930,  age  56  years.  Graduate  of  Jefferson 
Medical  College  of  Philadelphia,  1896.  Licensed  in 
California,  1898.  Doctor  Read  was  a member  of  the 
San  Francisco  County  Medical  Society,  the  California 
Medical  Association,  and  a Fellow  of  the  American 
Medical  Association. 

* * * 

Erratum. — The  notice  of  death  of  Dr.  Joseph  Salem 
Rubin,  page  293  of  the  April  journal,  copied  from  the 
February  22,  1930  Journal  of  the  American  Medical 
Association,  page  577,  we  are  glad  to  state,  was  an 
error.  Doctor  Rubin,  in  a personal  letter,  informs  us 
he  is  still  engaged  in  the  practice  of  medicine  at  Los 
Angeles.  


THE  WOMAN’S  AUXILIARY  OF  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION* 

For  the  convenience  of  officers  of  the  county  auxili- 
aries, the  names  and  addresses  of  the  national  officers 
and  of  standing  committees  of  the  Woman’s  Auxiliary 
of  the  American  Medical  Association  are  here  printed. 
It  is  possible  that  county  auxiliaries  may  wish  to 
organize  their  own  standing  committees  after  a some- 
what similar  plan: 

^ Officers 

President,  Mrs.  George  H.  Hoxie,  3719  Pennsyl- 
vania Avenue,  Kansas  City,  Missouri. 

President-elect,  Mrs.  J.  Newton  Hunsberger,  514 
West  Main  Street,  Norristown,  Pennsylvania. 

Corresponding  secretary,  Mrs.  G.  B.  Arnold,  906 
East  Armour  Boulevard,  Kansas  City,  Missouri. 

Recording  secretary,  Mrs.  Arthur  T.  McCormick, 
Brown  Hotel,  Louisville,  Kentucky. 

Treasurer,  Mrs.  Fred  L.  Adair,  2500  Blaisdell 
Avenue,  Minneapolis,  Minnesota. 

Historian,  Mrs.  S.  C.  Red,  817  Caroline  Street, 
Houston,  Texas. 

* As  county  auxiliaries  to  the  Woman's  Auxiliary  of  the 
California  Medical  Association  are  formed,  the  names  of 
officers  should  be  forwarded  to  the  state  secretary-treas- 
urer, Mrs.  R.  A.  Cushman,  632  North  Broadway,  Santa 
Ana,  and  to  the  California  Medical  Association  office. 
Room  2004,  450  Sutter  Street.  San  Francisco.  Brief  re- 
ports of  county  auxiliary  meetings  will  be  welcomed  for 
publication  in  this  column. 


368 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Chairman  of  Standing  Committees 

Program — Mrs.  E.  V.  DePew,  1115  East  Agarita 
Avenue,  San  Antonio,  Texas. 

Press  and  Publicity — Mrs.  Allan  H.  Bunce,  368 
Ponce  de  Leon  Avenue,  N.  E.,  Atlanta,  Georgia. 

Public  Relations — Mrs.  M.  P.  Overholser,  State 
Hospital  No.  2,  St.  Joseph,  Missouri. 

Finance — Airs.  James  Blake,  Hopkins,  Alinnesota. 

Revisions — Mrs.  J.  N.  Hunsberger,  514  West  Main 
Street,  Norristown,  Pennsylvania. 

Printing — Airs.  C.  B.  Forcey,  105  Beaver  Street, 
Sewickley,  Pennsylvania. 

Social— Mrs.  Southgate  Leigh,  526  Shirley  Avenue, 
Norfolk,  Virginia.  jg, 


CONTRA  COSTA  COUNTY 

The  Woman’s  Auxiliary  of  the  Contra  Costa  County 
Medical  Society  held  its  monthly  meeting  April  8 
at  the  Congregational  Church  in  Martinez.  Mrs.  J.  M. 
McCullough,  president,  presided.  The  minutes  of  the 
previous  meeting  were  read  and  approved.  An  article 
on  “Reasons  for  a Woman’s  Auxiliary”  by  the  Iowa 
State  Medical  Society  was  read. 

A committee  composed  of  Mrs.  I.  O.  Church 
(chairman),  Airs.  H.  L.  Neufeld,  and  Mrs.  F.  W. 
Overdahl  was  appointed  to  visit  Sunshine  Camp,  the 
county  preventorium.  All  members  were  urged  to 
visit  Sunshine  Camp  to  acquaint  themselves  with  the 
work  being  done  for  the  undernourished  and  pre- 
tuberculous  children  of  this  county. 

A Silver  Tea  is  planned  for  May  20  at  the  home 
of  Mrs.  J.  L.  Beard  of  Martinez.  Airs.  J.  W.  Bum- 
garner is  in  charge  of  the  program. 

After  the  business  meeting,  those  present  enjoyed 
vocal  selections  by  Mrs.  I.  O.  Church,  with  Airs. 
J.  W.  Bumgarner  as  accompanist.  Three  very  pleas- 
ing readings  were  then  given  by  Airs.  F.  W.  Overdahl. 
Later  the  doctors  joined  the  ladies,  and  refreshments 
were  served  by  the  auxiliary. 

Alembers  present  were:  Mesdames  I.  O.  Church, 
J.  L.  Beard,  H.  D.  Neufeld,  C.  R.  Leech,  L.  H.  Fraser, 
J.  W.  Bumgarner,  F.  W.  Overdahl,  J.  M.  McCullough, 
and  S.  N.  Weil.  Helen  Weil,  Secretary. 

■» 


LOS  ANGELES  COUNTY 

The  regular  meeting  of  the  Woman’s  Auxiliary  was 
held  Thursday,  April  17,  at  2:30  p.  m.  in  the  Assem- 
bly Hall,  Friday  Alorning  Club  building,  Los  Angeles, 
with  Mrs.  James  F.  Percy,  president,  presiding.  Mrs. 
George  C.  Hunter,  acting  secretary. 

Dr.  George  H.  Kress,  editor  of  California  and 
Western  Medicine,  was  the  distinguished  speaker  of 
the  afternoon. 

A musical  program  was  given  by  Mrs.  William  A. 
Clark,  violinist,  with  Airs.  E.  D.  Kremers,  accom- 
panist, from  Pasadena.  The  tea  hour  was  in  charge 
of  Long  Beach  members,  Mrs.  B.  von  Wedelstaedt, 
chairman. 

The  following  committees  in  charge: 

Reception — Mesdames  William  H.  Duffield,  Los 
Angeles;  LeRoy  B.  Sherry,  Pasadena;  H.  R.  Boyer, 
Glendale;  Fred  B.  Clarke,  Long  Beach;  Elliot  P. 
Smart,  San  Fernando. 

Hostess — Mrs.  Robert  V.  Day;  assistant,  Airs.  John 
V.  Barrow. 

Credentials — Mrs.  Elliot  Alden. 

Ushers — Mrs.  Verne  R.  Mason. 

Press  and  Publicity — Mrs.  Edward  Huntington 
Williams. 

Ways  and  Means — Mrs.  Philip  Schuyler  Doane. 

Membership — Mesdames  Edgerton  O.  Crispin,  Los 
Angeles;  Harry  F.  Markolf,  Pasadena;  H.  V.  Brown, 
Glendale;  William  B.  Wright,  Jr.,  Long  Beach;  John 
L.  McDaniel,  San  Fernando. 

Bulletins— Mrs.  George  G.  Hunter. 


President’s  Aide — Airs.  W.  H.  Futch. 

Program — Alesdames  E.  M.  Lazard  and  H.  G. 
Alarxmiller. 

Courtesy — Airs.  Wilbur  Parker;  assistant,  Mrs. 
W.  H.  Alayne. 

Club  Survey — Airs.  Norman  Williams. 

Sick — Mrs.  Arnold  Burkelman. 

In  May  the  Los  Angeles  County  Aledical  Associa- 
tion is  planning  to  give  an  aviation  ball  and  frolic 
in  honor  of  the  Woman’s  Auxiliary. 

Cora  Young  Williams, 

„ Publicity  Chairman. 

MONTEREY  COUNTY 

A Woman’s  Auxiliary  of  the  Alonterey  County 
Medical  Association  was  formed  on  April  4. 

Six  charter  members  elected  the  following  officers: 
Airs.  C.  H.  Lowell,  president;  Mrs.  R.  M.  Fortier, 
first  vice-president;  Airs.  R.  J.  Cluen,  second  vice- 
president;  Airs.  Arthur  A.  Arehart,  secretary-treasurer. 

The  next  meeting  of  the  auxiliary  will  be  held 
Thursday  afternoon,  April  10,  at  the  Del  Alonte  Hotel, 
when  plans  for  the  convention  of  the  State  Medical 
Association  will  be  considered. 

Mrs.  Arthur  A.  Arehart, 

^ Secretary. 

ORANGE  COUNTY 

The  regular  meeting  of  the  Woman’s  Auxiliary  of 
the  Orange  County  Medical  Association  was  called 
to  order  by  the  president,  Mrs.  F.  E.  Coulter,  at  the 
home  of  Airs.  R.  A.  Cushman  on  March  4. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted  with  corrections. 

A Committee  on  Publicity  was  appointed  as  fol- 
lows: Mrs.  R.  A.  Cushman,  chairman;  Mrs.  W.  P. 
Baker. 

The  Committee  on  Entertainment  for  the  wives  of 
delegates  to  the  Southern  California  Medical  Asso- 
ciation was  announced  by  Airs.  Coulter  as  follows: 
Mrs.  Harry  Huffman,  general  chairman;  Alesdames 
Robertson  Yeagle,  Clark,  D.  R.  Ball,  H.  A.  Johnston, 
Newkirk,  Baker,  and  Cushman. 

A report  of  the  tentative  plans  was  made  by  the 
chairman,  Airs.  Huffman. 

The  treasurer’s  report  was  read  and  accepted. 

An  amusing  excerpt  from  Alma  Whitacker’s 
“Sugar  and  Spice”  about  the  meeting  of  the  Los 
Angeles  auxiliary  was  read  by  Mrs.  Coulter. 

An  excellent  and  interesting  talk  on  the  work  of 
the  Orange  County  Health  Department  was  given 
by  Dr.  K.  H.  Sutherland,  head  of  the  department. 

It  was  moved  and  seconded  that  a courtesy  com- 
mittee be  appointed  to  attend  to  sending  flowers  to 
sick  members  of  the  auxiliary.  Alotion  carried. 

It  was  moved  and  seconded  that  a committee  for 
hostess  problems  be  appointed.  Motion  carried. 

The  meeting  was  then  adjourned. 

* * * 

The  regular  meeting  of  the  Woman’s  Auxiliary  of 
the  Orange  County  Medical  Association  was  called 
to  order  by  the  president,  Mrs.  F.  E.  Coulter,  at  the 
home  of  Mrs.  Frank  Paterson,  2315  Heliotrope  Drive, 
Santa  Ana,  on  April  1.  Thirty-five  members  were 
present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted.  A letter  from  the  Ebell  Society,  in  answer 
to  our  letter  of  February  23,  was  read.  A note  of 
thanks  from  Mrs.  Chapline  was  also  read. 

The  president  then  appointed  the  following  com- 
mittees: 

Committee  on  Entertainment  (Hostess  Problems) — 
Mrs.  Frank  Paterson  (chairman),  Mrs.  Emmett  Raitt, 
and  Mrs.  H.  M.  Robertson. 


May,  1930 


STATE  MEDICAL  ASSOCIATIONS 


369 


Committee  on  Flowers  (Courtesy  Committee) — 
Mrs.  R.  P.  Yeagle  (chairman),  Mrs.  J.  1.  Clark,  and 
Mrs.  H.  D.  Newkirk. 

Mrs.  Paterson  reported  for  the  Entertainment  Com- 
mittee that  the  May  meeting  would  be  held  at  the 
home  of  Mrs.  D.  A.  Harwood,  2467  Riverside  Drive, 
Santa  Ana.  Mrs.  W.  F.  Kistinger  will  be  cohostess. 

Mrs.  Yeagle  reported  for  the  Flower  Committee 
that  calls  had  been  made  on  Mrs.  Chapline  and  Mrs. 
Johnston  and  flowers  taken  to  each. 

A motion  was  made  by  Mrs.  Kistinger  and  sec- 
onded that  a silver  offering  be  taken  at  each  meeting 
to  cover  the  expenses  of  the  Flower  Committee. 
Motion  carried. 

Business  of  the  meeting  was  then  set  aside  for 
our  speaker,  Doctor  Ruble,  who  gave  a most  com- 
prehensive talk  on  immunity  and  the  benefits  of 
examinations  of  the  school  children.  The  decrease  of 
the  virulence  of  diphtheria,  especially,  and  other  con- 
tagious diseases  in  general,  due  to  inoculations  of 
children,  was  shown. 

On  resumption  of  the  business  of  the  day,  Mrs. 
Huffman  reported  on  the  plans  for  the  entertain- 
ment of  the  wives  of  the  visiting  delegates  to  the 
Southern  California  Medical  Association. 

It  was  decided  that  the  dues  of  the  auxiliary  should 
run  from  January  to  January  of  each  year. 

Mrs.  Cushman,  secretary-treasurer  of  the  State 
Auxiliary,  speaking  of  the  coming  meeting  at  Del 
Monte,  urged  all  wives  to  accompany  their  husbands 
if  possible. 

Mrs.  Baker  moved  that  the  hour  of  the  meetings 
be  2:30  o’clock  hereafter.  Motion  was  seconded  and 

carried. 

It  was  moved  by  Mrs.  Paterson  that  all  members 
of  the  auxiliary  are  expected  to  come  to  the  meetings 
and  only  those  not  able  to  come  are  to  send  regrets 
to  the  hostess.  Motion  was  seconded  and  carried. 

The  meeting  was  then  adjourned. 

Edna  M.  Ball,  Secretary. 


NEVADA  STATE  MEDICAL 
ASSOCIATION 

W.  A.  SHAW President 

R.  P.  ROANTREE,  Elko .President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER.  Carson  City Second  Vice-President 

HORACE  J.  BROWN Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON.... Trustees 

COMPONENT  COUNTY  SOCIETIES 

WASHOE  COUNTY 

The  regular  meeting  of  the  Washoe  County  Medi- 
cal Society  was  held  at  the  Reno  City  Hall  on 
March  8,  Dr.  E.  E.  Hamer  of  Carson  presiding. 

The  Library  Committee  appointed  at  the  last  meet- 
ing of  the  society  reported  cooperation  with  the  trus- 
tees of  the  Washoe  County  Library  and  stated  that 
there  would  be  placed  on  file  for  interested  readers 
the  current  medical  literature  of  the  day. 

Since  the  last  meeting  of  the  society,  every  Nevadan 
was  pained  to  learn  of  the  untimely  death  of  a former 
president  of  this  society  who  served  as  chief  public 
health  officer  of  Nevada  for  four  years.  The  death  of 
Dr.  Henry  Albert  at  Des  Moines,  at  which  city  he 
had  his  headquarters  since  leaving  Reno  four  years 
ago,  was  received  with  sincerest  regret  by  the  medi- 
cal profession  of  Nevada,  to  whom  he  had  endeared 
himself  by  his  splendid  scientific  labor.  The  com- 
mittee appointed  by  the  president  to  draft  resolutions 
relative  to  his  work  and  death  responded  in  a suitable 
manner. 

Doctor  Perry  of  Reno  read  a well-illustrated  paper 
on  “Colles’  Fracture.”  The  doctor  dwelt  upon  the 
anatomical  points  involved,  the  pathology  and  treat- 
ment. With  reference  to  the  use  of  patent  splints  for 
such  cases,  Doctor  Perry  said  that,  in  his  opinion, 
better  results  were  obtained  by  making  a splint  to  fit 


the  individual  than  by  the  use  of  ready-made  ones. 
Complete  relaxation  under  ether,  sufficient  traction, 
supporting  splints  with  x-rays  to  observe  results,  cor- 
rections of  malpositions  and  early  movements  of  the 
fingers  with  massage,  would  in  the  majority  of  cases 
restore  normal  contour  and  function. 

Dr.  Richard  Schofield,  industrial  surgeon  at  Hobart 
Mills,  followed  with  a paper  on  “Fracture  of  the 
Elbow,”  citing  fifteen  cases.  The  essential  points 
stressed  in  Doctor  Schofield’s  paper  were  more  time 
and  patience  in  getting  broken  parts  into  coaptation 
with  liberal  aid  of  x-ray  pictures  taken  during  the 
operation  to  assure  that  the  parts  were  coapted.  Next 
to  avoid  keeping  fractured  bones  too  long  in  one 
position  without  releasing  the  splints  and,  guided  by 
the  x-ray  picture,  making  a readjustment  where 
necessary. 

In  both  papers  stress  was  laid  upon  necessity  of 
an  aseptic  field  in  all  compound  fractures.  The  writer 
of  these  excerpts  would  add  the  use,  too,  of  tetanus 
antitoxin  in  every  compound  fracture  and  when  in 
doubt  as  to  results,  the  need  for  consultation.  Con- 
sultation divides  responsibility,  and  in  bad  cases  avoids 
possible  lawsuit.  A poorly  reduced  fracture  is  always 
a living  testimony  against  the  operator  and  a dam- 
aging exhibit  as  long  as  the  patient  lives. 

No  further  discussions.  The  society  decided  that  it 
would  cooperate  with  the  Lassen  County  Medical 
Society  to  hold  a joint  meeting  with  them  during  the 
coming  summer  months. 

There  was  a large  attendance,  two  men  coming 
from  Susanville,  about  one  hundred  miles  away,  and 
several  from  points  fifty  and  sixty  miles.  Let  the 
eastern  medicos,  if  they  chance  to  read  this,  sit  up  and 
think  what  such  distances  mean. 

Meeting  adjourned. 

Thomas  W.  Bath,  Secretary. 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 


j.  U.  GIESY,  701  Medical  Arts  Building, 

Salt  Lake  City Associate  Editor  for  Utah 


COMPONENT  COUNTY  SOCIETIES 

SALT  LAKE  COUNTY 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society  was  held  at  the  Newhouse  Hotel  Monday, 
March  10. 

The  meeting  was  called  to  order  at  8:15  p.  m.  by 
President  M.  M.  Nielson.  Thirty-six  members  and 
three  visitors  were  present. 

Joseph  E.  Peck  presented  a paper  upon  “Rural  Ob- 
stetrics,” which  was  discussed  by  J.  Z.  Brown,  S.  G. 
Kahn,  E.  M.  Neher,  and  W.  F.  Beer. 

L.  E.  Viko  read  a paper  entitled  “The  Etiology  of 
Heart  Disease,  with  Especial  Reference  to  Utah.” 
This  paper  was  discussed  by  Clarence  Snow,  W.  R. 
Tyndale,  J.  Z.  Brown,  A.  C.  Callister,  and  G.  H.  Pace. 

A.  C.  Callister,  reporting  for  the  Committee  on 
Public  Health  and  Legislation,  explained  the  Porter 
Bill,  now  before  the  United  States  Senate,  and  sug- 
gested that  the  society  go  on  record  as  being  against 
this  bill.  This  report  was  discussed  by  M.  M.  Nielson, 
Clarence  Snow,  and  E.  M.  Neher.  Clarence  Snow 
moved  that  the  society  exert  its  efforts  toward  the 
prevention  of  the  Porter  Bill  before  the  United  States 
Senate,  and  that  the  secretary  be  instructed  to  write 
to  Senators  Smoot  and  King  and  Representative 
Colton  to  that  effect;  and,  furthermore,  that  a copy 
of  this  action  be  sent  to  Secretary  Olin  West  of  the 
American  Medical  Association.  Motion  seconded  and 
carried.  J.  Z.  Brown  suggested  that  a copy  also  be 
sent  to  the  originator  of  this  bill. 

The  application  of  Kenneth  E.  Noyes  was  read  and 
turned  over  to  the  board  of  censors. 


370 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


M.  M.  Nielson  presented  a plan  for  classification  of 
all  members  of  the  Salt  Lake  County  Medical  Society 
in  the  telephone  directory.  He  appointed  a committee, 
consisting  of  R.  T.  Woollsey  (chairman),  Scott  Jones, 
and  A.  J.  Murphy,  to  investigate  this  plan. 

Meeting  adjourned  at  9:45  p.  m. 

* * * 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society  was  held  at  the  L.  D.  S.  Hospital  on 
Monday,  March  24. 

The  meeting  was  called  to  order  at  8 p.  m.  by 
President  M.  M.  Nielson.  Fifty-nine  members  and 
nine  visitors  were  present. 

The  minutes  of  meeting  of  March  10  were  read  and 
accepted  without  correction. 

The  following  clinical  program  was  presented  by 
members  of  the  hospital  staff: 

Coronary  Thrombosis,  Clarence  Snow;  Irritable 
Colon  and  Visceroptosis,  W.  R.  Tyndale;  Perforated 
Duodenal  Ulcer,  Ralph  Cornwall;  Subdiaphragmatic 
Abscess,  L.  A.  Stevenson. 

J.  R.  Wherrit,  K.  E.  Noyes,  and  Maurice  Gordon 
were  elected  members  of  the  society. 

R.  T.  Woolsey  reported  for  the  committee  on  tele- 
phone classification.  This  committee  favored  the  pur- 
chase of  the  space  on  the  inside  page  of  the  telephone 
directory  for  listing  of  members  of  the  Salt  Lake 
County  Medical  Society.  This  was  discussed  by 
M.  M.  Nielson  and  Claude  Shields.  Clarence  Snow 
moved  that  the  report  of  the  committee  be  adopted 
and  that  a special  assessment  of  $3  per  year  be  levied 
on  each  practicing  physician  of  the  society,  and  that 
this  assessment  be  paid  at  the  same  time  as  the  dues. 
Motion  carried. 

L.  J.  Paul  moved  that  the  assessment  for  the  year 
1930  should  be  paid  by  April  14.  Seconded  and 
carried. 

Meeting  adjourned  at  10:05  p.  m. 

Barnet  E.  Bonar,  Secretary. 

rir 


UTAH  COUNTY 

The  regular  bimonthly  meeting  of  the  LTah  County 
Medical  Society  was  held  March  12. 

President  Harriss  of  the  B.  Y.  U.,  who  had  just 
returned  from  Russia,  gave  an  interesting  talk  on 
“The  Economic  Situation  in  Russia  and  Comments 
on  Russian  Sanitary  Conditions.” 

Mrs.  R.  G.  Clark  and  Mrs.  J.  L.  Aird  gave  several 
musical  numbers. 


The  second  meeting  in  March  was  on  March  26. 
Doctor  Hagan  of  Spanish  Fork  gave  a brief  account 
of  his  visit  to  New  Pork  in  his  postgraduate  course. 
Dr.  Fred  R.  Taylor  gave  a review  of  the  American 
Medical  Association  meeting  in  Portland,  Oregon, 
last  summer. 


A report  was  given  by  Dr.  J.  W.  Aird  on  the  find- 
ings of  the  committee  to  investigate  the  Porter  Bill 
that  is  up  before.  Congress  relative  to  centralizing 
authority  in  narcotics.  The  committee  reported  as 
unfavorable  to  take  any  action  in  the  matter.  Follow- 
ing a brief  discussion  by  Dr.  F.  W.  Taylor,  it  was 
voted  that  the  association  do  nothing  further  about 

the  Porter  Bill.  r t a,  o , 

J.  L.  Aird,  Secretary. 


WEBER  COUNTY 

At  the  regular  meeting  of  the  Weber  County  Medi- 
cal Society  held  in  the  Spanish  Room  of  the  Hotel 
Bigelow  March  27,  Dr.  Paul  Weeks  gave  an  interest- 
ing paper  on  “Physio-electrotherapy,”  illustrated  by 
two  reels  of  moving  pictures. 

State  President-elect  William  Rich,  Secretary  M.  M. 
Critchlow,  and  Treasurer  Edwin  LaCompte  from  Salt 
Lake  City  were  in  attendance  and  spoke  briefly  rela- 
tive to  our  state  society  meeting  to  be  held  in  Salt 
Lake  City  next  September. 

Conrad  H.  Jenson,  Secretary. 


UTAH  NEWS 

Meeting  of  the  American  Association  for  the  Study 
of  Goiter. — The  annual  meeting  of  the  association  will 
be  held  at  Seattle,  Washington,  with  headquarters  at 
the  Hotel  Olympic,  July  10  and  11,  with  an  excursion 
to  Mount  Rainier  for  all  attending  members  on  the 
12th.  Our  association  this  year  is  the  guest  of  the 
King  County  Medical  Society,  Seattle  Washington. 

A very  interesting  scientific  program  is  promised. 
The  tentative  one  published  assures  a very  good  final 
program. 

All  members  in  good  standing  in  their  county  or 
provincial  societies  are  eligible,  and  invited  to  become 
attending  members  upon  presentation  of  their  creden- 
tials and  payment  of  a small  fee  ($5). 

* * * 

The  regular  monthly  meeting  of  the  Holy  Cross 
Hospital  Clinical  Society  was  held  the  night  of 
March  17  at  the  hospital. 

The  following  scientific  program  was  presented: 
Malignancy  of  Uterus,  Tubes,  and  Ovaries,  Claude 
Shields;  Study  of  Electrocardiographic  Tracings, 
R.  Tandowsky;  Use  of  Sodium  Amytal  in  Eclampsia, 
B.  E.  Bonar;  Hour-Glass  Stomach,  F.  B.  Bailey. 

* * * 

Meetings  of  the  Academy  of  Medicine  have  con- 
tinued during  the  past  month.  The  following  pro- 
grams have  been  presented: 

March  13 — Vincent’s  Angina  of  Lung,  Dr.  Van 
Scoyoc;  Metabolic  Arthritis,  Dr.  Le  Barge. 

March  20 — General  Aspects  in  Otolaryngology,  Dr. 
Gordon;  Malignant  Tumors  of  the  Breast,  Dr.  George 
Middleton. 

March  27 — Demonstration  of  Successful  Cure — Case 
of  Aneurysm  with  Reconstruction  of  Femoral  Artery, 
Dr.  F.  Hatch;  Schneider’s  Index,  Dr.  Skofield. 

April  3 — Can  Malignant  Tumors  be  Graded  Histo- 
logically? Dr.  Flood;  Pathology  of  Impacted  Teeth. 
Dr.  Smith. 


Death  Notice 

Young,  Albert  Carrington.  Died  March  25,  1930. 
age  72  years.  Graduate  of  Dartmouth  Medical  School, 
Hanover,  1895.  Licensed  in  Utah,  1895.  Doctor  Car- 
rington was  a member  of  Salt  Lake  County  Medical 
Society,  the  Utah  State  Medical  Association,  and  a 
Fellow  of  the  American  Medical  Association. 


OBITUARY 
George  F.  Roberts 
1886-1930 

Dr.  George  F.  Roberts,  Salt  Lake  physician,  died 
Sunday,  March  30,  at  his  home,  1403  East  Ninth 
South  Street,  after  an  illness  of  ten  days.  He  was 
forty-four  years  of  age. 

Born  at  Kaysville,  he  attended  the  public  schools 
of  Salt  Lake  and  later  was  graduated  from-the  Uni- 
versity of  Utah  Medical  School.  He  attended  Rush 
Medical  College  in  Chicago,  where  he  was  graduated 
in  1912. 

After  serving  an  internship  at  St.  Mark’s  Hospital, 
Doctor  Roberts  began  the  practice  of  medicine  in 
1914.  In  1916  he  served  as  captain  of  the  Medical 
Corps  with  the  National  Guard  on  the  Mexican 
border.  During  the  World  War  he  was  a major  with 
the  159th  Medical  Corps  in  France. 

For  a number  of  years  he  was  assistant  county  phy- 
sician and  was  well  known  in  Masonic  circles. 

In  addition  to  his  parents,  he  is  survived  by  his 
widow,  Mrs.  Florence  Shermer  Roberts;  one  son, 
Edward  Roberts;  two  daughters,  Janet  and  Susan 
Jean. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  department  are 
grouped:  News;  Medical  Economics;  Correspondence;  Department  of  Public  Health;  California  Board  of  Medical 
Examiners;  and  Twenty-Five  Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 

NEWS 


Graduate  Summer  Courses. — The  University  of 
California  Medical  School  will  hold  its  sixth  annual 
session  of  graduate  summer  courses  from  June  2 to 
June  21.  1930. 

June  2 to  7 — This  week  will  be  devoted  to  a review 
of  the  recent  advances  in  the  fundamental  sciences, 
clinical  medicine,  clinical  surgery,  and  dentistry. 

June  9 to  21 — During  the  second  and  third  weeks, 
most  of  the  clinical  branches  will  be  covered  in  the 
morning  and  afternoon  courses,  which  will  include 
the  following  subjects:  general  medicine,  circulatory 
diseases,  applied  anatomy  and  physiology  of  the  ner- 
vous system,  pediatrics,  infant  feeding  and  hygiene 
of  infancy,  general  surgery,  fractures,  otorhinolaryn- 
gology, urology,  tumors,  x-ray,  surgical  anatomy, 
pathology,  and  laboratory  diagnosis. 

In  addition  to  the  regular  courses,  during  the 
second  and  third  weeks,  there  will  be  daily  noon  lec- 
tures and  clinico-pathological  conferences.  These  will 
be  open  to  the  medical  public. 

Announcement  of  courses  will  be  mailed  on  request. 

Please  address:  The  Dean’s  Office,  University  of 
California  Medical  School,  Parnassus  and  Third 
avenues,  San  Francisco. 


Lane  Medical  Lectures. — The  twenty-third  course 
of  lectures  will  be  delivered  by  Charles  R.  Stockard, 
M.  D.,  Ph.  D.,  and  Sc.  D.,  Professor  of  Anatomy,  Cor- 
nell University  Medical  School,  New  York  City,  on 
the  evenings  of  May  5,  6,  7,  8,  and  9,  1930  at  8:15 
o’clock  in  Lane  Hall,  Stanford  University  Medical 
School,  Sacramento  Street  near  Webster,  San  Fran- 
cisco. 

The  medical  profession,  students  of  medicine, 
teachers,  and  research  workers  are  cordially  invited 
to  attend. 

The  titles  of  the  lectures  to  be  given  by  Dr.  Charles 
R.  Stockard  are  as  follows: 

May  5 — Medical  and  Biological  Aspects  of  Con- 
stitution. 

May  6 — Germinal  Constitution. 

May  7 — Developmental  Constitution. 

May  8 — The  Interplay  of  Inheritance  and  Environ- 
ment in  Constitution. 

May  9 — Postnatal  Reactions  and  Periodic  Changes 
in  Constitution. 

Doctor  Stockard  will  also  give  a lecture  at  Stanford 
University  on  Wednesday,  May  7,  at  4:15  p.  m.,  on 
“Structural  Types  in  Animals  and  Men.” 


Special  Lecture  Course  at  Stanford  School  of  Medi- 
cine.— The  special  two  weeks’  course  will  be  given 
early  in  the  summer  of  1930,  probably  from  June  16 
to  June  28.  The  exact  date  will  be  announced  by  cir- 
cular. The  course  is  intended  to  cover  some  of  the 
advances  in  various  fields  of  medicine,  particularly 
the  clinical,  made  during  the  last  decade  and,  it  is 
hoped,  will  meet  the  needs  of  the  practitioner  who, 
having  but  a short  time  at  his  disposal,  wishes  to 
obtain  a cursory  review  of  the  outstanding  features  of 
recent  medical  progress. 

Four  sessions  will  be  held  daily:  two  in  the  morn- 
ing and  two  in  the  afternoon,  with  suitable  intervals 
and  opportunities  for  free  discussion  of  the  subjects 
with  the  instructors. 

For  full  details,  address  William  Ophuls,  dean, 
Clay  and  Webster  streets,  San  Francisco. 


Pacific  Physical  Therapy  Meeting. — The  annual 
meeting  of  the  Pacific  Physical  Therapy  Association 
will  be  held  at  the  Alexandria  Hotel,  Los  Angeles, 
June  13  and  14,  under  the  presidency  of  Dr.  William 
W.  Worster  of  San  Gabriel.  The  program  is  now 
being  assembled  and  includes  a number  of  essayists 
of  national  reputation. 

This  meeting  will  be  preceded  by  the  twelfth  an- 
nual session  of  the  Western  School  of  Physical  Ther- 
apy, June  9 to  12,  conducted  by  the  following  staff: 
Dr.  Burton  B.  Grover  (president),  Dr.  A.  D.  Will- 
moth,  Dr.  J.  E.  G.  Waddington,  Dr.  J.  C.  Elsom,  and 
Dr.  M.  W.  Kapp.  A full  and  interesting  week  of 
physical  therapy  will  thus  be  assured  to  those  in 
attendance.  The  classes  will  be  limited  to  regular 
physicians,  medical  students,  and  technicians  properly 
sponsored. 

The  entire  mezzanine  floor  of  the  Alexandria  will 
be  occupied  by  the  exhibits,  which  will  be  even  more 
complete  and  elaborate  than  last  year. 

For  information  and  program,  address  Dr.  Charles 
Wood  Fassett,  secretary,  506  Detwiler  Building,  Los 
Angeles.  

The  Annual  Meeting  of  the  American  Physio- 
therapy Association  will  be  held  at  Detroit  June  23-26 
inclusive.  All  meetings  other  than  clinics  will  be  held 
at  headquarters,  Fort  Shelby  Hotel. 

An  invitation  is  extended  to  members  of  the  Cali- 
fornia Medical  Association  to  attend  this  annual 
session  of  the  American  Physiotherapy  Association. 


California  Conference  of  Social  Work. — With  the 
attention  of  the  nation  focused  on  law  and  law  en- 
forcement, the  California  Conference  of  Social  Work 
has  chosen  “Social  Progress  and  the  Law”  as  the 
general  theme  for  its  twenty-second  annual  meeting 
to  be  held  in  Santa  Barbara  May  13-17,  1930.  Justin 
Miller,  dean  of  the  law  school  of  the  University  of 
Southern  California,  who  is  president  of  the  conference, 
explained  that  the  California  conference,  which  meets 
annually,  always  chooses  a general  theme  around 
which  to  base  its  discussions.  The  topic  this  year  was 
chosen  in  the  belief  that  bringing  social  workers,  law- 
yers, and  local  government  officials  into  better  rela- 
tions for  understanding  the  problems  of  one  another 
will  result  in  better  cooperation  and  more  effective 
work. 

The  conference  Section  of  Public  Health  under  the 
chairmanship  of  Dr.  John  L.  Pomeroy,  health  officer 
of  Los  Angeles  County,  will  present  a program  espe- 
cially interesting  to  doctors,  nurses,  medical  social 
workers,  hospital  administrators,  and  local  govern- 
ment officials.  On  Wednesday,  May  14,  with  Dr. 
Aaron  M.  Rosanoff  presiding,  “Mental  Hygiene  and 
Endocrinology”  will  be  discussed  under  the  leader- 
ship of  Doctors  Edward  H.  Williams  and  Charles  L. 
Bennett.  Doctors  Herman  Adler  and  Williams  Engel- 
bach  will  be  the  consultants. 

On  Thursday,  May  15,  with  George  B.  Mangold, 
Ph.  D.,  as  chairman  and  Dr.  Paul  Popenoe  as  con- 
sultant, the  subject  will  be  “Practical  Eugenics/’  Dr. 
Adelaide  Brown,  Dr.  Margaret  Smyth,  Mrs.  Kemper 
Campbell,  and  Nadine  Kavinoky  will  lead  the  dis- 
cussions. Dr.  Walter  M.  Dickie  will  preside  over  the 
session  devoted  to  the  discussion  of  county  health 
units.  Doctor  Pomeroy  will  be  the  consultant.  The 
discussion  leaders  will  be  Dr.  Percy  Magan  for  the 

371 


372 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


medical  profession,  Miss  Zdenka  Buben  for  the  medi- 
cal social  worker,  and  Dr.  Guy  S.  Millberry  for  the 
dental  profession. 

On  Saturday,  May  17,  the  subject  will  be  “The 
Cost  of  Medical  Care.”  Dr.  William  P.  Shepard  will 
preside  and  a member  of  the  national  committee,  to 
be  announced  later,  will  act  as  consultant.  Dr.  John 
Ruddock  will  present  the  point  of  view  of  the  private 
practitioner,  Miss  Marguerite  Spiers  that  of  the  hospi- 
tal social  worker,  Miss  D.  Dean  Urch  the  viewpoint 
of  the  nursing  profession,  and  Dr.  Walter  H.  Brown 
that  of  the  public  health  official. 

One  of  the  general  sessions  of  the  conference  to 
be  held  the  evening  of  May  16  will  be  addressed  by 
Dr.  Frederick  H.  Allen,  director  of  the  Philadelphia 
Child  Guidance  Clinic,  who  is  directing  the  mental 
hygiene  survey  being  made  under  the  auspices  of 
the  California  State  Department  of  Social  Welfare. 
Doctor  Allen,  a graduate  of  the  University  of  Cali- 
fornia and  of  the  Johns  Hopkins  Medical  School,  will 
speak  on  “What  Is  Mental  Hygiene.”  Other  speakers 
at  the  general  sessions  will  be  Justin  Miller,  who  will 
speak  on  “Social  Progress  and  the  Law”;  Jack  Black, 
author  of  “You  Can  Win,”  who  will  speak  on  “Law 
and  the  Criminal”;  and  Frederic  P.  Woeller,  whose 
subject  will  be  “American  Objectives.” 


Meeting  for  Study  of  Goiter. — The  American  As- 
sociation for  the  Study  of  Goiter  will  hold  its  annual 
meeting  in  Seattle,  Washington,  July  10,  11,  12,  1930. 
There  will  be  thirty-three  papers  covering  all  phases 
of  the  goiter  problem,  delivered  by  men  from  all  sec- 
tions of  the  United  States.  The  program  has  been 
arranged  by  choosing  speakers  from  as  many  parts 
of  the  country  as  possible  in  order  to  give  a repre- 
sentative cross  section  of  the  problems  coincident  to 
the  study  of  goiter  in  America. 

All  the  hospitality  that  Seattle  can  muster  has  been 
promised  to  those  who  attend  the  meeting  by  the 
vice-president,  Dr.  J.  Tate  Mason,  under  whose  direc- 
tion the  meeting  is  being  conducted. 


Exhibit  of  Bibliographical  Interest  at  University 
Medical  Library. — In  connection  with  the  four  hun- 
dredth anniversary  of  the  publication  of  Fracastoro’s 
poem,  “Syphilis  sive  Morbus  Gallicus,”  in  1530,  an 
exhibit  of  material  relating  to  this  poem  is  on  display 
in  the  University  of  California  Medical  School  Library. 


Library  of  Medical  and  Dental  Schools  of  Uni- 
versity of  California. — Arrangements  have  been  com- 
pleted for  the  consolidation  of  the  libraries  of  the 
Medical  and  Dental  schools  of  the  University  of  Cali- 
fornia on  the  Parnassus  campus  in  San  Francisco. 
The  combined  libraries  will  be  housed  in  a completely 
remodeled  library  room  in  the  Medical  School  build- 
ing and  will  be  conveniently  located  and  arranged  for 
the  students  and  staffs  of  the  various  departments 
of  the  University  of  California  on  the  Parnassus 
campus.  The  combined  medical  and  dental  libraries 
will  place  the  resources  of  over  35,000  volumes  and 
over  450  current  periodicals  relating  to  medicine  and 
dentistry  at  the  disposal  of  the  two  professions  in 
the  State  of  California.  A packet  library  service  is 
provided  by  which  any  properly  qualified  physician 
or  dentist  or  medical  or  dental  institution  may  obtain 
books  for  a ten-day  period  subject  to  carriage  charges. 

In  order  to  make  the  library  as  useful  as  possible 
to  those  who  desire  to  work  in  it,  the  books  have 
been  arranged  in  cubicles  so  that  all  of  the  significant 
literature  relating  to  a special  field  may  be  found 
close  at  hand  to  the  table  at  which  the  individual  may 
be  working.  The  total  number  of  medical  and  dental 
periodical  files,  exclusive  of  government  and  institu- 
tional reports,  numbers  over  750  titles  of  which  more 
than  300  are  in  complete  sets. 


American  College  of  Physicians. — The  American 
College  of  Physicians  will  hold  its  fifteenth  annual 
clinical  session  at  Baltimore,  Maryland,  from  March 
23  to  27,  inclusive,  1931.  The  Lord  Baltimore  Hotel 
will  be  headquarters. 


Dr.  Sydney  R.  Miller  of  Baltimore,  as  president, 
will  have  charge  of  the  selection  of  the  general  scien- 
tific program.  Dr.  Maurice  C.  Pincoffs  of  Baltimore 
has  been  appointed  by  the  board  of  regents  as  the 
general  chairman  of  the  session,  and  will  make  all 
local  arrangements,  including  the  making  up  of  the 
program  of  clinics.  Business  details  will  be  handled 
by  the  executive  secretary,  Mr.  E.  R.  Loveland,  from 
tbe  college  headquarters,  133-135  South  Thirty-sixth 
Street,  Philadelphia,  Pennsylvania. 


Nineteen  Hundred  and  Thirty  Is  a “Measles  Year.” 

Since  the  first  of  January  nearly  five  thousand  cases 
of  measles  have  been  reported  in  California.  Every 
third  or  fourth  year  a new  group  of  children  who  have 
no  immunity  to  measles  contract  the  disease,  causing 
the  number  of  cases  reported  to  mount  in  a flare-up  of 
extensive  proportions.  It  is  apparent  that  the  year 
1930  is  one  of  these  “measles  years.”  As  soon  as  the 
new  fuel  becomes  consumed  the  outbreak  will  die 
down,  only  to  flare  up  again  three  or  four  years  hence, 
when  a new  group  of  nonimmune  children  becomes 
infected.  Health  officers  throughout  the  state  are 
cautioned  to  use  every  available  method  for  protect- 
ing very  young  children  against  this  disease.  The 
complications  that  occur  with  measles  in  children 
under  one  year  of  age  very  often  prove  fatal.  Because 
of  its  easy  communicability,  measles  is  extremely  diffi- 
cult to  control.  Most  of  the  responsibility  in  the 
prevention  of  measles  rests  with  parents  who  fail  to 
prevent  contact  of  young  children  with  known  cases 
of  the  disease.  Following  are  the  numbers  of  cases 
reported  this  year:  January,  2797;  February,  3899; 
March  to  March  18,  3604. 


Lepers  Removed  to  Federal  Leprosarium. — Eleven 

lepers  from  eight  California  counties  were  transferred 
to  the  Federal  Leprosarium  at  Carrville,  Louisiana, 
on  February  21.  Twice  each  year  leprosy  patients 
who  have  been  discovered  in  California  communities 
are  transferred  in  a special  car,  through  cooperation 
with  the  federal  government,  to  the  leprosarium  at 
Carrville.  The  patients  which  were  moved  last  week 
came  from  the  following  counties:  San  Joaquin, 
Solano,  San  Francisco,  Madera,  San  Luis  Obispo, 
Monterey,  Los  Angeles,  and  Orange. 

Examination  for  Laboratory  Technicians  Announced. 

The  next  examination  for  certificates  of  proficiency 
for  laboratory  technicians  is  scheduled  for  May  8 in 
Los  Angeles  and  May  10  in  Berkeley. 

Separate  examinations  are  given  for,  and  separate 
certificates  issued  for  work  in  serology,  bacteriology, 
parasitology,  and  biochemistry.  The  latter  certificate, 
for  convenience,  covers  all  clinical  laboratory  pro- 
cedures not  included  under  bacteriology,  serology,  and 
parasitology.  Each  type  of  certificate  entitles  the 
holder  to  engage  in  tbe  line  of  work  covered  by  that 
certificate  only. 

Only  workers  in  official  public  health  laboratories 
and  in  clinical  laboratories  approved  by  the  State  De- 
partment of  Public  Health  are  required  to  hold  the 
certificate  of  proficiency. 

Persons  desiring  to  take  these  examinations  should 
write  to  Dr.  W.  H.  Kellogg,  Chief,  State  Bacterio- 
logical Laboratory,  Berkeley,  for  application  forms. 
All  applications  must  be  mailed  on  or  before  May  1. 


Total  Deaths  with  Rates,  1920-1929,  for  California 


Total  Rate  per  1000 

Year  deaths  population 

1920  47,124  13.5 

1921  47,379  13.2 

1922.  51,968  14.1 

1923.  54,416  14.3 

1924  56,751  14.5 

1925  56,707  14.1 

1926  58,742  14.2 

1927  61,430  14.5 

1928  66,249  15.2 

1929  65,363  14.7 


Dr.  R.  W.  Binkley  has  been  appointed  city  health 
officer  of  Selma,  Fresno  County,  to  succeed  Dr.  C.  B. 
Cowan. 


May,  1930 


MISCELLANY 


373 


CLIPPINGS  FROM  THE  LAY 
PRESS 


Cerebrospinal  Fever 

Editorial  reference  is  made  in  this  issue  of  Cali- 
fornia and  Western  Medicine  of  a special  article  by 
Dr.  J.  D.  Geiger  of  the  Hooper  Foundation,  and  of  the 
clipping  on  cerebrospinal  meningitis  which  follows: 

"Gaining  by  leaps  from  spring  to  spring,  the  dreaded 
cerebrospinal  meningitis  has  increased  nearly  400  per  cent 
in  the  United  States  in  four  years,  according  to  statistics 
of  the  Public  Health  Service. 


"At  the  same  time  it  is  announced  that  Dr.  Sara  Bran- 
ham of  the  United  States  Hygienic  Laboratory  has  suc- 
ceeded in  isolating  a hitherto  unknown  fifth  variety  of 
the  meningococcus  bacterium  which  attacks  the  mem- 
branes of  the  brain  and  spinal  column,  causing  an  in- 
flammation which  often  results  in  death  or  permanent 
disability. 


“Meningitis  always  has  its  greatest  run  in  the  late 
winter  and  early  spring,  when  common  colds  are  most 
prevalent  and  the  resistance  at  a low  ebb.  But  its  dis- 
tribution from  year  to  year  still  is  a mystery  to  the 
medical  profession  which  the  new-found  bacterium  may 

help  solve.  -T  TT  . ,,r 

New  Wave  Under  Way 

"Apparently,  the  Public  Health  Service  statistics  show, 
the  disease  runs  in  waves.  The  first  available  figures  are 
for  1910,  with  a death  rate  of  four  in  a million.  It  in- 
creased steadily  to  a peak  in  the  war  year  of  1917  with 
a death  rate  of  thirty-nine  in  a million,  declining  to  ten 
in  a million  during  1922.  In  1927,  with  a spring  peak  of 
about  eighty  cases,  the  death  rate  had  come  up  again  to 
sixteen  and  apparently  to  the  start  of  another  wave. 

"That  is  the  latest  year  for  which  the  actual  death 
statistics  are  available.  But  in  192S  the  cases  reported 
had  increased  to  a peak  of  170  in  a week,  a 100  per  cent 
increase  over  the  previous  peak.  Last  year  there  was  a 
peak  of  320  and  this  year  it  rose  to  340. 


Seasonal  Decline 

"For  the  last  two  weeks  there  has  been  the  character- 
istic seasonal  decline;  the  rate  actually  is  small  compared 
with  such  epidemics  as  diphtheria  and  measles,  with 
thousands  of  cases  reported  a week  at  this  time  of  year. 
But  the  startling  increase  in  meningitis  has  physicians 
worried. 

"Public  health  officials  are  uncertain  whether  it  is  a 
disease  that  moves  in  waves  or  whether  it  actually  is 
gaining  a stronger  foothold  in  the  population  at  large.  It 
is  peculiar  in  that  there  are  many  more  carriers  of  the 
disease  than  victims.  During  a local  epidemic  meningo- 
cocci are  found  in  more  well  than  sick  persons.  The  car- 
riers, unaffected  themselves,  have  no  way  of  knowing 
that  they  are  potential  menaces  to  their  neighbors.  They 
have  either  an  inherent  or  acquired  immunity.  It  is 
possible,  it  is  pointed  out,  that  all  these  carriers  have 
had  the  disease  in  a mild  form  under  such  favorable  con- 
ditions that  they  did  not  know  they  were  sick,  and  hence 
have  built  up  a resistance  to  any  further  infection. 


Numerous  Serums 

"During  the  last  few  years  several  meningitis  serums 
have  been  made,  but  the  results  have  been  disappointing. 

"When  an  epidemic  breaks  out  local  physicians  have 
no  way  of  telling  which  variety  is  causing  the  trouble. 
Local  areas  seem  to  have  their  own  varieties.  One  of 
them  is  practically  confined  to  Illinois.  Some  European 
varieties  do  not  answer  American  descriptions  and  may 
not  have  crossed  the  Atlantic. 

"The  disappointing  results  of  present  serums,  it  w'as 
pointed  out,  may  be  due  to  the  fact  that  the  right  variety 
has  not  been  included. 


Peru  Indians  Make  Jungle  Ants  Martyrs 
for  Surgery* 

"The  use  of  ‘surgical  ants’  with  powerful  jaws  to  stitch 
the  wounds  of  human  beings  and  other  primitive  medical 
practices  developed  by  the  Indians  living  far  in  the  in- 
terior of  Peru  are  described  in  a report  received  today 
at  Field  Museum  of  Natural  History  from  the  Marshall 
Field  expedition  to  the  Amazon. 

"Llewellyn  Williams,  leader  of  the  Peruvian  division 
of  the  expedition,  has  just  returned  to  Iquitos  after  a 
collecting  trip  along  the  Amazon  and  some  of  its  tribu- 
taries which  took  him  as  far  as  the  Brazilian  border. 
Parts  of  the  regions  he  explored  are  believed  never  to 
have  been  entered  by  white  men  before. 

4 See  editorial  on  page  359. 


Natives  Original 


“ ‘The  natives  of  the  equatorial  forest  show  great  origi- 
nality and  dexterity  in  the  treatment  of  wounds  and  ill- 
ness,’ writes  Mr.  Williams.  ‘Trees,  shrubs,  and  plants 
with  medicinal  properties  are  widely  employed,  and  a 
surgical  handicraft  in  which  certain  insects  are  used  has 


been  developed. 

“ ‘In  the  case  of  a gaping  wound,  a certain  ant  which 
has  very  powerful  jaws  is  sought,  and  the  ant  is  made  to 
bite  the  severed  edges  of  the  cut  skin  and  thus  bring 
them  into  juxtaposition.  In  the  operation  the  ant-surgeon 
loses  its  own  life,  for  after  it  has  drawn  the  skin  closed 
with  its  jaws,  its  body  is  snipped  off  and  the  lifeless  head 
remains  with  its  death  grip  on  the  skin  until  the  wound 
is  healed.  Sometimes  these  Indians  are  found  with  half 
a dozen  of  these  ants’  heads  holding  a large  wound  closed. 


“ ‘After  intertribal  battles  in  which  fighting  is  done 
with  axes  and  machetes  or  bush  knives,  many  of  the 
warriors  return  home  with  deep,  ghastly  and  apparently 
fatal  wounds.  The  women,  however,  are  usually  suc- 
cessful in  treating  these  wounds.  After  bathing  them, 
they  apply  ginger  as  a local  anesthetic.  Then  a plaster 
is  made  from  a pulp  of  a weed  known  as  “Santa  Maria,” 
and  the  wound  is  bandaged  with  a dried  banana  leaf.  In 
a week  or  so  most  of  the  wounds  heal.  Sometimes  the 
crushed  body  of  a certain  ant  is  applied  as  a salve.  The 
injured  men  are  placed  on  a diet,  eliminating  salt  and 
fats,  and  made  to  drink  large  quantities  of  an  infusion 


prepared  from  the  bark  of  a tree. 

“ ‘Long  thorns  are  sometimes  used  as  surgeon’s  needles. 
The  skin  at  one  side  of  the  opened  wound  is  pierced  with 
the  thorn  and  it  is  then  thrust  across  to  and  through  the 
opposite  skin  edge,  the  protruding  end  of  the  thorn  being 
fastened  with  string  and  left  there  until  the  two  edges 
have  fused.  Burrow  in  Fiesh 


“ ‘In  the  wet  lowlands  there  is  a female  jigger  or  bur- 
rowing flea  which  buries  itself  in  one’s  flesh.  There  its 
body  swells  and  becomes  globular,  being  distended  with  a 
huge  quantity  of  tiny  eggs.  The  natives  remove  this  by 
working  carefully  around  the  insect’s  body  with  a needle. 
Skill  is"  necessary  to  avoid  breaking  the  egg  sac,  for  if  a 
single  egg  is  left  in  the  wound  the  operation  is  valueless. 

“ ‘There  is  also  a worm  which  burrows  itself  into  the 
legs  of  its  victims,  forming  a swelling  like  a boil  which 
breaks,  and  then  the  worm  protrudes  its  head.  Any  at- 
tempt to  drag  it  out  suddenly  fails,  as  it  tears.  The 
natives  draw  a few  inches  out  carefully  day  by  day,  roll- 
ing the  exposed  end  around  a small  piece  of  wood.  Much 
delicate  manipulation  is  required,  as  this  entozoon  ranges 
from  six  to  ten  feet  in  length.’  ” 


TWENTY-FIVE  YEARS  AGO 


EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  5,  May  1905 

From  some  editorial  notes: 

. . . Insurance  Examiners. — The  journal  very  gladly 
publishes,  on  page  160,  a letter  from  the  secretary  of 
the  Placer  County  Medical  Society  on  the  subject  of 
small  fees  from  large  companies  for  life  insurance 
examinations.  Several  times  has  the  journal  com- 
mented on  this  subject  and  urged  that  physicians 
throughout  the  state  refuse  to  make  such  examina- 
tions for  a fee  less  than  $5.  . . . 

. . . Hall  of  Exhibits. — The  journal  for  July  of  last 
year  commented  upon  the  disgraceful  character  of  the 
‘‘Hall  of  Exhibits,”  the  side-show  of  the  American 
Medical  Association.  A member  of  the  Publication 
Committee  was  taken  to  task  for  this  editorial  utter- 
ance, the  argument  being  that  the  trustees  of  the 
American  Medical  Association  have  nothing  to  do 
with  this  “hall”;  that  it  is  always  arranged  for  by  the 
local  Committee  of  Arrangements;  that  this  com- 
mittee must  provide  (and  pay  for)  the  various  meet- 
ing places  required,  and  that  consequently  the  “hall 
of  (disgraceful)  exhibits”  has  to  be.  That  a large  per- 
centage of  the  remedies  exhibited  are  “nostrums” 


* This  column  strives  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


374 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


(secret  formula  “proprietary”  preparations),  is  not 
denied;  that  to  “promote  the  use”  of  such  stuff  is 
“derogatory  to  professional  character”  is  also  not 
denied.  . . . 

. . . The  Wily  Politician. — The  physician  is  the  only 
breadwinner  whose  duty,  conscientiously  lived  up  to, 
is  to  work  against  his  own  business  interests.  The 
whole  history  of  medicine  shows  an  unending  effort 
on  the  part  of  its  followers  to  prevent  disease;  to  pre- 
vent epidemics;  to  prevent  accidents;  and  yet  it  is 
from  the  existence  of  disease  and  accidental  injury 
that  the  physician  derives  his  meager  support.  . . . 


From  the  address  of  the  president,  Frank  L.  Adams, 
M.  D.,  Oakland,  thirty-fifth  annual  meeting  of  the  Medi- 
cal Society  of  the  State  of  California: 

Herbert  Spencer  has  divided  education  into  mental, 
moral,  and  physical,  and  has  shown  in  his  masterly 
way  that  a perfect  physique  and  physical  well-being 
are  the  foundations  for  the  other  two.  . . . 

. . . The  physician,  by  reason  of  his  profession,  his 
general  education  and  special  training,  owes  a sacred 
duty  to  the  state  to  advance  the  well-being  of  his 
fellow  man.  . . . 

From  an  article  on  “Some  Notes  on  Recent  Progress  in 
the  Surgery  of  the  Ear  and  Brain ” by  A.  Barkan,  M.  D., 
San  Francisco: 

...  In  the  main  this  very  informal  communication 
embraces  personal  experiences  during  my  attendance 
of  the  British  Medical  Association  meeting,  July  last, 
in  Oxford,  and  last  year’s  International  Congress  of 
Ear  Surgeons  in  Bordeaux.  In  Oxford  Prof.  Mac- 
ewen  delivered  the  general  oration  on  surgery.  . . . 

. . . The  part  of  his  address  which  I desire  to  bring 
to  your  special  notice  dealt  with  localization  of  brain 
abscess  arising  from  primary  pyogenic  cranial  lesions, 
the  determination  of  abscess,  versus  meningitis  and 
the  results  achieved  in  dealing  surgically  with  tuber- 
cular meningitis.  . . . 


From  the  minutes  of  the  thirty-fifth  annual  session  of 
the  Medical  Society  of  the  State  of  California,  Riverside, 
April  IS,  19,  20,  1905: 

The  session  just  held  was  one  which  will  long  be 
remembered  by  those  who  attended  it.  The  registra- 
tion was  the  largest  recorded  for  a number  of  years, 
230  having  signed  the  register.  . . . 


From  medical  society  reports: 

Alameda  County. — Following  its  most  excellent  cus- 
tom of  previous  years,  the  Alameda  County  Medical 
Society  gave  a dinner  on  the  evening  of  April  8 and 
invited  the  officers  of  the  state  society  to  be  its  guests. 
The  special  feature  this  year  was  that  the  dinner  was 
given  to  Dr.  Frank  Adams,  the  retiring  president  of 
the  state  society.  Good  cheer  and  good  fellowship 
were  the  only  topics  permitted  discussion,  under  the 
rules,  and  they  were  well  discussed.  . . . 

Humboldt  County. — It  was  also  decided  to  send  a 
telegram  to  the  Governor  asking  him  to  sign  the  bill 
appropriating  $150,000  for  a state  hospital  for  the 
tuberculous  poor,  but  at  a later  hour  it  was  reported 
that  the  bill  had  already  been  vetoed  and  the  message 
was  not  sent.  . . . 

The  California  Academy  of  Medicine. — Two  Unusual 
Cases  of  Gastric  Carcinoma.  Dr.  W.  F.  Cheney  re- 
ported two  cases  of  gastric  carcinoma,  which  were 
interesting  because  they  produced  no  symptoms  refer- 
able to  the  stomach.  . . . 

. . . Bicornate  Uterus.  Dr.  George  Somers  re- 
ported two  cases  of  bicornate  uterus.  . . . 

. . . Intestinal  Obstruction  from  Meckel’s  Diver- 
ticulum. Dr.  Emmet  Rixford  demonstrated  a Meckel’s 
diverticulum  which  had  been  the  cause  of  an  intestinal 
obstruction  in  a child.  . . . 


DEPARTMENT  OF  PUBLIC 
HEALTH 

By  W.  M.  Dickie,  Director 

Recent  Advantages  in  Medical  Entomology. — Rocky 
Mountain  Spotted  Fever.— This  febrile  disease,  trans- 
mitted by  ticks  and  having  its  center  of  endemicity 
in  the  Bitter  Root  Valley  of  Montana  but  appearing 
as  far  west  as  California,  occasionally  Fas  been  the 
focus  of  extremely  interesting  investigations.  In 
addition  to  the  Rocky  Mountain  spotted  fever  tick 
( D ermacentor  venustus) , it  is  known  now  to  be  trans- 
mitted by  the  rabbit  tick  (Haemaphy  salis  leporis- 
palustris)  which  is  instrumental  in  spreading  the  in- 
fection from  rabbit  to  rabbit,  thus  increasing  the 
number  of  reservoirs  at  which  the  Dermacentor  ticks. 
may  be  infected  as  young  ticks  to  carry  the  infection 
over  to  the  larger  animals,  such  as  the  Rocky  Moun- 
tain goat  and  eventually  to  man. 

Studies  of  the  virus  show  striking  differences  in  its 
manifestations  in  the  tick  and  in  man.  The  tick  virus, 
properly  treated,  has  immunizing  value  for  human 
beings  which  is  lacking  in  the  human  virus.  The  tick 
virus  apparently  requires  periodic  activation  in  the 
form  of  a blood  meal.  It  is  present  in  the  salivary 
glands  and  feces  of  infected  ticks,  but  is  virulent  only 
after  they  have  been  sucking  blood  for  a time.  This 
is  of  public  health  significance  in  that  if  ticks  are 
removed  from  human  beings  at  frequent  intervals  no 
infection  would  take  place  even  though  infected  ticks 
had  actually  been  sucking  blood  for  a period  of  an 
hour  or  even  slightly  longer. 

Yellow  Fever. — With  the  discovery  that  certain 
monkeys  could  be  infected  with  yellow  fever,  enor- 
mous progress  has  been  made  in  settling  some  of  the 
baffling  questions  that  have  handicapped  man’s  at- 
tempts to  stamp  out  this  scourge  of  the  tropics.  In 
addition  to  the  well-known  yellow  fever  mosquito 
( Aedes  aegypti),  long  thought  to  be  the  only  source 
of  transmission,  six  other  species  have  been  shown 
capable  of  performing  this  unwholesome  service.  The 
blood  of  infected  monkeys  has  also  been  shown  to 
contain  a virus  capable  of  infecting  a healthy  subject 
through  the  unabraded  skin;  a costly  bit  of  informa- 
tion for  which  three  workers  at  the  International 
Health  Board’s  laboratory  in  West  Africa — Stokes, 
Young,  and  Noguchi — undoubtedly  paid  with  their 
lives. 

Antilarval  Measures  in  Malaria. — The  work  of  the 
Italian  Government  in  cooperation  with  the  Inter- 
national Health  Board  in  demonstrating  the  possi- 
bility of  accomplishing  absolute  control  of  malaria 
by  larvicidal  measures  alone  is  of  inestimable  con- 
solation to  those  entomologically  minded  public  health 
workers  who  have  battled  for  the  importance  of  in- 
sect control  rather  than  carrier  control  in  antimalarial 
endeavors.  By  controlling  the  anophelines  surround- 
ing two  towns,  these  workers  were  able  to  convert 
veritable  pest  holes  of  malaria  into  summer  resorts 
and  nationally  recognized  health  centers  in  the  course 
of  two  years.  On  the  other  hand,  intensive  treatment 
with  quinin  in  another  town  where  the  mosquitoes 
were  not  controlled  failed  to  check  the  disease;  in 
fact,  the  rate  actually  increased.  It  was  also  observed 
with  considerable  satisfaction  that  in  districts  where 
antilarval  measures  were  being  used,  treatment  by 
quinin  was  far  more  effective,  explained,  no  doubt,  by 
tbe  relative  freedom  from  reinfection  in  these  areas. — 
Stanley  Freeborn,  M.  D.,  University  of  California. 


May,  1930 


MISCELLANY 


375 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 

By  C.  B.  PlNKHAM,  M.  I). 

Secretary  of  the  Board 

News  Items,  May  1930 

Narcotic  Warning. — For  many  years  the  directory 
published  by  the  Board  of  Medical  Examiners  of  the 
State  of  California  has  carried  very  definite  informa- 
tion regarding  narcotic  regulations,  both  state  and 
federal;  also  a copy  of  the  Medical  Practice  Act.  De- 
spite numerous  warnings,  investigation  reports  show 
that  some  duly  licensed  physicians  and  surgeons  in 
California  are  allowing  their  sympathies  to  run  away 
with  their  better  judgment  by  writing  prescriptions 
for  narcotic  addicts,  in  violation  of  the  law.  As  re- 
lated in  prior  warnings,  this  constitutes  a violation 
of  both  the  Medical  Practice  Act  and  the  State  Poison 
Law  and  is  punishable.  Any  physician  following  this 
procedure  may  expect  to  be  subject  to  arrest  by  the 
narcotic  inspectors  and  also  subject  to  a citation  call- 
ing him  before  the  Board  of  Medical  Examiners  to 
show  cause  why  his  license  to  practice  in  this  state 
should  not  be  revoked.  Physicians  are  also  warned 
to  safeguard  their  narcotic  prescriptions  by  writing 
in  ink  and,  following  the  Roman  numerals,  the  word 
representing  the  figure,  cases  having  recently  been 
discovered  where  a prescription  written,  say  for  four- 
teen quarter-grain  tablets  has  been  raised  by  prefix- 
ing two  or  three  additional  Roman  numerals  rep- 
resenting ten,  so  that  the  prescription  reads,  say 
thirty- four.  Narcotic  regulations  are  so  embarrassing 
addicts  and  peddlers  that  innumerable  instances  of 
forged  prescriptions  are  being  uncovered.  Again  we 
reiterate  our  prior  warnings  against  any  physician  and 
surgeon  having  printed  on  his  prescription  blank  his 
Harrison  narcotic  registration  number,  for  this  makes 
forgery  easy  for  both  the  peddler  and  the  addict. 


Authorized  to  slash  red  tape  and  put  real  “teeth" 
in  the  Federal  Government’s  drive  against  the  nar- 
cotic drug  menace,  Harry  D.  Smith  was  sworn  in 
yesterday  as  Pacific  Coast  Supervisor  of  Federal  Nar- 
cotic Enforcement.  . . . The  office  he  holds  is  a newly 
created  one  with  jurisdiction  over  California,  Wash- 
ington, Oregon,  Nevada,  Montana,  Idaho,  Alaska,  and 
Hawaii.  . . . The  supervisor  has  sweeping  powers, 
delegated  by  Commissioner  of  Prohibition  and  Nar- 
cotics J.  M.  Doran.  With  Smith  on  duty  here,  it  will 
no  longer  be  necessary  for  local  officials  to  obtain 
authorization  from  Washington  before  making  a 
move  and  this  will  eliminate  delays  which  in  the  past 
frequently  gave  violators  a chance  to  escape  arrest. 
There  will  be  no  change  in  the  narcotic  personnel 
here,  according  to  Smith.  He  praised  Harry  V. 
Williamson,  chief  of  the  local  division,  for  his  work 
in  preparing  the  “Black  Tony"'  Parmagini  case  (San 
Francisco  Examiner,  April  18,  1930). 


Initiative  petitions  are  being  prepared  to  place  on 
the  November  ballot  amendments  to  the  Chiropractic 
Licensing  Board  Act  that  originally  were  proposed  by 
Initiative  . . . (San  Francisco  Chronicle,  March  12, 
1930).  


Mark  L.  Emerson,  M.  D.,  was  recently  appointed 
city  health  officer  at  Oakland,  taking  the  office 
vacated  by  Charles  R.  Fancher,  M.  D.,  who  resigned 
to  become  city  commissioner  of  that  city. 


Dr.  F.  P.  Fuller,  523  West  Sixth  Street,  is  charged 
with  failure  to  report  all  tuberculosis  cases  treated 
in  his  office,  a violation  of  the  Public  Health  Law, 
in  a misdemeanor  complaint  issued  by  the  district 
attorney  yesterday  (Los  Angeles  Times,  March  16, 
1930). 


Accused  of  violating  the  Public  Health  Law,  Dr. 
F.  P.  Miller,  523  West  Sixth  Street,  was  named  in  a 
district  attorney’s  complaint  issued  today  by  Bonner 
Richardson,  chief  complaint  deputy.  The  complaint, 
which  was  signed  by  Carl  R.  Williams,  charges  that 
Doctor  Miller,  a tuberculosis  specialist,  “in  defiance 
of  regulations  persists  in  failing  to  report  a majority 
of  his  cases  in  contagious  stages  of  the  disease”  (Los 
Angeles  Record,  March  15,  1930). 


A bunco  game  in  which  several  score  of  San  Fran- 
cisco nurses  were  alleged  to  have  been  duped  was 
disclosed  by  reported  victims  to  the  News  today. 
Hundreds  of  dollars  were  lost  through  a fictitious 
hospital  organization  headed  by  a man  posing  as  Dr. 
George  Miller,  it  was  charged.  Detective  Sergeant 
Thomas  Curtis,  investigating  the  operations  of 
“Miller,”  found  that  an  office  had  been  outfitted  at 
112  Market  Street.  Clients  were  lured  there  by  an 
advertisement.  “Miller”  interviewed  applicants  and  is 
said  to  have  secured  from  $10  up  for  purchase  of 
uniforms  and  fare  to  the  sanitarium,  which  he  de- 
clared was  near  Watsonville.  More  than  one  hundred 
are  said  to  have  sought  employment.  . . . Investiga- 
tion discloses  that  “Miller”  occupied  the  office  for 
four  days,  then  disappeared.  He  told  women  who  paid 
fees  to  meet  him  last  Sunday  at  the  offices  of  a stage 
company  and  they  would  proceed  to  Watsonville. 
Though  the  nurses  crowded  the  stage  depot,  “Miller” 
failed  to  appear  . . . (San  Francisco  News,  Febru- 
ary 4,  1920).  

The  case  of  Dr.  Edwin  L.  Mott,  charged  with  a 
misdemeanor,  failure  to  report  to  the  police  that  he 
had  treated  a patient  suffering  from  a gunshot  wound, 
was  taken  under  advisement  yesterday  afternoon, 
following  trial  before  Police  Judge  J.  H.  Crichton 
without  a jury.  . . . Doctor  Mott  said  on  the  stand 
he  did  not  know  the  provisions  of  the  law,  which  went 
into  effect  on  August  15,  last  . . . (Fresno  Republican, 
April  8,  1930).  

According  to  reports,  Nell  E.  Anderson,  licensed 
cosmetologist  who  was  advertising  plastic  surgery, 
pleaded  guilty  in  the  courts  of  Los  Angeles  on  April  1 
to  a charge  of  violation  of  the  Medical  Practice  Act 
and  was  sentenced  to  serve  180  days  in  the  city  jail, 
suspended  for  six  months  and  defendant  placed  on 
probation. 


Dr.  Francis  James  Bold,  Whittier  physician,  yester- 
day was  cited  for  the  second  time  to  appear  before 
the  State  Board  of  Medical  Examiners  to  answer 
charges  of  unprofessional  conduct,  growing  out  of  the 
alleged  performing  of  an  illegal  operation.  The  hear- 
ing was  set  for  July  8 in  San  Francisco  (Los  Angeles 
Illustrated  Daily  News,  April  1,  1930).  (Previous  entry, 
April  1930.)  


Marie  Caron,  midwife,  whose  license  was  revoked 
by  the  Board  of  Medical  Examiners  July  17,  1929, 
is  reported  to  have  withdrawn  her  appeal  from  the 
recent  Los  Angeles  conviction  on  a charge  of  prac- 
ticing medicine  on  a midwife  license  and  is  now  serv- 
ing a six  months’  jail  sentence. 


Dr.  Motoharu  Chono  of  Japan  took  the  State  Medi- 
cal Board  examinations  four  times  and  failed  each 
time.  Wishing  to  practice  in  California,  he  went  to 
Nevada,  where  he  says  he  got  a license  on  which  he 
sought  reciprocity  when  he  returned  several  months 
ago  to  Florin.  Today  another  chapter  is  being  writ- 
ten in  Chono’s  efforts  to  practice  medicine  among 
his  countrymen.  He  is  being  tried  in  the  Justice 
Court  at  Elk  Grove  on  the  charge  of  practicing  medi- 
cine without  a license  . . . (Sacramento  Bee,  April  9, 
1930). 


376 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  5 


Investigation  reports  show  that  Armando  Domin- 
guez, a persistent  violator  of  the  Medical  Practice  Act 
in  San  Bernardino  County,  was  again  arrested  on 
April  1 on  a charge  of  violation  of  the  Medical  Prac- 
tice Act.  (Previous  entries,  October  and  November 
1929.)  


Dr.  I.  S.  Egan,  who  has  been  employed  for  some 
time  in  the  Weimar  Joint  Sanatorium  as  a physician, 
was  arrested  Monday  on  complaint  of  J.  W.  David- 
son, special  agent  of  the  Board  of  Medical  Exam- 
iners of  the  State  of  California,  and  F.  J.  O’Farrell, 
narcotic  inspector  of  the  State  Division  of  Nar- 
cotic Enforcement,  Department  of  Penology,  on  two 
charges.  . . . Pleaded  guilty  to  both  charges.  The 
judgment  of  the  court  was  that  he  pay  a fine  of  $100 
on  each  count  and,  in  lieu  of  a fine,  be  imprisoned 
for  sixty  days  in  the  county  jail.  The  court  then-  sus- 
pended both  fine  and  prison  sentence  until  the  first 
of  April  to  allow  Egan  the  opportunity  of  leaving 
the  state  . . . (Colfax  Record,  March  28,  1930). 


Dr.  Glen  G.  English,  thirty-two,  of  1053  Edin- 
borough  Avenue,  arrested  early  yesterday  after  a 
scuffle  in  which  he  was  said  to  have  attempted  to 
choke  the  officer,  yesterday  afternoon  was  named  in 
a drunk-driving  complaint  issued  by  Deputy  Dis- 
trict Attorney  Bonner  Richardson.  . . . He  was  taken 
to  Dickey  & Cass  Hospital  in  Hollywood,  where 
physicians  declared  he  was  under  the  influence  of 
liquor  . . . (Los  Angeles  Illustrated  Daily  News, 
March  15,  1930).  


Dr.  St.  Louis  Estes,  the  man  who  started  a not 
inconsiderable  portion  of  the  population  of  the  United 
States  to  chewing  on  cabbages,  gnawing  carrots  and 
nibbling  le'tuce,  was  yesterday  sued  for  $500,000  ali- 
mony by  Mrs.  Clara  Estes,  who  says  she  is  his  first 
wife  and  the  mother  of  his  three  legitimate  chil- 
dren. . . . Mrs.  Estes’  complaint  charges  that  she  and 
the  dentist  expert  lived  happily  in  Chicago  until  1922, 
at  which  time  Doctor  Moraine  entered  their  lives.  . . . 
Doctor  Estes  first  sprang  into  the  public  eye  eight 
years  ago,  when  he  asserted  any  bald  man  could  grow 
hair  on  his  head  by  sticking  to  a prescribed  diet. 
Later  in  his  lectures  he  extended  the  list  of  human 
ills  to  be  cured  by  his  raw  vegetable  diet  and  said 
it  was  a mistake  for  any  man  to  die  before  attaining 
an  age  of  125  years.  In  San  Francisco  last  year 
Doctor  Estes  became  embroiled  in  difficulties  with 
the  State  Board  of  Medical  Examiners.  It  was 
charged  that,  although  Doctor  Estes  was  a licensed 
dentist,  he  was  not  a physician  or  surgeon  and  that 
this  fact  was  not  made  clear  in  his  advertisements 
with  which  he  attracted  throngs  to  his  lectures.  . . . 
The  charge  against  Doctor  Estes  was  dismissed  in 
the  Superior  Court  and  he  immediately  retaliated  with 
a $500,000  civil  action  against  those  responsible  for 
his  arrest.  This  suit  has  never  come  to  trial.  Doctor 
Estes  now  makes  his  home  in  Los  Angeles  (San 
Francisco  Chronicle,  February  4,  1930). 


Reports  relate  that  Lucille  Francis,  licensed  cosme- 
tologist, who  was  advertising  “surgery  face  lift,”' 
pleaded  guilty  on  March  28  in  the  courts  of  Los 
Angeles  on  a charge  of  violation  of  the  Medical  Prac- 
tice Act  and  was  sentenced  to  pay  a fine  of  $100  or 
serve  twenty-five  days  in  the  city  jail,  sentence  sus- 
pended for  two  years. 


Dr.  J.  G.  Ham  of  San  Bernardino,  who  pleaded 
guilty  to  a charge  of  conspiracy  to  perform  an  illegal 
operation,  was  sentenced  to  two  years  in  the  county 
jail  today  by  Superior  Judge  Charles  L.  Allison  as  a 
condition  of  probation  given  the  defendant.  The  court 
characterized  the  case  as  a “very  difficult  matter  for 
me”  and  continued  in  addressing  the  defendant, 
“When  you  are  sober  and  in  your  right  mind,  appar- 
ently there  is  little  danger  of  your  doing  wrong,  but 
when  you  are  drinking  or  under  the  influence  of  in- 


toxicants, your  sense  of  moral  responsibility  appears 
greatly  weakened.”  Doctor  Ham  may  at  the  expira- 
tion of  one  year  of  his  term  apply  for  modification  of 
the  jail  sentence,  the  court  said,  but  the  first  year 
must  be  served  before  modification  application  will 
be  considered  . . . (San  Bernardino  Telegram,  April  5, 
1930).  James  G.  Ham’s  license  to  practice  as  a phy- 
sician and  surgeon  in  California  was  revoked  Octo- 
ber 18,  1928,  having  been  found  guilty  of  habitual 
intemperance.  (Previous  entries,  May,  August,  and 
September  1926;  December  1928.) 


Maurice  LeBelle,  advertising  Chirothesian  treat- 
ment in  Los  Angeles,  was  found  guilty  on  April  10 
in  the  courts  of  Los  Angeles  on  a charge  of  violation 
of  the  Medical  Practice  Act,  according  to  investiga- 
tion reports. 

“Dr.”  Arthur  C.  McCowan,  who  jumped  bail  in 
Oakland  recently  after  his  arrest  for  violation  of  the 
State  Medical  Practice  Act,  has  been  identified  as 
Arthur  E.  Webb,  former  convict  in  two  federal  peni- 
tentiaries. . . . Webb,  who  posed  as  Doctor  McCowan, 
a physician,  in  Oakland,  fled  California  while  at 
liberty  on  bail  after  his  arrest  as  a bogus  doctor  and 
since  then  has  been  arrested  in  Portland  on  a theft 
charge.  . . . The  real  Doctor  McCowan  (McCown) 
is  a physician  living  near  Portland,  whose  credentials 
were  stolen  in  a house  burglary.  Medical  officials 
also  charge  that  Webb  posed  as  a doctor  in  Alaska 
and  has  served  terms  in  McNeil  and  Leavenworth 
penitentiaries  (San  Francisco  Call-Bulletin,  March  8, 
1930).  Information  recently  received  from  the  Oregon 
Board  of  Medical  Examiners  relates  that  the  investi- 
gator for  said  board  had  obtained  from  this  impostor 
the  medical  credentials  found  on  his  person  at  the 
time  of  arrest  and  had  returned  same  to  the  bona 
fide  Arthur  C.  McCown,  well-known  practitioner  of 
Houlton,  Oregon. 

According  to  reports,  Mrs.  Versa  I.  McKinney  was 
arrested  in  Los  Angeles  on  March  27  on  a charge 
of  alleged  abortion  and  committed  to  jail  in  default 
of  $250  bail.  

Rudolph  R.  Pohlman,  advertised  himself  as  a 
scientific  health  expert,  and  holding  a diploma  or 
certificate  from  the  “Health  Center  Institute  of  Drug- 
less Healing,”  was  reported  to  have  pleaded  guilty 
to  a violation  of  the  Medical  Practice  Act  in  Santa 
Monica  on  April  3 and  sentenced  to  pay  a fine  of 
$100,  which  sentence  was  suspended  and  defendant 
placed  on  probation  for  two  years. 


Opening  a determined  drive  against  narcotic  users 
and  peddlers,  state  and  city  narcotic  officers  last  night 
cooperated  in  sweeping  raids  in  which  five  persons, 
of  whom  three  were  physicians,  were  arrested.  Dr. 
Samuel  Cotterell,  forty-five,  of  2502  South  Central 
Avenue,  Dr.  Walter  W.  Hopkins,  forty-seven,  of  4018 
South  Central  Avenue,  and  Benjamin  Colly,  twenty- 
nine,  proprietor  of  a pharmacy  at  Twenty-fifth  Street 
and  Central  Avenue,  all  negroes  and  said  to  comprise 
an  active  narcotic  ring,  were  taken  in  one  raid.  Doctor 
Clayton  Allen  and  his  wife,  Mrs.  Zula  Allen,  were 
arrested  at  their  home,  1806  West  Vernon  Avenue  in 
a second  raid  and  were  charged  with  violation  of  the 
State  Poison  Act,  a felony.  A quantity  of  narcotics 
was  confiscated  (Los  Angeles  Illustrated  Daily  News, 
January  31,  1930). 


Thomas  R.  Hart,  former  deputy  district  attorney; 
Elon  G.  Galusha  and  Dr.  Noah  L.  Weiner  yesterday 
were  acquitted  by  Superior  Judge  Wood  of  a charge 
of  conspiracy  to  commit  extortion  of  $5,000  from  Fred 
Reed,  inventor  and  operator  of  a Hollywood  Sani- 
tarium. The  three  were  asserted  to  have  plotted  to 
get  $5000  from  Reed  in  a threat  to  cause  his  prose- 
cution on  a charge  of  violating  the  Medical  Practice 
Act  . . . (Los  Angeles  Times,  December  3,  1929). 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


THE  NEW  VOGUE  IN  DOCTORS’  EQUIPMENT 


By  ALLISON 


We  are  distributors  of  the  distinctive  ALLISON  line  of  treatment  room,  consultation  office 
and  reception  room  furniture.  Let  us  help  you  in  planning  your  new  office,  or  in  refurnishing 
your  old  suite.  May  we  send  catalog?  Free  on  request. 


TRAVERS  SURGICAL  CO. 

Physicians’  and  Hospital  Supplies 

FRESNO  SAN  FRANCISCO 

933  Van  Ness  429  Sutter  Street 

CALIFORNIA’S  LEADING  SURGICAL  SUPPLY  HOUSE 


y 


iSack.  yirv  1893 

At  the  Columbian  Exposition  held  in  1893, 
Sharp  and  Smith  was  awarded  a medal 
"for  producing  excellent  surgical  instru- 
ments of  scientific  design,  best  material 
and  excellent  workmanship.” 

This  evidence  of  progressive  leadership, 
Sharp  and  Smith  had  earned  and  con- 
tinues to  deserve  by  cooperation  with  such 
authorities  as  Dr.  Rankin,  to  produce  in- 
struments and  supplies  that  contribute  to 
the  advance  of  your  profession. 

You  order  from  the  SandS  Catalog  with 
a confidence  based  on  86  years  of  SandS 
leadership. 

General  Surgical  and  Hospital  Supplies 
65  East  Lake  Street  Chicago,  Illinois 

Western  Branch:  1203  W.  Sixth  Street 
Los  Angeles,  Calif. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


j 14 


• • • powerful  and 
rapid  in  action.  Kills 
bacteria  almost 
instantly. 


Valuable  in  the  treatment 
of  all  open  wounds,  abra- 
sions, and  infections  of  the 
mucous  membranes 


12  FLUID  OUNCES 


U3U0R  hcxvlrcsobcinolis.  s & o 

'IT;  r‘  ^djcatcs  a solution 

TENSION  OF  37  l,%  NES  PER  crNT!**1* 

GENERAL  ANTISEPTIC 

i„A.STable.  non-toxic.  no* 
JTATimg  germicidal  sol 
WHICH  RETAINS  ITS  ACT' 

S "MEN  APPLIED  to  tissue 
peaces  and  destroy 
*TH0GEN|c  bacteria  oj 

.'L’TlAN  15  SECONDS  CO* 


ffiXYLRESORCINOl 
SOLUTION  S.T.31 


• • • especially  suggested, at 
this  time  of  the  year,  as  a 
nasal  spray,  mouth  wash 
and  gargle. 


SHARP  & DOHME 


BALTIMORE 

NEW  YORK  CHICAGO  NEW  ORLEANS 

PHILADELPHIA 


ST.  LOUIS 
BOSTON 


ATLANTA 


KANSAS  CITY 


SAN  FRANCISCO 


DALLAS 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


Dairy  Delivery  Company 

Successors  in  San  Francisco  to 

Millbrae  Dairy 

The  Milk  With  More  Cream 


We  deliver  daily  from 
San  Francisco 
to 

Menlo  Park 

PHONE  VALENCIA  TEN  THOUSAND 
and  BURLINGAME  3076 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  31) 

dies,  1929,  p.  73),  0.243  gram  (3)4  grains)  in  5 cubic 
centimeters  of  solution.  Lakeside  Laboratories,  Inc., 
Milwaukee,  Wisconsin. — Jour.  A.  M.  A.,  March  1, 
1930,  p.  634. 

Squibb’s  Dextro-Vitavose. — A mixture  of  Squibb’s 
vitavose  (New  and  Nonofficial  Remedies,  1929,  p.244), 
one  part,  and  dextrose,  two  parts.  E.  R.  Squibb  & 
Sons,  New  York. — Jour.  A.  M.  A.,  March  29,  1930, 
p.  920. 

FOODS 

The  following  products  have  been  accepted  as  con- 
forming to  the  rules  of  the  Committee  on  Foods  of 
the  Council  on  Pharmacy  and  Chemistry  of  the 
American  Medical  Association: 

Peter  Pan  Bread  (P.  F.  Peterson  Baking  Co., 
Omaha.) — A thoroughly  baked  white  bread  having  a 
soft,  velvety  texture  and  sweet  flavor. 

Clapp’s  Original  Approved  Baby  Soup  and  Strained 
Vegetables  (Harold  H.  Clapp,  Inc.,  Rochester,  New 
York). — Baby  Soup:  A combination  of  beef  juice  and 
vegetables.  Wheatheart  Soup : A combination  of  wheat 
germ,  vegetables,  and  cereals.  Strained  Vegetables: 
Spinach,  wax  beans,  carrots,  asparagus,  peas,  beets, 
prune  pulp,  apricot  pulp,  and  tomatoes.  In  these 
products  all  possible  food  values  are  retained  and  the 
least  amount  of  water  is  used  in  cooking. 

Checkr-Redi-Cooked  Oats  or  Checkr  Rolled  Oats 
(Ralston  Purina  Co.,  St.  Louis).  — Checkr-Redi- 
Cooked  Oats  have  been  precooked  to  bring  out  their 
mellow  flavor  and  to  make  them  quickly  prepared  and 
easily  digested. 

Minute  Gelatin  (Minute  Tapioca  Co.,  Inc.,  Orange, 
Massachusetts). — Pure  granulated  gelatin  offered  in 
convenient  size  cartons  for  household  use. — Jour. 
A.  M.  A.,  March  1,  1930,  p.  635. 

(Continued  on  Page  41) 


Suggest  this 
Pure  Fruit  Juice , 
so  rich  in 
Food  Values 

Young  and  old  relish  the  delicious  mel- 
low taste  of  ’49  Brand  California  Grape 
Juice.  For  general  diet  and  hospital  use  ’49 
Grape  Juice  is  unsurpassed  because  of  its 
high  percentage  of  . natural  invert  sugar, 
valuable  mineral  salts,  and  stimulating  laxa- 
tive properties. 

An  exclusively  controlled  process  is  respon- 
sible for  the  fresh,  lasting  purity  of  ’49  Brand. 

All  the  natural  goodness  of  selected,  mature 
grapes  is  brought  to  you  in  ’49.  Nothing — 
not  even  sugar — is  added  to  the  pure  juice. 


Physicians,  dietitians 
or  hospitals  interested 
in  learning  more  about 
’49  Brand  California 
Grape  Juice,  either 
Red  or  White,  may 
write  to 


VITA-FRUIT  PRODUCTS  INC. 

RUSS  BLDG.,  SAN  FRANCISCO 

GRAPE  JUICE  PLANT  AT  LODI 

PARROTT  6c  CO. 

SALES  REPRESENTATIVES 

SAN  FRANCISCO  LOS  ANGELES  PORTLAND 

SEATTLE  TACOMA  SPOKANE 


3(> 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Rainier  Pure  Grain  Alcohol 

US  P 

The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRAIN  ONLY 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 

RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calif. 


Mercurochrome  - 220  Soluble 

(Dibrom-oxymercuri- fluorescein.) 


The  Stain  Provides  for  Penetration 

and 

Fixes  the  Germicide  in  the  Tissues 


Mercurochrome  is  bacteriostatic  in  ex- 
ceedingly high  dilutions  and  as  long  as 
the  stain  is  visible  bacteriostasis  is  pres- 
ent. Reinfection  or  contamination  are 
prevented  and  natural  body  defenses 
are  permitted  to  hasten  prompt  and 
clean  healing,  as  Mercurochrome  does 
not  interfere  with  immunological  proc- 
esses. This  germicide  is  non-irritating 
and  non-in  jurious  when  applied 
to  wounds. 

HYNSON,  WESTCOTT  & DUNNING,  INC. 

Baltimore,  Maryland 


For  use  in  the  Prevention  and  Treatment 
of  the  Acid- Ash  Type  of 

ACIDOSIS 

California  Lima  Bean  FLOUR! 

Alkalinity,  of  course,  neutralizes  acidity.  And 
Limas  are  one  of  the  most  alkaline  foods 
known — 41.65  per  100  grams! 

To  meet  a definite  demand  from  the  medical 
profession,  we  have  developed,  to  a high  degree 
of  fineness,  a Lima  Bean  FLOUR — for  making 
non-acid  breads,  muffins,  pancakes  and  waffles 
for  Basic  Diet  menus! 

Lima  FLOUR  is  available  in  10- lb.  bags  at 
$1.20,  and  in  100-lb.  bags  at  $10.00.  Upon 
receipt  of  price  and  delivery  instructions  your 
order  will  be  shipped  parcel  post  or  express  col- 
lect. Send  orders,  and  make  check  or  money 
order  payable  to — 

CALIFORNIA  LIMA  BEAN 
GROWERS  ASSOCIATION 

Oxnard,  California 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


One  of 
America’s 
Leading  Hos- 
pital Supply 
Houses— 

Manufacturers  of  "Porcello’ 
Aseptic  Steel  Furniture 


Reid 

Bros. 

Factory  at 
Irvington, 
California 


OFFICES 

91  Drumm  Street  San  Francisco,  Calif. 

Phone  DOuglas  1381 

1417  Fourth  Avenue,  Seattle,  Washington 


__  SAVE  MONEY  ON  _ 

YOUR  X-RAY  SUPPLIES 


W e Save  You  from  10%  to  25% 

GET  OUR  PRICE  LIST  AND  DISCOUNTS 


Insures  finest  radiographs  on  heavy  parts,  such  as 
kidney,  spine,  gall-bladder  or  heads. 

Curved  top  style — up  to  17  x 17  size  cassettes $250.00 

Flat  top  style  for  11  x 14  size 175.00 

Flat  top  style  for  14  x 17  size. 260.00 

X-RAY  FILM — Buck  Silver  Brand  or  Eastman  Super- 
speed Duplitized  Film.  Heavy  discounts  on  carton 
quantities.  Buck,  Eastman  and  Justrite  Dental  Films. 
BARIUM  SULPHATE — for  stomach  work,  purest 
grade.  Also  BARI-SUSP  MEAL.  Low  Prices. 
DEVELOPING  TANKS  — 4,  5 & 6 compartment 
soapstone,  EBONITE  2J4,  5 & 10  gallon  sizes. 
Enamel  Steel  and  Hard  Rubber  Tanks. 
COOLIDGE  X-RAY  TUBES— 7 styles.  Gas  Tubes. 
INTENSIFYING  SCREENS  & CASSETTES  for 
reducing  exposures.  Special  low  prices. 

JONES  BASAL  METABOLISM  UNITS, 

Most  accurate,  reliable,  portable — $235.00. 

If  you  have  a machine  Geo.  IV.  Brady  & Co. 

have  us  put  your  name  781  s.  Western  Ave. 

on  our  mailing  list.  Chicago 


Tycos  Pocket  Type 
Sphygmomanometer 

r I 'WENTY-TWO  years  ago  the  first  Tycos 
Sphygmomanometer  was  placed  on  the 
market.  Although  modifications  have  been  made 
whenever  desirable,  fundamentally  the  instru- 
ment remains  the  same  today. 

Every  Tycos  Sphygmomanometer  has  adhered 
to  an  indisputable  principle  — that  only  a dia- 
phragm-type instrument  is  competent  for  the 
determination  of  blood  pressure.  To  faithfully 
record  the  correct  systolic  pressure,  an  indi- 
cator’s accuracy  must  not  be  affected  by  the 
speed  at  which  the  armlet  pressure  is  released, 
only  a diaphragm  instrument  can  guarantee  this. 
To  honestly  give  the  true  diastolic  pressure,  a 
sphygmomanometer  must  respond  precisely  to 
the  actual  movements  of  the  arterial  wall,  again, 
only  a diaphragm  instrument  can  do  this. 

Portable,  the  entire  apparatus  in  its  handsome 
leather  case  is  carried  in  coat  pocket.  Durable, 
its  reliability  in  constant  use  has  been  proved 
by  many  thousands  of  instruments  during  the 
past  twenty-two  years.  Accurate,  its  precision 
is  assured  by  relation  of  the  hand  to  the  oval 
zero. 

Further  information  relative  to  the  Tycos 
Pocket  Type  Sphygmomanometer  will  be  fur- 
nished upon  request. 

Write  for  new  1930  edition  of  Tycos  Bulletin  #6 
“Blood  Pressure-Selected  Abstracts.”  A great 
aid  to  the  doctor  who  wishes  to  keep  abreast 
of  blood  pressure  diagnosis  and  technique. 

Taylor  Instrument  Companies 

ROCHESTER,  N.  Y.,  U.  S.  A. 

CANADIAN  PLANT  MANUFACTURING  DISTRIBUTORS 
TYCOS  BUILDING  I N G REAT  B RITAI N 

TORONTO  SHORT  &.  MASON,  LTD.,  LONDON-E  17 


Illinois 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


38 


Analyzed  and  Certified  Products 


NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 

CErjifTED  intramuscular  medications 

PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


Get  Your  Lifetime 
$37.50  Baumanometer 


Now 

And  because  it  is  a Lifetime  Baumanometer, 
individually  calibrated  and  scientifically  ac- 
curate, the  KOMPAK  Model  eliminates  any 
past  reasons  for  using  inaccurate  or  clumsy 
bloodpressure  apparatus. 


You  Are  Invited  to  Inspect  This  Master  Instrument 

WALTERS  SURGICAL  CO. 

SURGICAL  INSTRUMENTS 
521  Sutter  Street  SAN  FRANCISCO 


Four  Fifty 

I Sutter 

San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


39 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 

NEW  YORK,  NEW  YORK 

FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  haring  an  addict  problem  is 
invited  to  write  for  "Hospital  Treatment  for 
Alcohol  and  Drug  Addiction 


FRANK  F.  WEDEKIND  CO. 

SURGICAL  SUPPLY  CENTER 
First  Floor,  Medical  Building 
Opposite  St.  Francis  Hospital 
BUSH  AND  HYDE  STREETS 

Telephone  GRaystone  9210 
Main  Store  and  Fitting  Rooms 

2004-06  Sutter  street  west  6322 

Corsets  . . Surgical  Appliances  . . Storm  Binders 
Orthopedic  Appliances  . . Elastic  Hosiery  . . Trusses 
California  Manufacturing  Agents  for 

The  "Storm  Binder”  and  Abdominal  Supporter 
( Patented) 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . . and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


NEW! 


KOMPAK  MODEL 


nTiTTVTTTv 


STANDARD  FOR  BLOODPRESSURE 


Demonstration,  or  Sent  for  Inspection  Upon  Request 


RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


40 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


FINANCING  THE  DOCTOR’S  PATIENTS 

A Definite  Payment  Plan 

CASH  for  the  Doctor  CREDIT  for  the  Patient 

HUNDREDS  OF  SATISFIED  DOCTORS 
THOUSANDS  OF  SATISFIED  PATIENTS 

W e Collect  Annually  Over  $200,000 

No  Investment  No  Entrance  Fee 

Medico-Dental  Finance  Corporation 

Suite  410 — 450  Sutter  Street  San  Francisco,  Calif. 


Medico-Dental  Finance  Corporation  of  Oakland 

909  Financial  Center  Building  Oakland,  Calif. 


FOR 

SALE 


Beautifully 
situated 
in  the 

Sierra  Nevada 
Foothills 


This  desirable  convalescent  home  and  grounds  covering  65  acres,  conveniently  located  on  the  highway  three 
miles  from  Colfax.  In  center  of  locality  noted  for  climate  beneficial  to  tuberculous  patients. 

Will  accommodate  25  people — good  water  supply — garden — small  orchard.  All  in  first  class  condition. 

Was  built  for  and  occupied  by  Standard  Oil  Company  of  California  as  a sanatorium  for  the  tuberculous. 

For  further  information  write  H.  S.  THOMSON,  M.  D.,  225  Bush  Street,  San  Francisco 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


41 


CALSO  WATER 


PALATABLE  ALKALINE  SPARKLING 


Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Calso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Calso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Los  Angeles 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  35) 

Quaker  Oats  (The  Quaker  Oats  Co.,  Chicago). — 

Brands:  Quick  Quaker  Oats;  Rolled  Quaker  Oats; 
Mother's  Oats;  Quick  Mother’s  Oats.  Quaker  Oats 
provides  50  per  cent  more  protein  than  wheat,  60  per 
cent  more  than  wheat  flour,  more  than  twice  as  much 
as  rice;  100  per  cent  more  than  cornmeal.  It  is  rich 
in  minerals  and  vitamin  B. 

PROPAGANDA  FOR  REFORM 

Ephedrol  with  Ethylmorphin  Hydrochlorid  (Lilly) 
Not  Acceptable  for  New  and  Nonofficial  Remedies. — 
The  Council  on  Pharmacy  and  Chemistry  reports  that 
this  is  a shotgun  cough  mixture,  relying  on  an  opiate 
for  its  effect,  and  on  the  vogue  of  ephedrin  for  sales 
appeal.  The  Council  declared  Ephedrol  with  Ethyl- 
morphin Hydrochlorid  unacceptable  for  New  and 
Nonofficial  Remedies  because  it  is  an  unscientific  mix- 
ture marketed  under  an  unacceptable  proprietary 
name  with  unwarranted  therapeutic  claims. — Jour. 
A.  M.  A.,  March  1,  1930,  p.  634. 

New  Treatments  for  Cancer. — Hanson  reports  re- 
sults closely  resembling  those  described  by  Coffey 
and  Humber,  following  the  administration  of  thymus 
extract.  Sokoloff  reports  similar  results,  following  the 
use  of  an  extract  of  the  suprarenal  combined  with 
iron.  Charlton  announces  lytic  effects  on  cancer  cells 
following  the  administration  of  an  extract  of  the 
omentum.  The  interest  of  the  Coffey-Humber  method, 
in  its  present  stage  of  investigation,  lies  primarily  in 
the  fact  that  the  available  evidence  seems  to  demon- 
strate a definite  effect  on  cancer  tissue  as  the  result 
of  injecting  suprarenal  extract  into  the  body  at  points 
removed  from  the  tumor. — Jour.  A.  M.  A.,  March  1, 
1930,  p.  639. 

Medical  Publicity  Bureau.- — In  an  article  dealing 
with  the  subject  of  this  caption  that  appeared  in  the 
(Continued  on  Page  43) 


^ OW ...  A World  Mart 
of  Surgical  Supplies 
Brought  to  You  . . . 
...IN  LOS  ANGELES 

For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 

Send  (or  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 

KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


. . . No  Variation 


UNIFORMITY  and  accuracy  of 
formulae  are  of  primary  im- 
portance in  the  successful  use  of 
Lactic  Acid  Milk.  When  Merrell- 
Soule  Powdered  Whole  Lactic  Acid 
Milk  is  used,  you  are  assured  of 
these  factors  even  when  the  milk 
is  prepared  by  an  inexperienced 
person. 

As  the  largest  manufacturer  of 
Powdered  Lactic  Acid  Milk,  the 
Merrell-Soule  Co.,  Inc.,  employs 
every  facility  for  scientific  control, 
assuring  absolute  uniformity  of 
acidity  and  fat  content.  Published 
analyses  are  strictly  adhered  to. 

Physicians  who  are  recommend- 
ing Lactic  Acid  Milk  for  infant 


feeding  will  find  Merrell-Soule 
Powdered  Whole  Lactic  Acid  Milk 
more  satisfactory  in  every  respect. 
It  is  a cultured  milk  and  thus  en- 
joys the  advantages  generally  be- 
lieved to  be  present  due  to  the 
therapeutic  value  of  the  viable  or- 
ganisms themselves.  It  is  more 
palatable  than  the  ordinary  acidi- 
fied milk.  Its  powdered  form 
makes  for  ease  and  accuracy  in 
preparing  the  formula. 

The  Merrell-Soule  Co.,  Inc.,  also 
manufactures  Powdered  Skimmed 
Lactic  Acid  Milk. 

• Literature  and  samples 
sent  on  request. 

Merrell-Soule  Co.,  Inc., 

350  Madison  Avenue,  New  York 


(Recognizing 
the  importance 
of  scien  tific 
control,  all  con- 
tact with  the 
laity  is  predi- 
cated on  the 
policy  that 
KLIM  and  its 
allied  products 
be  used  in  in- 
fant feeding 
only  according 
to  a physicians 
formula) 


Merrell-Soule  Powdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 


B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 


Training;  School  for 
Nurses 


For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  41) 

journal  December  7,  1929,  the  statement  was  made 
that  Dr.  William  J.  Robinson  was  the  principal  stock- 
holder in  this  bureau.  After  the  appearance  of  the 
article,  Doctor  Robinson  wrote  to  the  journal  stat- 
ing that  the  use  of  his  name  in  this  connection  was 
without  justification.  A correction  of  this  statement 
was  published  in  the  journal  January  25,  1930,  stating 
that  the  statement  was  incorrect.  The  journal  now 
publishes,  at  Doctor  Robinson’s  request,  an  affidavit 
from  the  doctor  to  the  same  effect. — Jour.  A.  M.  A., 
March  1,  1930,  p.  652. 

Causyth. — A number  of  German  journals  have  con- 
tained more  or  less  laudatory  reports  regarding  Cau- 
syth, but  these  are  not  considered  to  present  accept- 
able evidence  for  the  value  of  the  preparation.  Ac- 
cording to  the  advertising,  Causyth  is  a “cyclohexa- 
trienpyridinsulphonacid,  derived  from  Pyrazol,  the 
(Continued  on  Next  Page) 


Creating  Joy 

Qreate  joy  jor  yourself  and  others 
by  sending  flowers 


224-226  Grant  Avenue 
Telephone:  SUtter  6200 
SAN  FRANCISCO 


44  CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Banning  Sanatorium 


Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
T reatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


Dr.  Pollard’s  High  Tension  Stethoscope 


Postpaid  Price  $6.00 


A SCOPE  with  which  you 
can  hear  the  heart  sounds 
through  an  overcoat,  coat  and 
vest,  and  with  which  you  can 
easily  hear  the  fetal  heart 
sound.  The  regulation  bin- 
aurals  are  furnished  with  this 
stethoscope. 

TRY  IT  a week;  if  not  sat- 
isfied, return  and  your  money 
will  be  cheerfully  refunded. 


JOHN  D.  POLLARD,  M.  D. 

3603  Flournoy  Street  Chicago,  111. 


Health  First 

SPRING  WATER 

Delivered 

to  Offices  and  Homes 
Entire  Bay  District 

Purity  Spring  Water  Co. 

2050  Kearny  Street 
San  Francisco 
Phone  DAvenport  2197 


NICHOL/  POWDER 


Get  this  Nasal  Powder- 

J FREE  / 

We  want  every  physician  to 
try  Nichols  Nasal  Syphon. 
Powder- It's  new  and  unusual- 
ly fine  for  use  with  the  Nichols 
Nasal  Syphon-  or  wherever 
nasal  cleansing  is  indicated, 

NI.CHOI/ 

NA/AL  y’YPHON.INC. 
159  East 34'.t St.-  N.Y.C. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 
formula  being  C22H24N.i05S.”  The  product  has  not 
been  considered  by  the  Council  on  Pharmacy  and 
Chemistry  nor  has  the  Mallinckrodt  Chemical  Works, 
which  exploits  it  by  way  of  its  Canadian  branch 
“Mallinckrodt  Chemical  Works  Limited  of  Canada,” 
requested  the  Council  to  report  on  it.  Apparently  no 
reports  have  been  published  in  American  medical 
journals  which  are  confirmatory  of  the  German  propa- 
ganda. A pharmacologist  who  has  given  much  atten- 
tion to  the  action  of  salicylates  and  other  drugs  used 
in  the  treatment  of  rheumatism  reviewed  seven  of  the 
eight  papers  which  were  referred  to  in  an  advertising 
circular.  He  held  the  evidence  to  be  unsatisfactory 
and  uncritical  and  no  justification  for  the  extravagant 
(Continued  on  Page  49) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


Ql/lien  is  blather  my  of  OJalue 
in  njour  Practice  ? 


YOUR  decision  to  use  diathermy 
in  the  treatment  of  any  condition 
will,  of  course,  be  based  on  recognized 
medical  authority.  Many  physicians 
have  become  interested  as  a result  of 
observing  the  many  references  to  dia- 
thermy in  current  medical  literature, 
and  no  doubt  intend  to  investigate 
for  themselves  when  opportunity  pre- 
sents. But  a busy  practice  affords 
little  of  the  time  required  in  search- 
ing the  files  of  the  medical  library, 
and  it  is  put  off  indefinitely. 

A preliminary  survey  of  the  articles 
on  diathermy,  published  during  the 
past  year  or  so,  is  available  to  you  in 


the  form  of  a 64'page  booklet  entitled  “In- 
dications  for  Diathermy.”  In  this  booklet 
you  will  find  over  250  abstracts  and  ex' 
tracts  from  articles  by  American  and  foreign 
authorities,  including  references  to  more 
than  a hundred  conditions,  in  the  treatment 
of  which  the  use  of  diathermy  is  discussed. 

If  you  number  yourself  among  the  phy' 
sicians  who  have  not  adopted  diathermy 
in  practice,  and  desire  to  investigate  this 
form  of  therapy  in  view  of  reaching  your 
own  conclusion  as  to  its  value  in  your 
practice,  you  will  find  this  booklet  a conve' 
nient  reference. 

A copy  will  be 
sent  on  request. 


SAN  FRANCISCO:  Four-Fifty  Sutter 
LOS  ANGELES:  Medico-Dental  Bldg. 

GENERAL  A ELECTRIC 


2012  Jackson  Boulevard 
FORMERLY  VICTOR 


Chicago,  111.,  U.S.  A. 


X-RAY  CORPORATION 


Join  us  in  the  (general  Electric  Hour  broadcast  every  Saturday  night 
on  a nationwide  N.  B.  C.  network. 


General  Electric  X-Ray  Corporation 
2012  Jackson  Blvd.,  Chicago. 

Not  being  a user  of  diathermy  in  my  prac- 
tice, please  send  your  64-page  booklet  “ Indi- 
cations for  Diathermy.” 


Dr 

Address . 
City 


. State. 


+6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


DIATHERMY  GALVANIC  SINE  WAVE  X-RAY 

Dewar  & Hare  Electric  Co. 

386  Seventeenth  Street  i Oakland,  California 
THE  "THERMOTAX” 

A high  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 

THE  "ELECTROTAX” 

A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 


Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


Protection  for  the 

PROFESSIONAL  INCOME 


JC'OR  several  years,  the  Guardian  has  made  available  the  broadest  protection  yet 
^ developed  for  the  man  of  professional  training. 

. . . Its  unique  Professional  Disability  clause  provides  for  a replacement  of  professional 
income  when  suspended  by  the  insured’s  inability  to  continue  his  professional  duties — 
however,  we  regret  to  announce  that  after  June  30th,  1930,  the  writing  of  Professional 
Disability  must  be  discontinued. 

The  Guardian  Life  Insurance  Company  of  America 

New  York  City 

"THE  COMPANY  THAT  GUARDS  AND  SERVES” 

Full  particulars  gladly  furnished  by 

George  Leisander,  Manager  Brust  8C  Von  Breton,  Managers 

SAN  FRANCISCO  AGENCY  LOS  ANGELES  AGENCY 

620-624  Phelan  Building  540  Fidelity  Building 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


Milk  Is  Both  a Great  Food  and  a Great  Danger! 
Retain  the  Great  Food — Eliminate  the  Danger! 

Prescribe  Dryco—the  Safe  Milk 

1.  No  danger  of  milk-borne  typhoid! 

2.  No  danger  of  milk-borne  sore-throat! 

3.  No  danger  of  milk-borne  scarlet  fever! 

4.  No  danger  of  milk-borne  diphtheria! 

5.  No  danger  of  milk-borne  tuberculosis! 

6.  No  danger  of  milk-borne  undulant  fever! 

Dry co  Is  Free  from  all  Pathogenic  Bacteria! 


Let  us  send  clinical  data  and  samples  of  this  milk 
Pin  this  to  your  Rx  blank  or  letterhead  and  mail 


THE  DRY  MILK  COMPANY,  INC.,  205  East  42nd  Street,  New  York,  N.  Y. 


48 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 

/ 

FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  i Excellent  Cuisine 

DR.  MAX  ROTHSCHILD  DR.  HARRY  C.  WARREN 

Medical  Director  Asst.  Medical  Director 


Rates  and  Prospectus  on  Request 


San  Francisco  Office 
384  Post  Street 
Phone  DAVENPORT  4466 


Address:  BELMONT,  CALIF. 
Phone  BELMONT  100 
(3  Trunk  Lines) 


No.  611 — 16"  Physician’s  Bag,  in  Black  or 
Brown,  Price  $13.00 

Bischoff’s  Surgical  House 

THE  HOUSE  OF  SERVICE 

427  20th  Street,  Elks  Bldg.,  Oakland,  Calif. 

Branch,  68  So.  1st,  San  Jose,  Calif. 

A COMPLETE  LINE  OF  PHYSICIAN’S, 
HOSPITAL  AND  SICKROOM  SUPPLIES 


Johnston -Wickett 
Clinic 

ANAHEIM,  CALIFORNIA 

Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 

Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 

Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


Announcing 

The  new 

AUDIPHONE 

This  hearing  device  is  equipped  with  a small 
inconspicuous  earpiece  and  a powerful  light- 
weight battery  which  can  be  easily  concealed. 

The  Audiphone  was  developed  in  the  Bell 
Telephone  Laboratories,  and  is  manufactured 
by  the  Western  Electric  Company — a strong 
guarantee  of  its  reliability. 

Full  details  or  demonstration  upon  request 


W.  D.  FENNIMORE  , 5 , A.  R.  FENNIMORE 


177-181  Post  Street  San  Francisco 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  44) 

claims  of  the  advertising. — Jour.  A.  M.  A.,  March  1, 
1930,  p.  656. 

Pneumococcus  Vaccines  Omitted  From  New  and 
Nonofficial  Remedies. — The  Council  on  Pharmacy 
and  Chemistry  reports  that  increasing  experience  has 
failed  to  demonstrate  the  value  of  pneumococcus  vac- 
cine in  the  treatment  of  pneumonia,  and  the  prophy- 
lactic value  of  the  vaccine  has  not  been  conclusively 
proved.  The  Council  came  to  the  conclusion  that  the 
experience  with  this  vaccine  has  not  afforded  accept- 
able evidence  for  its  therapeutic  usefulness  and  voted 
to  omit  it,  with  the  accepted  brands,  from  New  and 
Nonofficial  Remedies.  In  accordance  with  this  action, 
the  Council  announces  the  omission  of  Pneumococcus 
Vaccine  Immunizing  (Gilliland  Laboratories,  Inc.); 
Pneumococcus  Vaccine  (Lederle  Antitoxin  Labora- 
tories); Pneumococcus  Vaccine,  Prophylactic  (Eli 
Lilly  & Co.);  Pneumococcus  Antigen  (Lilly);  Pneu- 
mococcus Vaccine  (National  Drug  Co.);  Pneumococ- 
cus Vaccine  (Four  Types)  (Parke,  Davis  & Co.); 
Pneumococcus  Immunogen  (Parke,  Davis  & Co.; 
Pneumococcus  Vaccine  (E.  R.  Squibb  & Sons). — 
Jour.  A.  M.  A.,  March  8,  1930,  p.  716. 

Tom  Hayes — The  Indecent  Fraud  of  Archie  T. 
Hay. — Archie  T.  Hay,  who  did  business  from  189 
North  Clark  Street,  Chicago,  under  the  trade  name 
“Tom  Hayes”  has  been  selling  on  the  mail-order  plan 
a salve  or  ointment  called  “T.  N.  T.  (Tom’s  New 
Treatment)”  for  cases  of  “lost  manhood.”  The  nos- 
trum sold  by  Archie  T.  Hay  was  prepared  for  him, 
according  to  the  government  authorities,  by  Stearns 
and  White,  Chicago.  The  Postmaster-General  de- 
clared the  Tom  Hayes  business  a fraud  and  debarred 
it  from  the  mails. — Jour.  A.  M.  A.,  March  8,  1930, 
p.  735. 


The  NEED 

of  Professional  Liability  Insurance 
is  admitted  by  every  thoughtful 
practitioner.  It  remains  but  to 
choose 


the  KIND 

best  suited  to  the  individual’s  re- 
quirements and  to  be  satisfied  that 


the  COST 


is  a fair  one  for  the  value  received. 


THE 

UNITED  STATES  FIDELITY 
AND  GUARANTY  COMPANY 

Provides  the  Kind  of  policy  contract 
which  gives  adequate  protection, 
backed  by  a tried  and  permanent 
organization  assuring  the  best  qual- 
ity of  service  and  at  a Cost  which 
is  satisfactory. 


Over  $ 68,000,000 
in  Resources 


We  insure  only 
ethical  practitioners 


BRANCH  OFFICES 

340  Pine  Street,  San  Francisco,  Calif. 

1404  Franklin  Street,  Oakland,  Calif. 

724  South  Spring  Street,  Los  Angeles,  Calif. 

602  San  Diego  Trust  QC  Savings  Building 
San  Diego,  Calif. 

Continental  Nat’l  Bank  Bldg.,  Salt  Lake  City,  Utah 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5° 


A PRIMER 

FOR  THE  TUBERCULOUS 
AND  OTHER  ESSAYS  ON 
TUBERCULOSIS 

By  ROBERT  A.  PEERS 
M.D.,  C.D.,  C.M.,  F.T.M.C.,  F.A.C.P. 


Authoritative,  instructive 
. and  intensely  interesting, 
this  book  is  a notable  contribu- 
tion to  medical  science  in  that  it 
reviews  the  researches  of  a suc- 
cessful physician  whose  study  of 
tuberculosis  has  been  his  life’s 
work,  and  who  possesses  the 
happy  faculty  of  telling  about 
it  in  an  absorbingly  interesting 
fashion. 

Together  with  some  thirty- 
three  essays  and  addresses,  this 
book  contains  also  Dr.  Peers’ 
well  known  Primer  for  the  Tu- 
berculous, which  is  used  by  his 
patients  as  a guide  book  on  the 
road  to  cure;  also  his  Tubercu- 
losis Primer  for  School  Chil- 
dren, which  has  had  wide  cir- 
culation among  school  children, 
not  only  in  California  but  in 
other  states. 


While  the  book  is  couched  in 
the  language  of  the  layman  and 
designed  primarily  as  a guide 
to  the  patient  and  homes  touched 
by  tuberculosis,  it  is  by  no  means 
out  of  place  in  the  doctor’s  li- 
brary. Once  perused,  it  will  be 
deemed  indispensable  to  nurses, 
teachers,  social  workers  and  in 
the  sanatorium. 

336  pages,  printed  on  Antique 
Book  paper.  Half  bound  vol- 
ume with  square  art  canvas  back, 
paper  sides  and  pasted  labels. 


| The  James  H.  Barry  Company, 

1122  Mission  Street, 

I San  Francisco,  California. 

Please  send  me copies  of  “A  Primer 

for  the  Tuberculous  and  Other  Essays  on 
i Tuberculosis,”  for  which  I herewith  enclose 
I $3.50  per  copy. 

• Name 

I Address 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5i 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  275  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newly  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


Onuisa 


A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER. 


II 

■ Looks  like  a dress  silk  stocking.  A new  German 

■ invention.  Gives  compression  when  drawn  up  at 
the  top.  Tightness  regulated  in  direct  relation  to 
vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treatment  of  varicose  veins 
and  swollen  limbs.  Neat  and  comfortable. 

Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 


PRICES 

Length  as  illustrated $ 7.00 

Half  thigh  length 9.00 

Full  length  10.00 


In  ordering  give  patient’s 
calf  measurement. 


SOLD  AND  FITTED  BY 


<J» 


323  W.  6TH  STREET 


Phone  MUtual  8081 


LOS  ANGELES,  CALIF. 


52 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SAMTA  BARBARA  TONIC 


Experienced  Technicians  in  Clinical  Laboratory  and 
Physiotherapy  Departments.  Electrocardiographic  and 
Basal  Metabolic  determinations  made. 


The 

Santa  Barbara  Clinic 

1421  State  Street 

SANTA  BARBARA,  CALIFORNIA 

General  Surgery 

REXWALD  BROWN,  M.  D. 

IRVING  WILLS,  M.  D. 

Internal  Medicine 

HILMAR  O.  KOEFOD,  M.  D. 

H.  E.  HENDERSON,  M.  D. 

WM.  M.  MOFFAT,  M.  D. 

NEVILLE  T.  USSHER,  M.  D. 

Obstetrics  and  Gynecology 

BENJAMIN  BAKEWELL,  M.  D. 
LAWRENCE  F.  EDER,  M.  D. 

Diseases  of  Children 

HOWARD  L.  EDER,  M.  D. 

Ear,  Nose  and  Throat 

H.  T.  PROFANT,  M.  D. 

WM.  R.  HUNT,  M.  D. 

U rology 

IRVING  WILLS,  M.  D. 

Orthopedics 

RODNEY  F.  ATSATT,  M.  D. 

Eye 

F.  J.  HOMBACH,  M.  D. 
Roentgenology 

M.  J.  GEYMAN,  M.  D.,  Consultant 


ST.  JOSEPH’S  HOSPITAL 


SAN  FRANCISCO, 
CALIFORNIA 


Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


MAYBE  YOU  NEED  MONEY? 

"WE  GET  THE  COIN”  "WE  PAY ” 

BITTLESTON  COLLECTION  AGENCY,  Inc. 

1211  Citizens  National  Bank  Bldg.  LOS  ANGELES  TRinity  6861 


Mexico  City’s  New  Social  Center. — As  a part  of  the 
Mexican  Government’s  social  welfare  program,  a 
social  center  for  men,  women  and  children  was 
recently  opened  in  a densely  populated  neighborhood 
of  Mexico  City.  The  completed  plan  will  include  a 
children’s  playground,  a children’s  library  in  charge 
of  competent  librarians,  story  telling  classes,  swim- 


ming pools,  gymnasiums,  athletic  fields,  and  other 
recreational  facilities.  For  mothers  there  will  be  lec- 
tures and  individual  advice  on  child  care,  as  well  as 
suitable  games  and  other  forms  of  recreation,  their 
children  in  the  meantime  being  cared  for  in  a special 
nursery. — United  States  Department  of  Labor,  Children’s: 
Bureau,  W ashington. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 

Los  Angeles  Office  For  particulars  address: 

WILSHIRE  MEDICAL  BLDG.  POTTENGER  SANATORIUM 

1930  Wilshire  Blvd.  Monrovia,  California 


New  York  Post-Graduate 
Medical  School  and  Hospital 

Offers  an  Eight  Months’  Course  in 

OTO-LARYNGOLOGY  Beginning  June  1,  1930 

Included  in  the  course  are:  Anatomy  and  Physiology  of 
the  Nose,  Throat,  and  Ear;  Embryology,  Histology,  Path- 
ology, and  Bacteriology  of  the  Nose,  Throat,  and  Ear  (given 
by  laboratory  staff);  Dissection  of  the  Head  and  Neck, 
and  Nose,  Throat,  and  Ear  Operations  (cadaver);  Daily 
Clinics  in  a large  Out  Patient  Department;  Bronchoscopy, 
Esophagoscopy,  etc. 

During  the  last  four  months  the  matriculate  performs 
under  supervision  a number  of  the  more  common  nose 
and  throat  operations  in  the  out  patient  department. 

The  course  may  be  followed  by  a four  months’  course  in 
Ophthalmology  beginning  February  1,  1931. 

For  descriptive  booklet  and  further  information , address 

THE  DEAN 

313  East  Twentieth  Street  New  York  City 


Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


Doctor! 

BUY  NOW — 

SAVE  MONEY 

Sensational  Stock 
Reducing  Sale  of 

Used  Equipment 

Treatment  room  Furniture,  Quartz  Lamps, 
Electro-Therapy  Apparatus  and  Accessories 
Surgical  Instruments,  Medical  Supplies 
All  standard  makes  and  models  at  bargain 
prices.  Everything  RENEWED  and  fully 
GUARANTEED. 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Building 

391  SUTTER  STREET 

SAN  FRANCISCO 

Telephone:  SUTTER  5314 


54 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ST.  MARY’S  HOSPITAL  San  Francisco 

Conducted  by  Sisters  of  Mercy 

Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.  A.  C.  3. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Burns,  M.  D. 


Obstetrics 

Philip  H.  Arnot,  M.  D. 
Medtcine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 

Stephen  Cleary,  M.  D. 

T.  T Shea.  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Chas.  C.  Mohun,  M.  D. 

Randolph  G.  Flood,  M.  D. 

Heart 
Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 
Dentistry 

Thos.  Morris,  D.  D.  S. 
Francis  L.  Meagher,  D.  D.  S. 


Trademark  UCTAD  H/Y99  Trademark 
Registered  £ fJKlYI  Registered 

Binder  and  Abdominal  Supporter 


"Type  A”  "Type  N” 


The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-Iliac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 

Katherine  L.  Storm,  M.  D. 

Originator,  Owner  and  Maker 
1701  Diamond  Street,  Philadelphia,  Pa.,  U.  S.  A. 


A n unusual  opportunity  for  physician 
to  establish  offices  in  the  financial  dis- 
trict of  San  Francisco. 

The  Physician’s  Suite  in  the  Russ 
Building,  consisting  of  reception,  con- 
sultation, two  treatment  rooms  and  la- 
boratory is  available  for  occupancy. 

For  further  information  apply  at  office  of 

RUSS  BUILDING  COMPANY 

Room  1101  Telephone  KEarny  1600 

Other  Professional  Suites  are  Occu- 
pied by  Dentist,  Optometrist,  Optical 
Shop,  Chiropodist  and  Drug  Store 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

•f 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Year  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


“TRADE  IN  SACRAMENTO” 

WITH 

EUGENE  JAY  B. 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 


Surgeons * Instruments  * Physicians * and  Hospital  Supplies 


HAVE  YOU  SEEN  THE  NEW  No.  24  BLADE? 


Orthopedic  Appliances,  Elastic  Hosiery,  Abdominal,  Ptosis, 
Sacro-Iliac  and  Maternity  Supports,  Crutches, 
Wheel-Chairs,  Invalid  Supplies. 

SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY 


Agents  for  Bard-Parker  Company 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


56 


belongs  in  the  diet 
ASK  YOUR  DOCTOR! 


SHOULD  SUGAR  HAVE  A PLACE  IN 
THE  DIET?  Here  are  some  interesting 
facts  — information  which  your  doctor 
would  give  you. 

Sugar  is  a preferred  fuel  food.  When 
eaten  in  any  form,  it  combines  with  oxygen 
in  the  body.  Seventy-five  per  cent  of  its 
energy  goes  into  heat  and  the,rest  supplies 
power  to  the  muscles. 

Sugar  makes  essential  foods,  which  are 
the  vehicles  or  carriers  of  roughage,  min- 
eral salts  and  vitamins,  more  palatable.  It 
modifies  harsh  acids, heightens  bland  flavors. 

Consider  how  many  fruits  and  vegetables 


that  you  eat  are  sweet.  How  unpleasant 
they  would  be  without  this  palatable  flavor. 
Often,  however,  certain  familiar  vegetables 
lose  the  sweetness  they  possessed  when 
fresh  picked,  because  their  sugar  has  been 
converted  into  starch.  In  such  cases  it  is 
proper  to  add  a dash  of  sugar  in  cooking 
them  to  restore  their  original  flavor. 

Think  of  these  facts  as  you  plan  your 
meals.  And  in  addition  to  using  sugar  as 
a flavor  remember  that  simple  wholesome 
desserts  have  their  place  in  balanced  meals. 
The  normal  diet  calls  for  sugar.  Ask  your 
doctor ! The  Sugar  Institute. 


^3  ((Good  food  promotes  good  health ” 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  an  Approved 

Clinical  Laboratory 

DEFINITION 

"*  * * A clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application  of 
one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and  methods,  for 
for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in  the  human  body.” 

" Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  personnel  and 
records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed  as  approved.” 

''The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to  be 
properly  carried  out.” 

THE  DIRECTOR 

" The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college  or 
university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have  specialized  in 
clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for  at  least  three  years. 
He  must  be  a man  of  good  standing  in  his  profession.” 

" The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major  part  of 
his  time  to  the  supervision  of  the  laboratory  work.” 

" The  director  may  make  diagnoses  only  when  he  is  a licensed  graduate  of  medicine,  has  specialized 
in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of  disease  in  the 
patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports.” 

" The  director  may  have , assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hematologic, 
biochemical,  serologic  and  pathologic  should  be  made  to  the  director.” 

RECORDS 

" Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  laboratory 
should  have  appended  pertinent  clinical  data.” 

PUBLICITY 

" Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bulletins 
or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the  name,  address, 
telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel,  fields  of  work  covered, 
office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain  misleading  statements.  Only 
the  names  of  those  rendering  regular  service  to  the  laboratory  should  appear  on  letterheads  or  other  form 
of  publicity.” 

FEES 

"*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director  and 
any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism,  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5 8 


Annual  Meeting 

of  the 

American  Association 
for  the  Study  of  Qoiter 

SEATTLE,  WASHINGTON 


July  10,  11,  12,  1930 


Addresses  or  Demonstrations 

will  be  made  by  the  following  (partial  list): 

ROY  D.  McCLURE,  Detroit 
WM.  J.  KERR,  San  Francisco 
J.  EARLE  ELSE,  Portland,  Oregon 
LEWIS  M.  HURXTHAL,  Boston 
THOMAS  M.  JOYCE,  Portland,  Oregon 
CHARLES  T.  STURGEON,  Los  Angeles 
LEO  P.  BELL,  Woodland,  California 
MARTIN  B.  TINKER,  Ithaca 
THOMAS  O.  BURGER,  San  Diego 
C.  G.  TOLAND,  Los  Angeles 
JOHN  S.  HELMS,  Tampa 
C.  A.  ROEDER,  Omaha 
LeROY  LONG,  Oklahoma  City 
HAROLD  BRUNN,  San  Francisco 
ROBERTSON  WARD,  San  Francisco 
R.  J.  MELLZNER,  San  Francisco 
PHILIP  K.  GILMAN,  San  Francisco 
E.  R.  ARN,  Dayton,  Ohio 
E.  STARR  JUDD,  Rochester,  Minn. 


All  Physicians  Interested  in  Recent  Advances  in 
Knowledge  of  Diseases  of  the  Thyroid  Gland 
Are  Cordially  Invited  to  Attend  This  Meeting. 

Special  Pullman  Cars  will  be  attached  to  the 
C.  and  N.  W.  Canadian  National  Train  leaving 
Chicago,  5:40  P.  M.,  Wednesday,  July  2.  Stop- 
over Thursday  night  and  Friday  at  Winnipeg 
for  Special  Clinics.  Stopover  Sunday  and  Mon- 
day in  Jasper  National  Park.  Travel  through 
the  Canadian  Rockies  Tuesday.  Arrive  in  Seattle, 

July  9. 

Headquarters:  OLYMPIC  HOTEL 

Communications  relative  to  this  meeting  should  be 
addressed  to: 

J.  TATE  MASON 

Chairman,  Committee  on  Arrangements 

Mason  Clinic,  Seattle,  Washington 


LA  VIDA 

Mineral  Water 


LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  #2.00  per  case  (4  gal.) 

Carbonated:  #2.00  per  dozen 
(12  oz.)  bottles 

Tonic  Ginger  Ale:  #2.25  per  doz. 

(12  oz.)  bottles 


*CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

LABORATORIES 

Celestins 
LA  VICHY 

Grains  per  gallon 

VIDA 

of  France 

Calcium  Bicarbonate  

3.74 

43.28 

Magnesium  Bicarbonate  ... 

.....  0.98 

5.00 

Sodium  Bicarbonate  _ 

252.6 

205.53 

Sodium  Chloride  

....  94.0 

21.94 

Iron  Oxide  

0.07 

0.13 

Trace 

Silica  . 

6.42 

0.001 

2.63 

Sodium  Sulphate  

14.97 

TOTAL  

357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 


BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 


Consultants: 

Walter  F.  Schaller,  M.  D. 
Walter  B.  Coffey,  M.  D. 
Charles  Miner  Cooper,  M.  D. 
Walter  W.  Boardman,  M.  D. 
Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSCH  & LOMB  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 


Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty-fourth  Avenue  Oakland,  Calif. 

Telephone  Fruitvale  488 


Post  Graduate  School  of  Surgical  Technique 

INC. 

2512  Prairie  Avenue  (opposite  Mercy  Hospital) 

CHICAGO,  ILLINOIS 

A School  of  Surgical  Technique  Conducted  by  Experienced  Practicing  Surgeons 

1.  General  Surgery:  100  hours  (2  weeks)  course  of  intensive  instruction  and  practice  in  surgical  technique  combined  with 
clinical  demonstrations  (for  practicing  surgeons). 

2.  General  Surgery  and  Specialties:  Three  months’  course  comprising:  (a)  review  in  anatomy  and  pathology;  (b)  demon- 

stration and  practice  in  surgical  technique;  (c)  clinical  instruction  by  faculty  members  in  various  hospitals,  stressing 
diagnosis,  operative  technique  and  surgical  pathology. 

3.  Special  Courses:  Orthopedic  and  traumatic  surgery;  gynecology  and  radiation  therapy;  eye,  ear,  nose  and  throat,  thoracic, 
genito-urinary  and  goiter  surgery;  bronchoscopy,  etc. 

All  courses  continuous  throughout  the  year.  Detailed  information  furnished  on  request 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


► 

► 


► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 

► 


H 


HAY  FEVER 

An  Advertising  Statement 

AY  FEVER,  as  it  occurs  throughout  the  United  States,  is  actually  peren- 
nial rather  than  seasonal,  in  character. 

Because  in  the  Southwest — Bermuda  grass,  for  instance,  continues  to  flower 
until  December  when  the  mountain  cedar,  of  many  victims,  starts  to  shed  its 
pollen  in  Northern  Texas  and  so  continues  into  February.  At  that  time,  else- 
where in  the  South,  the  oak,  -birch,  pecan,  hickory  and  other  trees  begin  to 
contribute  their  respective  quotas  of  atmospheric  pollen. 

But,  nevertheless,  hay  fever  in  the  Northern  States  at  least,  is  in  fact  seasonal 
in  character  and  of  three  types,  viz.: 

TREE  HAY  FEVER—  March,  Aprit  and  May 
GRASS  HAY  FEVER — May,  June  and  July 
WEED  HAY  FEVER  — August  to  Frost 

And  this  last,  the  late  summer  type,  is  usually  the  most  serious  and  difficult 
to  treat  as  partly  due  to  the  greater  diversity  of  late  summer  pollens  as  re- 
gionally dispersed. 

With  the  above  before  us,  as  to  the  several  types  of  regional  and  seasonal 
hay  fever,  it  is  important  to  emphasize  that  Arlco-Pollen  Extracts  Jor  diagnosis 
and  treatment  cover  adequately  and  accurately  all  sections  and  all  seasons — 
North,  East,  South  and  West. 

FOR  DIAGNOSIS  each  pollen  is  supplied  in  individual  extract  only . 

FOR  TREATMENT  each  pollen  is  supplied  in  individual  treat- 
ment set. 

ALSO  FOR  TREATMENT  we  have  a few  logically  conceived  and  scientifi- 
cally justified  mixtures  of  biologically  related  and  simultaneously  pollinating 
plants.  Hence,  in  these  mixtures  the  several  pollens  are  mutually  helpful  in  build- 
ing the  desired  group  tolerance. 

IF  UNAVAILABLE  LOCALLY  THESE  EXTRACTS 
WILL  BE  DELIVERED  DIRECT  POST  PAID 
SPECIAL  DELIVERY 

List  and  prices  oj  food,  epidermal,  incidental  and  pollen 
proteins  sent  on  request 

The  Arlington  Chemical  Company 

YONKERS,  N.Y. 


◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 


J 

◄ 

◄ 

3 


◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

◄ 

\ 

4 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


61 


Hay  Fever 

Pollen  Extracts  - Mnlford 


( Council  Accepted ) 


Nearly  100  pollens  including  those  of  first  im- 
portance from  every  life  zone  and  geographical 
division  of  the  United  States  and  Canada. 

Botanically  true  to  label,  and  from  pollens  of 
outstanding  purity. 

Standardized  as  to  nitrogen  content. 

Uniform  strength  expressed  in  terms  of  protein 
units. 

Fully  active  as  shown  by  clear-cut  diagnostic  skin 
reactions  and  by  therapeutic  results. 

Ready  for  immediate  use.  No  preliminary  mixing 
required. 

CONVENIENT  DOSAGE  FORMS 

FOR  DIAGNOSIS: 

Dried  Pollens  (Scratch  Test). 

Pollen  Extracts,  500  units  per  cc  (Intradermal  Test). 

FOR  TREATMENT: 

15-dose  treatment,*  IS  graded  doses  in  syringes. 

15-dose  treatment*  in  three  5 cc  vials  (250, 500  and  1000 
protein  units). 

Single  5 cc  vials  (500  units  per  cc).  All  pollens. 

•Ragweed,  Timothy,  Lamb’s  Quarters,  Wormwood  only. 


H.  K.  MULFORD  COMPANY 

The  Pioneer  Biological  Laboratories 
PHILADELPHIA,  U.  S.  A. 


91516 


62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Patient  Types  . . . 

The  Hospital  Case 

v confined  to  the  bed,  weak  and  nervous,  the  hospital  patient 

under  your  care  is  hardly  a fit  subject  for  the  old-fashioned  dras- 
tic purge. 

Petrolagar  has  many  advantages  in  maintaining  bowel  function. 
It  is  palatable.  It  mixes  easily  with  bowel  content,  supplying 
unabsorbable  moisture  with  less  tendency  to  leakage.  It  does  not 
interfere  with  digestion  and  is  prescribed  in  preference  to  plain 
mineral  oil. 

Petrolagar  restores  normal  peristalsis  without  causing  irritation, 
producing  a soft-formed  consistency  that  provides  real  comfort  to 
bowel  movement. 

Petrolagar  is  composed  of  65%  (by  volume)  mineral  oil  with 
the  indigestible  emulsifying  agent  agar-agar. 


Petrolagar 


Address. 


Petrolagar  Laboratories,  Inc.,  C.W.  5 

536  Lake  Shore  Drive, 

Chicago,  111. 

Gentlemen: — Send  me  copy  of  “HABIT 
TIME”  (of  bowel  movement)  and  speci- 
mens of  Petrolagar. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


63 


ft 

V 
ft 

ft 

v» 

ft 

v 

ft 

ke 

ft 

V 
ft 


V 
ft 

IV* 

ft 

v< 

ft 

Vi 

ft 

VI 

ft 

V 

V 
ft 
VI 
[ft 
VI 
ft 


ft 

V 
ft 
VI 
ft 

V 
ft 

V 
ft 
|V 
ft 
VI 
ft 
VI 
ft 

[ft 


bk 

bk 


¥ 

bk 

&k 


bk 


bk 

bk 


bk 

bk 

bk 

bk 

bk 

*/ 

bk 

** 

ak 

¥ 

bk 

*k 

M. 

ak 

*/| 

bk 

bk 


Colfax  School  for  the 
Tuberculous 

QolfaXy  California 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


■J  Patients  are  given  individ- 

* ual  care  by  experienced 

tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 
individual  needs. 

f)  Patients  are  taught  how  to 

secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 

aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4 The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5 Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  [Medical  ’Director 

Colfax , California 


64 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Accurate  digitalis  dosage  by  mouth 

DIGITAN  TABLETS 

CONVENIENT  STANDARDIZED 

DEPENDABLE 

Sample  sent  upon  request 

MERCK  & CO.  Inc. 

Rahway,  N*  J* 

Mellin’s  Food 

All  the  resources  and  experience  of  the  Mellin’s  Food  Company  are  concentrated 
upon  the  one  thought  of  making  a product  of  the  highest  possible  excellence  that 
can  always  be  relied  upon  to  accomplish  its  mission — 

A means  to  assist  physicians  in  the 
modification  of  milk  for  inf  ant  feeding. 


This  single-minded  devotion  to  one  job  has  its  reward  in  the  sincere  esteem 
and  ever-increasing  confidence  held  for  Mellin’s  Food  by  physicians  everywhere. 


A Maltose  and  Dextrins 
Milk  Modifier 


Mellin’s  Food  Company 


Boston,  Mass. 


Which  form  of  S. 

should  be 


M.  A. 

used  . . 


The  Powder  and 
Concentrated  Liquid 
Fomns  of  S.  M.A.  have 
the  same  composition 
when  diluted  according 
to  directions,  and  give 
equally  good  results  in 
practice.  Infants  may 
be  changed  from  one 
form  to  the  other 


Powder  Form 


Powder  Form  • • This  form  lends  itself  to 
the  preparation  of  a small  quantity  at  a 
time  as  in  starting  feedings,  or  in  giving 
supplementary  feedings.  It  is  also  con- 
venient for  preparing  individual  feedings 
where  cooling  facilities  are  not  available, 
or  for  use  in  traveling. 


whenever  conditions 
arise  which  make  the 
otheT  form  more  con- 
venient. 


Concentrated 
Liquid  Form 


Concentrated  Liquid  Form'S^  • • This  is  the 
more  simple  fomn  to  prepare  as  it  is  already 
in  liquid  form.  It  is  as  simple  as  mixing  two 
glasses  of  water.  One  container  makes  a liquid 
quaTt  of  S.M.A.  ready  to  feed  and  should  be 
used  in  cases  where  the  infant  is  taking  that 
amount  of  food  in  from  one  to  two  days.  This 
form  is  very  convenient  in  institutions  where 
a large  number  of  infants  are  being  fed 
S.  M.  A.  at  one  time.  ■SfrNow  available  on  the 
West  Coast. 


Wnte  us  for  samples  and 
ask  for  our  little  tabulat- 
ed information  booklet 
No.  35,  no  obligation,  of 
course. 


Protein  S.M.A. 
(Acidulated  ) 


Protein  S.  M.  A.  (Acidulated)  is  indicated 
in  cases  of  diarrhea,  malnutrition,  marasmus, 
premature  infants  and  other  infants  needing 
a higher  protein  intake.  It  is  very  effective 
also  during  the  course  of  mild  infections  such 
as  pyelitis  and  otitis  media. 


THE  LABORATORY  PRODUCTS  COMPANY  ♦ © ■»  CLEVELAND,  OHIO 

In  Canada:  64  Gerrard  Street,  East,  Toronto,  Ontario 

West  of  Rockies:  437-8-9  Phelan  Building,  San  Francisco,  California 


Ill 

BRILLIANT 

RESULTS  with 


“Toxok” 

(CUTTER) 

Enthusiastic  reports  come  to  us  constantly  endorsing  the  unusually  high 
degree  of  effectiveness  of  this  Cutter  product  as  a preventive  of,  and  treat- 
ment for 

POISON  OAK  DERMATITIS 

“TOXOK”  is  a highly-purified  extract  of  the  Poison  Oak  plant  (Rhus 
Diversiloba)  to  be  injected  intramuscularly  at  from  twelve  to  twenty-four 
hour  intervals.  In  the  great  majority  of  cases  swelling  and  itching  subside 
in  twenty-four  to  forty-eight  hours. 

“TOXOK”  may  be  had  either  in  1 c.c.  TTlP  CTJTTFR 
ampules,  or  in  “ready-to-use”  syringes  -1- V_/  ±.  T 1>IV 

containing  three  1 c.c.  doses,  (ordinarily  clfooTcltOrV 

ample  treatment)  and  three  sterile  needles.  • 

Similar  treatment  with  “TOXOK”  as  a Established  1897 

seasonal  prophylactic  is  highly  efficient.  Berkeley,  - - California 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 
E.  A.  TRENKLE,  Manager 


Phone  GRAYSTONE  1200 


ANNUAL  SESSIONS 

American  Medical  Association,  Detroit,  Michigan,  June  23-27,  1930 
California  Medical  Association,  San  Francisco,  April  27-30,  1931 
Nevada  State  Medical  Association,  Reno,  September  26-27,  1930 
Utah  State  Medical  Association,  Salt  Lake  City,  September  9-11,  1930 


**35*  *835*  **35»  ; 


CALIFORNIA 


AND 


WESTERN  MEDICINE 

Owned  and  Published  SMonthly  by  the  California  SMedical  dissociation 

FOUR  FIFTY  SUTTER,  ROOM  2004,  SAN  FRANCISCO 
ACCREDITED  REPRESENTATIVE  OF  THE  CALIFORNIA,  NEVADA  AND  UTAH  MEDICAL  ASSOCIATIONS 


VOLUMB  XXXII 
NUMBER  6 


JUNE  • 1930 


50  CENTS  A COPY 
85.00  A YEAR 


CONTENTS  AND  SUBJECT  INDEX 


SPECIAL  ARTICLES: 

The  Value  of  Radiotherapy  in  Mediasti- 
nal Tumors.  By  Arthur  U.  Desjar- 
dins, Rochester,  Minnesota ...377 

Clam  and  Mussel  Poisoning.  By  George 
E.  Ebright,  San  Francisco 382 

Discussion  by  H.  Sommer,  Ph.  D.,  San  Fran- 
cisco ; K.  F.  Meyer,  Ph.  D.,  San  Francisco ; 

J.  H.  Kuser,  San  Rafael. 

The  Immunobiologic  Reaction  in  Tuber- 
culosis. By  Roy  E.  Thomas,  Los 
Angeles  385 

Discussion  by  F.  M.  Pottenger,  Monrovia ; 
Robert  A.  Peers,  Colfax;  Harold  K.  Faber, 

San  Francisco. 

Free  Fascial  Grafts — Their  Union  With 
Muscle.  By  S.  L.  Haas,  San  Fran- 
cisco   387 

Discussion  by  John  Hunt  Shephard,  San  Jose; 

Leo  Eloesser.  San  Francisco;  Sterling  Bunnell, 

San  Francisco. 

Intravenous  Infusion  of  Glucose — With 
Report  of  Anaphylactoid  Reaction. 

By  E.  Vincent  Askey  and  Ernest  M. 
Hall,  Los  Angeles 394 

Discussion  by  P.  J.  Hanzlik,  San  Francisco ; 
Jean  Oliver,  Brooklyn;  R.  W.  Lamson,  Los 
Angeles. 

Quinidin  — Some  Toxic  Effects.  By 

Harry  Spiro  and  William  W.  New- 
man, San  Francisco .398 

Discussion  by  Garnett  Cheney,  San  Fran- 
cisco ; John  J.  Sampson,  San  Francisco. 

Sphenoiditis — Its  Diagnosis  and  Treat- 
ment. By  Dean  E.  Godwin,  Long 
Beach  402 

Discussion  by  J.  Frank  Friesen,  Los  Angeles; 
Robert  C.  Martin,  San  Francisco. 

Intracapsular  Cataract  Operations.  By 

Lloyd  Mills,  Los  Angeles . 405 

Discussion  by  Raymond  J.  Nutting,  Oakland ; 
Roderic  O’Connor,  Oakland ; William  A. 
Boyce,  Los  Angeles. 

Diseases  of  Human  Hypersensitiveness. 

By  Edward  Matzger,  San  Francisco-409 
Discussion  by  George  Piness,  Los  Angeles ; 
Albert  II.  Rowe,  Oakland. 

The  Evolution  of  Melotherapy — The 
Lure  of  Medical  History.  By  Pan. 

S.  Codellas,  San  Francisco 411 

CLINICAL  NOTES  AND  CASE  REPORTS: 

Rectovaginal  Fistula  in  Infancy.  By 
Lloyd  A.  Clary,  San  Francisco 413 


BEDSIDE  MEDICINE: 

The  Treatment  of  Juvenile  Tubercu- 
losis   414 

Discussion  by  Lloyd  B.  Dickey,  San  Fran- 
cisco ; Clifford  Sweet,  Oakland ; Donald  K. 
Woods,  San  Diego;  William  M.  Happ,  Los 
Angeles. 

EDITORIALS: 

Influence  of  “Pre-Convention  Bulletin” 

at  Del  Monte  Session 416 

Comments  on  Some  Work  Phases  of 
the  1930  Del  Monte— Fifty-Ninth  An- 
nual Session  of  the  C.  M.  A 416 

Dr.  Holman  of  Stanford  Is  Awarded 
the  Samuel  D.  Gross  Prize 419 

MEDICINE  TODAY: 

Experimental  Perfusion  of  the  Frog’s  Kidney. 

By  Frank  Hinman,  San  Francisco 420 

Pituitary  Tumors  and  Diabetes  Insipidus.  By 
Cyril  B.  Courville,  College  of  Medical  Evan- 
gelists   420 

Blood  Chemistry  in  Diseases  of  the  Skin.  By 

M.  Scholtz,  Los  Angeles 421 

Cervicitis.  By  John  E.  Potts,  Los  Angeles 422 

Mercury  “Rubs.”  By  F.  F.  Gundrum,  Sacra- 
mento   422 

TRANSACTIONS  OF  ANNUAL  SES- 
SION: 

Pre-Convention  Bulletin  Reports 423 

Minutes  of  the  House  of  Delegates 432 

Minutes  of  the  Council  444 

STATE  MEDICAL  ASSOCIATIONS: 

California  Medical  Association 452 

Woman’s  Auxiliary 456 

Nevada  State  Medical  Association  459 

Utah  State  Medical  Association  459 

MISCELLANY: 

News  461 

Medical  Economics 462 

Twenty-Five  Years  Ago . 462 

Department  of  Public  Health 463 

California  Board  of  Medical  Examiners.. 464 
Directory  of  Officers,  Sections,  County 
Units,  and  Woman’s  Auxiliary  of  the 

California  Medical  Association 

Adv.  page  2 

Book  Reviews Adv.  page  11 

Truth  About  Medicines Adv.  page  19 

ADVERTISEMENTS— INDEX: 

- Adv.  page  8 


“Entered  as  second-class  matter  at  the  post  office  at  San  Francisco,  California,  under  the  Act  of  March  3,  1879.”  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917,  authorized  August  10,  1918. 


G R E E N S’ 

EYE  HOSPITAL 

for  Consultation,  Diagnosis 
and  Treatment  of  the  Eye 


Resident  Staff 

Aaron  S.  Green,  M.  D. 
Louis  D.  Green,  M.  D. 
Martin  /.  Green,  M.  D. 
Einar  V.  Blak,  M.  D. 
George  S.  Lachman,  M.  D. 
Vincent  V.  Suglian,  M.  D. 


THE  HOSPITAL 

is  open  to  physicians  who  are  eligible  for  membership  in 
the  A.M.  A.  Facilities  are  especially  designed  for  Ophthal- 
mology and  include  X-Ray,  Radium,  Physio-Therapy  and 
Clinical  Laboratories. 

A private  out  patient  department  is  conducted  daily  be- 
tween the  hours  of  9 a.  m.  and  5 p.  m.  A report  of  findings 
and  recommendations  for  treatment  are  returned  with  the 
patients  who  are  referred  for  consultation. 

A PART  PAY  CLINIC 

is  also  conducted  from  2 p.  m.  until  7 p.  m.  This  is  for 
patients  of  limited  income.  Examination  fees  in  the  clinic 
are  $2. 50  for  the  first  visit  and  $1.50  for  subsequent  visits. 
Moderate  fees  for  drugs,  laboratory  work,  X-Rays.  Oper- 
ating fees  are  arranged  according  to  the  circumstances  of 
each  individual. 


Bush  at  Octavia  Street  ♦ Telephone  WE  st  4300  ♦ San  Francisco,  California 

^Address  communications  to  Superintendents 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


/ 


BUSH  ELECTRIC  CORPORATION 


334  Sutter  Street 

San  Francisco,  Calif. 
SUtter  6088 


1207  West  Sixth  Street 

Los  Angeles,  Calif. 
MUtual  6324 


u s 4 


We  carry  a 
full  line  of 
Accessories 
X-Ray  Film 
Intensifying 
Screens 
Cassettes 
Developing 
Tanks 

Barium  Sulphate 
Leaded  Gloves 
and  Aprons 
Timers 
Illuminators 
Darkroom 
Lamps 
Negative 
Preservers 
Reiber 
Stabilizer 
and  Control 
Coolidge  Tubes 
Film  Developing 
Hangers 
Bullitt’s  Mastoid 
Apparatus 

Prompt  service 
on 

all  orders 

"Actinotherapy 
and  Allied 
Physical 
Therapy” 

By 

T.  Howard  Plank 
M.D. 

Price  $5.00 


The  New  Bush 
Mobile  and 
Portable 
X-Ray  Unit. 
Capacity 
30  M.A., 

Variable  Spark 
Gap 

3 to  5 inch. 
Complete  in 
every  detail 
Voltmeter 
Milliammeter 
Cone 

Foot  Switch 
30  M.A. 
Radiator  Type 
Coolidge  Tube 
are 

Supplied 


A timer 
working  from 
l/4  to  12  seconds 
may  be  added 
if  desired. 


Jil  u 0 Ij 


Patronize  Your  Home  Firm 

Because  We  Are  Progressive 


2 


Officers  of  the  California  Medical  Association 


General  Officers 

President — Lyell  C.  Kinney,  510  Medico- 
Dental  Building,  233  A Street,  San  Diego. 
President-Elect — Junius  B.  Harris,  Medico- 
Dental  Building,  1127  11th  Street,  Sac- 
ramento. 

Speaker  of  House  of  Delegates — Edward  M. 
Pallette,  Wilshire  Medical  Building,  1930 
Wilshire  Boulevard,  Los  Angeles. 
Vice-Speaker  of  House  of  Delegates — John 

H.  Graves,  977  Valencia  Street,  San 
Francisco. 

Chairman  of  Council — Oliver  D.  Hamlin, 
Federal  Realty  Building,  Oakland. 

Chairman  of  Executive  Committee — T.  Hen- 
shaw Kelly,  830  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

Secretary — Emma  W.  Pope,  Four  Fifty 
Sutter,  Room  2004,  San  Francisco. 

Editors — George  H.  Kress,  245  Bradbury 
Bldg,  304  South  Broadway,  Los  Angeles. 
Emma  W.  Pope,  Four  Fifty  Sutter,  Room 
2004,  San  Francisco. 

General  Counsel — Hartley  F.  Peart,  1800 
Hunter-Dulin  Building,  111  Sutter  Street, 
San  Francisco. 

Assistant  General  Counsel — Hubert  T.  Mor- 
row, Van  Nuys  Building,  210  West  Sev- 
enth Street,  Los  Angeles. 

Councilors 


First  District — Imperial,  Orange,  Riverside 
and  San  Diego  Counties,  Mott  H.  Arnold 
(1932),  1220  First  National  Bank  Build- 
ing, 1007  Sth  Street,  San  Diego. 

Second  District — Los  Angeles  County,  Wil- 
liam  Duffield  (1933),  516  Auditorium 
Building,  427  West  Fifth  Street,  Los  An- 
geles. 

Third  District — Kern,  San  Bernardino,  San 
Luis  Obispo,  Santa  Barbara  and  Ventura 
Counties,  Gayle  G.  Moseley  (1931),  Medi- 
cal Arts  Building,  Redlands. 

Fourth  District — Calaveras,  Fresno,  Inyo, 
Kings,  Madera,  Mariposa,  Merced,  Mono, 
San  Joaquin,  Stanislaus,  Tulare  and  Tuol- 
umne Counties,  Fred  R.  DeLappe  (1932), 
218  Beaty  Building,  1024  J Street,  Mo- 
desto. 


Fifth  District — Monterey,  San  Benito,  San 
Mateo,  Santa  Clara  and  Santa  Cruz 
Counties,  Alfred  L.  Phillips  (1933),  Farm- 
ers and  Merchants  Bank  Building,  Santa 
Cruz. 

Sixth  District — San  Francisco  County,  Wal- 
ter B.  Coffey  (1931),  501  Medical  Build- 
ing, 909  Hyde  Street,  San  Francisco. 

Seventh  District — Alameda  and  Contra  Costa 
Counties,  Oliver  D.  Hamlin  (1932)  Chair- 
man, Federal  Realty  Building,  Oakland. 

Eighth  District — Alpine,  Amador,  Butte,  Co- 
lusa, El  Dorado,  Glenn,  Lassen,  Modoc, 
Nevada,  Placer,  Plumas,  Sacramento, 
Shasta,  Sierra,  Sutter,  Tehama,  Yolo  and 
Yuba  Counties,  Robert  A.  Peers  (1933), 
Colfax. 

Ninth  District — Del  Norte,  Humboldt,  Lake, 
Marin,  Mendocino,  Napa,  Siskiyou,  So- 


lano, Sonoma  and  Trinity  Counties,  Henry 
S.  Rogers  (1931),  Petaluma. 

At  Large — George  G.  Hunter  (1932),  910 
Pacific  Mutual  Bldg.,  523  West  6th  Street, 
Los  Angeles. 

At  Large — Ruggles  A.  Cushman  (1933),  632 
North  Broadway,  Santa  Ana. 

At  Large — George  H.  Kress  (1931),  245 
Bradbury  Building,  304  South  Broadway, 
Los  Angeles. 

At  Large — Joseph  Catton  (1932),  825  Med- 
ico-Dental Building,  490  Post  Street,  San 
Francisco. 

At  Large — T.  Henshaw  Kelly  (1933),  830 
Medico-Dental  Building,  490  Post  Street, 
San  Francisco. 

At  Large — Edward  N.  Ewer  (1931),  251 
Moss  Avenue,  Oakland. 


Standing  Committees 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker  of  the  House 
of  Delegates,  the  Secretary-Treasurer,  the  Editor,  and  the  Chair- 
man of  the  Auditing  Committee.  (Committee  Chairman,  T. 
Henshaw  Kelly;  Secretary,  Dr.  Emma  W.  Pope.) 

Committee  on  Associated  Societies  and  Technical  Groups 


George  H.  Kress,  Los  Angeles 1933 

Harold  A.  Thompson,  San  Diego 1932 

William  Bowman,  Los  Angeles 1931 

Committee  on  Extension  Lectures 

Robert  A.  Peers,  Colfax 1933 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge,  Berkeley ' 1931 

The  Secretary Ex-officio 

Committee  on  Health  and  Public  Instruction 

Henry  S.  Rogers,  Petaluma 1933 

Fred  B.  Clarke  (Chairman),  Long  Beach 1932 

Gertrude  Moore,  Oakland 1931 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

Gayle  G.  Moseley,  Redlands 1933 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Committee  on  Industrial  Practice 

Mott  H.  Arnold,  San  Diego 1933 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Committee  on  Medical  Economics 

Ruggles  A.  Cushman,  Santa  Ana 1933 

John  H.  Graves  (Chairman),  San  Francisco 1932 

Joseph  M.  King,  Los  Angeles 1931 

Committee  on  Medical  Education  and  Medical  Institutions 

George  G.  Hunter,  Los  Angeles 1933 

George  Dock,  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 


Committee  on  Medical  Defense 


Fred  R.  DeLappe,  Modesto 1933 

George  G.  Reinle,  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Committee  on  Membership  and  Organization 

Jesse  W.  Barnes,  Stockton 1933 

Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks,  San  Francisco 1931 

The  Secretary Ex-officio 

Committee  on  History  and  Obituaries 

Emmet  Rixford,  San  Francisco 1933 

Charles  D.  Ball,  Santa  Ana - 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Publications 

Frederick  F.  Gundrum,  Sacramento 1933 

Morton  R.  Gibbons,  San  Francisco 1932 

Percy  T.  Magan,  Los  Angeles 1931 

The  Secretary Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Joseph  Catton,  San  Francisco 1933 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

The  President Ex-officio 

The  President-Elect Ex-officio 

Committee  on  Scientific  Work 

Francis  M.  Pottenger,  Monrovia 1933 

Emma  W.  Pope  (Chairman),  San  Francisco 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland 1931 

Verne  R.  Mason,  Sec’y  Sect.  Med.,  Los  Angeles 1931 

Clarence  E.  Rees,  Sec’y  Sect.  Surg.,  San  Diego 1931 


Delegates  and  Alternates  to  the  American  Medical  Association 


DELEGATES 

Dudley  Smith,  Oakland (1930- 

Albert  Soiland,  Los  Angeles (1930- 

Fitch  C.  E.  Mattison,  Pasadena (1930- 

Irving  S.  Ingber,  San  Francisco (1931- 

Percy  T.  Magan,  Los  Angeles (1931- 

Junius  B.  Harris,  Sacramento (1931- 


ALTERNATES 

1931) Joseph  Catton,  San  Francisco 

1931).  William  H.  Gilbert,  Los  Angeles 

1931)  James  F.  Percy,  Los  Angeles 

1932)  William  E.  Stevens,  San  Francisco 

1932) ..Charels  D.  Lockwood,  Pasadena 

1932) John  Hunt  Shephard,  San  Jose 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 


SPECIAL  MOTORCYCLE  SERVICE 

HOURS:  Week  Days,  8 A.  M.  to  9 P.  M.;  Sundays,  9-1,  6-8 

SIX  PHONES:  GArfield  4417-4418-4419-4420-4421-4422 

For  Emergencies  Only — Phone  WEst  1400 


CITRIN 

CAPSULES 

Each  capsule  contains  50  mgms. 
of  Cucurbocitrin 

POTENT 

To  be  administered  under  a 
physician's  supervision 


T o Be  Had 
at 

OUR 

PHARMACIES 


DOSAGE 

1,  2 or  3 capsules  daily  before 
meals,  as  indicated. 

U.  S.  Patent  No.  1,626,321 


Manufactured  Solely  by 
THE  TABLE  ROCK 
LABORATORIES,  INC. 
GREENVILLE,  S.  C. 


LILLY’S  INHALANT  EPHEDRINE 
COMPOUND,  No.  20 

THE  large  demand  for  Lilly’s  Inhalant 
Ephedrine  Compound,  No.  20,  is  indica- 
tive of  the  popularity  and  wide  use  of  this 
product. 

For  physicians  who  prefer  an  inhalant 
without  the  cooling,  aromatic  principles  of 
camphor,  menthol,  and  thyme,  there  is 
available 

LILLY’S  INHALANT  EPHEDRINE 
PLAIN,  No.  21 

Both  of  these  products  relieve  nasal  con- 
gestion promptly.  Both  are  supplied  through 
the  drug  trade  in  one-ounce  (30  cc.)  and  pint 
(475  cc.)  bottles. 

LILLY’S  EPHEDRINE  JELLY 

A new  and  very  convenient  form  for  nasal 
application  of  Ephedrine.  It  contains  ephed- 
rine sulphate  one  per  cent,  eucalyptol  one- 
tenth  per  cent,  with  aromatics  in  a bland, 
water-soluble  base. 

Lilly’s  Ephedrine  Jelly  is  supplied  by  the 
drug  trade  in  half-ounce,  nasal-tip  collapsible 
tubes. 


A 

T 

Y 

0 
U 
R 

S 

E 

R 

V 

1 

C 

E 


Freshly  prepared  daily 

A 

SPECIAL  EMULSION 

of 

COD  LIVER  OIL 

and 

GLYCEROPHOSPHATES 

with 

WHEAT  GERM  VITAMINS 

A freshly  prepared  emulsion  containing  a 
high  grade  Lofoten  Cod  Liver  Oil  which 
meets  every  U.  S.  P.  requirement.  It  is 
standardized  and  certified  by  the  University 
of  Oslo,  Norway,  for  vitamin  A growth 
promoting  value  and  vitamin  D antirachitic 
value,  combined  with  the  glycerophosphates 
of  lime  and  soda  and  wheat  vitamins. 

DOSAGE:  One-half  to  one  teaspoon- 
ful three  times  a day  for  CHILDREN . 
One  to  two  tablespoonfuls  three  times 
a day  for  ADULTS.  May  be  given  in 
milk  or  with  orange  juice. 


Broemmel’s 

SERUMS  / 

Third  Floor  Medico-Dental  Bldg. 

Post  and  Mason  Streets 
Telephones:  GArfield  0265-0266 
California  and  Steiner  Streets 
Telephones:  WEst  0558-0559 


Prescription 

ESTABLISHED  1868 


VACCINES  i 


Special  Attention  Given  All 
Telephone  Prescriptions 

FOUR  STORES  will  furnish 
special  Motorcycle  Service  de- 
livery to  any  part  of  the  city 
at  any  hour  of  the  day  or 
evening. 


Pharmacies 


ANTITOXINS 


Fourth  Floor  450  Sutter 
Telephones:  GArfield  4486-4487 

Second  Floor  Fitzhugh  Bldg. 
Post  and  Powell  Streets 

Telephones:  GArfield  4417-4418- 
4419-4420-4421-4422 


4 


Officers  of  Scientific  Sections  of  California  Medical  Association 


Anesthesiology 

Chairman,  William  W.  Hutchinson,  1202 
Wilshire  Medical  Building,  1930  Wilshire 
Boulevard,  Los  Angeles. 

Secretary,  Mary  E.  Botsford,  807  Francisco 
St.,  San  Francisco. 

Dermatology  and  Syphilology 

Chairman,  Hiram  E.  Miller,  803  Fitzhugh 
Building,  384  Post  St.,  San  Francisco. 

Vice-Chairman,  Charles  R.  Caskey,  715 
Wilshire  Medical  Bldg.,  1930  Wilshire 
Blvd.,  Los  Angeles. 

Secretary,  Norman  N.  Epstein,  Rm.  1304, 
450  Sutter  St.,  San  Francisco. 

Chairman,  Section  Program  Committee, 
Merlin  T.  Maynard,  408  Medico-Dental 
Building,  San  Jose. 

Eye.  Ear,  Nose  and  Throat 

Chairman,  Andrew  B.  Wessels,  1305  Medico- 
Dental  Building,  233  A Street,  San  Diego. 

Vice-Chairman,  Isaac  H.  Jones,  Wilshire 
Medical  Bldg.,  1930  Wilshire  Blvd.,  Los 
Angeles. 

Secretary,  Frederick  C.  Cordes,  817  Fitz- 
hugh  Bldg.,  384  Post  St.,  San  Francisco. 

General  Medicine 

Chairman,  Ernest  H.  Falconer,  316  Fitz- 
hugh Building,  384  Post  St.,  San  Fran- 
cisco. 

Secretary,  Verne  R.  Mason,  838  Pacific 
Mutual  Bldg.,  523  W.  6th  St.,  Los  An- 
geles. 


Alameda  County  Medical  Association 
2404  Broadway,  Oakland 
President,  Albert  M.  Meads,  251  Moss  Ave., 
Oakland. 

Secretary,  Gertrude  Moore,  2404  Broadway. 
Oakland. 

Butte  County  Medical  Society 
President,  J.  Lalor  Doyle,  Morehead  Build- 
ing, Chico. 

Secretary,  J.  O.  Chiapella,  Chiapella  Build- 
ing, Chico. 

Contra  Costa  County  Medical  Society 
President,  J.  W.  Bumgarner,  906  Macdonald 
Ave.,  Richmond. 

Secretary,  L.  H.  Fraser,  American  Trust 
Building,  Richmond. 

Fresno  County  Medical  Society 
President,  W.  E.  R.  Schottstaedt,  1759  Ful- 
ton St.,  Fresno. 

Secretary,  J.  M.  Frawley,  713  T.  W.  Patter- 
son  Building,  Fresno. 

Glenn  County  Medical  Society 
President,  Etta  S.  Lund,  143  North  Yolo 
Street,  Willows. 

Secretary,  T.  H.  Brown,  Orland. 

Humboldt  County  Medical  Society 
President,  Edgar  Holm,  507  F Street, 
Eureka. 

Secretary,  L.  A.  Wing,  Eureka. 

Imperial  County  Medical  Society 
President,  W.  W.  Apple,  Davis  Building, 
El  Centro. 

Secretary,  B.  R.  Davidson,  114  South  Sixth 
Street,  Brawley. 

Kern  County  Medical  Society 
President,  Edward  A.  Schaper,  Keene. 
Secretary,  George  E.  Bahrenburg,  Bakers- 
field. 

Lassen-Plumas  County  Medical  Society 
President,  Bert  J.  Lasswell,  Quincy. 
Secretary,  C.  I.  Burnett,  Knoch  Building, 
Susanville. 

Los  Angeles  County  Medical  Association 
412  Union  Insurance  Building 
1008  West  Sixth  Street,  Los  Angeles 
President,  Robert  V.  Day,  Wilshire  Medical 
Building,  1930  Wilshire  Blvd.,  Los  An- 
geles. 

Secretary,  Harlan  Shoemaker,  412  Union 
Insurance  Building,  1008  West  Sixth 
Street,  Los  Angeles. 

Marin  County  Medical  Society 
President,  Frank  M.  Cannon,  Pt.  Reyes 
Station. 

Secretary,  L.  L,  Robinson,  Larkspur. 

Mendocino  County  Medical  Society 
President,  L.  K.  Van  Allen,  Ukiah. 
Secretary,  Paul  J,  Bowman,  Fort  Bragg. 

Merced  County  Medical  Society 
President,  Chester  A.  Moyle,  6 Bank  of 
Italy  Bldg.,  Merced. 

Secretary,  Fred  O.  Lien,  Shaffer  Building. 
Merced. 


Chairman  of  Section  Program  Committee, 
Walter  P.  Bliss,  407  Professional  Bldg., 
65  N.  Madison  Ave.,  Pasadena. 

General  Surgery 

Chairman,  Lemuel  P.  Adams,  Strad  Bldg., 
230  Grand  Ave.,  Oakland. 

Secretary,  Southern  Division,  Clarence  E. 
Rees,  2001  Fourth  Street,  San  Diego. 

Secretary,  Northern  Division,  Stanley  R. 
Mentzer,  Rm.  1009,  450  Sutter  Street, 
San  Francisco. 

Industrial  Medicine  and  Surgery 

Chairman,  Robert  W.  Wilcox,  114  E.  7th 
Street,  Long  Beach. 

Secretary,  Fraser  L.  Macpherson,  610 
Medico-Dental  Bldg.,  233  A Street,  San 
Diego. 

Chairman  of  Program  Committee,  Floyd 
Thurber,  214  Hollywood  First  National 
Bank  Building,  Los  Angeles. 

N europsychiatry 

Chairman,  George  G.  Hunter,  910  Pacific 
Mutual  Building,  523  West  6th  Street, 
Los  Angeles. 

Secretary.  Henry  G.  Mehrtens,  Stanford 
Hospital,  San  Francisco. 

Obstetrics  and  Gynecology 

Chairman,  William  H.  Gilbert,  305  Medico- 
Dental  Building,  746  Francisco  Street, 
Los  Angeles. 

Secretary,  John  C.  Irwin,  1709  West  8th 
Street,  Los  Angeles. 


Pathology  and  Bacteriology 

Chairman,  Ernest  M.  Hall,  St.  Vincent’s 
Hospital,  Los  Angeles. 

Secretary,  George  D.  Maner,  Wilshire  Med- 
ical Building,  1930  Wilshire  Boulevard, 
Los  Angeles. 

Chairman  of  Section  Program  Committee, 
Z.  E.  Bolin,  University  of  California 
Medical  School,  San  Francisco. 

Pediatrics 

Chairman,  Donald  K.  Woods,  5 th  and 
Laurel  Streets,  San  Diego. 

Secretary,  E.  Paul  Cook,  215  Sainte  Claire 
Bldg.,  San  Jose. 

Chairman  of  Section  Program  Committee, 
Clifford  D.  Sweet,  242  Moss  Avenue, 
Oakland. 

Radiology  (Including  Roentgenology  and 
Radium  Therapy) 

Chairman,  Charles  M.  Richards,  303  Medico- 
Dental  Building,  San  Jose. 

Secretary,  L.  Henry  Garland,  Rm.  1739, 
450  Sutter  Street,  San  Francisco. 

Chairman  of  Section  Program  Committee, 
William  H.  Sargent,  Franklin  Building, 
1624  Franklin  Street,  Oakland. 

Urology 

Chairman,  Harry  W.  Martin,  1010  Quinby 
Building,  650  S.  Grand  Avenue,  Los 
Angeles. 

Secretary,  Nathan  G.  Hale,  Medico-Dental 
Building,  1127  11th  Street,  Sacramento. 


Officers  of  County  Medical  Associations 

Monterey  County  Medical  Society 
President,  Charles  H.  Lowell,  Carmel. 


Secretary,  John  A.  Merrill,  308  Spazier 
Building,  Monterey. 

Napa  County  Medical  Society 
President,  George  I.  Dawson,  1130  First 
St.,  Napa. 

Secretary,  Carl  A.  Johnson,  1130  First  St., 
Napa. 

Orange  County  Medical  Society 
President,  H.  Miller  Robertson,  212  Medical 
Bldg.,  Santa  Ana. 

Secretary,  Harry  G.  Huffman,  615  First 
National  Bank  Bldg.,  Santa  Ana. 

Placer  County  Medical  Society 
President,  Max  Dunievitz,  Colfax 
Secretary,  R.  A.  Peers,  Colfax. 

Associate  Secretary,  C.  J.  Durand,  Colfax. 

Riverside  County  Medical  Society 
President,  Paul  F.  Thuresson,  740  West  14th 
Street,  Riverside. 

Secretary,  T.  A.  Card,  Glenwood  Block, 
Riverside. 

Sacramento  Society  for  Medical 
Improvement 

President,  Gustave  Wilson,  609  California 
State  Life  Building,  10th  and  J Streets, 
Sacramento. 

Secretary,  Frank  W.  Lee,  510  Physicians 
Bldg.,  1027  Tenth  St.,  Sacramento. 

San  Benito  County  Medical  Society 
President,  L.  C.  Hull,  Hollister. 

Secretary,  L.  E.  Smith,  Hollister. 

San  Bernardino  County  Medical  Society 
President,  E.  L.  Tisinger,  County  Hospital. 
San  Bernardino. 

Secretary,  E J.  Eytinge,  47  East  Vine 
Street,  Redlands. 

San  Diego  County  Medical  Society 

Fourteenth  Floor,  Medico-Dental  Building 
233  A Street,  San  Diego 
President,  C.  M.  Fox,  910  Medico-Dental 
Building,  233  A Street,  San  Diego. 
Secretary,  William  H.  Geistweit,  Jr..  810 
Medico-Dental  Building,  233  A Street, 
San  Diego. 

San  Francisco  County  Medical  Society 
2180  Washington  Street,  San  Francisco 
President,  Harold  K.  Faber,  Lane  Hospital, 
2398  Sacramento  Street,  San  Francisco. 
Secretary,  T.  Henshaw  Kelly,  2180  Wash- 
ington Street,  San  Francisco. 

San  Joaquin  County  Medical  Society 
President,  Harry  E.  Kaplan,  611  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

Secretary,  C.  A.  Broaddus,  907  Medico- 
Dental  Building,  242  North  Sutter  Street, 
Stockton. 

San  Luis  Obispo  County  Medical  Society 
President,  Howard  A.  Gallup,  774  Marsh 
Street,  San  Luis  Obispo. 

Secretary,  Allen  F.  Gillihan,  San  Luis 
Obispo. 


San  Mateo  County  Medical  Society 
President,  Harper  Peddicord,  Box  704,  Red- 
wood City. 

Secretary,  B.  H.  Page,  231  Second  Avenue, 
San  Mateo. 

Santa  Barbara  County  Medical  Society 
President,  Hugh  F.  Freidell,  1525  State 
St.,  Santa  Barbara. 

Secretary,  William  H.  Eaton,  Health  De- 
partment, Santa  Barbara. 

Santa  Clara  County  Medical  Society 
President,  E.  P.  Cook,  215  St.  Claire  Build- 
ing, San  Jose. 

Secretary,  C.  M.  Burchfiel,  218  Garden  City 
Bank  Building,  San  Jose. 

Santa  Cruz  County  Medical  Society 
President,  M.  F.  Bettencourt,  Lettunich 
Building,  Watsonville. 

Secretary,  Samuel  B.  Randall,  Farmers  and 
Merchants  Natl.  Bank  Bldg.,  Santa  Cruz. 

Shasta  County  Medical  Society 
President,  Earnest  Dozier,  Masonic  Build- 
ing, Redding. 

Secretary,  C.  A.  Mueller,  Redding. 

Siskiyou  County  Medical  Society 
President, 

Secretary,  Ruth  C.  Hart,  Fort  Jones. 

Solano  County  Medical  Society 
President,  D.  B.  Park,  327  Georgia  Street, 
Vallejo. 

Secretary,  J.  E.  Hughes,  327  Georgia  Street, 
Vallejo. 

Sonoma  County  Medical  Society 
President,  Chester  Marsh,  Sebastopol. 
Secretary,  J.  Leslie  Spear,  616  Fourth 
Street,  Santa  Rosa. 

Stanislaus  County  Medical  Society 
President,  R.  S.  Hiatt,  Beaty  Bldg.,  1024 
J Street,  Modesto. 

Secretary,  Donald  L.  Robertson,  1003  12th 
Street,  Modesto. 

Tehama  County  Medical  Society 
President,  F.  H.  Bly,  Red  Bluff. 

Secretary,  F.  J.  Bailey.  Red  Bluff. 

Tulare  County  Medical  Society 
President,  H.  G.  Campbell,  117  West  Hono- 
lulu Street,  Lindsay. 

Secretary,  S.  S.  Ginsburg,  Bank  of  Italy 
Building,  Visalia. 

Tuolumne  County  Medical  Society 
President,  George  C.  Wrigley,  Sonora. 
Secretary,  W.  L.  Hood,  Sonora. 

Ventura  County  Medical  Society 
President,  D.  G.  Clark,  130  N Tenth  St., 
Santa  Paula. 

Secretary,  C.  A.  Smolt,  23  S.  California  St., 
Ventura. 

Yolo-Colusa  County  Medical  Society 
President,  Leo  P.  Bell,  Woodland  Clinic, 
Woodland. 

Secretary,  W.  E.  Bates,  719  Second  Street, 
Davis. 

Yuba-Sutter  County  Medical  Society 
President,  Granville  S.  Delamere,  316  D 
Street,  Marysville. 

Secretary,  Fred  W.  Didier,  Wheatland. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


. • . powerful  and 
rapid  in  action.  Kills 
bacteria  almost 
instantly. 


Valuable  in  the  treatment 
of  all  open  wounds,  abra- 
sions, and  infections  of  the 
mucous  membranes 


12  FLUID  OUNCES 


Exylresorcinc 
SOLUTION  S.I22 


;L*QUCR  HCXYLPCSOnClNOUS.  s & 0.' 

“WfATO*  SOLUTION  WlWglgS 
,ALt  TENSION  OF  .17  HYNES  >*£R  CENTIME11*' 

GENERAL  ANTISEPTIC 

A STAOI  c-  M^\M.TOYlC  NO* 


loot  STasle.  non-toxic.  NO* 

wATiNG.  GERMICIDAL  S«. 

On  which  bct«ius  ITS  ACTI' 


Tins, LtKMlLiuoi-  --  ... 

fvN^HlCH  retains  its  acti 
When  apdi  im  to  tis^ 


teEN  APPLES  TO 
» [ACES  and  destroy 
aNogEN|C  bacteria 

'Act  ™an  15  SECONDS  CC* 


• • • especially  suggested, at 
this  time  of  the  year,  as  a 
nasal  spray,  mouth  wash 
and  gargle. 


SHARP  & DOHME 

BALTIMORE 


NEW  YORK  CHICAGO 

PHILADELPHIA 


NEW  ORLEANS  ST.  LOUIS 

BOSTON 


ATLANTA 


KANSAS  CITY 


SAN  FRANCISCO 


DALLAS 


6 


State  Board  of  Health 

San  Francisco,  337  State  Building 

Los  Angeles,  823  Sun  Finance  Building 
Sacramento,  Forum  Building 
President,  G.  E.  Ebright,  San  Francisco. 
Director,  Walter  M.  Dickie,  Berkeley. 

Secretary,  C.  B.  Pinkham,  623  State  Build- 
ing, San  Francisco. 

Secretary,  George  H.  Sanderson,  809 
Medico-Dental  Building,  Stockton. 

Southern  California  Medical  Association 

President,  Joseph  K.  Swindt,  Pomona. 
Secretary,  William  J.  Norris,  509  Medical 
Office  Bldg.,  1136  W.  6th  Street,  Los 
Angeles. 

Better  Health  Foundation 

President,  Reginald  Knight  Smith,  490  Post 
Street,  San  Francisco. 

Chairman  Executive  Committee,  Walter  B. 

Coffey,  65  Market  Street,  San  Francisco. 
Treasurer,  John  Gallwey,  1195  Bush  Street, 
San  Francisco. 

Secretary,  Celestine  J.  Sullivan,  490  Post 
Street,  San  Francisco. 

State  Board  of  Medical  Examiners 

San  Francisco,  623  State  Building 

Los  Angeles,  821  Associated  Realty  Bldg., 
510  West  Sixth  Street 

Sacramento,  420  State  Office  Building 
President,  P.  T.  Phillips,  Santa  Cruz. 

California  Northern  District  Medical  Society 
President,  Orrin  S.  Cook,  Mater  Miseri- 
cordiae  Hospital,  Sacramento. 

Woman’s  Auxiliary  of  the  California  Medical  Association 

State  Auxiliary  Officers 

President,  Mrs.  James  F.  Percy,  1030  South 
Alvarado  Street,  Los  Angeles. 

First  Vice-President,  Mrs.  James  M.  Mc- 
Cullough, Crockett. 

Second  Vice-President,  Mrs.  Thomas  A. 
Stoddart,  851  California  Street,  San 
Francisco. 

Secretary-Treasurer,  Mrs.  Dexter  R.  Ball, 
2419  Bonnie  Brae,  Santa  Ana. 

Officers  of  County  Auxiliaries 

Contra  Costa  County — President,  Mrs.  J.  M. 
McCullough,  Crockett ; Secretary-Treasurer, 
Mrs.  S.  N.  Weil,  Rodeo. 

Kern  County — President,  Mrs.  F.  A.  Hamlin, 
Bakersfield ; Secretary-Treasurer,  Mrs.  C.  S. 
Compton,  Bakersfield. 

Los  Angeles  County — President,  Mrs.  James 
F.  Percy,  Los  Angeles ; Secretary-Treas- 
urer, Mrs.  Martin  G.  Carter,  Los  Angeles. 
Monterey  County — President,  Mrs.  C.  H. 
Lowell,  Carmel ; Secretary-Treasurer,  Mrs. 
Arthur  A.  Arehart,  Pacific  Grove. 

Napa  County — President,  Mrs.  W.  L.  Blod- 
get,  Calistoga ; Secretary,  Mrs.  Lawrence 
Welti,  Napa. 

Orange  County — President,  Mrs.  F.  E.  Coul- 
ter, Santa  Ana;  Secretary-Treasurer,  Mrs. 
Dexter  R.  Ball,  Santa  Ana. 

San  Bernardino  County — President,  Mrs. 
F.  E.  Clough,  San  Bernardino;  Secretary- 
Treasurer,  Mrs.  C.  L.  Curtiss,  Redlands. 
Sonoma  County — President,  Mrs.  Leslie  G. 
Spear,  Santa  Rosa ; Secretary-Treasurer, 
Mrs.  Sara  J.  Pryor,  Santa  Rosa. 

W.  A.  SHAW,  Elko President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 


HORACE  T.  BROWN,  Reno Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 

Place  of  next  meeting Reno,  September  26-27,  1930 


Utah  State  Medical  Association 


H.  P.  KIRTLEY,  Salt  Lake  City President  J.  U.  GIESY.  701  Medical  Arts  Building, 

WILLIAM  L.  RICH.  Salt  Lake  City President-Elect  Salt  Lake  City Associate  Editor  for  Utah 

M.  M.  CRITCHLOW,  Salt  Lake  City Secretary  Place  of  next  meeting Salt  Lake  City,  September  9-11,  1930 


The  institutions  here  listed  have  announcements  in  this  issue  of  California  and  Western  Medicine 


ALEXANDER  SANITARIUM 

Nervous  and  Mild  Mental  Diseases 

Belmont,  Calif. 

FRANKLIN  HOSPITAL 

Limited  General  Hospital 

Fourteenth  and  Noe  Streets,  San  Francisco 

SANTA  BARBARA  CLINIC 

1421  State  Street,  Santa  Barbara 

SCRIPPS  METABOLIC  CLINIC 
SCRIPPS  MEMORIAL  HOSPITAL 

La  Jolla,  San  Diego,  Calif. 

ALUM  ROCK  SANATORIUM 

For  Treatment  of  Tuberculosis 

San  Jose,  California 

GREENS*  EYE  HOSPITAL 

Consultation,  Diagnosis  and  Treatment  of 
Diseases  of  the  Eye 

Bush  and  Octavia  Streets,  San  Francisco 

SOUTHERN  SIERRAS  SANATORIUM 

Scientific  Treatment  of  Tuberculosis 
Banning,  Calif. 

ANDERSON  SANATORIUM 

Mental  and  Nervous  Diseases 

2535  Twenty-fourth  Avenue 

Oakland,  Calif. 

JOHNSTON-WICKETT  CLINIC 

Anaheim,  Calif. 

SAINT  FRANCIS  HOSPITAL 

Limited  General  Hospital 

Bush  and  Hyde  Streets,  San  Francisco 

BANNING  SANATORIUM 
Treatment  of  Tuberculosis  and  Throat 
Diseases 

Banning,  Calif. 

JOSLIN’S  SANATORIUM 

Nervous  and  Mental 

Lincoln,  Calif. 

ST.  JOSEPH’S  HOSPITAL 

Limited  General  Hospital 

Buena  Vista  and  Park  Hill  Avenues 

San  Francisco,  Calif. 

CALIFORNIA  SANITARIUM 

For  the  Treatment  of  Tuberculosis 
Belmont,  San  Mateo  County,  Calif. 

LAS  ENCINAS  SANITARIUM 

Nervous  and  General  Diseases 

Las  Encinas,  Pasadena,  Calif. 

ST.  LUKE’S  HOSPITAL 

Limited  General  Hospital 

27th  and  Valencia  Streets,  San  Francisco 

CANYON  SANATORIUM 

For  the  Treatment  of  Tuberculosis 
Redwood  City,  Calif. 

LIVERMORE  SANITARIUM 

Nervous  and  General  Diseases 
Livermore,  Calif. 

CHILDREN’S  HOSPITAL 

General  Hospital  for  Women  and  Children 
3700  California  Street,  San  Francisco,  Calif. 

ST.  MARY’S  HOSPITAL 

General  Hospital 

2200  Hayes  Street,  San  Francisco,  Calif. 

MONROVIA  CLINIC 

Diagnosis  and  Treatment  of  Tuberculosis 
137  N.  Myrtle  Street,  Monrovia,  Calif. 

COLFAX  SCHOOL  FOR  THE 
TUBERCULOUS 

For  the  Treatment  of  Tuberculosis 
Colfax,  Calif. 

OAKS  SANITARIUM 

For  the  Treatment  of  Tuberculosis 

Los  Gatos,  Calif. 

SUTTER  HOSPITAL 

General  Hospital 

28th  and  L Streets,  Sacramento,  Calif. 

PARK  SANITARIUM 

Mental  and  Nervous,  Alcoholic  and  Drug 
Addictions 

1500  Page  Street,  San  Francisco,  Calif. 

CHARLES  B.  TOWNS  HOSPITAL 
Alcoholism  and  Drug  Addiction 

293  Central  Park  West,  New  York,  N.  Y. 

COMPTON  SANITARIUM  AND  LAS 
CAMPANAS  HOSPITAL,  COMPTON 

Neuropsychiatric  and  General 

DANTE  SANATORIUM 

Limited  General  Hospital 

Van  Ness  and  Broadway,  San  Francisco 

POTTENGER  SANATORIUM 

AND  CLINIC 

For  the  Treatment  of  Tuberculosis 
Monrovia,  Calif. 

TWIN  PINES 

For  Neuropsychiatric  Patients 
Belmont,  Calif. 

CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 


P 

JLurity... 

Protein  Reduced 
to  a Minimum  in 

„ Parke,  Davis  & Co.’s 

1 ETANUS  ANTITOXIN, 

P.  D.  & Co.,  is  a physio-  TETANUS 

logical  solution  of  the  anti-  . _ _ . . _ . 

A1VTTTOXT1SJ 

toxin-containing  pseudo-  XXX  X -L>| 

globulins  of  Antitetanic 

Serum,  containing  the  very  minimum  of  non-essential  pro- 
tein elements,  such  as  serum  albumen  and  the  euglobulins. 
You  will  approve  the  small  volume  ol  the  dose  thus 
secured,  and  the  greater  freedom  from  reactions  which 
these  manufacturingimprovements  have  rendered  possible. 


Average  Prophylactic  Dose,  Bio.  141 — 1500  units  in  syringe 
Average  Therapeutic  Dose,  Bio.  146 — 10,000  units  in  syringe 

-3  WRITE  FOR  BOOKLET  ON  TETANUS  ANTITOXIN,  P.  D.  & CO.  £ 

PARKE,  DAVIS  & COMPANY 

DETROIT  ^ MICHIGAN 

<s£^(^r^s>  <S£^c^r^s> 

NEW  YORK  - KANSAS  CITY  - CHICAGO  - BALTIMORE  - NEW  ORLEANS  - MINNEAPOLIS 

SEATTLE  | J l In  Canada : WALKERVILLE  - MONTREAL  - WINNIPEG 


s 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALPHABETICAL  LIST  OF  ADVERTISERS 

Members  of  the  California  Medical  Association  can  aid  their  Journal  and  the  firms 
who  advertise  therein,  by  cooperation  as  indicated  in  the  footnote  on  this  page. 


KT^O 


Page 


Alexander  Sanitarium  55 

Aloe  Co.,  A.  S 41 

Alum  Rock  Sanatorium 19 

American  Surgical  Sales  Co., 


Anderson  Sanatorium,  The 59 

Annual  Meeting  of  American 

Ass’n  for  Study  of  Goiter 58 

Approved  Clinical  Laboratories  57 
Arlington  Chemical  Co.,  The 60 

Banning  Sanatorium  44 

Barry  Co.,  James  H 50 

Bausch  & Lomb  Optical  Co 59 

Benjamin  and  Rackerby 55 

Benjamin,  M.  J 51 

Bittleston  Collection  Agency,  Inc.  52 

Brackford  Corporation,  Ltd 20 

Broemmel’s  Prescription  Phar- 
macy   3 

Brown  Press  39 

Bush  Electric  Corporation 1 

Butler  Building  16 

California  Lima  Bean  Growers’ 

Ass’n  37 

California  Optical  Co 49 

California  Sanatorium  48 

Calso  Water  Co. 41 

Camp  & Co.,  S.  H 30 

Canyon  Sanatorium  18 

Certified  Laboratory  Products.  38 

Charles  B.  Towns  Hospital 39 

Children’s  Hospital  51 

Ciba  Co.,  Inc 17 

Clark-Gandion  Co.,  Inc 14 

Classified  Advertisements  10 

Colfax  School  for  the  Tuber- 
culous   63 

Compton  Sanitarium  and  Las 

Campanas  Hospital  9 

Cutter  Laboratory  4 Cover 

Dairy  Delivery  Co 35 

Dante  Sanatorium  4 Cover 

Dewar  & Hare  Electric  Co 46 

Doctors’  Business  Bureau 19 

Dry  Milk  Co.,  The 47 

Four  Fifty  Sutter 38 

Franklin  Hospital  43 

Frazier,  Delmar  J 12 

Furscott,  Hazel  E 24 


Page 


General  Electric  X-Ray  Corp 45 

Golden  State  Milk  Products  Co.  30 

Greens’  Eye  Hospital 2 Cover 

Gunn,  Herbert,  Stool  Examina- 
tion Laboratory  24 

Guth,  C.  Rodolph,  Clinical  Lab- 
oratory   10 

Hexol,  Inc , 34 

Hill-Young  School  of  Corrective 

Speech  24 

Hittenberger  Co.,  C.  H.. 10 

Hoffmann-La  Roche,  Inc 13 

Holland-Rantos  Co.,  Inc 24 

Hospitals  and  Sanatoriums 6 

Hynson,  Westcott  & Dunning, 

Inc 36 

Jacobs,  Louis  Clive 16 

Johnston-Wickett  Clinic  48 

Joslin’s  Sanatorium  31 

Kelley-Koett  Mfg.  Co.,  Inc.,  The..  15 

Keniston-Root  Corporation  41 

Knox  Gelatine  Laboratories 25 

Laboratory  Products  Co 3 Cover 

Las  Encinas  Sanitarium 12 

La  Vida  Mineral  Water  Co 58 

Lederle  Laboratories,  Inc 23 

Lengfeld’s  Pharmacy  24 

Lilly  & Company,  Eli 32 

Lister  Bros.,  Inc 11 

Livermore  Sanitarium  29 

Maltbie  Chemical  Co.,  The 28 

Mead  Johnson  & Co 21 

Medical  Protective  Co.,  The 61 

Medico-Dental  Finance  Corp 40 

Merck  & Co.,  Inc 64 

Merrell-Soule  Co.,  Inc 42 

Monrovia  Clinic  43 

National  Ice  Cream  and  Cold 

Storage  Co 29 

New  York  Polyclinic  Medical 

School  and  Hospital 9 

New  York  Post  Graduate  Med- 
ical School  and  Hospital 39 

Nichols  Nasal  Syphon 44 

Nonspi  Company  28 

Oaks  Sanitarium  9 

Officers  of  the  California  Med- 
ical Association  2-4 

Officers  of  Miscellaneous  Med- 
ical Associations  6 


Page 


Park  Sanitarium  24 

Parke,  Davis  & Co 7 

Physiotherapy  & X-Ray  Courses 

Children’s  Hospital 34 

Podesta  and  Baldocchi 43 

Post  Graduate  School  of  Surgical 

Technique,  Inc 40 

Pottenger  Sanatorium  53 

Purity  Spring  Water  Co 44 

Rainier  Brewing  Co 36 

Richter  & Druhe 56 

Riggs  Optical  Company 31 

Saint  Francis  Hospital 14 

Santa  Barbara  Clinic,  The 52 

Scherer  Co.,  R.  L 26 

Scripps  Metabolic  Clinic  and 

Memorial  Hospital  18 

Sharp  & Dohme  5 

Sharp  & Smith  34 

Shasta  Water  Co.,  The 22 

Shumate’s  Prescription  Phar- 
macies   24 

Soiland,  Albert  (Radiological 

Clinic)  30 

Southern  Sierras  Sanatorium 22 

Squibb  & Sons,  E.  R 27 

Stacey,  J.  W.,  Medical  Books 11 

St.  Joseph’s  Hospital 52 

St.  Luke’s  Hospital 23 

St.  Mary's  Hospital 54 

Storm  Binder  and  Abdominal 

Supporter  54 

Sugarman  Clinical  Laboratory.  ..  16 
Sutter  Hospital,  Sacramento 14 

Taylor  Instrument  Companies...  37 

Towns  Hospital,  Charles  B 39 

Trainer-Parsons  Optical  Co 26 

Travers’  Surgical  Co 33 

Twin  Pines  59 

Union  Square  Building 11 

United  States  Fidelity  & Guar- 
anty Co 49 

Vita-Fruit  Products,  Inc 35 

Vitalait  Laboratory  12 

Waiss  Hollow  Needle  & Holder....  20 

Wallace,  Sidney  J. 53 

Walters  Surgical  Company... 56 

Wedekind  Co.,  Frank  F. 39 

Wilson  Laboratories,  The  62 


California  and  Western  Medicine,  the  Journal  of  our 
Association,  in  its  present  form,  is  made  possible  in 
part  because  of  the  generous  cooperation  of  firms  who 
believe  that  its  pages  can  successfully  carry  a message 
concerning  their  products  to  a desirable  group  of 
present  and  future  patrons. 

The  five  thousand  and  more  readers  of  California 
and  Western  Medicine  often  have  occasion  to  pur- 
chase articles  advertised  in  this  publication. 


Other  things  being  equal,  it  would  seem  that  recipro- 
cal courtesy  and  cooperation  should  lead  our  members 
to  give  preference  to  those  firms  who  place  announce- 
ments in  our  publication. 

Cooperation  might  go  even  farther  than  that.  When 
ordering  goods  from  our  advertisers  mention  Califor- 
nia and  Western  Medicine.  By  the  observance  of  this 
rule  a distinct  service  will  be  given  your  Association, 
its  Journal  and  our  advertisers. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


TllC  Oirlks  Sanitarium  Los  Cjatos , (California 

A Moderately  Priced  Institution  for  the  Scientific  Treatment  of  Tuberculosis 


FOR  PARTICULARS  AND  BOOKLET  ADDRESS 


WILLIAM  C.  VOORSANGER,  M.  D. 

Medical  Director 

San  Francisco  Office 


PAUL  C.  ALEXANDER,  M.  D. 

Asst.  Medical  Director 

490  Post  Street 


COMPTON  SANITARIUM  and 
LAS  CAMPANAS  HOSPITAL 

COMPTON,  CALIF. 

50  minutes  from  Los  Angeles.  115  beds  for 
neuropsychiatric  patients.  40  beds  for  medical- 
surgical  patients.  Clinical  studies  by  experienced 
psychiatrists.  X-ray  and  clinical  laboratories. 
Hydrotherapy.  Occupational  therapy.  Ten 
acres  landscaped  garden.  Tennis.  Baseball. 
Motion  pictures.  Scientifically  sound-proofed 
rooms  for  psychotic  patients.  Accommodations 
ranging  from  ward  beds  to  private  cottage. 

G.  E.  MYERS,  M.  D.,  Medical  Director 

Philip  J.  Cunnane,  M.  D.  G.  Creswell  Burns,  M.  D. 
Helen  Rislow  Burns,  M.  D. 

Office:  1052  West  6th  Street,  Los  Angeles 


The  New  York  Polyclinic 

MEDICAL  SCHOOL  AND  HOSPITAL 

( Organized  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 

We  announce 

POST-GRADUATE  INSTRUCTION 

for  the 

GENERAL  PRACTITIONER 

For  information  address  MEDICAL  EXECUTIVE  OFFICER:  345  W.  50th  St.,  New  York  City 


10 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SUPPORTERS 

for 

Sacro-Iliac  Subluxation 

Model  150A 
Canvas  sacro-iliac 
and  low  back  sup- 
porter. Buckles  in 
front  and  laces  in 
back,  permitting 
unusually  accu- 
rate adjustment. 
Equipped  with 
9"  spinal  steels 
and  felt  sacrol 
pad.  One  of  the 
prevailing  types 
used  for  support- 
ing conditions  in- 
. volving  sacrum 

Price  #8.00  and  low  back 

injuries. 

The  designing  and  fitting  of  the  proper  type  sup- 
porters  for  subluxation  of  the  sacro-iliac  joint  has 
been  one  of  the  most  important  services  of  the 
Hittenberger  organization. 

We  carry  the  famous  S.  H.  CAMP  Supporters 

C.  H.  HITTENBERGER  CO. 

MArket  4244 

1115  Market  Street  460  Post  Street 

Established  1912 


Dextrose  & Sodium  Chloride 

( Searle  ) 

The  Ideal  Solution  for  the  Obliterative 
Treatment  of  Varicose  Veins 

The  strong  obliterative  action  of  a 30%  solu- 
tion of  Sodium  Chloride  with  the  milder  action 
of  a 50%  dextrose  plus  a minute  amount  of 
benzyl  alcohol  combined  in  one  ampoule. 

The  dextrose  acts  as  a buffer  protecting  the 
subcutaneous  tissues  against  the  irritative  action 
of  the  solution  if  a portion  of  it  is  inadvertently 
deposited  outside  the  vein.  The  danger  of  ulcera- 
tion and  sloughing  following  such  an  accident  is 
practically  eliminated. 

The  benzyl  alcohol  gives  a local  anesthetic 
effect  reducing  to  a minimum  and  frequently 
eliminates  the  pain  and  cramps  which  ordi- 
narily follow  such  injections. 

Supplied  only  in  20  cc.  serum-type  ampoules 
allowing  the  withdrawal  of  any  amount  without 
wasting  or  contaminating  the  remaining  portion. 


C.  CCLCLPH  GUTH 

BIOLOGICS  &.  THERAPEUTIC  SPECIALTIES 

WILLIAM  H.  BANKS,  M.  D.,  Medical  Diret  tor 

Phone  KEarny  3644 

811  Flood  Bldg.  San  Francisco,  Calif. 

ASSOCIATED  WITH 

FRATES  a LOVOTTI.  PROFESSIONAL  PHARMACISTS 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  these  insertions  are  $4  for  fifty  words  or  less; 
additional  words  5 cents  each. 


WE  TAKE  CLINICAL  PHOTOGRAPHS  FOR  PUBLICA- 

tion  or  record  purposes.  Lantern  slides  for  projection  in  black 
and  white  or  in  colors.  Complete  photomicrographic  equipment. 
Portable  equipment  available  at  all  times.  Write  for  schedule  of 
rates.  The  Shaw  Laboratory,  1155  California  Street,  San  Fran- 
cisco, California.  Phone  Franklin  2203. 


WANTED — REPRESENTATIVE  OF  THE  BETTER  CLASS 

to  call  on  physicians  and  dentists  in  California.  Immediate,  per- 
manent, well  paid  work.  State  age,  experience  and  so  forth.  Lee  & 
Febiger,  600  S.  Washington  Square,  Philadelphia,  Pa. 


FOR  SALE— 160  ACRES  MOUNTAIN  LAND  IN  LAKE 

_ County,  California.  3000  feet  elevation.  Heavily  wooded  with 
pine  and  oak  trees.  Several  mineral  springs.  Fine  deer  range.  Un- 
surpassed view.  Near  state  highway.  Some  improvements,  also 
family  orchard.  An  ideal  location  for  a sanitarium  for  tuberculous 
or  mental  patients.  Terms  reasonable.  Address  Box  600,  Cali- 
fornia and  Western  Medicine. 


LOCATION  WANTED  IN  SOUTHERN  CALIFORNIA. 

Physician  mature,  specializing  in  nonsurgical  treatment  of 
hernia,  wishes  to  associate  himself  with  ethical  private  clinic  or 
medical  group  in  Southern  California.  Has  definite  standing  and 
has  contributed  many  articles  to  literature.  Is  prepared  to  invest 
where  there  is  suitable  opportunity.  Willing  to  share  office  with 
established  internist,  urologist  or  proctologist  in  Southern  Cali- 
fornia (preferably  a large  city)  who  is  in  a position  to  refer  hernia 
cases.  Address  Box  610,  California  and  Western  Medicine. 


WANTED— POSITION  AS  TECHNICIAN  BY  CAPABLE 

woman.  Thoroughly  experienced  in  routine  laboratory  work, 
hematology,  blood  chemistry,  Wassermann  and  Kahn  Reaction, 
bacteriology,  Basal  Metabolism  and  tissue  work.  Also  x-ray  and 
physiotherapy.  Understands  bookkeeping  and  typing.  Address 
Box  620,  California  and  Western  Medicine. 


FOR  SALE— GENERAL  PRACTICE  AND  DRUG  STORE, 

some  office  equipment  and  furnishings.  San  Joaquin  Valley 
town,  prosperous  dairy  district.  Competition  light.  Good  reasons 
for  selling.  Price  $1,000 — $500  cash,  balance  to  suit.  Rent  of 
building,  3 rooms,  office  and  store,  $20  per  month.  Address  Box 
630,  California  and  Western  Medicine. 


PHYSICIAN  OR  GROUP  WANTED  AS  PARTNER  IN  PRO- 

jected  corporation.  Hot  springs  resort.  Water,  Sodium-sulphate. 
Mineral  analysis  sent  upon  request.  Newly  completed  inn  and 
baths.  Two  plunges  and  other  attractive  features.  Valuable  prop- 
erty, 65  acres.  Altitude  6700  feet  among  the  pines.  Address  Box 
640,  California  and  Western  Medicine. 


SPLENDID  OPPORTUNITY  FOR  YOUNG  BUSINESS 

merchandiser  to  invest  $5,000  with  services  in  ethical  medical 
line.  Safe  and  sound.  Address,  E.  H.  Cordes,  17  North  Virginia 
Street,  Nevada. 


SITUATIONS  WANTED  — SALARIED  APPOINTMENTS 

for  Class  A physicians  in  all  branches  of  the  Medical  Profession. 
Let  us  put  you  in  touch  with  the  best  man  for  your  opening.  Our 
nation-wide  connections  enable  us  to  give  superior  service.  Aznoe’s 
National  Physicians’  Exchange,  30  North  Michigan,  Chicago. 
Established  1896.  Member  The  Chicago  Association  of  Commerce. 


"RAINBOW  RIDGE”  CHARMING  COUNTRY  PLACE  IN 

Los  Gatos  Hills,  1800  feet  altitude  among  wonderful  redwood 
and  sequoia  groves.  Main  bungalow,  guest  cottage,  baths,  servants’ 
cabin,  double  garage  with  ample  storeroom,  tank  house,  hot  and 
cold  showers,  brick  driveways  and  walks.  Beautiful  shrubs,  forty 
trees  of  assorted  fruits.  Ideal  summer  or  all  year  home.  Famous 
health  building  climate.  Unexcelled  for  sanitarium.  Exceptionally 
good  road.  $25,000,  reduced  from  $35,000.  Address,  Howard 
Throckmorton,  Los  Gatos,  California,  or  756  South  Spring  Street, 
Los  Angeles. 


The  Pellagra  Preventive  Action  of  Canned  Salmon. 

In  connection  with  studies  relating  to  the  pellagra 
preventive  properties  of  various  food  substances  the 
United  States  Public  Health  Service  has  recently  an- 
nounced that  canned  salmon  (Alaska  chum)  contains 
the  pellagra  preventive  factor.  By  reason  of  its 
potency  in  preventing  pellagra  and  its  availability  in 
the  preserved  state,  salmon  may  be  considered  a fair 
substitute  for  meat  in  the  area  of  pellagra  endemicity 
where  meat  is  not  readily  available.  The  demonstra- 
tion of  the  pellagra  preventive  value  of  canned  salmon 
furnished  further  evidence  of  the  soundness  of  the 
working  hypothesis  that  black  tongue  in  dogs  is  the 
analogue  of  pellagra  in  man. — United  States  Public 
Health  Service. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


// 


BOOKS  RECEIVED 

Uterine  Tumors.  By  Charles  C.  Norris,  M.  D.,  Pro- 
fessor of  Gynecology  and  Obstetrics  and  Director  of  the 
Department,  University  of  Pennsylvania.  Leather.  Pp. 
251,  illustrated.  Price,  $3.  New  York:  PXarper  Brothers, 
1030. 


Cancer  of  the  Breast.  By  William  Crawford  White, 
M.  D.,  F.  A.  C.  S.,  Junior  Surgeon  to  the  Roosevelt  Hospi- 
tal, Consulting  Surgeon  to  the  New  York  Nursery  and 
Child’s  Hospital.  Leather.  Pp.  221,  illustrated.  Price,  $3. 
New  York:  Harper  Brothers,  1930. 


Birth,  Stillbirth,  and  Infant  Mortality  Statistics  for  the 
Birth  Registration  Area  of  the  United  States.  1927.  Thir- 
teenth Annual  Report.  Part  I.  Summary  and  rate  tables 
and  general  tables.  Paper.  Pp.  253.  Washington:  The 
United  States  Printing  Office,  1930. 


Mortality  Statistics.  1927.  Part  II.  United  States  De- 
partment of  Commerce.  Bureau  of  the  Census.  Text  and 
tables.  Paper.  Pp.  159.  Washington:  The  United  States 
Printing  Office,  1930. 


Lectures  on  Colonic  Therapy.  Its  Indications,  Technic, 
and  Results.  By  O.  Boto  Schellberg,  New  York  City. 
Paper.  Pp.  55.  New  York  City:  The  Oboschell  Corpo- 
ration, 1930. 


Gynecology  for  Nurses.  By  George  Gellhorn,  M.  D., 
F.  A.  C.  S.,  Professor  of  Gynecology  and  Obstetrics  and 
Director  of  the  Department,  St.  Louis  University  of  Medi- 
cine. 12mo  of  275  pages,  with  145  illustrations.  Cloth. 
Price,  $2  net.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1930. 


Obstetrics  for  Nurses.  By  Joseph  B.  DeLee,  M.  D.,  Pro- 
fessor of  Obstetrics  and  Gynecology,  University  of  Chi- 
cago, School  of  Medicine;  Obstetrician  to  the  Chicago 
Lying-In  Hospital  and  Dispensary.  New  (ninth)  edition, 
revised.  12mo  of  645  pages,  with  269  illustrations.  Cloth. 
Price,  $3  net.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1930. 


Medical  Education  and  Related  Problems  in  Europe. 

By  the  Commission  on  Medical  Education,  April  1930. 
Paper.  Pp.  200. 


Methods  and  Problems  of  Medical  Education.  Sixteenth 
series.  Paper.  Pp.  251.  New  York:  The  Rockefeller 
Foundation,  1930. 


Recent  Advances  in  Neurology.  By  W.  Russell  Brain, 
M.  A.,  D.  M.  (Oxon.),  M.  R.  C.  P.  (London),  Assistant 
Physician  to  the  London  Hospital,  and  E.  B.  Straus,, 
B.  A.,  B.  M.,  B.  Ch.  (Oxon.,  M.  R.  C.  P.  (London  Clinical 
Assistant  to  the  Neurological  and  Psychiatric  Clinic  of 
the  University  of  Marburg.  Second  edition.  Cloth.  Pp. 
429,  with  39  illustrations.  Price  $3.50  net.  Philadelphia: 
P.  Blakiston’s  Son  & Co.,  Inc.,  1930. 


Merck’s  Index.  Fourth  edition.  An  Encyclopedia  for 
the  Chemist,  Pharmacist  and  Physician,  giving  the  names 
and  synonyms;  source,  origin,  or  mode  of  manufacture; 
chemical  formulas  and  molecular  weights;  physical  char- 
acteristics; melting  and  boiling  points;  solubilities;  spe- 
cific gravities;  medicinal  action;  therapeutic  uses;  ordi- 
nary and  maximum  doses;  incompatibilities;  antidotes; 
special  cautions;  hints  on  keeping  and  handling,  etc.,  of 
the  chemicals  and  drugs  used  in  chemistry,  medicine,  and 
the  arts.  Leather.  Pp.  585.  Price,  $5,  with  a discount 
of  50  per  cent  to  members  of  and  those  affiliated  with  the 
medical,  chemical,  pharmaceutical,  and  allied  professions. 
New  York:  Merck  & Co.,  Inc.,  1930. 


BOOK  REVIEWS 

The  Blood  Picture  and  Its  Clinical  Significance  (Including 
Tropical  Diseases) — A Gu|de  Book  on  the  Microscopy 

of  Blood. — By  Professor  Dr.  Victor  Schilling.  Trans- 
lated and  edited  by  R.  B.  H.  Gradwohi.  Seventh  and 
eighth  revised  edition.  Pp.  408.  Illustrated.  St  Louis: 
The  C.  V.  Mosby  Company,  1929. 

In  this  book  the  author  has  attempted,  with  some  suc- 
cess, to  establish  a systematic  method  by  means  of  which 
the  differential  leukocyte  count  of  the  blood  is  amplified 
by  further  classification  of  individual  cells.  The  method 
is  especially  applicable  to  neutrophilic  leukocytes,  but 
the  significance  of  coincident  percentage  variations  of 
other  leukocytes  (monocytes,  lymphocytes,  eosinophils, 
etc.),  is  clearly  and  convincingly  shown.  The  relationship 
(Continued  on  Next  Page) 


THREE  BOOKS 

Worth  While 

DRAPER:  Disease  and  the  Man $ 4.50 

BECKMAN:  Treatment  in  General 

Practice  10.00 

CHRISTOPHER:  Minor  Surgery 8.00 

J.  W.  Stacey,  Inc. 

236-238  Flood  Bldg.  San  Francisco,  Calif. 

GARFIELD  0838 


Exclusively 

PHYSICIANS  y SURGEONS  / DENTISTS 
350  Post  Street,  Facing  Union  Square 
GAr  field  1014 


USTEBS/% 


NO 

Starch 


CASEIN  PALMNUT  DIETETIC 

FLOUR 


prescribed  in 

Diabetes 


Strictly  starch-free,  palatable  muffins,  bread,  cakes, 
pastry,  etc.,  are  easily  made  in  any  home  from 
Listers  Flour.  Recipes  are  easy  to  follow  and  Listers 
Flour  is  self-rising.  One  month’s  supply  $4.85 


Ask  for  nearest  Depot  or  order  direct. 

LISTER  BROS.  Inc.,  41  East  42nd  St.,  NEW  YORK,  N.Y. 


12 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


A Thoroughly  Equipped 

PHYSICAL  THERAPY  LABORATORY 

Including  Hydrotherapy  and  Massage  Available  to  Patients  Under  Prescription  of  Licensed  Physicians 

426-427  Dalziel  Building 
OAKLAND 
PHONE  LAKESIDE  5659 


DELMER  J.  FRAZIER 


LAS  IX  ISAS  - - - PASADENA,  CALIE. 

A SANITARIUM  FOR  THE  TREATMENT  OF  GENERAL  AND  NERVOUS  DISEASES 

BOARD  OF  DIRECTORS:  George  Dock.,  M.D.,  Pres.;  W.  Jarvis  Barlow,  M.D.;  Stephen  Smith,  M.D. ; 

F.  C.  E.  Mattison,  M.D. ; F.  H.  Macpherson 

Address:  STEPHEN  SMITH,  or  CHARLES  W.  THOMPSON,  Medical  Directors , Pasadena,  California 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 

of  the  differential  count  of  leukocytes  to  the  total  leuko- 
cyte count  is  also  defined. 

The  author’s  method  is,  for  the  most  part,  squarely 
based  upon  essentials  already  well  recognized  and  gener- 
ally accepted  by  medical  men,  and  this  circumstance  lends 
considerable  strength  and  plausibility  to  his  premise. 

In  effect  Doctor  Schilling  has  not  only  preserved  the 
advantages  of  Arneth’s  classification,  but  has  simplified 
and  amplified  similar  principles  in  such  a way  as  to  make 
them  more  immediately  applicable  to  clinical  practice. 

H.  A.  W. 


Roentgenographic  Technique — A Manual  for  Physicians, 
Students,  and  Technicians.  By  Darmon  Artelle  Rhine- 
hart.  Pp.  388.  Illustrated.  Philadelphia:  Lea  and 
Febiger,  1930.  Price,  $5.50. 

Quot  homines,  tot  sententiae — than  which  is  no  more 
adequate  expression  of  the  relation  between  roentgenolo- 
gists and  their  technical  methods.  Between  the  man 
who  professes  to  be  above  the  necessity  for  good  films 
and  boasts  of  his  ability  to  make  diagnoses  from  films 
the  technical  quality  of  which  is  beneath  contempt,  to 
the  other  who  spends  as  much  time  and  care  in  the 
minutiae  of  his  technical  procedures  as  he  does  on  his 
study  of  the  films  after  he  gets  them,  there  is  a broad 
gap  which  includes  all  the  practitioners  of  the  fascinating 
art  and  science. 

This  book  is  the  expression  of  one  man’s  method  and, 
as  such  books  go,  it  is  a good  one.  The  technique  it 
describes  is  not  above  criticism,  but  it  would  do  for  a 
beginner,  and  if  the  beginner  were  human  he  would  have 
his  own  methods  securely  on  tap  within  a year.  The 
author  would  have  done  well  to  have  devoted  a little 
more  space  to  the  fundamental  principles  of  detail  and 
contrast  and  methods  of  getting  the  most  satisfactory 
diagnostic  combinations  of  the  two.  The  simple  rules  of 
the  relations  between  photographic  quality  and  small 
focal  spots,  low  voltage,  high  milliamperage,  long  ex- 
posure time  and  secure  immobilization  are  so  funda- 
mental, so  easy  and  so  widely  neglected  that  it  would 
seem  impossible  to  overstress  them.  Any  intelligent  per- 
son who  knows  and  understands  them  can  do  good  techni- 
cal work  in  two  weeks.  Any  technician  who  does  not 
know  and  understand  them  will  never  be  really  con- 
versant with  the  limitations  or  the  potentialities  of  the 
art.  It  is  a pity  that  this  book  is  not  a little  more  spe- 
cific about  such  fundamentals.  J.  M.  R. 


Getting  Well  and  Staying  Well — A Book  for  Tuberculous 
Patients,  Public  Health  Nurses,  and  Doctors.  By 

John  Potts.  Second  edition.  Pp.  221.  St.  Louis:  The 
C.  V.  Mosby  Company,  1930. 

As  stated  in  the  subtitle,  this  is  a book  for  tuberculous 
patients,  public  health  nurses,  and  doctors. 

It  is  an  infinitely  practical  book,  written  primarily  for 
the  lay  reader,  yet  contains  much  information  acceptable 
to  the  physician  faced  with  the  personal  problems  of  a 
tuberculous  patient. 

The  first  chapters  deal  with  suspecting  tuberculosis  and 
the  importance  of  early  diagnosis.  The  saying  is  quoted, 


“People  don't  die  because  of  tuberculosis,  but  because 
of  ignorance  of  tuberculosis.”  Not  only  doctors,  but  the 
public  must  be  educated  into  recognizing  the  early  stages 
and  accepting  the  diagnosis  while  there  is  yet  good  hope 
of  recovery.  Too  many  people  ignore  the  possibility  in 
themselves  and  then  refuse  a competent  diagnosis,  be- 
cause they  do  not  fit  into  the  typical  lay  picture  of 
tuberculosis,  emaciation,  night  sweats,  and  hemorrhage. 

(Continued  on  Page  14) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


in  place  of  morphine 
as  a sedative,  analgesic  anti  hypnotic 
in  any  case  where  an  opiate 
is  indicated  and  see  whether 
you  do  not  prefer  its  action 

SOME  SPECIAL  INDICATIONS 
FOR  THE  USE  OF  PANTOPON 


In  respiratory  affections 

Coughs,  particularly  of  the  acute 
type,  dry  paroxysmal,  and  severely  rack- 
ing to  the  patient,  preventing  sleep. 
Add  1/24  gr.  of  Pantopon  to  each  dose  of 
your  expectorant. 

For  night  cough  of  tuberculosis 

Pantopon  proves  very  effective. 

In  asthmatic  attacks  use  Pantopon 
in  •/ 6 gr.  doses. 

For  prompt  pain-relief 

Acute  indigestion;  gall-stone  and 
renal  colics.  Use  ^ gr.  Pantopon  by 
injection  in  place  of  the  usual  % gr.  of 
morphine. 

In  fractures,  painful  injuries, 

etc.,  relieve  pain  and  induce  sleep  with 
Pantopon. 

In  carcinomas  and  other  inoper- 
able cases,  where  an  opiate  is  needed 
frequently  to  keep  patients  comfort- 
able,use  Pantopon  in  placcof  morphine. 

Locomotor  ataxia.  Try  Pantopon 
for  relief  in  the  crises. 

In  obstetrics 

For  the  pains  of  labor  Pantopon 
alone,  or  with  Scopolamine  Stable 
‘Roche’,  is  extensively  employed. 


In  heart  conditions 

In  angina  pectoris  Pantopon  is  used 
by  many  cardiologists  for  the  relief  of 
pain. 

In  cardiac  dyspnea  Pantopon  exerts 
a fine  sedative  influence,  a fact  frequent- 
ly reported  in  the  literature. 

For  rest  and  sleep 

In  pneumonia  and  influenza  try 

Pantopon,  % gr.,  orally  or  by  injection; 
or  % gr.  in  the  form  of  a cocoa  butter 
suppository. 

In  surgical  cases 

As  an  adjunct  to  anesthesia,  either 
1/6  gr.  by  injection  one  hour  before  and 
another  1/6  gr.  half  hour  before,  or  % 
gr.  half  hour  before. 

For  the  control  of  postoperative 
pain,  institutions  all  over  the  country 
use  Pantopon  in  place  of  morphine. 
Many  anesthetists  and  surgeons  are  em- 
phatic in  their  preference  for  Pantopon 
to  morphine. 

In  neurology  and  psychiatry 

For  highly  nervous  and  neurotic 
patients,  when  opiates  are  needed, 
neurologists  employ  Pantopon  in  place 
of  morphine. 


H gr.  Pantopon  is  usually 
given  instead  of  ^ gr. 
morphine  

for  SEDATION: 

from  Vu  to  Vi2  gr. 

for  PAIN  RELIEF: 

from  % to  XA  gr. 

for  COUGH: 

K 4 gr.  to  the  doit  in  prescrip - 
lions  in  place  of  codeine. 


Powder:  vials  of  l,  Yt,  V\ 
and  % oz 

Hypodermic  tablets:  gr. 
tubes  oj  20;  special  bottles 
1000  for  hospital  use.  . . . 


Ampuls:  gr.  ( 1.1  cc.) 

cartons  of  6 and  12;  special 
cartons  of  100  each  for  bos 
Pita l use 


Oral  tablets:  % gr.,  vials 
of  20 


Subject  to 

Federal  Narcotic  Regulations 

Hoffmann -LaRoche  .Inc. 

fMakcKT  qffMedicinw  of  Rare  Qualify 

NUTLEY  A NEW  JERSEY 


H 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


SUTTER  HOSPITAL 

Twenty-eighth  and  L 
SACRAMENTO,  CALIFORNIA 
Telephone  Main  7676 

Thoroughly  efficient  surgical,  medical,  ob- 
stetrical and  pediatrical  divisions,  supported 
by  exceptional  clinical  and  X-ray  laboratories, 
with  physical  therapy  and  dietetic  facilities. 
Graduate  staff  throughout.  Accredited  by 
A.  C.  S. 

A friendly  welcome  to  out-of-town  patrons 


SAINT  FRANCIS  HOSPITAL 

AND 

SCHOOL  OF  NURSING 

A General  Hospital  With  Accommodations  for  Three  Hundred  Patients 

DIRECTORS 

JOHN  GALLWEY,  M.  D.  W.  W.  WYMORE,  M.  D. 

W.  B.  COFFEY,  M.  D.  JOHN  H.  GRAVES,  M.  D. 

THOS.  E.  SHUMATE,  M.  D.  M.  O.  AUSTIN,  M.  D. 

Managing  Director,  L.  B.  ROGERS,  M.  D. 

Address  Communications 

SAINT  FRANCIS  HOSPITAL 

Bush  and  Hyde  Streets  Telephone  PROSPECT  7600  San  Francisco 


J.  H.  O’CONNOR,  M.  D. 
B.  A.  MARDIS,  M.  D. 
H.  E.  MANWARING 


ELASTIC  HOSIERY 

Seamed  or  Seamless 

Largest  Buyers  and 
Makers  of  Elastic  Hos- 
iery in  the  West.  All 
sizes,  weights  and  col- 
ors continuously  on 
hand.  For  extremely 
urgent  needs  we  can 
make  and  deliver  any 
special  Elastic  Stock- 
ing or  Belt  in  four 
hours’  time. 

Cooperation  With  the  Profession 

To  save  your  time,  we  will  gladly  demon- 
trate  any  C-G  Appliance  in  your  own 
office  or  in  our  store.  Make  an  appoint- 
ment to  suit  your  convenience. 

BELTS  r TRUSSES  i ELASTIC  WEAR 

Clark-Gandion  Co.,  Inc. 

Since  1903 

1108  Market  Street,  San  Francisco 
522  16th  Street,  Oakland 
26  Years  of  Expert  Truss  Fitting 


BOOK  REVIEWS 


(Continued  from  Page  12) 

After  the  diagnosis  is  made,  the  importance  to  the 
patient  of  “learning  tuberculosis’’  is  stressed.  The  pa- 
tient must  understand  the  road  which  has  to  be  followed, 
the  pitfalls  which  may  be  met  with  and  the  consequences 
which  will  surely  follow  if  he  loses  patience  and  strays 
from  the  road.  There  follows  a short  account  of  the 
needed  rest,  sleep,  and  diet,  which  constitute  the  “rest 
cure,”  and  the  essential  points  of  sanitation,  disposal  of 
sputum,  bedding  and  utensils,  and  the  importance  of 
ventilation.  The  mental  aspect  of  the  treatment  is  not 
forgotten — “peace,  quiet  and  cheerfulness,”  and  the 
avoidance  of  tactless  visitors,  conflicts  with  family  and 
friends  who  doubt  the  diagnosis  and  offer  advice. 

Later  chapters  deal  with  the  evidences  of  improvement, 
the  outlook,  and  the  causes  of  failure,  subsequent  dan- 
gers of  physical  strain,  acute  infections  and  pregnancy, 
and  the  importance  of  finding  suitable  employment  and 
submitting  to  check-up  examinations. 

All  through  the  book  the  economics  of  tuberculosis  are 
considered,  the  advantage  of  early  and  thorough  treat- 
ment, of  looking  ahead  to  the  expense  entailed  by  pro- 
longed rest,  and  avoiding  waste  of  money  by  urging  un- 
necessary change  of  climate.  H.  M.  D. 


The  Science  of  Nutrition  Simplified — A Popular  Introduc- 
tion to  Dietetics.  By  D.  D.  Rosewarne.  Pp.  314.  Illus- 
trated. St.  Louis:  The  C.  V.  Mosby  Company,  1929. 
Price,  $3.50. 

The  author  has  succeeded  very  well  in  outlining  the 
scientific  data  which  has  accumulated,  covering  the 
science  of  nutrition  in  such  a manner  that  the  ordinary 
person  may  be  able  to  settle  questions  of  diet  satisfac- 
torily. 

The  first  part  of  the  book  is  devoted  to  a complete 
statement  in  simplified  terms  of  the  nutritional  needs  of 
the  organism,  and  has  then  gone  on  to  show  how  those 
needs  are  satisfied  by  the  different  nutriments. 

A chapter  preceding  the  discussion  of  the  necessity  of 
the  organism  for  various  foodstuffs,  is  devoted  to  pre- 
liminary considerations  which  outlines  in  general  the 
object  of  dietetics  and  the  function  of  foods. 

The  book  is  very  well  written,  quite  conservative,  accu- 
rate, and  suitable  for  the  lay  mind  as  well  as  for  many 
physicians  whose  sorties  into  the  field  of  dietetics  are 
limited. 

It  should  be  stated  that  the  book  does  not  enter  into 
the  discussion  of  the  science  of  nutrition  as  applied  to 
pathological  conditions.  It  is  limited  to  the  normal  indi- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


*5 


vidual  except  that  there  is  a short  chapter  on  the  special 
diets  to  be  used  in  childhood,  pregnancy,  and  that  type  of 
obesity  which  results  from  dietetic  errors. 

Finally  a group  of  accurate  food  tables  are  appended. 

H.  C.  S. 


Stone  and  Calculous  Disease  of  the  Urinary  Organs.  By 

J.  Swift  Joly.  Pp.  568.  Illustrated.  St.  Louis:  The 
C.  V.  Mosby  Company,  1929.  Price,  $16. 

From  the  very  first  chapter  of  this  exceptional  volume, 
one  is  fascinated  by  its  readability  and  impressed  with 
the  care  that  has  been  taken  with  its  preparation. 

For  over  twenty  years  no  book  has  appeared  devoted 
exclusively  to  stone  and  calculous  disease  of  the  urinary 
organs,  and  this  book  fills  a long-felt  want  in  this  respect. 

The  author  begins  his  book  with  a very  erudite  yet 
extremely  interesting  history  of  stone,  from  the  earliest 
records,  and  prepares  one  by  the  scholastic  handling  of 
this  subject  for  the  chapters  that  follow. 

From  then  on  he  follows  the  question  in  a most  thor- 
ough and  complete  manner,  beginning  with  the  chapter 
devoted  to  the  composition  and  formation  of  oalculi,  their 
characteristics  and  etiology,  wherein  is  shown  the  results 
of  studies  in  the  fields  of  physics,  chemistry,  and  physio- 
logical chemistry. 

The  remainder  of  the  volume  deals  with  the  distribu- 
tion anatomically  of  stones  and  their  treatment,  both 
medical  and  surgical.  Differential  diagnosis  is  carefully 
considered  and  the  surgical  side  is  presented  in  very 
complete  detail,  including  the  complications  that  might 
present  themselves. 

Throughout  this  volume  adequate  illustrations  are 
present,  closely  following  the  text. 

Thirty-four  pages  are  devoted  to  a very  able  discussion 
of  calculous  anuria  with  the  indications  for  operative  or 
nonoperative  treatment.  Each  chapter  has  a rather  com- 
plete bibliography  appended. 

This  book  is  to  be  highly  recommended  to  the  general 
practitioner  and  to  the  specialist  as  being  both  instruc- 
tive and  tremendously  interesting  as  well.  S.  O. 


Surgical  Diseases  of  the  Thyroid  Gland.  By  E.  M.  Eberts, 
with  the  assistance  of  R.  R.  Fitzgerald  and  Philip  G. 
Silver.  Pp.  238.  Illustrated.  Philadelphia:  Lea  and 
Febiger,  1929. 

Doctor  Eberts  has  written  a small  volume  on  the  thy- 
roid gland  which  should  find  a ready  welcome  from  the 
medical  profession.  It  is  a contribution  which  will  be 
appreciated  by  those  having  a special  interest  in  thyroid 
disease  because  of  the  excellent  bibliographs  and  the 
readily  available  data  upon  all  angles  of  the  thyroid  ques- 
tion. To  the  general  practitioner  it  should  be  of  great 
value  as  a guide  in  thyroid  disturbances,  and  to  the 
student  I would  be  happy  to  offer  it  as  a thyroid  bible. 

The  chapters  on  embryology,  anatomy,  physiology,  and 
pathological  physiology  cover  these  subjects  in  a concise 
and  accurate  manner,  mentioning  the  controversial  points 
but  not  dragging  the  reader  into  a maze  of  discussion 
on  the  unsettled  phases.  In  the  section  on  pathology, 
choice  of  the  term  “adenoid  goiter’’  for  the  pathological 
entity  of  Graves’  disease,  known  to  most  American 
writers  as  hyperplasia,  is  unfortunate  because  of  its  simi- 
larity to  adenoma.  However,  with  the  present  unsettled 
state  of  classification  in  thyroid  disease,  no  present-day 
pathological  classification  is  entirely  satisfactory.  Doctor 
Eberts’  tabulation  could  be  simplified  to  advantage. 

The  pathological  criteria  of  malignancy  are  ably  dis- 
cussed, and  the  reader’s  appetite  for  further  study  is 
whetted  by  reference  to  the  foremost  writers  on  this  sub- 
ject. The  author  has  failed  to  mention  the  extreme  diffi- 
culty often  found  in  differentiating  malignancy  from 
certain  types  of  thyroiditis.  His  reference  to  parathyroid 
tumors  is  of  unusual  interest. 

The  clinical  sections  of  Doctor  Eberts’  work,  based 
upon  the  study  of  twenty-two  hundred  cases,  are  mines 
of  practical  information.  The  author’s  careful  methods 
of  study,  and  equally  careful  follow-ups,  are  reflected 
through  each  page  of  these  sections.  A simple  clinical 
classification  of  goiters,  with  adequate  criteria  for  differ- 
ential diagnosis,  make  the  work  especially  valuable.  One 
is  given  the  benefit  of  the  author’s  large  experience  in 
deciding  the  type  of  treatment.  His  plan  of  preoperative 
preparation  in  Graves’  disease  is  worthy  of  particular 
attention. 

It  is  surprising  that  only  one  unilateral  and  no  bilateral 
vocal  cord  palsies  have  occurred  in  over  one  thousand 
operative  cases,  and  still  more  surprising  that  no  case  of 
postoperative  tetany  has  been  seen.  For  this  reason  the 
author  has  failed  to  emphasize  the  danger  of  nerve  injury 
in  the  small  gland  seen  in  certain  cases  of  Graves’  dis- 
ease, or  the  ever-present  menace  of  postoperative  tetany 
in  removal  of  aberrant  parathyroid  bodies  in  any  type 
of  goiter. 

The  data  contained  in  the  chapter  on  malignant  dis- 
ease is  worthy  of  publication  as  a separate  monograph, 
and  is  a real  contribution  to  the  rather  scant  literature 
on  this  subject  by  American  writers.  The  incidence  of 
malignancy  in  the  series  is  similar  to  that  of  other 
American  clinics,  and  the  prognosis  rather  better.  It  is 
gratifying  to  note  the  uniformity  with  which  surgeons 
of  considerable  experience  in  thyroid  work  recommend 
early  operation  upon  adenomatous  goiters  as  a cancer 
preventive.  This  is  a logical  conclusion  in  the  Montreal 
Clinic,  where  90  per  cent  of  cancers  came  from  pre- 
existing adenomata,  and  three  per  cent  of  all  adenoma- 
tous goiters  operated  upon  proved  malignant. 

(Continued  on  Next  Page) 


a new  Tilting  Table 

l„  Keleket 


The  Keleket  Automatic  Motor  Driven 
Tilting  Table  is  a brilliant  revelation  in 
Tilting  Table  design.  It  possesses  those  ex- 
clusive Keleket  qualifications  of  simplified 
operation,  adequate  protection  and  amazing 
performance  that  make  it  the  most  efficient 
Table  ever  offered  to  the  Medical  Profession. 

Every  feature  of  practicality  that  the 
modern  Diagnostician  could  desire,  is  em- 
bodied in  this  ultimate  achievement  of  en- 
gineering skill.  Complete  descriptive  litera- 
ture is  now  available. 


^eiKibii.iiFii-iMinEinr  mm  c w™ 

Cooiny  ton.  Kentucky  t/SA. 

Pacific  Coast  Branches 
San  Francisco  Los  Angeles 

278  Post  Street  1401  S.  Hope  Street 

Tel. : SUtter  7431  Tel. : WEstmore  5972 


i6 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ANNOUNCEMENT 


OUT  OF  TOWN  PHYSICIANS  ARE  CORDIALLY  INVITED  TO  ATTEND  CLINICAL  DEMONSTRATIONS  OF  THE  MORE 
IMPORTANT  UROLOGICAL  DISEASES.  ARRANGEMENTS  ARE  AVAILABLE  FOR  THE  EXAMINATION.  STUDY  AND 
TREATMENT  OF  CASES  WITH  CYSTOSCOPIC  DEMONSTRATIONS.  A COURSE  IN  CYSTOSCOPY  WITH  URETERAL 
CATHETERIZATION,  KIDNEY  FUNCTIONAL  TESTS,  PYELOGRAPHY,  FULGU RATION  OF  BLADDER  TUMORS,  ETC., 
WILL  BE  GIVEN. 

FOURTEENTH  FLOOR-FOUR-FIFTY 

LOUIS  CLIVE  JACOBS,  M.  D.,  Urologist  san  FRANcfscof  California 


OFFICES  FOR  THE  MEDICAL  AND  DENTAL  PROFESSION 

FOR  RENT 

THE  BUTLER  BUILDING 

Southwest  Corner  Geary  and  Stockton  Streets 

Facing  Union  Square 
NOW  UNDER  MANAGEMENT  OF 

BUCKBEE,  THORNE  & CO. 

151  SUTTER  STREET  DAvenport  7322 


SUGARMAN  CLINICAL  LABORATORY 


SUITE  1439 


450  Sutter  Street 

Telephone:  DAvenport  0342 


San  Francisco,  Calif. 

Emergency:  WEst  1400 


BOOK  REVIEWS 


(Continued  from  Preceding  Page) 

I feel  that  Doctor  Eberts'  book  fills  a real  need  in  medi- 
cal literature.  It  is  a guide  book  to  one  who  would  in- 
crease his  knowledge  of  thyroid  disease.  The  under- 
graduate, the  internist,  the  surgeon,  and,  perhaps  espe- 
cially, he  who  is  a student  of  this  subject,  each  will  find 
profit  in  this  book,  and  will  find  also  that  pleasure  which 
comes  from  the  perusal  of  what  has  been  well  pondered 
and  what  is  well  expressed.  R.  W. 


The  Pathology  of  the  Eye.  By  Jonas  S.  Friedenwald. 
Pp.  253.  Illustrated.  New  York,  The  Macmillan  Com- 
pany, 1929. 

Good  textbooks  on  pathology  of  the  eye  have  been  so 
hard  to  find  up  to  the  present  time  that  any  book  on  this 
subject  would  have  been  very  welcome.  But  having  this 
want  supplied  by  a book  of  such  excellence  as  this  one 
by  Doctor  Friedenwald  has  caused  much  rejoicing  among 
those  interested  in  the  study  of  the  pathological  changes 
in  the  human  eye. 

The  book  contains  over  two  hundred  and  fifty  very 
excellent  illustrations,  which  are  remarkable  for  the  flaw- 
less reproduction  of  microscopic  details.  In  the  text,  em- 
phasis has  been  laid  upon  the  reactions  of  various  parts 
of  the  eye  to  similar  diseases  and  injuries,  as  well  as  the 
similarity  between  ocular  disease  and  disease  in  other 
organs.  As  the  author  states,  “The  aim  is  rather  to  form 
a bridge  leading  from  general  pathology  to  this  special 
field.  . . . ’’ 

Throughout  the  work  the  author  has  put  down  original 
observations,  many  not  previously  published.  Results  of 
some  experimental  work  is  also  given  for  the  first  time. 

A valuable,  brief  review  of  ocular  anatomy  and  physi- 
ology opens  the  book.  D.  P. 


Hypertension  and  Nephritis.  By  Arthur  M.  Fishberg. 
Pp.  566.  Illustrated.  Philadelphia:  Lea  and  Febiger, 
1930. 

Doctor  Fishberg’s  book  is  an  excellent  r§sum£  of  our 
present  knowledge  in  the  field  of  hypertension  and  neph- 
ritis. In  the  presentation  of  this  material,  the  author 
makes  good  his  claim  that  the  book  is  “written  primarily 
from  the  point  of  view  of  the  actual  practice  of  medicine.’’ 

The  first  ten  chapters  of  the  book  are  devoted  to 
pathological  physiology  of  the  kidney.  Here  the  unitary 
nature  of  impairment  of  renal  function  is  advocated,  and 
a welcome  simplicity  of  functional  testing  of  the  kidney 
proposed.  This  part  of  the  book  also  stresses  the  dis- 


tinction between  impairment  of  renal  function  and  renal 
insufficiency;  and  discusses  compensation  and  decompen- 
sation in  impairment  of  renal  function.  In  addition,  the 
author’s  concepts  of  "hypertensive  encephalopathy’’  and 
“hypertensive  retinitis”  do  much  to  simplify  our  under- 
standing of  uremia  and  other  end  stages  of  Bright’s  dis- 
ease by  removal  of  certain  factors  which  are  still  largely 
regarded  as  part  and  parcel  of  these  end  stages. 

In  the  clinical  part  of  the  book,  consisting  of  fourteen 
chapters.  Doctor  Fishberg  follows  essentially  the  classifi- 
cation of  nephritis  proposed  by  Volhard  and  Fahr;  and 
his  handling  of  the  subject  is  thoroughly  sound  and  con- 
servative. Especially  gratifying  is  the  author’s  point  of 
view  on  treatment  in  which  he  steers  a middle  course, 
basing  the  degree  of  dietary  restriction  on  the  severity 
of  renal  insufficiency.  This  principle,  which  is  widely 
recognized  in  its  application  to  cardiac  insufficiency, 
justly  deserves  emphasis;  also  in  relation  to  the  func- 
tional state  of  the  kidneys. 

The  last  chapter  deals  with  renal  and  hypertensive 
disease  in  pregnancy.  T.  L.  A. 


Selected  Readings  in  Pathology  From  Hippocrates  to  Vir- 
chow. Edited  by  Esmond  R.  Long.  Pp.  301.  Illus- 
trated. Baltimore:  Charles  C.  Thomas,  1929.  Price,  $4. 

The  author,  who  is  a professor  of  pathology  in  the 
University  of  Chicago,  has  read  over  the  works  of  the 
masters  in  pathology  and  has  selected  from  their  writings 
examples  of  their  important  communications.  He  has 
varied  his  selections  most  admirably  and  has  brought 
together  the  excogitations  of  the  great  minds  of  almost 
every  country  and  century. 

The  time  covered  reaches  from  Hippocrates  (460  B.  C.) 
to  Virchow  (1858).  The  countries  of  the  men  touched  on 
are  Greece,  Rome,  Arabia,  Italy,  France,  Holland,  Eng- 
land, Ireland,  Austria,  Germany,  and  America. 

America  is  represented  by  three  names.  These  are 
Horner,  with  an  excerpt  from  the  first  pathology  written 
in  America;  Gerhard,  whose  example  tells  of  the  separa- 
tion Of  typhus  and  typhoid  fever;  and  the  illustrious  name 
of  Samuel  Gross,  who  wrote  the  first  accepted  text  on 
pathologic  anatomy. 

This  volume,  read  in  combination  with  Long’s  other 
book,  “The  History  of  Pathology,”  will  lay  a proper  his- 
torical foundation  for  the  student  entering  pathology. 

Every  physician  can  get  a thrill  from  this  book.  Read 
Celsus  on  the  signs  of  inflammation;  Galen  on  diabetes; 
Rhazes  on  smallpox;  Fracastoro  on  syphilis;  Wlepfer  on 
apoplexy;  Sylvius  on  tuberculosis;  Lancisi  on  sudden 
death  and  forensic  medicine;  Astruc  on  venereal  dis- 
eases; Laennec  on  tuberculosis;  Bright  on  nephritis; 

(Continued  on  Page  18) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


n 


A Product  Worthy  of  the  Name . . . 

A Name  Worthy  of  the  Product 

Because  of  its  purity,  effectiveness,  and  dependability 

DIGIFOLINE,  “CIBA” 

stands  out  as  a truly  remarkable  digitalis  preparation. 

Many  leading  cardiologists  have  adopted  Digifoline, 
“Ciba”  in  their  daily  practice,  and  are  using  the  liquid 
and  tablets  for  oral  and  rectal  administration,  and  the 
ampules  for  intravenous,  intramuscular,  and  subcuta- 
neous injection.  Digifoline,  “Ciba”  contains  the  heart 
influencing  glucosides  of  the  digitalis  leaf  and  is  free 
from  any  inert  irritating  or  disturbing  foreign  substances. 


We  will  gladly  send  you 
a trade -size  package  of 
Digifoline,  “ Ciba”  for 
clinical  tests....  Simply 
address  us,  using  your 
letterhead. 


CIBA  COMPANY,  INC.,  NEW  YORK  CITY 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


18 


CANYON  SANATORIUM  the  Treatment  of  Tuberculosis 

REDWOOD  CITY,  CALIFORNIA 


NESTLED  IN  THE  FOOTHILLS 

For  particulars  address  RALPH  B.  SCHEIER,  M.  D.,  MEDICAL  DIRECTOR 
490  Post  Street  San  Francisco,  California  Telephone  DOuglas  4486 


The  Scripps 
Metabolic  Clinic 

For  the  treament  and  investigation  of: 
Diabetes,  Nephritis,  Obesity, 
Thyroid  Disturbances  and 
Cardiac  Diseases. 

James  W.  Sherrill,  M.  D. 
Director 

Located  at  La  Jolla,  San  Diego, 
California,  noted  for  its  scenic 
beauty  and  mild,  equable  climate. 
The  institution  is  at  the  ocean’s 
edge,  at  the  foot  of  Soledad 
Mountain.  Non-sectarian  in  char- 
acter and  not  conducted  for  profit. 


BOOK  REVIEWS 


(Continued  from  Page  16) 

Louis  on  statistics  on  medicine;  Hodgkin  on  Hodgkin’s 
disease;  Corrigan  on  aortic  insufficiency;  Andral  on  hema- 
tology; Addison  on  Addison’s  disease;  and  Virchow  on 
thrombosis  and  embolism  and  his  lecture  on  cellular 
pathology.  If  these  do  not  give  a feeling  of  admiration 
for  these  minds  and  feeling  of  healthy  humility,  the  spirit 
is  not  in  you. 

The  book  is  beautifully  printed  and  bound  in  the  well- 
known  manner  of  Thomas  the  publisher.  Z.  E.  B. 


Minor  Surgery.  By  Frederick  Christopher,  with  a fore- 
word by  Allen  B.  Kanavel.  Pp.  694.  Illustrated. 
Philadelphia  and  London;  W.  B.  Saunders  Company, 
1929. 

In  this  day  of  specialization  and  overemphasis  on  the 
problems  of  major  surgery,  we  have  lost  sight  to  a large 
extent  of  the  everyday  minor  accidents  that  befall  human 
beings.  It  is  the  successful  treatment  of  these  types  of 


cases  that  in  the  eyes  of  the  laity  often  stamps  the 
doctor  as  being  good  or  bad. 

Doctor  Christopher’s  recent  excellent  work  on  minor 
surgery  is  a real  contribution  in  helping  the  profession 
to  successfully  treat  this  type  of  case.  This  work  is 
unique  in  that  it  not  only  gives  detailed  technique  in  the 
diagnosis  and  treatment  of  every  possible  problem  of 
minor  surgery,  but  at  the  same  time  offers  a compre- 
hensive review  of  the  various  methods  with  complete 
bibliography  on  almost  every  page  of  the  text. 

The  section  on  treatment  of  bone  injuries  and  the  ap- 
plication of  splints  and  plaster  of  Paris,  is  especially 
to  be  commended  for  the  minuteness  of  the  detail  which 
is  so  important  in  this  type  of  work.  The  problem  of 
so-called  minor  infections  which  so  often  is  the  pitfall  of 
the  general  practitioner  is  thoroughly  and  accurately 
discussed. 

It  is  really  difficult  to  begin  to  comment  on  individual 
chapters  of  this  book,  as  the  more  one  studies  it  the 
more  impressive  it  becomes,  so  that  finally  one  is  led  to 
the  conclusion  that  it  is  the  finest  work  to  date  on  the 
subject  of  minor  surgery  and  can  be  recommended  with- 
out hesitation  to  the  medical  student,  the  intern,  the 
general  practitioner,  and  the  specialist  in  surgery. 

F.  I.  H. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


19 


The  Doctors  Business  Bureau 

701-705  Balboa  Building 

SAN  FRANCISCO,  CALIFORNIA 

Fourteen  years  of  successful  and  satisfactory  service  to  doctors. 

More  than  eighteen  hundred  members  of  the  California  Medical  Association  are  using  the 
Bureau  to  their  advantage. 

At  the  urgent  solicitation  of  doctors  in  Sonoma  County  and  vicinity  an  office  has  been  estab- 
lished at  Santa  Rosa. 

(Ask  the  Sonoma  County  Medical  Society  about  it.) 

Collection  stamps  service  for  your  own  office  use  is  recommended  for  economy  and  efficiency. 
Every  account  referred  to  the  Bureau’s  Collection  Department  receives  the  most  careful  and 
confidential  personal  attention. 

TELEPHONE  OR  WRITE  FOR  PARTICULARS 

COLLECTION  DEPARTMENT 

THE  DOCTORS  BUSINESS  BUREAU 

Balboa  Building,  San  Francisco,  California 

SANTA  ROSA  Phone  GARFIELD  0460  LOS  ANGELES 

BONDED  LICENSED 


TRUTH  ABOUT  MEDICINES 

New  and  Nonofficial  Remedies 

(Abstracts  from  reports  of  Council  on  Pharmacy  and 
Chemistry,  A.  M.  A.) 

In  addition  to  the  articles  previously  enumerated, 
the  following  have  been  accepted: 

Mead,  Johnson  & Co.— Mead’s  Dextri-Maltose  with 
Vitamin  B. 

Parke,  Davis  & Co. — Ampoules  of  Pitocin,  0.5  cc. 

Diphtheria  Toxin-Antitoxin  Mixture  0.1  L Plus 
Nonsensitizing  (Sheep). — A diphtheria  toxin-antitoxin 
mixture  (New  and  Nonofficial  Remedies,  1929,  p.  360), 
each  cubic  centimeter  of  which  constitutes  a single 
dose  of  diphtheria  toxin  neutralized  with  the  proper 
amount  of  antitoxin  produced  from  sheep.  It  is 
marketed  in  packages  of  three  vials,  each  containing 
one  cubic  centimeter;  in  packages  of  one  vial  con- 
taining 10  cubic  centimeters;  in  packages  of  one  vial 
containing  30  cubic  centimeters;  and  in  packages  of 
thirty  vials,  each  containing  one  cubic  centimeter. 
United  States  Standard  Products  Co.,  Woodworth, 
Wisconsin. 

Tablets  Tutocain  No.  6.— Each  tablet  contains  tuto- 
cain  (New  and  Nonofficial  Remedies,  1929,  p.  51), 
0.05  gram.  Winthrop  Chemical  Co.,  Inc.,  New  York. 

Ampoules  of  Pitocin  0.5  Cubic  Centimeter. — Each 
ampoule  contains  more  than  0.5  cubic  centimeter  of 
pitocin  solution.  Parke,  Davis  & Co.,  Detroit. — Jour. 
A.  M.  A.,  July  13,  1929,  p.  117. 

Merthiolate  Jelly  1:2000. — It  contains  merthiolate 
(Jour.  A.  M.  A.,  December  7,  1929,  p.  1809),  0.05  per 
cent,  eucalyptol  0.016  per  cent,  eugenol  0.016  per  cent 
in  a water-soluble  base.  Eli  Lilly  & Co.,  Indianapolis. 

Merthiolate  Ointment  1:1000. — It  contains  merthio- 
late (Jour.  A.  M.  A.,  December  7,  1929,  p.  1809)  0.1 
(Continued  on  Page  23) 


Alum  Rock  Sanatorium 
TUBERCULOSIS 


Situated  at  1,000  feet  elevation  on  the  Eastern 
foothills  of  San  Jose,  California,  six  miles  from 
the  center  of  the  city. 

Limited  to  Twenty-Eight  Patients 

RATES  AND  FOLDER  ON  APPLICATION 


Consultants: 

Dr.  Philip  King  Brown 
Dr.  George  H.  Evans 
Dr.  Leo  Eloesser 


Medical  Superintendent 
Chas.  P.  Durney,  M.  D. 
Phone  Ballard  6144 


20 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Surgeons  using  the  Waiss  hollow 
needle  express  themselves  as  being 
delighted  with  its  adaptability  in 
suturing,  stating  that  it  greatly 
facilitates  their  work.  No  bother 
with  pliers!  No  doubled  sutures. 
But — a needle  and  holder  that  work 
smoothly  and  efficiently  at  all  times. 


WAISS 

D=a  © 1LILOW 

Surgical  Needle 

ana  Holder 

jor 

MODERN 
SUTURY 


MODEL  B-l 

Waiss  hollow  needle  with 
automatic  type  holder, 
containing  magazine  for 
spool  of  suture  material. 
Inset  shows  point  of 
needle  enlarged,  with  view 
of  hollow  through  which 
suture  passes. 


The  Waiss  hollow  needle  deposits  a single  strand  of  suture  within  the  wound  or 
incision,  leaving  it  in  situ,  ready  for  tying.  No  part  of  the  suture  comes  in 

contact  with  the  flesh  except  that  which  actually  remains  therein.  / 

/ 


Waiss  hollow  needles  are 
made  in  all  standard 
types  and  sizes,  for  use 
with  any  brands  of  su- 
tures desired. 


Waiss  holders  are  made  in  three 
models,  with  either  plain  or 
grooved  handles.  Needles  and 
holders  are  guaranteed  to  be 
free  of  mechanical  defects. 


/ 

/ 

/ 

/ 

/ 

/Brackwood 
Corporation, 
/ Ltd., 


/ 6331  Hollywood 
• Boulevard, 

/ Los  Angeles,  Calif. 

Send  the  Coupon  Today  / 

/ Please  send  me,  without 
' obligation,  photographs 
/ and  complete  information 
* regarding  Waiss  needles  and 

BRACKWOOD  CORPORATION,  Ltd.  /ho,ders 

6331  HOLLYWOOD  BOULEVARD  / Name 

. Address 

LOS  ANGELES  CALIFORNIA  / 

• City State 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


21 


— 

The  Pediatrician’s  Formula 

The  first  suggestion  for  the  prepara- 
tion of  Mead’s  Dextri-Maltose  came 
from  pediatricians.  Naturally,  their 
preference  for  this  particular  fot  m of 
carbohydrate  is  back  of  its  very  con- 
ception. Dextri-Maltose  brings  moth- 
ers with  their  babies  back  to  your 
office,  not  only  because  of  its  clinical 
results,  but  because  it  satisfies  the 
mother  that  her  baby  is  receiving 
individual  attention — that  it  is  get- 
ting “a  formula”. 

From  your  viewpoint,  this  mother- 
psychology  is  all  the  more  an  import- 
ant point  of  medical  economics,  be- 
cause there  are  no  feeding  directions 
or  descriptive  circulars  in  the  pack- 
ages of  Dextri-Maltose.  It  is  truly  the 
doctor’s  formula. 


DEXTRI-MALTOSE  NOS  1,  2 AND  3,  SUPPLIED  IN  I LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITERATURE  ON 
REQUEST.  MEAD  JOHNSON  & CO  . EVANSVILLE,  IND  .USA 


Dextri-Maltose  for 
Modifying  Lactic  Acid  Milk 

In  using  lactic  acid  milk  for  feeding 
infants,  physicians  find  Dextri- 
Maltose  the  carbohydrate  of  choice: 

To  begin  with,  Dextri-Maltose  is  a 
bacteriologicaliy  clean  product,  un- 
attractive to  flies,  dirt,  etc.  It  is  dry, 
and  easy  to  measure  accurately. 

Moreover,  Dextri-Maltose  is  prepared 
primarily  for  infant  - feeding  pur- 
poses by  a natural  diastatic  action. 

Finally,  Dextri-Maltose  is  never  ad- 
vertised to  the  public  but  only  to  the 
physician,  prescribed  by  him  ac- 
cording to  the  individual  require- 
ments of  each  baby. 


DEXTRI-MALTOSE  NOS  1,  2 AND  3,  SUPPLIED  IN  1-LB  AND 
5-LB  TINS  AT  DRUGGISTS  SAMPLES  AND  LITER ATURE  ON 
REQUEST,  MEAD  JOHNSON  & CO  , EVANSVILLE.  IND  . U S A 


standardized  activated 


ergosterol,  from  Acterol 


to  Mead’s  Viosterol  in  Oil, 


Because  we  have  changed  the  name 


of  the  American  pioneer 


MEAD’S  VIOSTEROL, 
COUNCIDACCEPTED 
Licensed  by  Wisconsin 
Alumni  Research  Founda- 
tion. Supplied  in  S cc.  and 
50  cc.  bottles  with  stand- 
ardized dropper.  Patients 
will  find  the  large  size 
econimical.  Due  to  the 
recent  change  in  name,  it  1 
is  now  necessary  to  specify 
Mead's,  to  get  the  Ameri-  j 
can  pioneer  product.  ! 

FOR  RICKETS,  TETANY  * 

AND  OSTEOMALACIA 

.....  


MEAD  JOHNSON  & CO.,  EVANSVILLE,  IND. 


100  D,  it  is  important  that 
our  medical  friends  who 
know  the  rich  laboratory 
and  clinical  background  of 
Acterol  specify  MEAD’S 
Viosterol  in  order  to  get 
the  same  identical  product. 


22 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ALQUA  FOR  ACIDOSIS 


“RpH  (alkaline  reserve)  values  of  8.4  to  8.55  are  normal  for  adults.  It  has 
been  Marriott’s  experience  that  if  the  RpH  does  not  fall  below  7.9,  the 
acidosis  may  be  successfully  combated  by  administration  of  ALKALIES 
by  mouth.” 


ACIDOSIS — An  intoxication  with 
Acid  toxins  and  a corresponding 
lessening  of  the  Alkaline  Reserve 
(RpH),  is  present  in  nearly  all 
acute  and  chronic  diseases. 

ALQUA  WATER — contains  all  the 
ALKALINE  SALTS  necessary 
to  neutralize  ACIDOSIS  and 
maintain  the  normal  RpH. 


ALQUA  WATER— In  addition  to 
the  virtues  of  ordinary  alkaline 
waters,  Alqua  has  the  distinct 
advantage  of  being  prepared  from 
pure,  glacier  water  from  Mount 
Shasta. 

To  insure  a palatable  water  of 
uniform  alkalinizing  power  an 
absolutely  pure  water  supply  is 
essential.  Glacier  water  is  the 
purest  water  found  in  nature. 


Have  your  patient  order  ALQUA  by  the  case.  (12  full  quarts) 

It  is  more  economical. 


The  Shasta  Water  Company 

Bottlers  and  Controlling  Distributors 
San  Francisco,  Oakland,  Sacramento,  Los  Angeles,  Calif.,  U.  S.  A. 

At  All  Druggists 


SOUTHERN  SIERRAS  SANATORIUM 

For  Tuberculosis  and  Allied  Affections 

BANNING,  CALIFORNIA 

Climate  Favorable  Throughout  The  Year 


Many  aids  for  comfort  and  convenience. 
Simmons’  Beautyrest  mattresses  throughout. 
Radio  connection  in  each  apartment. 


Tempting,  tasteful  foods  prepared  by  a woman  cook. 
Special  dietaries  when  required. 

A spot  of  beauty  in  an  atmosphere  of  contentment. 


RATES  WITHIN  THE  MEANS  OF  THE  AVERAGE  PATIENT 


A REPUTATION  FOR  SERVICE  AND  SATISFACTION 


Charles  E.  Atkinson,  M.  D. 
Medical  Director 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


23 


ST.  LUKE’S  HOSPITAL 


SAN  FRANCISCO 


ACCREDITED  FOR  INTERN  TRAINING  BY  THE  AMERICAN  MEDICAL  ASSOCIATION 

A limited  general  hospital  of  200  beds  admitting  all  classes  of  patients  except  those  suffering 
from  communicable  or  mental  diseases.  Organized  in  1871,  and  operated  by  a Board  of 
Directors,  under  the  direct  supervision  of  the  Executive  Committee  of  the  Medical  Staff. 


BENJAMIN  H.  DIBBLEE 
President 


EXECUTIVE 

COMMITTEE 

Alanson  Weeks,  M.D. 
Chairman 

W.  G.  Moore,  M.D. 

Harold  P.  Hill,  M.D. 

Geo.  D.  Lyman,  M.D. 

Howard  H.  Johnson, 
M.  D.,  Med.  Dir. 
Secretary,  Executive 
Committee. 


I.  C.  KNOWLTON 
Secretary 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  19) 

per  cent  in  a petrolatum  base.  Eli  Lilly  & Co.,  In- 
dianapolis.— Jour.  A.  M.  A.,  April  19,  1930,  p.  1237. 

FOODS 

The  following  products  have  been  accepted  as  con- 
forming to  the  rules  of  the  Committee  on  Foods  of 
the  Council  on  Pharmacy  and  Chemistry  of  the 
American  Medical  Association: 

Klim  Powdered  Whole  Milk  (Merrell-Soule  Co.). — - 

It  is  whole  milk  from  which  all  but  about  2 per  cent 
or  less  of  the  normal  water  has  been  removed  by 
means  of  the  spraying  process  of  drying  milk.  It 
contains:  fat,  28.0  per  cent;  protein,  26.7  per  cent; 
lactose,  38.0  per  cent;  ash,  5.8  per  cent;  water,  1.5 
per  cent.  Klim  milk  is  used  for  supplementary  feed- 
ing to  be  used  according  to  a physician’s  formula. 

Borden’s  Natural  Flavor  Malted  Milk  (The  Borden 
Company,  New  York). — It  is  a processed  mixture  of 
barley  malt,  wheat  flour,  and  whole  milk,  reduced  to 
powdered  form.  The  product  contains:  fat,  9.2  per 
cent;  protein,  15.5  per  cent;  lactose,  13.5  per  cent; 
maltose,  35.6  per  cent;  dextrin,  20.2  per  cent;  ash, 
3.8  per  cent;  moisture,  2.2  per  cent.  It  is  easily 
digested. 

Mellin’s  Food  (Mellin’s  Food  Company,  Boston). — 

It  is  a milk  modifier.  It  contains:  fat,  0.16;  protein, 
10.35;  maltose,  58.88;  dextrins,  20.69;  soluble  carbo- 
hydrates, 79.57;  salts,  4.30;  water,  5.62.  Mellin’s  Food 
is  a soluble,  easily  digestible  dry  extract  made  from 
wheat  flour,  wheat  bran,  malted  barley,  and  potassium 
bicarbonate. 

Mellin’s  Food  Biscuits  (Mellin’s  Food  Company, 
Boston). — They  contain  a large  percentage  of  Mellin’s 
Food. — Jour.  A.  M.  A.,  April  12,  1930,  p.  1145. 

(Continued  on  Page  26) 


HAY 

FEVER 

has  been  prevented  in 
thousands  of  cases  ivith 

Pollen  Antigen 

J&ederle 

Prophylactic  Treatment 

may  be  commenced  as  late  as  two  weeks 
before  the  date  of  the  expected  attack. 
Fifteen  graduated  doses  of  an  appropriate 
Antigen  are  required.  Patients  usually 
suffer  little  inconvenience  from  the  in* 
jections,  and  many  are  completely  pn> 
tected  from  Hay  Fever  attacks. 

Full  information  upon  request 

Lederle  Laboratories 

INCORPORATED 


n New  York 


U 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


PARK  SANITARIUM 

Corner  Masonic  Avenue  and  Page  Street,  San  Francisco 

For  the  care  and  treatment  of  Nervous  and  Mental  Diseases,  Selected 
Alcohol  and  Drug  Addiction  Cases. 

Open  to  any  physician  eligible  to  the  American  Medical  Association.  Patients 
referred  by  physicians  remain  under  their  care  if  desired. 

V.  P.  Mulligan,  M.  D. 

Medical  Director 

Cars  Nos.  6,  7,  and  17  Telephone  MArket  0331 


Stool  Examination 

In  response  to  numerous  requests  the  services  of  a 
laboratory  dealing  exclusively  with  tropical 
diseases  are  offered  the  medical  profession 
for  the  examination  of  stools  with 
especial  reference  to  parasites. 

Containers  will  be  fur- 
nished upon  request. 

HERBERT  GUNN,  M.  D. 

2000  Van  Ness  Avenue 

San  Francisco  Telephone:  GRaystone  1027 


Shumate’s 

PRESCRIPTION  PHARMACIES 
37  DEPENDABLE  STORES  37 

Conveniently  Located  to  Serve  You 
Refrigerated  Biologies  / Prescription 
Technique 

Catering  to  the  Medical  Profession  Since  1890 
SAN  FRANCISCO 


We  solicit  correspondence  from  physicians 
regarding  pharmaceutical  and  proprietary 
preparations. 

-4>- 

LENGFELD’S  PHARMACY 

216  Stockton  Street  San  Francisco,  Calif. 

Telephone  SUtter  0080 


HOLLAND-RANTOS 
COMPANY,  Inc. 

Gynecological  and  Obstetrical 
Specialties 

Descriptive  Leaflets,  Reports  and  P?ice  List 
Send  on  Request 


156  FIFTH  AVENUE 


NEW  YORK  CITY 


Hazel  E.  Furscott 

PHYSIOTHERAPY 

Service  Available 

Only  Under  Prescription  of  Doctors 
of  Medicine 

Mercury  Quartz  Vapor  Lamps  for  Rent 

219  Fitzhugh  Bldg.  DOuglas  9124  380  Post  St. 

San  Francisco,  California 


THE  HILL- YOUNG  SCHOOL 
OF  CORRECTIVE  SPEECH 

LOS  ANGELES,  CALIFORNIA 

A home  or  day  school  for  children  of  good  mentality, 
whose  speech  has  been  delayed  or  is  defective. 

One  kindergarten  or  grade  teacher  to  each  group  of  seven 
children.  Private  lessons  when  desirable.  The  child  speech- 
less at  two  should  receive  attention  to  prevent  future  diffi* 
culty.  Special  plan  for  children  under  6 years  of  age. 
Individual  needs  considered  in  cooperation  with  the  child's 
physician.  Testimonials  from  physicians. 

School  Publications — $2.00  each:  "Overcoming  Cleft 
Palate  Speech,”  "Help  for  You  Who  Stutter.” 

Principals 

Mr.  and  Mrs.  G.  Kelson  Young 
2809-15  South  Hoover  Street  WEstmore  0512 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


25 


/ When  you  prescribe 
/ for  a diabetic  patient 
/ keep  in  mind  the  efficacy 
" of  Knox  Gelatine  as  an 
agent  for  satisfying  appetite 
without  violating  the  most  rigid 
protein  diet. 

/ Here  is  the  purest  of  gelatine,  uncol- 
/ ored,  unflavored  and  unsweetened. 
/ It  may  be  combined  with  such  fruits, 
/ vegetables,  and  other  foods,  as  are  pre- 
/ scribed  for  a diabetic  patient — and  served 
/ as  a dish  so  appetizing  in  taste  and  appear- 
/ ance , so  satisfying  in  bulk,  that  the  most 
/ eager  appetite  will  find  itself  happily  abated. 

/ Recognized  dietetic  authorities  have  pre- 
/ pared  dishes  made  with  Knox  Sparkling  Gelatine 
/ that  are  a real  contribution  to  the  successful  treat- 
' ment  of  diabetes.  Here  are  two  recipes  that  will  aid 
you  in  giving  diabetic  patients  complete  instructions 
for  home  co-operation  with  your  treatment. 


KIM  OX  is  the 

W GELATINE 

Contains  No  Sugar 


JELLIED  VEGETABLE  SALAD  (Six  Sewing,) 

Grama  Prot.  Fat  Carb.  Cal, 

1 tablespoon  Knox  Sparkling  Gelatine  7 6 

y cup  cold  water,  ly  cups  hot  water  ....  UM  .... 

1 teaspoonful  whole  mixed  spices  ....  .... 

y teaspoon  salt,  y cup  vinegar  _ ..... 

y cup  chopped  cabbage  50  1 ....  3 

y cup  chopped  celery  60  1 .2 

y cup  canned  green  peas  40  1 4 

y cup  cooked  beets,  cubed  40  1 3 

Jellied  Chicken  in  Cream  (s.*  serving,) 

Grams  Prot.  Fat  Carb.  Cal* 

1 tablespoonful  Knox  Gelatine  7 6 

y cup  cold  chicken  broth  or  water.  ..  ....  

1 y cups  boiling  chicken  broth,  fat  free  ....  

y teaspoon  salt 

Pinch  pepper 

1 cup  cooked  chicken,  cubed  125  24  20 

y cup  cream,  whipped 55  1 22  i.5 

Total  10  ....  12  88 

One  serving  2 ....  2 15 

Soak  gelatine  in  cold  water  for  five  minutes.  Bring  to  boil  water,  salt 
and  spices.  Pour  on  gelatine  to  dissolve  it  and  add  vinegar.  When 
jelly  is  nearly  set,  stir  in  the  vegetables,  pour  into  mold  and  chill 
until  firm.  Unmold  on  lettuce  and  serve  with  salad  dressing.  Garnish 
with  sprig  of  parsley  or  strip  of  pimento. 

Total  31  44  1.5  526 

One  serving  5 7 ....  88 

Soak  gelatine  in  cold  liquid  for  five  minutes  and  dissolve  in  hot 
broth.  Season  with  salt  and  pepper  and  chill  until  nearly  set.  Fold 
in  chicken  and  whipped  cream.  Turn  into  molds  and  chill  until 
firm.  Serve  on  lettuce  or  garnish  with  parsley  and  strip  of  pimento. 

you  agree  that  recipes  like  the  ones  on  this  page  will  be  helpful  in  your  diabetic  practice,  write  for  our 
complete  Diabetic  Recipe  Book — it  contains  dozens  of  valuable  recommendations.  W e shall  be  glad  to 
mail  you  as  many  copies  as  you  desire.  Knox  Gelatine  Laboratories  417  Knox  Ave.,  Johnstown,  N.  Y. 

Name Address City. 


SATISFYING 
HUNGER 
in  DIABETES 


State. 


26 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


"Wappler”  Fluoroscopic  Unit 

A complete  unit,  consisting  of  Upright  Fluoroscope,  X-Ray 
Generator  with  control  and  Coolidge  Tube.  When  installed  in  your 
office,  X-Ray  Fluoroscopic  examinations  available  to  you  by  the 
simple  turning  on  of  a switch. 

Wappler  Electric  Company  also  offers  a complete  line  of  Valve 
Tube  Rectified  X-Ray  Apparatus.  Suitable  sizes  for  the  small  office 
or  the  largest  hospital  laboratory. 

Write  or  phone  to  the  nearest  “Scherer”  store  for  full  details  and 
special  price  offers. 

R.  L.  SCHERER  COMPANY 

Los  Angeles,  California  Fresno  San  Franc‘sco>  Calif. 

736  South  Flower  Street  c 679  Sutter  Street 

ban  Diego 

TRINITY  6377  PROSPECT  3248 


CARL  ZEISS,  JENA 

MICROSCOPES 

Represent  the  finest  possible  craftsmanship,  opti- 
cally and  mechanically,  in  the  microscope  field. 
Priced  from  #128.00  up.  Terms  if  desired. 

Trainer-Parsons  Optical  Co. 

228  POST  STREET  SAN  FRANCISCO 

GArfield  7100 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  23) 

Instant  Postum  (Vacuum  Cereal  Beverage)  (Pos- 
tum  Co.,  Inc.,  Battle  Creek,  Michigan). — A beverage 
made  only  of  whole  wheat  and  bran  roasted  with  a 
small  portion  of  sugar-cane  molasses.  It  contains  no 
caffein. 

Postum  Cereal  (Postum  Co.,  Inc.,  Battle  Creek, 
Michigan). — It  is  made  only  of  whole  wheat  and  bran 
roasted  with  a small  portion  of  sugar-cane  molasses. 
It  contains  no  caffein. 

Sac-a-Rin  Brand  of  Canned  Vegetables  (Kings 
County  Packing  Co.,  Oakland,  California). — Brands: 

California  Tomatoes;  California  Asparagus;  Cali- 
fornia Spinach.  These  are  vegetables  packed  without 
added  salt  or  sugar  for  dietetic  purposes.  For  use 
when  an  intake  of  carbohydrate — particularly  sugar — 
is  to  be  restricted. 

Borden’s  Sweet  Chocolate  Flavor  Malted  Milk  (The 
Borden  Co.,  New  York). — It  has  the  following-  aver- 
age composition:  fat,  6.7  per  cent;  protein,  9.7  per 
cent;  sucrose,  47.8  per  cent;  other  carbohydrates 
(maltose,  dextrin,  lactose),  31.0  per  cent;  ash,  2.4  per 
cent;  insoluble  chocolate  solids,  0.4  per  cent;  moisture, 
2.0  per  cent.  This  product  differs  from  other  choco- 
late malted  milks  in  that  the  cocoa  is  cooked. 

Quaker  Puffed  Wheat  (The  Quaker  Oats  Co., 
Chicago). — It  is  made  from  whole  wheat;  25  per  cent 
is  bran.  The  minerals  are  retained.  Puffed  wheat 
with  whole  milk  is  approximate  in  energy  value  to  a 
dish  of  hot  cooked  cereal. 

Sanka  Coffee  (Sanka  Coffee  Corporation,  Brooklyn 
and  Los  Angeles). — A blend  of  South  American  coffee 
with  Mocha  and  Java.  The  caffein  is  removed  by  a 
process  which  removes  97  per  cent  or  more  of  the 
caffein  originally  present  in  the  bean  (based  on  1.1  per 
(Continued  on  Page  28) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


27 


So  comes  the  warning  from  the 
Metropolitan  Life  Insurance  Co.  statisti- 
cians, who  add  “Both  countries  recorded  new  maxi- 
mum death  rates  last  year”. 

^et,  it  is  consoling  to  learn  from  the  same 
authority  that  more  and  more  diabetics  are  sur- 
viving to  advanced  ages. 

Some  observers  have  expressed  the  opinion  that 
but  one  diabetic  in  ten  requires  Insulin.  Neverthe- 
less, some  unforeseen  circumstances  may  induce 
coma  at  some  time  in  the  other  nine. 

Whether  for  the  emergency  case  of  diabetic  coma 
or  for  routine  use,  INSULIN  SQUIBB,  because  of 
its  stability,  uniformity  of  potency,  low  nitrogen 


You  are  cordially 
invited  to  listen 
to  the  Squibb 
Radio  Program, 
presenting  WILL 
ROGERS  and  a 
Concert  Orches- 
tra, at  10:00  P.M. 
(Current  New 
York  Time)  every 
Sunday  evening 
over  36  stations 
of  the  Columbia 
Broadcast  in  g 
System. 


content  and  freedom  from  reaction-producing  pro- 


teins, will  always  be  found  dependable.  It  is  being 
used  by  an  increasing  number  of 
physicians  and  to  all  physicians 
it  should  be  acceptable. 

Insulin  Squibb  is  manufactured 
under  license  from  the  University 
of  Toronto  and  is  Council  Accepted. 


ER  Squibb  &.  Sons 

MANUFACTURING  CHEMISTS  TO  THE  MEDICAL  PROFESSION  SINCE  1853 


New  York 


28 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


EVERY  PHYSICIAN  “Read&i  Of. 

This,  (foimial  7a  (iMwme 
To 

CALCREOSE — calcium  creosotate 
— is  a mixture  containing  in  loose 
chemical  combination  approxi- 
mately equal  weights  of  creosote  and  lime 
and  provides  a form  of  creosote  which 
patients  will  tolerate. 

Caicreose  is  not  only  a stimulant  expectorant  in 
bronchitis  and  of  value  in  the  treatment  of 
tuberculosis,  but  is  also  of  value  as  a urinary  anti- 
septic in  frequent  and  burning  urination  and  as  an  \ 
intestinal  antiseptic  in  enteritis  and  similar  disturbances.  N 
Write  us  today  for  the  complimentary  package  which  is 
illustrated  above. 


CHEMICAL  RESEARCHES 

Fellowship 

Chemical  researches  on  creosote  were  carried  on 
under  the  1928-29  Maltbie  Chemical  Company 
Fellowship  for  Creosote  Research  in  the  Chemical 
Department  of  Princeton  University. 


PHARMACOLOGICAL  RESEARCHES 

Fellowship 

Laboratory  tests  to  establish  the  relative  efficiency 
of  creosote,  guaiacol,  and  other  creosote  con- 
stituents are  now  under  way  at  the  Philadelphia 
Collese  of  Pharmacy  and  Science. 


MALTBIE  CHEMICAL  COMPANY  - NEWARK’ NEW  JERSEY 


We  would  like  to 
have  you  try 


I 


anAu 


('An  Antiseptic  Liquid) 


cs4urifui  c&nAjdiMiiim 

NONSPI  destroys  armpit  odor 
and  removes  the  cause — exces- 
sive perspiration. 

This  same  perspiration,  excreted 
elsewhere  through  the  skirt 
pores,  gives  no  offense  because 
of  better  evaporation. 


'We  will  gladly  mail  you 
Physician’s  testing  samples. 


Send  free  NONSPI 
samples  to: 


THE  NONSPI  COMPANY 
2652  WALNUT  STREET 
KANSAS  CITY,  MISSOURI 

Name Jp 

Mima 

City. 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  26) 

cent  of  caffein).  It  may  be  used  when  other  coffee 
has  been  forbidden. 

Milk-Packed  Coconut  (Franklin  Baker)  (Franklin 
Baker  Co.,  Hoboken,  New  Jersey). — The  shredded 
coconut  is  packed  in  cans  without  the  addition  of 
sugar,  the  can  being  filled  with  coconut  milk. 

Franklin  Baker  Premium  Coconut  (Franklin  Baker 
Co.,  Hoboken,  New  Jersey). — The  shredded  coconut 
is  mixed  with  added  sugar  and  5 per  cent  glycerin 
and  passed  through  driers. 

Southern  Style  Coconut  (Franklin  Baker)  (Frank- 
lin Baker  Co.,  Hoboken,  New  Jersey).— Coconut  meat 
is  passed  through  an  automatic  shredding  machine, 
after  which  the  added  sugar  is  mixed  with  the  coconut 
meat,  the  resultant  product  being  passed  through 
driers.  The  product  is  packed  in  cans  in  an  atmos- 
phere of  carbon  dioxid. 

Heilman’s  Mayonnaise  (Richard  Heilman,  Inc., 
Long  Island  City,  New  York). — It  is  made  from  a 
blend  of  edible  vegetable  oils,  vinegar,  egg  yolk, 
spices,  and  condiments  beaten  to  a stable  emulsion. 

Minute  Tapioca  (Minute  Tapioca  Co.,  Inc.,  Orange, 
Massachusetts). — It  is  made  from  tapioca  flour.  The 
flour  is  bolted,  mixed  with  water,  steam-cooked, 
granulated  and  dried. 

PROPAGANDA  FOR  REFORM 

Citrin  Not  Acceptable  for  New  and  Nonofficial 

Remedies. — The  Council  on  Pharmacy  and  Chemistry 
reports  that  Citrin  is  marketed  by  the  Table  Rock 
Laboratories  in  the  form  of  capsules  claimed  to  con- 
tain “50  milligrams  cucurbocitrin,”  the  latter  being 
“a  nontoxic  glucosid-saponin  processed  from  the  seed 
of  the  watermelon  ( Cucurbita  citrullus) .”  In  the  in- 
formation submitted  to  the  Council,  Citrin  is  stated 
to  be  “the  crude  extract”  obtained  from  the  water- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


2Q 


LIVERMORE  SANITARIUM 


The  Hydropathic  Department 
devoted  to  the  treatment  of  gen- 
eral diseases  excluding  surgical 
and  acute  infectious  cases.  Spe- 
cial attention  given  functional 
and  organic  nervous  diseases.  A 
well  equipped  clinical  laboratory 
and  modern  X-ray  Department 
are  in  use  for  diagnosis. 

The  Cottage  Department  (for 
mental  patients)  has  its  own 
facilities  for  hydropathic  and 
other  treatments.  It  consists  of 
small  cottages  with  homelike 
surroundings  permitting  the  seg- 
regation of  patients  in  accord- 
ance with  the  type  of  psychosis. 
Also  bungalows  for  individual 
patients,  offering  the  highest 
class  of  accommodation  with 
privacy  and  comfort. 

GENERAL  FEATURES 

1.  Climatic  advantages  not  excelled  in  United  States.  Beautiful  grounds  and  attractive  surrounding  country. 

2.  Indoor  and  outdoor  gymnastics  under  the  charge  of  an  athletic  director.  An  excellent  Occupational 
Department. 

3.  A resident  medical  staff.  A large  and  well  trained  nursing  staff  so  that  each  patient  is  given  careful 
individual  attention. 

Information  and  circulars  upon  request  CITY  OFFICES: 

Address:  CLIFFORD  W.  MACK,  M.  D.  San  Francisco  Oakland 

Medical  Director  450  §utter  Street  1624  Franklin  Street 

Livermore,  California 

Telephone  7-J  KEarny  6434  GLencourt  5989 


melon  seed.  The  available  evidence  does  not  indicate 
that  the  product  is  a pure  glucoside.  Citrin  is  stated 
to  be  “for  the  treatment  of  hypotensive  cardiovascular 
disease”  and  is  advertised  as  “The  new  therapy  for 
vascular  hypertension.”  The  Council  reviews  the 
available  evidence  for  the  usefulness  of  Citrin  and 
explains  that  the  question  at  issue  seems  to  be 
whether  the  observed  lowering  of  blood  pressure  by 
drugs  is  of  any  great  clinical  value,  and  when  this 
does  occur,  to  what  extent  it  is  due  to  the  drug  and 
to  what  extent  to  other  factors.  Altogether,  the 
Council  concludes  that  the  clinical  evidence  does  not 
establish  the  therapeutic  usefulness  of  Citrin;  hence, 
the  Council  declared  Citrin  unacceptable  for  New  and 
Nonofficial  Remedies.- — Jour.  A.  M.  A.,  April  5,  1930, 
p.  1067. 

Haley’s  M-O  Magnesia-Oil  Not  Acceptable  for 
New  and  Nonofficial  Remedies  and  Magnesia-Mineral 
Oil  (25)  Haley  Omitted  From  New  and  Nonofficial 
Remedies). — The  Council  on  Pharmacy  and  Chemis- 
try reports  that  Haley’s  M-O  Magnesia-Oil  (exploited 
with  the  emphasis  on  “Haley’s  M-O”)  is  the  name 
under  which  the  Haley  M-O  Co.,  Inc.,  has  marketed 
a mixture  of  magnesia  magma  (milk  of  magnesia) 
and  liquid  petrolatum;  that  the  firm  requested  ac- 
ceptance of  the  product  for  New  and  Nonofficial 
Remedies  stating  that  it  is  composed  of  magma  mag- 
nesiae  75  per  cent  by  volume  and  liquid  petrolatum 
25  per  cent  by  volume;  that  the  Council  refused  ad- 
mission of  the  product  to  New  and  Ncnofficial  Reme- 
dies because  the  use  of  a mixture  of  liquid  petrolatum 
and  magnesia  magma  in  fixed  proportions  under  an 
uninforming  name  is  detrimental  to  rational  prescrib- 
ing; and  that  the  preparation  was  accepted  after  the 
firm  had  adopted  the  name  Magnesia-Mineral  Oil 
(25)  Haley  and  had  revised  its  advertising  to  make 
it  acceptable.  After  the  Council  had  repeatedly  been 
obliged  to  object  to  the  advertising,  the  firm  wrote 
to  the  Council  that  its  attempt  to  meet  the  require- 
(Continued  on  Next  Page) 


TTnnnnnnnrB'TTrg'inroTrre^ 


For  Medicinal,  Industrial  and  Drinking  Purpose* 


jJULlBJUL&ULjLlJLJ^  tjUUUUXP 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3° 


Soiland  Clinic 

Drs.  Soiland,  Costolow  and 
Meland 

1407  South  Hope  Street,  Los  Angeles,  Calif. 

Telephone  WEstmore  1418 
HOURS:  9:00  to  4:00 

An  institution  fully  equipped  for  the  study, 
diagnosis  and  treatment  of  neoplastic  disease. 
Radiation  therapy  and  modern  electro- 
surgical  methods  featured. 

ALBERT  SOILAND,  M.  D. 

WM.  E.  COSTOLOW,  M.  D. 

ORVILLE  N.  MELAND,  M.  D. 

EGBERT  J.  BAILEY,  M.  D. 

A.  H.  WARNER,  Ph.  D.,  Physicist 


Supporting^  arments 

For  Diaphragm  and 
Upp  er  Body  Support 

This  new  Camp  High  Belt 
provides  adequate  support  to 
the  diaphragm  and  upper 
body.  Designed  particularly 
for  use  following  gall  bladder 
and  stomach  operations  and 
in  all  cases  where  scientific 
body  support  is  desired.  As  in 
all  Camp  Supports,  the  Camp 
Patented  Adjustment  is  the 
distinctive  feature — giving 
sacro'iliac  and  lumbar  support 
to  the  back.  Note  two  sets  of 
straps,  a new  departure  which 
makes  manipulation  easy  and 
a strong  pull  possible,  fitting 
the  support  closely  to  the 
body  and  assuring  comfort  to 
the  wearer. 

Write  for  physican's  manual. 

Two  Models : For  the  tall  man  with  full  upper  body — for  the  short  full  fig- 
ure. Adjustable  to  all  types.  Dealers  stocking  these  items  will  find  a ready 
sale  with  fine  profit  possibilities.  Sold  by  better  drug  and  surgical  houses. 

S.  H.  CAMP  AND  COMPANY 

I Manufacturers.  JACKSON,  MICHICAN 

CHICAGO  LONDON  NEW  YOKE 

Madison  St.  252  Regent  St.,  W.  880  Fifth  Ave. 


Satisfying  the  Most 
Discriminating  ♦ ♦ ♦ 

Qolden  State 

Rigid  safeguarding  of  the 
purity  and  richness  of  its 
products — combined  with 
efficient  service — has  gain- 
ed for  Golden  State  milk 
products  an  enviable 
reputation. 


Its  satisfied  customers  are  Golden 
State’s  best  endorsement 


Golden  State 
Milk  Products  Company 

MILK  t CREAM  / BUTTER 
ICE  CREAM  i COTTAGE  CHEESE 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 

merits  of  the  Council  were  proving  financially  un- 
profitable and  that  it  had  decided  to  go  back  to  the 
old  name  “Haley’s  M-O/’  This  means  that  physicians 
will  again  be  asked  to  use  this  simple  pharmaceutical 
mixture  under  an  uninforming  name.  The  Council 
directed  the  omission  of  Magnesia-Mineral  Oil  (25) 
Haley  from  New  and  Nonofficial  Remedies  and  de- 
clared Haley’s  M-O  Magnesia-Oil  (“Haley’s  M-O”) 
unacceptable  for  New  and  Nonofficial  Remedies. — 
Jour.  A.  M.  A.,  April  5,  1930,  p.  1067. 

Sun  Cholera  Mixture. — During  the  cholera  excite- 
ment in  New  York  in  June  1849,  a physician  by  the 
name  of  G.  W.  Busteed  sent  a recipe  for  the  dis- 
ease to  the  editor  of  the  New  York  Sun.  It  was 
printed,  and  was  so  successful  in  the  relief,  at  least, 
of  the  symptoms  that  it  came  to  be  popularly  known 
as  the  Sun  Cholera  Mixture.  It  was  admitted  to  the 
first  edition  of  the  National  Formulary  in  1883  and 
in  subsequent  editions  under  that  name.  The  original 
formula  called  for:  tincture  of  opium,  tincture  of  rhu- 
barb, tincture  of  capsicum,  spirit  of  camphor,  essence 
of  peppermint,  equal  parts.  The  formula  was  modi- 
fied somewhat  later,  on  account  of  the  changing 
strength  of  some  of  the  ingredients,  in  later  editions 
of  the  pharmacopeia. — Jour.  A.  M.  A.,  April  5,  1930, 

p.  1088. 

Corozone. — The  Corozone  unit  is  a small  portable 
ozonator  which  can  be  operated  on  the  ordinary  elec- 
tric light  circuit.  Ozone  in  sufficient  concentration 
to  kill  bacteria  is  not  suitable  for  ordinary  respira- 
tion because  of  its  irritant  action.  Ozone  cannot  be 
used  as  a substitute  for  good  ventilation  in  a room 
any  more  than  deodorants  or  perfumes  can  be  used 
as  a substitute  for  bathing  the  body.  There  has  been 
no  sound  scientific  work  brought  forward  to  show 
that  there  is  any  place  whatever  for  ozone  in  prob- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3i 


for 

NEAR  - POINT 
EECEIA  TEXT 

Accuracy — Rapidity — Convenience 

The  Dynamic  Fixator  as  a Near-Point  Phoria  testing  device  has 
the  following  advantages:  Its  luminous  beam  of  light  engages  bet- 
ter attention  and  stronger  concentration  on  the  part  of  the  patient. 
It  presents  a method  for  the  near  test  which  is  uniform  with  the 
method  for  the  distance  test.  It  reduces  errors  arising  from  con- 
fusion or  stupidity  of  the  patient.  Hyper-phorias,  Exo-phorias,  or 
Eso-phorias  are  easily  and  accurately  determined. 

Special  charts  accompany  the  instrument  and  enlarge  the  scope  of 
the  instrument  to  include  Near-Point  Duction  Test,  Amplitude  of 
Accommodation  Test,  besides  its  original  use 
as  a fixation  target  for  Dynamic  Retinoscopy. 

It  can  be  used  either  on  Phorometer  Rod,  in- 
verted or  erect,  or  on  the  headband  or  in  the 
hand  of  the  patient.  Instructions  are  in- 
cluded with  the  instrument. 


Send  for 
Free  Booklet 
In  Colors 


EIGGX  OPTICAL  CCMPANy 

CHICAGO  SAN  FRANCISCO 

OFFICES  IN  57  PRINCIPAL  CITIES  IN  THE  MID-WEST  AND  WEST 


lems  of  ventilation. — Jour.  A.  M.  A.,  April  5,  1930, 
p.  1089. 

Syrup  of  Alfemine,  et  al. — Sherman  L.  Davis,  Ph.D,, 
is  professor  of  chemistry  and  director  of  nutritional 
research  in  the  Indiana  University  School  of  Den- 
tistry. He  is  neither  a physician  nor  a dentist.  Dur- 
ing the  past  few  years  Professor  Davis  has  been  doing 
a good  deal  of  lecturing  before  dental  societies.  In 
his  talks  Professor  Davis  recommends  certain  pro- 
prietary medicinal  products,  four  in  number:  “Syrup 
of  Alfemine,”  “Vicodol,”  “Caperoid  Tablets,”  and 
“Vicaperol  Capsules.”  All  of  these  products  used  to 
be  manufactured  by  the  Ucoline  Products  Company 
of  Indianapolis.  The  manufacture  and  distribution  of 
these  products  has  been  taken  over  by  the  Rochester 
Laboratories,  Inc.,  Rochester,  Minn.  It  appears  that 
the  Rochester  Laboratories  distribute  the  preparations 
on  a royalty  basis;  the  royalties  being  turned  over  to 
the  trustees  of  Indiana  University.  Professor  Davis 
does  not  receive  any  part  of  the  royalty.  Undoubtedly, 
the  newly  formed  Council  on  Dental  Therapeutics  cre- 
ated by  the  American  Dental  Association  will,  in  due 
time,  investigate  and  report  on  the  formulas  of  Pro- 
fessor Davis  that  are  sold  under  proprietary  names. 
Meanwhile,  the  entire  arrangement  constitutes  an  un- 
usual scheme  in  its  relationship  to  the  practice  of 
either  scientific  medicine  or  dentistry. — Jour.  A.  M.  A., 
April  12,  1930,  p.  1163. 

Action  of  Phenolphthalein.  — One  should  always 
think  of  the  possibility  of  a phenolphthalein  eruption 
when  studying  the  etiology  of  a puzzling  exanthem. 
As  phenolphthalein  is  chiefly  excreted  into  the  intes- 
tine by  means  of  the  bile,  and  reabsorbed  from  the 
colon,  there  is  a tendency  for  its  action  to  continue 
for  several  days.  Hence,  its  continued  daily  use  may 
lead  to  ultimate  overaction  with  diarrhea,  abdominal 
pains,  tenesmus,  and  bleeding. — Jour.  A.  M.  A.,  April 
12,  1930,  p.  1165. 

(Continued  on  Page  34) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


^BlUCOSE  intravenously  is  used  in  surgical  acidosis  and  shock, 
toxemias  of  pregnancy,  in  pneumonia  and  other  infectious  dis- 
eases. It  also  has  indications  in  diseases  of  the  heart,  skin,  and 
liver,  in  mercury  and  phosphorus  poisoning,  and  cerebral  edema. 

Gl  ucose  intravenously  is  a source  of  food  and  energy,  con- 
tributes to  glycogen  storage,  conserves  body  tissues,  prevents 
or  overcomes  dehydration,  dilutes  circulating  toxins,  acts  as  a 
diuretic,  and  relieves  localized  edemas. 

Lilly  Glucose  Ampoules  (Dextrose,  U.  S.  P.  X.)  containing 
respectively  10,  25,  and  50  grams  of  glucose  in  approximately 
50  percent  solutions  are  supplied  through  the  drug  trade. 


SEND  FOR  NEW  AND 

COMPREHENSIVE  BOOKLET  ON  INTRAVENOUS 
GLUCOSE  MEDICATION 


ELI  LILLY  AND  COMPANY 

INDIANAPOLIS,  INDIANA,  U.  S.  A. 


CALIFORNIA 

AND 

WESTERN  MEDICINE 

VOLUME  XXXII  JUNE.  1930  No.~6 


THE  VALUE  OF  RADIOTHERAPY  IN 
MEDIASTINAL  TUMORS* * 

By  Arthur  U.  Desjardins,  M.  D. 

Rochester,  Minnesota 

"jK/TEDIASTINAL  tumors  often  constitute  a 
1VJL  difficult  problem  in  diagnosis  as  well  as  in 
treatment.  Such  neoplasms  may  assume  consider- 
able dimensions  before  the  patient  is  aware  that 
his  health  is  deteriorating  or  even  before  any 
symptoms  make  their  appearance.  Pain  is  the 
symptom  which  causes  most  patients  to  consult 
a physician,  but  many  tumors  originate  in  the 
mediastinal  structures  and  do  not  cause  pain  until 
they  have  attained  sufficient  size  to  interfere  with 
respiration,  circulation,  or  deglutition,  and  even 
then  many  mediastinal  growths  are  essentially 
painless.  Therefore,  the  early  recognition  of  such 
neoplasms,  so  significant  in  treatment,  is  not  so 
simple  as  it  may  appear.  Moreover,  the  impor- 
tance for  the  physician  to  know  the  character  of 
such  tumors  is  as  great  as  his  ability  to  obtain 
such  knowledge  may  be  difficult.  The  clinical 
manifestations  may  lead  the  physician  to  suspect 
a tumor,  but  the  physical  signs  may  give  an  inade- 
quate notion  of  its  size  and  situation.  Roentgeno- 
logic examination  of  the  intrathoracic  structures 
may  usefully  supplement  the  physical  manifesta- 
tions or  give  indispensable  information  about  the 
size  and  situation  of  the  tumor,  and  may  even 
give  a strong  clue  to  its  character,  but  only  too 
often  such  information  is  inadequate  or  cannot 
be  trusted  implicitly.  That  is,  although  the  roent- 
genologic examination  may  clearly  and  accurately 
show  the  outlines  of  the  tumor  it  cannot  be  relied 
on  to  furnish  conclusive  evidence  of  the  patho- 
logic character  of  the  growth.  When  such  neo- 
plasms have  metastasized  to  accessible  groups  of 
lymph  nodes,  biopsy  may  solve  the  diagnostic 
problem,  but  when  such  metastasis  has  not  oc- 
curred this  valuable,  although  not  infallible, 
source  of  information  cannot  be  utilized. 

DIAGNOSTIC  VALUE  OF  RAY  THERAPY 

It  is  generally  assumed  that  the  value  of  radio- 
therapy, as  the  term  implies,  is  limited  to  the 
treatment  of  malignant  and  other  lesions,  but,  as 
will  be  shown  presently,  this  is  not  the  case.  Be- 
sides its  strictly  therapeutic  value,  the  effect  of 
roentgen  or  radium  irradiation  on  mediastinal  as 

* FYom  the  Section  on  Therapeutic  Radiology,  The  Mayo 
Clinic,  Rochester,  Minnesota. 

* Read  before  the  General  Session  of  the  California 
Medical  Association  at  the  fifty-ninth  annual  session, 
Del  Monte,  April  28  to  May  1,  1930. 


well  as  other  neoplasms  may  furnish  invaluable 
diagnostic  indications,  and  such  indications  may 
often  be  as  conclusive  as  the  microscopic  inspec- 
tion of  tissue  excised  from  the  tumor.  To  those 
who  are  unfamiliar  with  the  action  of  roentgen 
and  radium  rays  on  normal  and  pathologic  tissues 
this  statement  may  appear  revolutionary  until  at- 
tention is  drawn  to  one  or  two  important  con- 
siderations. Usually  the  pathologist  must  base 
his  opinion  of  the  character  of  a tumor  on  the 
microscopic  appearance  of  one  or  several  small 
sections  of  tissue  from  one  or  more  parts  of  the 
growth.  Yet,  as  is  well  known,  different  parts 
of  many  neoplasms  vary  much  in  architecture  and 
cellular  morphology.  When  a tumor  is  irradiated, 
on  the  other  hand,  the  entire  neoplasm  is  exposed 
to  the  influence  of  the  rays,  and  relatively  homo- 
geneous tumors  made  up  largely  of  one  kind  of 
cell  retrogress  at  a specific  rate  and  in  a specific 
manner  according  to  the  degree  of  sensitiveness 
of  the  cells.  Moreover,  the  rate  and  manner  of 
regression  of  a tumor  agree  closely  with  the 
known  radiosensitiveness  of  its  normal  cellular 
prototypes.  Different  tumors  of  the  same  kind 
often  exhibit  variations  in  reaction,  but  only  occa- 
sionally is  the  range  of  such  variation  sufficient 
to  cause  confusion. 

LAW  OF  SPECIFIC  RADIOSENSITIVENESS  OF  CELLS 
Perhaps  no  law  in  radiology  or  in  general  medi- 
cine is  more  firmly  established  than  the  law  of 
the  specific  radiosensitiveness  of  cells.  Numerous 
experiments  on  animals  and  abundant  clinical 
evidence  have  proved  beyond  doubt  that  every 
variety  of  cell  in  the  body  and  every  organ  or 
structure  composed  largely  of  one  variety  of  cell 
has  a specific  sensitiveness  to  roentgen  or  radium 
rays.  The  investigations  of  Heineke,  Thies,  War- 
thin,  Krause  and  Ziegler,  Rudberg,  Aubertin  and 
Bordet,  Arella,  Regaud  and  Cremieu,  Pappenheim 
and  Plesch,  Lazarus-Barlow,  and  many  others 
have  conclusively  shown  that  the  lymphocytes  in 
the  spleen,  lymph  nodes,  intestinal  lymph  folli- 
cles, bone  marrow,  circulating  blood,  and  thymus 
gland  are  the  most  sensitive  cells  in  the  body. 
Large  numbers  of  such  cells  are  destroyed  within 
a few  days  even  after  moderate  irradiation,  and 
such  destruction  begins  within  half  an  hour  after 
exposure  to  the  rays.  The  rays  appear  to  act 
first  on  the  nucleus  which  begins  to  disintegrate 
and  break  up  into  fragments,  and  the  chromatin 
debris  from  the  destroyed  cells  is  taken  up  by 
some  of  the  reticular  cells,  which  thus  assume  a 
phagocytic  property  and  appear  to  digest  the 
fragmented  nuclear  chromatin  of  the  destroyed 


378 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Fig.  1. — Roentgenogram  made  Feb-  Fig.  2. — Roentgenogram  of  the  pa- 
ruary  3,  1930,  showing  a large  tumor,  tient,  shown  in  Figure  1,  made  three 
apparently  originating  in  the  medi-  weeks  after  a course  of  roentgen 
astinal  lymph  nodes.  irradiation  and  showing  marked  re- 

gression of  the  mediastinal  lymphad- 
enopathic  tumor. 


lymphocytes.  Some  of  the  cells  are  injured  and 
mitotic  division  is  inhibited  without  actual  dis- 
integration ; such  cells  may  regenerate  after  a 
time.  The  degree  of  lymphocytic  destruction  and 
the  rate  at  which  the  other  injured  cells  regenerate 
subsequently  have  been  shown  to  vary  according 
to  the  dose  of  rays  to  which  the  affected  struc- 
tures have  been  exposed. 

Next  in  sensitiveness  to  irradiation  are  the  basal 
epithelial  cells  of  the  salivary  glands,  the  spermo- 
togonial  epithelium  of  the  testis  and  the  follicular 
epithelium  of  the  ovary,  the  lining  epithelium  of 
the  upper  part  of  the  small  intestine,  the  basal 
epithelium  of  the  skin  and  mucous  membranes, 
the  peritoneum,  and  the  pleura  and  lungs.  Among 
the  less  sensitive  structures  are  the  kidneys,  liver, 
and  heart,  and  the  least  sensitive  tissues  are  those 
which  make  up  bone  and  the  nervous  system. 
Knowledge  of  the  specific  radiosensitiveness  of 
different  varieties  of  normal  cells  often  enables 
the  expert  radiologist  to  identify  certain  tumors 
by  their  rate  and  degree  of  re- 
gression after  exposure  to  the 
rays,  and  such  knowledge  is  of 
the  greatest  value  in  relation  to 
mediastinal  tumors.  As  might  be 
expected,  the  significance  of  such 
knowledge  is  greatest  in  relation 
to  tumors  derived  from  the  more 
sensitive  varieties  of  cells.  Thus 
neoplasms  originating  in  lym- 
phoid organs  or  structures  and 
made  up  largely  of  lymphocytes 
can  readily  be  distinguished  by 
their  characteristic  and  excep- 
tional radiosensitiveness.  The  re- 
action of  such  tumors  is  usually 
so  great,  and  corresponds  so 
closely  to  that  if  normal  lmpho- 
cytes,  that  irradiation  constitutes 
a valuable  diagnostic  procedure, 
because  it  permits  the  identifica- 
tion of  such  tumors  aside  from 


any  difference  in  their  clinical 
features.  Mediastinal  tumors  de- 
rived from  epithelial  cells,  such 
as  epithelioma  of  the  trachea, 
bronchus,  or  esophagus,  or  from 
connective  tissue  cells,  such  as 
sarcoma  (except  lymphosarcoma, 
which  is  composed  chiefly  of 
lymphocytes)  are  so  much  more 
resistant  to  irradiation  that  the 
differentiation  of  lymphoblas- 
tomatous  growths  from  other 
mediastinal  neoplasms  seldom 
presents  any  difficulty. 

COMMENTS  ON  ILLUSTRATIONS 

A few  examples  may  best  serve 
to  make  clear  the  value  of  radio- 
therapy as  a diagnostic  test. 
Figure  1 shows  a large  mediasti- 
nal tumor  before  the  patient  had 
received  any  treatment.  The  as- 
sociation of  moderate  cervical  and  axillary  lym- 
phadenopathy  indicated  lymphoblastoma,  but  in 
the  absence  of  biopsy  such  a diagnosis  rested  only 
on  what  might  be  termed  circumstantial  evidence. 
Figure  2 shows  the  mediastinum  of  the  same  pa- 
tient twenty-seven  days  later  or  three  weeks  after 
a single  course  of  roentgen-ray  treatment  which 
required  five  days,  and  only  part  of  which  was 
directed  to  the  mediastinal  tumor.  Such  rapid 
regression  of  the  growth  unmistakably  points  to 
a lymphoid  neoplasm,  the  seat  of  which  was  in 
the  mediastinal  lymph  nodes.  Epithelioma  of  the 
bronchus  or  esophagus  as  well  as  other  tumors 
which  not  infrequently  metastasize  to  the  medi- 
astinal nodes  never  recedes  so  much  in  such  a 
short  time.  The  only  exceptions  are  the  embryo- 
nal carcinoma  and  the  mixed,  or  teratoid,  tumors 
of  the  testis  which  sometimes  invade  the  medi- 
astinal nodes  secondarily  and  also  retrogress 
rapidly  under  irradiation,  but  the  difference  in 


Fig.  3. — Roentgenogram  made  Sep-  Fig.  4. — Roentgenogram  of  the  pa- 
tember  2,  1929,  showing  a large  bi-  tient,  shown  in  Figure  3,  made  about 
lateral  mediastinal  tumor.  seven  weeks  after  a course  of  roentgen 

irradiation  and  showing  pronounced  re- 
duction in  size  of  the  mediastinal 
tumor. 


June,  1930 


RADIOTHERAPY  IN  MEDIASTINAL  TUMORS — DESJARDINS 


379 


Fig-.  8. — Roentgenogram  made  July 
29,  1921,  showing  mediastinal  tumefac- 
tion, especially  on  the  right  side.  This 
was  associated  with  enlargement  of 
the  cervical  and  axillary  lymph  nodes. 


Fig.  9. — Roentgenogram  of  the  tho- 
rax, shown  in  Figure  10,  made  March 
28,  1922,  showing  complete  disappear- 
ance of  the  mediastinal  tumor.  A 
roentgenogram  made  September  28, 
1921,  had  presented  the  same  appear- 
ance. 


growths.  The  difference  in  the 
rate  of  regression  between  lym- 
phoid and  epithelial  or  connec- 
tive tissue  tumors  is  so  great  and 
so  distinct  as  to  leave  no  room 
for  doubt,  and  this  regardless  of 
the  grade  of  malignancy  of  the 
epithelioma  or  sarcoma.  The 
only  exception,  and  such  excep- 
tions are  decidedly  uncommon,  is 
found  in  those  rare  cases  in 
which  excessive  and  abnormal 
cellular  hyperplasia  in  the  en- 
larged lymph  nodes  is  compli- 
cated by  secondary  infection. 
The  inflammatory  process  in  such 
cases  may  greatly  alter  the  re- 
action of  the  lymphocytes,  and 
the  rate  of  regression  under  such 
conditions  may  be  reduced  suffi- 
ciently to  make  absolute  differ- 
entiation difficult. 


clinical  and  physical  manifestations  is  usually  such 
that  confusion  can  rarely  occur. 

Figure  3 shows  another  large  tumor  apparently 
originating  in  the  mediastinum  before  treatment. 
Figure  4 shows  the  marked  regression  of  the  neo- 
plasm which  occurred  during  the  next  eight  weeks 
or  within  seven  weeks  after  an  initial  course  of 
roentgen  irradiation  requiring  six  days  of  treat- 
ment. Such  rapid  reduction  in  the  size  of  the 
tumor  constitutes  an  absolute  indication  of  a 
growth  derived  from  lymphoid  tissue  and  com- 
posed largely  of  lymphocytes.  No  other  kind  of 
tumor,  with  which  this  could  be  confused,  could 
retrogress  so  rapidly.  This  rapid  rate  of  re- 
gression characterizes  tumors  originating  in  lym- 
phoid tissue  and  corresponds  so  closely  to  the 
radiosensitiveness  of  normal  lymphocytes  as  to 
furnish  an  invaluable  means  of  identifying  such 


The  exceptional  radiosensitive- 
ness of  lymphocytes  and  of  mediastinal  and  other 
tumors  derived  from  such  cells  also  makes  it 
possible  to  distinguish  growths  of  this  character 
from  lesions  such  as  aneurysm  of  the  aorta.  The 
differential  diagnosis  of  aneurysm  may  be  diffi- 
cult, and  the  deduction  from  roentgenologic  ap- 
pearances alone  that  the  condition  is  aneurysm 
may  often  be  unreliable.  Exposure  of  the  medi- 
astinum to  an  adequate  but  moderate  dose  of 
roentgen  rays  is  an  almost  infallible  means  of 
ascertaining  whether  an  abnormal  mediastinal 
shadow  is  caused  by  a lymphoid  tumor  or  by  an 
aortic  aneurysm.  In  the  case  of  the  former  the 
shadow  will  rapidly  diminish  in  size,  but  in  the 
case  of  the  latter  the  shadow  will  remain  un- 
changed. In  other  words,  the  lymphadenopathy 
will  promptly  show  the  influence  of  exposure  to 


Fig.  5. — Roentgenogram  made  March 
10,  1925,  showing  practically  com- 

plete right  hydrothorax,  indicating 
circulatory  obstruction  caused  by  en- 
larged mediastinal  lymph  nodes. 


Fig.  6.  — Roentgenogram  of  the 
thorax,  shown  in  Figure  5,  made 
April  7,  1925,  showing  beginning  ab- 
sorption of  the  remaining  fluid  in  the 
right  pleural  cavity  as  the  lymphad- 
enopathy receded  after  removal  of 
2700  cubic  centimeters  of  clear  fluid 
on  March  30,  1925. 


Fig.  7. — Roentgenogram  of  the  tho- 
rax, shown  in  Figures  5 and  6,  made 
May  25,  1925,  showing  complete  ab- 
sorption of  the  fluid  from  the  right 
pleural  cavity. 


380 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


the  rays,  while  the  aneurysm  will  not  be  affected 
in  the  least. 

Sometimes  the  diagnostic  problem  may  he  to 
decide  between  a malignant  tumor  and  a benign, 
inflammatory  process.  Again  radiotherapy  may 
furnish  an  important  clue.  Inflammatory  lesions 
confined  to  the  mediastinum  and  contiguous  struc- 
tures may  differ  considerably  according  to  the 
identity  of  the  infecting  organisms,  and  they  may 
vary  much  in  the  degree  of  leukocytic  infiltration. 
Some  degree  of  infiltration,  however,  is  usually 
present.  It  is  well  known  that  the  majority  of 
leukocytes  infiltrating  such  lesions  are  lympho- 
cytes, at  least  at  a certain  stage,  and  it  may  safely 
be  assumed  that  the  infiltrating  lymphocytes  will 
be  destroyed  by  irradiation.  The  effectiveness  of 
radiotherapy  for  numerous  acute  and  chronic 
forms  of  inflammation,  such  as  furuncle,  car- 
buncle, delayed  resolution  in  pneumonia,  tra- 
choma, erysipelas,  parotitis,  tuberculous  adenitis 
and  peritonitis,  and  actinomycosis,  rests  on  such 
vulnerability  of  the  leukocytes  and  especially  of 
lymphocytes.  Therefore,  if  a mediastinal  lesion 
reacts  at  the  rate  of  normal  lymphocytes  and  if 
the  clinical  features  are  distinctly  not  those  of 
lymphoblastoma,  it  may  confidently  be  assumed 
that  the  lesion  represents  some  variety  of  inflam- 
mation and  not  a malignant  condition.  Such  re- 
action probably  explains  the  exceptionally  prompt 
disappearance,  under  small  doses  of  roentgen  rays, 
of  lesions  previously  assumed  to  be  malignant. 

THERAPEUTIC  VALUE 

As  may  be  surmised  from  the  foregoing  con- 
siderations on  the  diagnostic  possibilities  of  radio- 
therapy, the  value  of  roentgen-ray  or  radium 
treatment  for  mediastinal  tumors  is  greatest  in 
neoplasms  derived  from  and  composed  of  cells 
which  have  a high  degree  of  radiosensitiveness, 
such  as  the  lymphadenopathic  growths  which 
typify  Hodgkin’s  disease,  lymphatic  leukemia,  and 
lymphosarcoma.  Unfortunately,  the  cause  of  these 
diseases,  or  of  these  different  phases  of  the 
same  pathologic  condition,  is  not  yet  known, 
and  the  ultimate  prognosis  is  almost  always 
unfavorable.  It  is  true  that  an  occasional  case 
of  Hodgkin’s  disease  is  discovered  and  treated 
early  and  that  a permanent  cure  sometimes 
results,  but  such  exceptions  are  so  infrequent 
as  to  emphasize  the  rule.  Desjardins  and  Ford 
(1923)  established  the  fact  that  the  duration 
of  the  disease  in  the  average  case,  without 
systematic  treatment,  is  approximately  two  and 
a half  years.  Even  though,  when  the  disease  is 
allowed  to  develop  without  any  attempt  at  thera- 
peutic control,  the  outlook  for  the  patient  is 
decidedly  unpromising  and  the  physical  status 
deteriorates  more  or  less  steadily,  adequate  treat- 
ment may  alter  the  situation  greatly  and  the  im- 
provement may  be  maintained  for  months  or 
years.  Enormous  mediastinal  tumors  of  this  char- 
acter interfering  with  respiration  or  circulation 
and  causing  cough,  dyspnea,  shortness  of  breath, 
engorgement  and  dilatation  of  the  superficial 


veins,  and  unilateral  or  bilateral  hydrothorax,  can 
often  be  made  to  disappear  and  the  general  con- 
dition to  improve  in  proportion.  The  rapidity 
with  which  even  marked  symptoms  begin  to  sub- 
side after  exposure  to  a suitable  dose  of  radi- 
ation is  a salient  and  characteristic  feature.  The 
respiratory  disturbances  and  the  hydrothorax  di- 
minish as  the  pressure  produced  by  the  enlarged 
mediastinal  nodes  is  relieved.  The  anemia  and 
pruritus,  which  so  often  accompany  Hodgkin’s 
disease  and  lymphosarcoma,  promptly  subside  or 
disappear  in  many  cases.  The  effectiveness  of  the 
treatment,  however,  depends  to  a considerable 
degree  on  the  extent,  degree  of  chronicity,  and 
stage  of  the  disease.  As  the  lymphoblastomatous 
process  becomes  general,  it  tends  to  reach  what 
may  be  designated  as  a critical  point.  Sufficient 
experience  with  the  disease  enables  one  to  recog- 
nize that  the  patient  has  reached  or  is  approach- 
ing this  stage.  The  importance  of  such  recogni- 
tion cannot  be  overemphasized  because,  instead 
of  improving  the  condition  of  the  patient,  ex- 
cessive or  too  concentrated  treatment  at  or  near 
the  critical  point  may  shorten  rather  than  lengthen 
life.  This  phase  of  the  disease  is  related  more  to 
the  course  than  to  the  extent  of  the  condition. 
In  some  patients  the  disease  may  be  extensive,  the 
symptoms  pronounced  and  the  patient  apparently 
not  far  from  death,  and  yet  recovery  may  be 
possible. 

ILLUSTRATIVE  CASES 

Case  1. — A man,  age  forty-nine  years,  registered  at 
the  clinic  February  18,  1925.  He  had  been  bedridden, 
suffered  from  extreme  dyspnea,  and  appeared  nearly 
moribund.  To  his  own  knowledge  he  had  been  a 
victim  of  Hodgkin’s  disease  for  several  years.  From 
time  to  time,  when  his  general  condition  had  begun 
to  depreciate,  he  had  gone  to  a local  radiologist  and 
received  roentgen-ray  treatment,  after  which  his  con- 
dition had  improved  for  a time.  In  1924  he  had  been 
well  enough  to  play  through  a strenuous  series  of 
tennis  championship  matches.  Only  two  months 
before  he  had  regarded  himself  as  fairly  well,  and 
yet  when  he  arrived  at  the  clinic  he  was  extremely  ill. 

The  cervical,  axillary,  inguinal,  and  even  the  retro- 
peritoneal lymph  nodes  were  enormously  enlarged. 
A roentgenologic  examination  of  the  thorax  showed 
a practically  complete  right  hydrothorax  (Fig.  5), 
indicating  associated  mediastinal  lymphadenopathy 
and  undoubtedly  accounting  for  the  dyspnea.  The 
patient’s  condition  was  so  low,  indeed,  that  the  advis- 
ability of  roentgen-ray  treatment  was  questioned. 

However,  it  was  felt  that  withdrawal  of  the  fluid 
by  thoracentesis  might  relieve  the  dyspnea  sufficiently 
to  make  treatment  possible.  Accordingly,  2700  cubic 
centimeters  of  clear  fluid  were  removed  March  11, 
1925,  and  the  respiratory  difficulty  diminished  materi- 
ally (Fig.  6).  Roentgen-ray  treatment  was  then  in- 
augurated by  short  daily  sessions  to  avoid  overtaxing 
the  patient’s  strength.  After  seven  days  of  treatment 
another  thoracic  roentgenogram  (Fig.  7)  showed  that 
the  remaining  fluid  was  being  slowly  absorbed  as  the 
mediastinal  adenopathy  regressed.  General  roentgen 
irradiation  was  continued  field  by  field  until,  twenty 
days  later,  the  fluid  remaining  in  the  right  pleural 
cavity  had  almost  disappeared  (Fig.  8).  One  month 
afterward  the  fluid  had  been  absorbed  completely 
(Fig.  9).  By  this  time  the  general  lymphadenopathy 
had  decreased  greatly  and  the  patient  had  recovered 
to  such  an  extent  that  he  could  walk  about  town 
freely.  He  left  the  clinic  to  spend  some  time  in 


June,  1930 


RADIOTHERAPY  IN  MEDIASTINAL  TUMORS — DESJARDINS 


381 


Europe.  He  failed  to  follow  instructions  about  sub- 
sequent treatment  and  died  the  following  winter. 

If  the  disease  is  discovered  early,  it  can  be 
brought  under  control  and  kept  so  for  a much 
longer  time,  and  life  may  he  prolonged  several 
years.  But  even  though  in  many  cases  the  fatal 
issue  cannot  be  postponed  indefinitely,  the  symp- 
toms can  be  relieved  more  or  less  completely  dur- 
ing the  interval.  Sometimes,  indeed,  the  clinical 
disturbances  may  be  abolished  so  completely  that 
the  patient  may  be  able  to  resume  part  or  all  of 
his  usual  activities  and  carry  on  until  shortly 
before  death.  Inasmuch  as  the  duration  of  the 
disease  tends  to  be  shorter  in  children  and  young 
adults  and  longer  in  persons  of  middle  and  old 
age,  age  is  one  of  the  factors  which  govern  the 
effect  of  treatment,  as  far  as  the  duration  of  such 
effect  is  concerned.  This  general  rule,  however, 
is  subject  to  many  exceptions;  it  is  a tendency 
rather  than  a rule.  But  the  more  chronic  the  dis- 
ease the  longer  the  effect  of  irradiation  on  its 
manifestations  tends  to  last. 

Case  2. — A woman,  age  twenty-seven  years,  regis- 
tered at  the  clinic  July  28,  1921,  complaining  of  en- 
larged lymph  nodes  on  the  right  side  of  the  neck. 
Her  illness  had  begun  early  in  1920  when,  shortly 
after  extraction  of  an  upper  molar  tooth,  she  had 
noticed  a lump  on  the  right  side  of  the  neck.  Before 
1918,  however,  she  had  had  repeated  attacks  of  tonsil- 
litis and  the  tonsils  had  been  removed  in  1917  for  this 
reason.  Early  in  1921  an  acute  respiratory  infection, 
with  cough  and  expectoration,  lasted  one  month  and 
was  accompanied  by  further  enlargement  of  the  right 
cervical  lymph  nodes,  and  this  was  accompanied  by 
general  pruritus. 

Examination  disclosed  slightly  enlarged  lymph 
nodes  on  both  sides  of  the  neck,  but  chiefly  in  the 
right  supraclavicular  space.  Percussion  of  the  thorax 
gave  an  abnormally  broad  area  of  mediastinal  dull- 
ness, and  a roentgenographic  examination,  July  29, 
1921,  showed  a mediastinal  tumor  chiefly  on  the  right 
side  (Fig.  10).  At  biopsy  a node  from  the  right  supra- 
clavicular space  yielded  the  pathologic  diagnosis  of 
Hodgkin’s  disease.  The  patient  then  received  a course 
of  rather  general  roentgen  irradiation  and  a second 
roentgenographic  examination  of  the  thorax,  Sep- 
tember 28,  1921,  showed  that  the  mediastinal  lym- 
phadenopathic  tumor  had  almost  completely  dis- 
appeared (Fig.  11).  Nevertheless  the  patient  was 
given  a second  course  of  treatment  between  Septem- 
ber 28  and  30,  1921. 

The  patient  remained  free  from  any  symptoms  re- 
lated to  the  lymphoblastomatous  process  until  early 
in  1927,  when  the  cervical  nodes  again  enlarged,  the 
face  became  puffy  and  congested,  the  respiration  be- 
came difficult,  and  general  itching  caused  distress  and 
interfered  with  sleep.  General  examination  disclosed 
bilateral  supraclavicular,  axillary,  inguinal,  mediasti- 
nal, and  possibly  also  retroperitoneal  lymphadenopa- 
thy,  and  a multitude  of  scratch  marks  corroborated 
the  patient’s  complaint  of  pruritus.  Roentgenographic 
examination  of  the  thorax  showed  fresh  tumefaction 
in  the  mediastinum,  with  secondary  bronchiectasis 
of  the  lower  lobe  of  the  right  lung.  A course  of 
roentgen-ray  treatment,  given  between  June  7 and  10, 
1927,  was  followed  by  rapid  improvement,  and  the 
patient  has  remained  free  from  symptoms  since  that 
time.  This  may  be  regarded  as  an  example  of  a 
rather  chronic  form  of  Hodgkin’s  disease  and  prob- 
ably accounts  for  the  more  lasting  influence  of  irradi- 
ation. The  patient  will  undoubtedly  die  of  the  disease 
sooner  or  later;  in  the  meantime  she  is  well  and  able 
to  carry  on  all  her  usual  activities. 


Another  essentially  lymphoid  tumor  in  the 
mediastinum  occurs  chiefly  in  children.  I refer 
to  lymphoid  hyperplasia  of  the  thymus  gland. 
It  has  never  yet  been  determined  what  consti- 
tutes a normal  thymus  gland,  as  far  as  size  is 
concerned,  and  the  relationship  of  what  may  ap- 
pear to  be  an  abnormally  large  gland  to  the  symp- 
toms presented  by  the  patient  has  not  been  clearly 
elucidated.  It  is  undeniable,  however,  that  irradi- 
ation causes  the  size  of  the  hyperplastic  gland  to 
diminish  rapidly,  and  the  rate  of  regression  again 
corresponds  to  the  rate  of  destruction  character- 
istic of  normal  lymphocytes.  This  tends  to  sup- 
port the  view  of  Hammar  and  others  that  the 
small  round  cells  of  the  thymus  gland  are  lympho- 
cytes. Such  knowledge  can  be  utilized  advan- 
tageously not  only  to  treat  a patient  with  thymic 
hyperplasia,  but  actually  to  distinguish  such  hy- 
perplasia from  other  conditions  which  may  simu- 
late it. 

Like  epithelial  tumors  in  general,  the  radio- 
sensitiveness of  epithelioma  of  the  bronchus  and 
esophagus  is  much  lower  than  that  of  lymphoid 
tumors,  because  the  sensitiveness  of  normal  epi- 
thelium is  much  less  than  that  of  lymphocytes. 
It  is  but  natural,  therefore,  that  bronchial  or 
esophageal  neoplasms  derived  from  epithelium 
should  react  less  rapidly  and  less  favorably  than 
lymphoid  growths.  This  is  precisely  what  occurs 
in  practice.  In  fact,  there  is  a considerable  gap 
in  radiosensitiveness  between  the  least  sensitive 
of  lymphoblastomas  and  the  most  sensitive  epi- 
theliomas. A small  proportion  of  patients  with 
tumors  of  this  kind  derive  benefit  to  the  extent 
of  temporary  inhibition  of  tumor  growth  and  im- 
provement in  general  condition  for  a number  of 
months,  but  the  improvement  in  the  majority  of 
patients  is  slight  and  lasts  only  a short  time.  In 
many  patients  the  beneficial  influence  of  the 
treatment  is  hardly  perceptible.  This  applies  to 
patients  treated  with  roentgen  rays  of  short  wave- 
length generated  at  high  voltage  as  well  as  to 
patients  treated  with  radium.  One  possibility  has 
not  been  adequately  tested.  On  theoretic  grounds 
it  would  appear  that  combined  treatment  with 
converging  beams  of  highly  filtered  roentgen  rays 
of  short  wave  length  and  the  more  penetrating 
gamma  rays  of  radium  might  lead  to  improved 
results  in  tumors  of  this  kind.  This  possibility 
deserves  a thorough  trial.  Sarcomas  (except  lym- 
phosarcoma) do  not  often  arise  in  the  mediastinal 
structures,  and  such  as  occur  in  this  region  are 
usually  metastatic.  The  radiosensitiveness  of  such 
growths  depends  on  the  variety  of  cell  of  which 
the  tumor  is  composed.  Academically  speaking, 
the  most  sensitive  variety  of  such  neoplasms  is 
represented  by  the  chondrosarcoma,  and  the  least 
sensitive  by  the  myxosarcoma,  but  in  practice  the 
difference  in  radiosensitiveness  between  the  two 
extremes  is  not  great,  and  associated  metastasis 
to  the  lungs  often  prevents  the  radiologist  from 
accomplishing  much. 

The  Mayo  Clinic. 


382 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


CLAM  AND  MUSSEL  POISONING* 

By  George  E.  Ebright,  M.  D. 

San  Francisco 


Discussion  by  H.  Sommer,  Ph.D.,  San  Francisco ; K.  F. 
Meyer,  Ph.D.,  San  Francisco;  J.  H.  Kuser,  M.D.,  San 
Rafael. 


"[INTEREST  in  poisoning  from  eating  mussels  in 
California  was  sharply  aroused  by  the  occur- 
rence of  one  hundred  and  two  cases  and  six 
deaths  in  the  summer  of  1927.  In  1928  no  human 
cases  occurred,  although  in  July  mussels  found 
south  of  Mussel  Rock  were  highly  toxic.  In  1929 
there  have  been  to  date  of  this  writing  fifty-five 
cases  of  mussel  poisoning  with  one  death;  and 
six  cases  of  poisoning  from  clams  with  three 
deaths. 


An  admirable  paper  by  Meyer,  Sommer,  and 
Schoenholz,  published  September  1928  in  the 
Journal  of  Preventive  Medicine,  presents  a re- 
view of  the  history  of  mussel  poisoning,  including 
the  California  epidemic  of  1927.  These  authors 
found  that  since  1793  approximately  two  hundred 
and  forty-four  people  have  been  poisoned  by  mus- 
sels, and  that  thirty-eight  (15.6  per  cent)  have 
died.  Of  the  twenty-one  observations  five  oc- 
curred in  England  and  five  in  California,  three  in 
Ireland,  two  in  Prussia  and  two  on  the  northern 
Pacific  Coast  and  one  each  in  Scotland,  Wales, 
Norway,  and  France.  The  highest  mortality 
(37  per  cent)  occurred  at  Timber  Cove,  Cali- 
fornia in  1903,  and  the  lowest  (5.8  per  cent)  in 
the  1927  outbreak.  The  earliest  known  cases  on 
the  Pacific  Coast  occurred  in  1793  in  an  English 
expedition  at  what  is  now  Vancouver.  This 
affected  a number  of  people  and  caused  one  death. 
Poisoning  from  mussels  was  known  to  the  Indians 
of  the  Pacific  Coast,  some  of  them  having  been 
accustomed  to  place  sentries  to  watch  for  lumi- 
nescence of  the  waves  which  was  associated  in 
their  minds  with  shellfish  poisoning.  At  such 
time,  shellfish  were  forbidden  to  be  eaten  for  two 
days;  those  eating  shellfish  caught  at  such  a time 
were  thought  to  be  subject  to  sickness  and  death. 


FIRST  OFFICIAL  RECORD  IN  CALIFORNIA 

In  1915  there  were  four  cases  of  mussel  poison- 
ing in  Santa  Cruz,  with  no  deaths.  Mussel  poison- 
ing entered  the  official  archives  of  California  with 
the  report  of  the  deaths  of  two  persons  in  Santa 
Cruz  in  1917.  The  State  Board  of  Health  report 
is  as  follows : 

On  July.  16,  1917,  two  persons,  Mr.  C.  and  daughter, 
age  five,  died  at.  Santa  Cruz  after  having  eaten  heartily 
of  the  California  black  mussel,  Mytilus  calif ornianus. 

The  circumstances  were  as  follows:  Two  families, 
C.  and  M.,  respectively,  from  Stockton,  California, 
were  spending  their  vacation  at  Santa  Cruz.  The  first 
family  consisted  of  the  parents,  a son  of  seventeen, 
a daughter  of  five,  and  a niece;  the  second,  of  the 
parents,  and  a son  of  about  seventeen.  At  the  low 
tide  on  the  morning  of  July  16  these  parties  gathered 
a quantity  of  mussels  from  a rock  near  Santa  Cruz, 
where  mussels  are  in  the  breakers  and  range  upward 
toward  high  tide  level.  The  mussels  were  cooked  and 
eaten  at  about  11  o’clock  in  the  morning  and  were, 
therefore,  perfectly  fresh.  Mr.  C.  ate  very  heartily, 

* Read  before  the  San  Francisco  County  Medical  Society, 
September  3,  1929. 


consuming  three  or  four  dozen,  it  is  said.  Mr.  M.  and 
his  wife  noticed  a peculiar  “metallic”  taste  to  the 
mussels  and  ate  sparingly.  Two  hours  after  the  meal 
the  first  symptoms  appeared.  Numbness  at  the  tip  of 
the  tongue,  and  numbness  and  tingling  of  the  finger 
ends,  then  lack  of  coordination  appeared,  the  patients 
reaching  for  objects  which  they  invariably  missed. 
Dizziness,  incoherence  of  speech  and  paralysis  set  in. 
A physician  was  summoned  at  3 o’clock  and  the 
daughter,  age  five,  died  shortly  thereafter.  Mr.  C. 
died  at  about  6:30  o’clock  that  evening  at  the  hospital. 
In  both  cases  the  respiratory  centers  were  affected 
before  the  circulatory  centers,  the  heart  continuing 
to  beat  some  minutes  after  the  cessation  of  breathing. 
Mrs.  C.  showed  no  symptoms  until  3:30  o’clock,  then 
had  a sudden  but  not  fatal  attack.  The  two  boys  had 
eaten  heartily  of  other  foods  after  their  meal  of  mus- 
sels and  were  slightly  affected,  as  were  also  Mr.  M. 
and  his  wife.  Other  symptoms  noted  by  all  who  ate 
of  the  mussels  were  constriction  of  the  throat,  some 
distress  in  the  chest,  and  stiffness  of  the  neck  muscles, 
and  a sensation  described  as  “the  teeth  being  set  on 
edge.”  The  following  day  there  was  some  pain  in  the 
back  of  the  head. 

It  is  also  reported  that  a party  of  five  persons  had 
been  made  ill  by  mussels  a few  days  prior  to  these 
fatal  cases. 

During  the  month  of  July  1927,  one  hundred 
and  two  people  were  taken  ill  with  mussel  poison- 
ing and  six  died. 

PROPHYLACTIC  MEASURES  BY  THE  STATE 

At  this  point  it  may  be  of  interest  to  refer 
briefly  to  the  organization  which  has  been  de- 
veloped by  the  State  of  California  to  combat 
epidemics  of  various  kinds. 

The  State  Board  of  Health,  under  the  authority 
of  the  law  which  requires  it  to  examine  into  the 
causes  of  communicable  diseases,  established  ex- 
ecutive divisions  or  bureaus  for  special  activities 
such  as  tuberculosis,  sanitary  engineering,  super- 
vision of  food  and  drugs,  epidemiology,  and  vital 
statistics.  It  has  also  found  it  advantageous  in 
dealing  with  many  problems  to  take  advantage  of 
the  availability  of  the  services  of  experts  in  the 
universities  who  have  been  willing  to  accept  the 
title  of  consultants  to  the  State  Board  of  Health 
and  who  render  valued  counsel  and  cooperation. 

California  has  ample  cause  for  gratitude  for 
the  manner  in  which  members  of  the  faculties  of 
the  University  of  California  and  Stanford  Uni- 
versity have  served  in  this  capacity.  To  Professor 
Charles  Gilman  Hyde,  California  is  indebted  for 
the  vision  which  created  and  shaped  the  policies 
of  the  Bureau  of  Sanitary  Engineering.  To  Pro- 
fessor W.  B.  Herms,  for  several  years’  work  on 
a mosquito  survey  of  the  state  which  laid  the 
foundation  of  activities  which  resulted  in  the 
elimination  of  malaria  as  a cause  of  death  in  this 
state.  To  Professor  Charles  A.  Kofoid,  for  coop- 
eration in  the  control  of  tropical  parasitical  dis- 
eases ; and  to  the  cooperation  of  Professor  Karl  F. 
Meyer,  Dr.  J.  C.  Geiger  and  Professor  Ernest  A. 
Dixon  on  the  botulism  problem,  all  working  under 
the  auspices  of  the  American  Canners’  Associa- 
tion, Doctor  Meyer  and  later  Doctor  Dixon  serv- 
ing also  as  consultants  to  the  State  Board  of 
Health. 

It  is  apparent  that  in  the  study  and  control  of 
the  problem  of  mussel  poisoning,  by  virtue  of  the 
fact  that  the  director  of  the  Hooper  Foundation 


June,  1930 


CLAM  AND  MUSSEL  POISONING — EBRIGIIT 


383 


for  Medical  Research  serves  as  consulting  bac- 
teriologist of  the  State  Board  of  Health,  there 
is  a very  desirable  combination  for  scientific  re- 
search and  executive  action  which  gives  promise 
of  practical  results.  Not  only  is  a daily  survey 
of  the  condition  of  shellfish  along  the  California 
coast  carried  on  during  the  summer  months  in 
reference  to  quarantine  requirements,  but  also  ad- 
vantage is  being  taken  of  the  opportunity  to  con- 
duct scientific  investigations  into  the  heretofore 
obscure  nature  of  the  toxin  sometimes  present 
in  these  shellfish,  and  the  causes  of  its  appear- 
ance. The  trend  of  investigations  to  date  seems 
to  indicate  the  possible  advisability  of  a definite 
closed  season  for  mussels  at  least,  during  the 
summer  months. 

CLINICAL  ASPECTS  OF  MUSSEL  POISONING 

Clinical  aspects  of  poisoning  by  the  common 
mussel,  Mytilus  editlis,  are  divided  into  three 
types. 

The  first  is  of  the  nature  of  a gastro-enteritis 
with  choleraic  symptoms,  such  as  nausea,  vomit- 
ing, diarrhea,  which  do  not  appear  until  after  a 
lapse  of  some  hours.  Death  may  result,  but  not 
as  a rule.  This  type  corresponds  to  similar  forms 
of  intoxication  caused  by  meat,  cheese,  and  other 
foods. 

A second  type  presents  essentially  nervous 
symptoms  and  is  the  most  common  form.  It 
begins  with  a sensation  of  heat.  Itching  appears, 
usually  at  first  on  the  eyelids,  but  before  long 
spreads  over  the  face  and  may  involve  a large 
part  of  the  body.  A diffuse  erythema  or  general 
urticaria  develops.  Angina  and  dyspnea  are  at 
times  pronounced.  Recovery  usually  takes  place 
after  a few  days. 

The  third  type  is  paralytic  and  is  the  most 
dangerous.  Its  aspects  are  similar  to  those  of 
curare  poisoning.  All  of  the  California  cases 
reported  are  easily  recognized  as  being  of  the 
paralytic  form. 

In  the  1927  epidemic,  poisoning  occurred  from 
eating  the  large  mussel,  Mytilus  calif  or  nianus, 
gathered  on  the  rocky  ocean  shore.  The  smaller 
variety,  Mytilus  edulis,  which  is  the  commercial 
variety  and  found  in  the  bays  of  California  was 
not  toxic.  This  accounted  for  the  fact  that  all  of 
the  poisoning  cases  were  those  which  occurred 
from  mussels  collected  by  amateurs  picnicking 
upon  the  ocean  shore.  It  was  therefore  not  found 
necessary  to  place  a quarantine  for  any  length  of 
time  upon  the  commercial  mussel.  During  the 
summer  of  1929,  however,  poisonous  mussels 
have  been  found  within  San  Francisco  bay. 

The  theory  that  poisonous  mussels  are  only 
those  which  are  exposed  to  the  air  at  low  tide  is 
not  tenable,  as  the  workers  of  the  Hooper  Foun- 
dation have  shown  that  the  most  poisonous  mus- 
sels may  be  found  deep  in  the  water  at  the  lowest 
tide.  No  satisfactory  explanation  has  yet  been 
found  as  to  the  origin  of  the  poison.  That  it  may 
be  related  to  a sex  poison  is  suggested  by  a possi- 
ble coincidence  with  the  spawning  season,  similar, 
in  a measure,  to  the  poisonous  eggs  of  the  black 


widow  spider.  It  has  been  definitely  shown  that 
the  poison  is  in  no  way  connected  with  sewage 
contamination,  nor  water  highly  impregnated  with 
copper  or  arsenic  salts  as  was  suggested  in  some 
of  the  European  cases.  Poisonous  mussels  may 
give  no  evidence  whatever  to  any  of  the  senses 
of  being  dangerous,  as  there  is  nothing  peculiar 
in  the  odor  or  appearance.  The  poison  is  not 
destroyed  by  cooking.  It  is  equally  potent  in 
the  raw  or  the  cooked  mollusk,  and  in  cooking, 
being  very  soluble  in  water,  the  broth  is  highly 
poisonous. 

GENERAL  SYMPTOMS 

The  symptoms  experienced  by  the  patient  in 
all  the  California  cases  are  extremely  uniform 
and  highly  characteristic,  ranging  from  a slight 
tingling  and  numbness  around  the  mouth  and  of 
the  fingers  and  toes  to  a more  intense  feeling  of 
numbness  of  the  extremities  with  complete  loss 
of  muscular  power  and  an  extreme  sensation  of 
weakness  followed  by  death  from  respiratory 
failure.  There  is  no  loss  of  consciousness,  the 
mind  remaining  perfectly  clear  to  the  end,  no 
convulsions  and,  as  a rule,  no  gastro-intestinal 
symptoms,  although  in  a few  cases  there  was 
noted  slight  nausea. 

In  the  1929  group,  Dr.  J.  H.  Ivuser  of  San 
Rafael  attended  six  patients  who  recovered.  He 
reports  that  the  symptoms  were  tingling  of  the 
fingers  and  mouth,  no  gastro-intestinal  symptoms, 
the  tongue  was  heavy,  patient  might  feel  as 
though  walking  on  rubber.  Recovery  was  com- 
plete within  ten  days.  These  were  mild  cases  and 
came  under  treatment  early.  Of  a number  of  pa- 
tients treated  by  the  San  Francisco  Health  De- 
partment, the  records  show  that  vertigo,  motor 
weakness,  peripheral  pain  and  paresthesia  were 
noted.  Doctor  Thurlow  of  Santa  Rosa  attended 
two  fatal  eases  of  clam  poisoning.  Each  of  two 
brothers,  aged  forty-two  and  forty-six  years,  ate 
one  long-necked  clam.  These  clams  were  eaten 
raw.  Within  one  hour  symptoms  appeared  which 
felt  like  alcoholic  intoxication — light-headedness, 
numbness  of  limbs,  and  slight  nausea.  These  men 
drove  twenty  miles  and  had  great  difficulty  keep- 
ing the  automobile  on  the  road.  On  alighting 
they  showed  a high  stepping,  staggering  gait,  very 
little  pain,  a sense  of  constriction  of  the  throat 
and  inability  to  swallow  and  an  intense  sense 
of  smothering,  with  mentality  perfectly  clear 
throughout  and  no  convulsions.  Death  occurred 
from  respiratory  failure,  one  brother  dying  one 
and  a half  hours  after  eating  the  clam,  and  the 
other  two  and  a half  hours  after  eating. 

DIAGNOSIS 

In  mussel  or  clam  poisoning  the  history  of  eat- 
ing the  mollusk,  the  rapid  onset  of  symptoms  as 
early  as  five  minutes  after  ingestion,  the  sensation 
of  tingling  and  numbness  of  the  fingers  and  toes 
which  spreads  upward  along  the  limbs  to  the 
trunk  and  neck  together  with  a pronounced  feel- 
ing of  weakness  and  loss  of  muscular  power,  the 
ataxia,  a sensation  of  floating,  the  absence  or 
very  slight  gastro-intestinal  symptoms,  a sense  of 
constriction  of  the  throat,  perfectly  clear  mind, 


384 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


absence  of  fever,  and  death  by  respiratory  failure, 
and  the  fact  that  the  poison  is  not  destroyed  by 
cooking  and  is  very  quickly  fatal  to  cats  and  to 
chickens,  serves  in  differentiating  the  condition 
from  the  following  conditions : 

From  Botulism. — Poison  of  botulism  is  readily 
destroyed  by  cooking,  symptoms  are  slow  in  onset, 
twenty  to  twenty-four  hours  or  longer  after  inges- 
tion. There  is  nausea,  vomiting,  gastric  pain,  ob- 
stinate constipation,  visual  blurring,  dilatation  of 
the  pupil,  and  strabismus.  There  is  a profuse 
secretion  of  sticky  mucus  in  the  mouth,  nose  and 
pharynx  which  chokes  and  strangles  the  patient, 
but  failure  of  the  respiratory  center  is  not  present 
as  in  mussel  poisoning.  In  fatal  cases  there  is 
collapse,  dyspnea,  sometimes  coma  or  wild  de- 
lirium shortly  before  death.  It  causes  “limber 
neck”  and  death  in  chickens. 

From  Meat  Poisoning. — The  meat  from  ani- 
mals diseased  with  Bacterium  enteritidis,  Bac- 
terium coli,  or  Bacterium  paratyphosum  gives  rise 
to  an  acute  gastro-enteritis.  This  poisoning  does 
not  kill  chickens  or  cats. 

From  Mushroom  Poisoning. — There  are  two 
forms  of  mushroom  poisoning,  essentially  differ- 
ent from  each  other. 

A.  Poisoning  from  Amanita  phalloides  (Poison 
Cup  or  Death  Angel). — This  form  is  very  poison- 
ous, the  mortality  rate  ranging  from  40  to  75  per 
cent.  Symptoms  occur  after  a prodromal  stage  of 
from  six  to  fifteen  hours,  ushered  in  by  extreme 
abdominal  pain,  vomiting,  and  diarrhea.  Vomitus 
and  stool  contain  undigested  food,  blood,  and 
mucus.  There  is  rarely  constipation.  Marked 
dehydration  of  the  patient  occurs  and  rapidly  pro- 
gressing weakness.  Jaundice,  cyanosis,  coldness 
of  the  skin,  in  the  course  of  two  or  three  days. 
Death  in  coma  in  four  to  eight  days.  Severe  cases 
in  forty-eight  hours.  Autopsy  reveals  enlarged 
pale  yellow  liver,  congestion  of  spleen  and  kidneys. 

B.  Poisoning  from  Amanita  muscaria  (Fly 
Mushroom) . — The  symptoms  of  poisoning  from 
Amanita  muscaria  are  diametrically  opposite  to 
the  manifestations  of  poisoning  from  atropin, 
which  is  a physiological  antidote.  They  are  char- 
acteristic and  striking,  and  readily  lead  to  an  early 
diagnosis. 

Almost  immediately  following  ingestion,  some- 
times in  one  or  two  hours,  usually  in  five  or  six, 
there  is  excessive  salivation,  perspiration  and 
lachrymation,  together  with  violent  retching  and 
vomiting,  and  with  a profuse  diarrhea  and  watery 
stools.  The  heart  is  slow  and  irregular,  respira- 
tions rapid.  There  is  marked  dyspnea  and  the 
bronchi  are  filled  with  mucus.  Mental  symptoms 
come  on  rapidly,  giddiness  with  confusion  of 
ideas  and,  rarely,  hallucinosis.  There  is  great 
variation  in  the  intensity  of  the  different  symp- 
toms, sometimes  the  gastro-intestinal  disturbance 
being  the  most  marked,  and  at  other  times  the 
mental  and  nervous  predominating.  Mild  cases 
may  present  excessive  salivation  and  perspiration 
and  a vague  discomfort  and  uneasiness  of  the 


stomach  and  intestines.  In  very  severe  cases  nerv- 
ous and  mental  manifestations  appear  early,  pre- 
senting delirium,  violent  convulsions,  and  early 
loss  of  consciousness  or  death  from  respiratory 
paralysis.  In  certain  cases  after  preliminary  nau- 
sea, vomiting  and  diarrhea,  excessive  perspiration 
and  salivation,  there  may  follow  a deep  sleep  of 
several  hours,  followed  by  profound  prostration 
and  recovery.  The  pupils  are  as  a rule  contracted 
and  do  not  react  to  light  nor  accommodation.1 

From  Acute  Ergot  Poisoning. — May  not  ap- 
pear for  some  hours  and  usually  begins  with 
vomiting.  There  are  burning  pains  in  the  abdo- 
men, tingling  of  the  extremities,  great  thirst, 
weakness,  and  diarrhea.  Other  symptoms  super- 
vene which  have  no  bearing  here. 

From  Vetch  Poisoning. — Rather  rare.  Seen  in 
Austria  and  Italy,  northern  Africa  and  in  India. 
Sudden  and  severe  pains  in  the  lumbar  regions, 
girdle  sensation,  motor  paralysis  of  the  lower 
extremities,  tremor,  and  fever. 

From  Curare  Poisoning. — The  history  alone 
would  be  of  value  in  differentiating  mussel 
poisoning  from  curare  poisoning  inasmuch  as 
the  latter  paralyzes  the  motor  end  plates  and  the 
respiratory  muscles. 

Poisoning  from  Conium  or  Poison  Hemlock. — 
This  type  of  poisoning  is  similar  to  curare  but 
causes  a milder  depression  of  the  motor  end- 
plates.  There  is  paralysis  with  slight  numbness 
beginning  in  the  toes,  gradually  ascending  until 
it  involves  the  trunk  with  death  from  respiratory 
paralysis.  Socrates,  dying  of  this  poison,  de- 
•scribed  quite  accurately  the  symptoms  of  mussel 
poisoning. 

r TREATMENT 

The  treatment  should  consist  of  prompt  empty- 
ing of  the  stomach  by  emesis  or  the  use  of 
a stomach  tube  and  brisk  purgation.  As  respira- 
tory stimulants,  aromatic  spirits  of  ammonia  and 
caffein  are  indicated.  When  necessary,  artificial 
respiration  should  be  given,  especially  in  view  of 
the  fact  that  by  means  of  emesis  and  purgation 
the  poison  can  be  quite  rapidly  eliminated  and 
artificial  respiration  may  tide  over  the  crisis. 

Convalescence  is  usually  complete  in  from  a 
few  days  to  a week  or  two. 

384  Post  Street. 

REFERENCE 

1.  Peterson,  Haines,  and  Webster:  Legal  Medicine 
and  Toxicology,  second  edition,  pp.  817. 

DISCUSSION 

H.  Sommer,  Ph.D.  and  K.  F.  Meyer,  Ph.D.  (Hooper 
Foundation  for  Medical  Research,  San  Francisco). — 
The  question  of  shellfish  poisoning  of  which  Doctor 
Ebright  has  given  a very  valuable  and  timely  account 
is  of  special  interest  to  the  physicians  of  central  Cali- 
fornia as  well  as  to  chemists  and  biologists.  As  far 
as  the  literature  reveals,  poisonings  by  mussels  simi- 
lar in  extent  to  the  recent  California  outbreaks  have 
never  been  observed;  likewise  cases  of  clam  poison- 
ing due  to  a neurotoxin  either  identical  or  very  simi- 
lar to  the  mussel  poison  are  not  recorded.  This 
naturally  raises  the  question  of  the  origin  of  the 
poison  and  the  cause  of  its  appearance  during  a few 
weeks  in  midsummer,  along  a rather  limited  stretch 
of  the  Pacific  Coast. 


June,  1930 


IM M U NOBIOLOGIC  REACTION  IN  TUBERCULOSIS — THOMAS 


385 


Based  on  laboratory  experiments  and  field  observa- 
tions by  the  Hooper  Foundation  extending  over  more 
than  two  years,  the  following  possibilities  seem  most 
likely.  The  mussel  poison  is  a metabolic  product 
which  may  be  elaborated  in  excessive  amounts  either 
during  the  spawning  period  or  after  ingestion  of  a 
particular  kind  of  food.  In  addition  to  this  it  is  not 
unlikely  that  the  meteorological  and  the  tidal  condi- 
tions are  of  considerable  importance  as  secondary 
factors.  Another  view  holds  that  the  toxin  is  pre- 
formed in  the  water,  originating  possibly  from  poison- 
ous animals  or  from  decomposition  of  vegetable 
matter,  and  is  absorbed  and  stored  in  the  shellfish. 
Hypotheses  which  are  based  on  the  assumption  of 
bacterial  decomposition,  copper  salts,  pollution  of  the 
water,  etc.,  as  causative  factors,  are  not  supported  by 
actual  observations. 

A noteworthy  feature  of  the  1929  outbreak  is  the 
fact  that  clams  from  various  localities  of  the  coast 
were  equally  as  poisonous  as  the  mussels.  Of  the 
eight  varieties  tested  in  the  laboratory,  five  kinds  of 
clams  which  are  commonly  used  as  food  were  found 
highly  toxic.  One  sample  of  oysters  and  several 
abalones  proved  harmless. 

It  has  again  been  noticed  that  the  digestive  organ 
(“liver'’)  of  the  shellfish  yields  by  far  the  most  potent 
poison.  Extraction  of  mussels’  livers  with  methyl 
alcohol  has  given  a crude  substance  which  is  lethal  to 
mice  in  doses  of  0.1  milligram  on  intrap,  injection. 
It  is  evident,  therefore,  that  we  are  dealing  with  a 
very  deadly  poison,  comparable  in  strength  to  some 
of  the  most  poisonous  alkaloids. 

Although  regular  observations  along  the  California 
coast  have  been  made  only  for  three  consecutive 
summer  seasons  the  epidemiological  facts  and  the 
laboratory  findings  thus  far  accumulated  fully  war- 
rant the  establishment  of  a strict  quarantine  on  all 
bivalves  during  the  summer  months. 

& 

J.  H.  Kuser,  M.  D.  (6  Cheda  Building,  San  Rafael). 
Doctor  Ebright’s  most  complete  and  extensive  report 
on  clam  and  mussel  poisoning  certainly  deserves 
study  by  the  medical  profession. 

On  July  22,  1929,  six  cases  of  mussel  poisoning 
were  reported  to  my  office.  Mussels  were  gathered 
under  water  and  had  never  been  exposed  to  low  tide. 
All  who  were  poisoned  recovered  after  washing  of 
the  stomach.  It  was  fortunate  that  two  medical  men 
were  present  who  gave  efficient  first  aid.  One  patient 
was  taken  to  the  hospital  for  treatment.  After  ten 
days  she  was  allowed  to  return  to  her  home.  She  was 
extremely  prostrated  and  toxic. 

This  office  was  informed  that  on  August  5 three 
deaths  occurred  after  eating  Tomales  clams.  None 
of  these  cases  came  under  our  personal  observation. 
The  State  Department  of  Public  Health  quarantined 
promptly  all  clams  and  mussels  from  Sonoma  and 
Marin  counties.  Specimens  of  mussels  and  clams  were 
at  stated  intervals  submitted  to  the  Hooper  Research 
Laboratories.  All  were  found  toxic  until  the  middle 
of  October.  The  last  shellfish  were  submitted  on 
October  31,  when  they  were  found  not  toxic.  Quaran- 
tine was  raised  on  November  2,  1929. 

A peculiar  condition  was  that  oysters  in  the  upper 
portion  of  Tomales  Bay  were  found  nontoxic  by  the 
laboratory.  These  specimens,  as  well  as  abalones, 
were  gathered  at  the  same  time,  on  August  16,  1929. 

Taking  into  consideration  the  extreme  toxicity  of 
these  shellfish  during  certain  periods  of  the  warm 
summer  months  and  that  no  specific  therapy  for  com- 
bating the  poison  has  yet  been  found,  and  the  impossi- 
bility of  distinguishing  poisonous  from  nonpoisonous 
mussels  or  clams,  it  would  seem  advisable  that  the 
state  authorities  establish  a closed  season  for  clams 
and  mussels  in  those  months  during  which  they 
have  been  found  poisonous  by  the  Hooper  Research 
Laboratory. 


THE  IMMUNOBIOLOGIC  REACTION  IN 
TUBERCULOSIS* 

WITH  REFERENCE  TO  INFANCY  AND 
CHILDHOOD 

By  Roy  E.  Thomas,  M.  D. 

Los  Angeles 

Discussion-  by  F.  M.  Pottenger,  M.  D.,  Monrovia ; 
Robert  A.  Peers,  M.  D.,  Colfax ; Harold  K.  Faber,  M.  D., 
San  Francisco. 

HP  WO  infants  are  exposed  to  tuberculosis.  Why 

does  one  develop  clinical  disease  while  the 
other  does  not? 

Of  two  children  who  have  developed  clinical 
tuberculosis  and  who  are  living  under  the  same 
conditions,  one  dies  and  the  other  recovers.  Why 
is  this  so  ? The  answer  to  both  questions  is  prob- 
ably to  be  found  in  the  study  of  the  subject  as 
indicated  by  the  caption  of  this  paper. 

MAJOR  FACTORS  TO  BE  CONSIDERED 

Primary  Infection. — This  may  occur  at  any 
age,  but  probably  takes  place  very  early  in  infants 
exposed  daily  to  open  cases  of  tuberculosis,  as 
in  cases  in  which  the  mother,  father,  or  both  are 
tuberculous.  Of  one  hundred  and  twenty-four 
tuberculous  infants  observed  by  Bernard 1 the 
mother  had  tuberculosis  in  ninety-five  instances, 
the  father  in  twenty,  and  both  father  and  mother 
in  twenty. 

The  route  of  infection  in  the  great  majority  of 
cases  is  probably  through  the  respiratory  tract 
by  inhalation  of  bacillus-laden  dust  particles  or 
droplets. 

The  Tubercle. — When  tubercle  bacilli  gain  en- 
trance to  susceptible  tissue  for  the  first  time  a 
tubercle  results,  the  formation  of  which  has  been 
so  beautifully  described  by  Krause  2 in  his  article, 
“The  Anatomical  Structure  of  the  Tubercle.” 

If  an  experimental  inoculation  of  virulent 
bacilli  is  made  in  a convenient  site,  such  as  the 
skin  or  cornea,  nothing  is  to  be  seen  for  nearly 
a week.  Then  a pale,  firm  nodule  appears  which 
slowly  enlarges.  About  the  third  week  this  nodule 
becomes  irregular  in  shape,  its  center  becomes 
yellowish  white  in  color,  and  induration  gives 
place  to  a doughy  consistence.  While  these 
changes  are  occurring,  the  zone  of  tissue  im- 
mediately surrounding  the  nodule  has  assumed  a 
pinkish  color.  At  the  same  time  small  secondary 
nodules  may  appear  on  the  edges  of  the  primarv 
nodule.  The  appearance  of  these  secondary  signs 
indicates  the  termination  of  what  Krause  calls 
the  preallergic  phase  of  tuberculosis.  Primary 
tubercle  develops  without  signs  of  inflammation. 

A microscopic  study  of  the  primary  tubercle 
shows  surrounding  each  bacillus  or  group  of 
bacilli  a collection  of  epithelioid  cells.  These 
characteristic  cells  are  arranged  in  roughly  con- 
centric layers  which  become  flattened  toward  the 
periphery,  where  interlacing  fibrils  appear.  Often 
near  the  center  of  this  spherical  collection  of  cells 

* Read  before  the  Pediatrics  Section  of  the  California 
Medical  Association  at  the  fifty-eighth  annual  session. 
May  6-9,  1929. 


386 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


are  found  large  multinuclear  cells  called  “giant 
cells,’’  which  probably  represent  degenerated  epi- 
thelioid cells.  The  other  cell  usually  present  in 
the  elementary  tubercle  is  the  lymphocyte,  found 
in  greatest  numbers  near  the  periphery  and  evi- 
dently an  invader,  in  contrast  to  the  epithelioid 
cell  which  is  apparently  derived  from  the  multi- 
plication of  cells  at  the  site  of  the  inoculation. 

It  will  be  evident  from  this  brief  description 
of  the  formation  of  the  primary  tubercle  that 
tuberculosis,  previous  to  the  occurrence  of  the 
phenomenon  we  call  allergy,  is  strictly  a prolifera- 
tive process. 

The  Allergic  Reaction  in  Tuberculosis. — Al- 
lergy has  been  defined  by  Kolmer  3 as  a state  of 
altered  reactivity  of  the  body  cells — usually  an 
exaggerated  susceptibility,  but  it  may  indicate 
reduced  susceptibility  or  tolerance. 

Zinsser4  says:  “All  forms  of  specific  hyper- 
sensitiveness are  probably  based  on  the  same 
fundamental  mechanism,  namely,  an  acquired  al- 
tered capacity  of  the  cells  to  react  to  the  par- 
ticular inciting  substance.” 

In  tuberculosis  a state  of  allergy  follows  the 
formation  of  primary  tubercle,  whether  this  re- 
sults from  the  implantation  of  living  or  dead 
bacilli.  An  allergic  reaction  is  the  response  to  the 
implantation  in  tissue  then  in  the  allergic  state, 
of  tubercle  bacilli,  living  or  dead,  or  the  injection 
of  tuberculin. 

This  response  is  characterized  by  exudation. 
It  is,  then,  the  allergic  reaction  which  causes  all 
tuberculous  inflammation,  resulting  in  infiltration, 
consolidation  or  effusion,  according  to  the  loca- 
tion involved.  It  follows  that  all  clinical  signs  and 
symptoms  are  dependent  upon  this  phenomenon. 

Endogenous  Reinfection. — This  occurs  to  some 
degree  in  all  cases  of  active  tuberculosis.  Bacilli 
reach  new  fields  through  the  lymphatics,  through 
the  blood  stream  and  by  direct  contact.  At  once 
the  protective  allergic  reaction  begins,  not  only 
at  the  point  of  reinoculation,  but  also  about  every 
other  focus  of  infection  in  the  body.  If  these 
reactions  are  not  too  severe  and  not  too  frequent 
they  stimulate  sufficient  proliferation  to  wall  off 
all  foci  and  thus  effect  a cure.  Allergic  reactions 
may  be  so  severe  as  to  result  quickly  in  death  or 
so  mild  that  no  clinical  evidence  of  them  is  ap- 
parent at  the  time. 

T uberculoimmunity. — Immunity  in  tuberculosis 
is  defined  by  Krause 5 as  that  condition  of  in- 
creased specific  resistance  to  implantation  and 
extension  of  tubercle  bacilli  which  comes  into 
existence  with  the  earliest  formation  of  the  ana- 
tomical tubercle.  If  we  accept  this  conception  it 
is  evident  that  immunity  begins  with  the  allergic 
state  and  that  both  continue  as  long  as  tubercle 
bacilli  continue  to  be  present  in  the  individual. 
Indeed,  the  only  distinction  between  allergy  and 
immunity  is  that  the  allergic  response  is  an  at- 
tribute of  the  local  cell  while  immunity  is  an 
acquired  characteristic  of  the  body  as  a whole. 

Practically  speaking,  immunity  has  to  do  chiefly 
with  exogenous  reinfection.  In  experimental  ani- 
mals reinoculation  results  in  a well  localized  and 


chronic  lesion  which  seldom  causes  death.  In 
those  cases  which  do  end  fatally,  the  progress  of 
the  disease  is  exceedingly  slow. 

Exogenous  Reinfection. — Does  adolescent  tuber- 
culosis result  from  endogenous  reinfection  from 
a focus  occurring  in  infancy,  or  is  it  an  exogenous 
reinfection  in  an  individual  whose  childhood  im- 
munity has  become  impaired  from  one  cause  or 
another  ? It  is  probable  that  both  occur.  It  is  also 
very  likely  that  a rare  case  of  primary  infection 
occurs  in  the  adult.  Lawrason  Brown  6 believes 
that  adult  pulmonary  tuberculosis  results  from 
exogenous  reinfection  between  the  ages  of  fifteen 
and  twenty  in  approximately  30  per  cent  of  cases. 

Production  of  Immunity  as  a Therapeutic  or 
Prophylactic  Measure. — Of  what  practical  value 
is  our  imperfect  knowledge  of  allergy  and  im- 
munity in  tuberculosis?  Attempts  to  produce  a 
passive  tuberculoimmunity  have  failed  because  the 
immune  reaction  is  cellular  and  not  humoral.  The 
active  immunization  of  infants  with  living  bacilli 
(Calmette’s  B.  C.-G.)  is  now  being  tried  on  rather 
a large  scale  in  France  and  elsewhere,  but  is  still 
in  the  experimental  stage. 

SUMMARY 

Primary  infection  usually  occurs  in  infants  ex- 
posed to  open  cases  of  tuberculosis  in  their  homes. 
It  occurs  chiefly  by  inhalation.  Its  first  mani- 
festation is  the  primary  tubercle,  developed  by 
proliferation  of  the  characteristic  epithelioid  cell. 
Following  this  preallergic  phase  occurs  the  allergic 
state,  upon  which  all  inflammatory  reaction  de- 
pends, and  tuberculoimmunity  which  largely  deter- 
mines the  clinical  course  of  the  disease.  I have 
tried  to  show  that  the  development  of  the  tubercle 
is  a proliferative  process  exclusively;  that  exuda- 
tion is  an  allergic  reaction  which,  although  at 
times  the  direct  cause  of  most  alarming  symp- 
toms, is  in  reality  a defensive  phenomenon. 

1136  West  Sixth  Street. 

REFERENCES 

1.  Bernard:  Am.  Rev.  of  Tuberculosis,  February, 
1927. 

2.  Krause:  Am.  Rev.  of  Tuberculosis,  February, 

1927. 

3.  Kolmer:  From  an  address  delivered  before  the 
American  Association  for  the  Study  of  Allergy, 
Minneapolis,  Minn.,  June  11,  1928. 

4.  Zinsser:  Bui.  N.  Y.  Academy  of  Medicine,  March, 

1928. 

5.  Krause:  Annals  of  Internal  Medicine,  March, 
1928. 

6.  Brown:  Am.  Rev.  of  Tuberculosis,  January,  1927. 

DISCUSSION 

F.  M.  Pottencer,  M.  D.  (Monrovia). — Dr.  Thomas’s 
paper  sets  out  the  early  immunological  reactions  in 
tuberculosis  in  a very  clear  manner. 

In  order  to  understand  tuberculosis  as  a clinical  dis- 
ease it  is  necessary  to  understand  what  takes  place 
at  the  time  of  the  primary  infection.  The  primary 
infection  soon  sensitizes  all  body  cells  to  tuberculo- 
protein,  so  that  when  they  come  in  contact  with  it 
again  they  are  resistant.  This  resistance  shows  itself 
in  many  ways,  the  most  evident  of  which  is  an  in- 
flammatory reaction.  This  inflammatory  reaction  is 
a very  important  factor  in  the  prevention  of  the 
spread  of  bacilli  through  the  tissues.  It  has  a tend- 
ency to  hem  them  in  wherever  they  are  deposited  and 
to  prevent  them  from  going  farther  until  they  are 
either  destroyed  or  are  encapsulated. 


June,  1930 


FREE  FASCIAL  GRAFTS — HAAS 


387 


As  a result  of  this  allergic  reaction,  bacilli  of  re- 
inoculation are  for  the  most  part  held  at  the  point  of 
implantation,  and  if  the  numbers  are  relatively  small 
the  infection  which  takes  place  usually  proves  to  be 
abortive.  This  is  probably  the  greatest  defensive 
factor  that  we  have  in  chronic  tuberculosis  during  the 
early  period  of  dissemination. 

It  is  probable  that  immunity  is  something  different 
from  sensitization  of  cells  and  allergy;  at  the  same 
time  it  is  also  probable  that  sensitization  and  allergy 
are  states  which  are  a part  of,  which  precede  and 
which  lead  up  to  the  ultimate  establishment  of 
immunity. 

Primary  infection  of  the  lung  is  necessarily  of  ex- 
ogenous origin.  It  may  be  that  the  bacilli  enter 
through  the  air  passages,  or  through  the  gastro- 
intestinal tract.  The  theory  of  the  former  method  has 
the  most  adherents;  but  those  who  adhere  to  the  latter 
call  attention  to  the  fact  that  if  bacilli  gain  entrance 
to  the  body  through  the  alimentary  canal  and  pass 
through  the  intestinal  wall,  they  immediately  enter 
the  lymph  channels,  are  poured  into  the  thoracic  duct, 
and  thence  into  the  subclavian  vein  going  to  the  heart, 
and  on  through  the  lesser  circulation.  So  the  first 
opportunity  for  implantation  would  be  in  some  por- 
tion of  the  lesser  circulation.  Entering  virgin  soil, 
as  the  bacilli  which  form  the  primary  inoculation  do, 
they  meet  no  specific  tissue  resistance;  but  entering 
immune  soil,  as  the  bacilli  of  reinoculation  do,  they 
meet  the  resistance  produced  by  cell  sensitization,  and 
a tissue  response  in  the  form  of  allergic  inflamma- 
tion. This  protection  becomes  so  great  after  infec- 
tion has  been  present  for  some  time  that  bacilli  can 
enter  the  tissues  from  without  only  with  great  diffi- 
culty, or  when  the  specific  protection  has  been 
lowered.  So  after  infection  has  once  taken  place  the 
endogenous  source  of  inoculation  is  much  more 
plausible  than  the  exogenous. 

* 

Robert  A.  Peers,  M.  D.  (Colfax). — Doctor  Thomas, 
in  his  paper,  and  Doctor  Pottenger,  in  the  discussion, 
have  covered  the  fundamentals  of  the  cellular  reaction 
to  first  and  to  subsequent  invasions  of  tubercle  bacilli. 
Further  discussion  of  the  point  would  lead  merely  to 
elaboration  of  details. 

In  considering,  however,  the  two  questions  which 
Doctor  Thomas  formulates  at  the  beginning  of  his 
paper,  one  must  recognize  other  factors  involved  be- 
sides those  of  allergy  or  immunity.  True,  there  is  in 
all  of  us  a certain  amount  of  natural  immunity,  a 
greater  or  lesser  amount  of  inherited  cellular,  or 
humoral  immunity,  or  both,  which  gives  each  of  us 
greater  or  lesser  resistance  to  the  invasion,  and  to 
the  multiplication  and  extension  to  other  parts 
of  the  organism  of  the  tubercle  bacillus.  This  natural 
immunity  or  lack  of  immunity  is  undoubtedly  a factor 
in  the  determination  of  which  infected  child  develops 
clinical  tuberculosis,  and  also  in  the  determination  of 
which  of  those  with  clinical  tuberculosis  will  fail  to 
recover. 

Again  the  question  of  dosage  plays  a part  in  the 
outcome  of  the  process  which  follows  implantation. 
A large  dose  of  bacilli  received  from  the  careless 
tuberculous  father  or  mother  is,  other  things  being 
equal,  more  dangerous  to  the  child  than  a small  dose 
of  bacilli.  Many  bacilli  furnish  the  exciting  cause  for 
many  primary  tubercles  in  first  infections.  Many 
bacilli,  in  secondary  infections,  furnish  the  medium 
for  many  isolated  foci  of  allergic  response.  Immunity 
is  a relative  term.  The  greater  the  dosage  of  bacilli 
the  more  probable  this  immunity  will  be  overcome. 

Accident,  as  Krause  has  pointed  out,  also  plays  a 
part  in  the  determination  of  the  result  of  infection. 
Some  tissues  are  more  suited  to  hold  and  fix  the 
bacilli  than  are  others.  Thus  the  accident  of  location 
of  the  first  tubercle  plays  quite  a part  in  retention 
or  extension.  The  same  is  true  in  secondary  infection 
whether  endogenous  or  exogenous.  The  accident  of 
the  rupture  of  a solitary  caseating  lymph  node  into 
a blood  vessel  or  into  the  thoracic  duct  with  the  pro- 
duction of  an  acute  miliary  tuberculosis  may  furnish 


the  answer  to  these  questions.  Or  again,  the  accident 
of  extension  to  the  meninges  of  the  brain  and  cord 
of  an  already  allergic  child  causes  symptoms  and 
results  due  to  the  allergic  response  of  exudation  quite 
different  from  those  experienced  in  the  more  fortu- 
nate individual  whose  allergic  response  occurs  in  the 
lungs. 

As  Doctor  Pottenger  states  truly,  “In  order  to 
understand  tuberculosis  as  a clinical  disease  it  is 
necessary  to  understand  what  takes  place  at  the  time 
of  the  primary  infection.” 

* 

Harold  K.  Faber,  M.  D.  (Stanford  University  Medi- 
cal School,  San  Francisco). — Discussion  of  the  sub- 
ject of  Doctor  Thomas’s  paper  would  be  incomplete 
without  mention  of  three  common  clinical  manifesta- 
tions of  immunobiologic  reaction  to  tuberculosis — 
erythema  nodosum,  phlyctenular  keratoconjunctivitis, 
and  the  so-called  epituberculous  lesion  of  the  lung. 
All  these  coincide  in  a large  majority  of  cases  with 
a period  of  violent  reactivity  to  tuberculin,  and  are 
regarded  by  good  authorities  as  effects  of  tuberculin 
itself.  The  literature  on  erythema  nodosum  in  rela- 
tion to  tuberculosis  is  quite  extensive.  The  work  of 
Ernberg  1 and  of  Wallgren2  may  be  cited.  Casparis3 
has  recently  discussed  the  relation  of  phlyctenular 
lesions  to  tuberculosis.  Eliasberg  and  NeulancTs 4 
paper  may  be  consulted  for  a discussion  of  the  epi- 
tuberculous infiltrations  of  the  lung.  Another  paper  of 
Wallgren’s 5 discusses  the  clinical  manifestations  of 
tuberculin  allergy  in  infants  and  children  in  consider- 
able detail. 

It  has  perhaps  been  too  seldom  appreciated  by  the 
medical  profession  at  large  that  the  development  of 
allergy  to  tuberculin  is  accompanied  in  many  instances 
by  rather  stormy  symptoms  and  fairly  characteristic 
signs  or  radiographic  changes,  which  can  often  be 
recognized  by  careful  study,  and  Doctor  Thomas,  in 
calling  attention  to  the  fact,  is  performing  a useful 
service. 


1 Jahrb.  f.  Kinderheilk.,  1921,  95,  1. 

2 Jahrb.  f.  Kinderheilk.,  1927,  117,  313, 

3 Am.  Jour.  Dis.  Child.,  1927,  34,  779. 
i Jahrb.  f.  Kinderheilk.,  1921,  94,  102. 

5 Am.  Jour.  Dis.  Child.,  1928,  36,  702. 


FREE  FASCIAL  GRAFTS — THEIR  UNION 
WITH  MUSCLE* * 


REPORT  OF  CASES 


By  S.  L.  Haas,  M.  D. 
San  Francisco 


Discussion  by  John  Hunt  Shephard,  M.  D.,  San  Jose ; 
Leo  Eloesser,  M.  D.,  San  Francisco ; Sterling  Bunnell, 
M.  D.,  San  Francisco. 


A NUMBER  of  operative  procedures,  particu- 
larly  the  cure  of  hernia,  depend  upon  the 
principle  that  fascia  will  unite  with  muscle. 


OBSERVATIONS  OF  SEELIG  AND  CHOUKE 
In  spite  of  the  large  number  of  successful 
hernia  operations,  Seelig  and  Chouke  1 concluded 
from  their  observations  on  recurrences  after 
herniotomy  that  fascia  will  not  unite  with  muscle. 
To  further  substantiate  their  claims  they  per- 
formed a series  of  experiments  on  animals  in 
which  they  reduplicated  the  fascia  lata  to  simu- 
late Poupart’s  ligament  and  sutured  the  edge  of 
the  turned  flap  to  the  underlying  muscle.  In 


* FTom  the  Surgical  Laboratory  of  the  Stanford  Uni- 
versity Medical  School  and  the  Shriners’  Hospital  for 
Crippled  Children,  San  Francisco. 

* Read  before  the  General  Surgery  Section  of  the  Cali- 
fornia Medical  Association  at  the  fifty-eighth  annual 
session.  May  6-9,  1929. 


388 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


every  instance  they  found  that  the  fascia  lata  was 
separated  from  the  muscle  by  a loose  areolar 
tissue.  If  the  muscle  was  traumatized  by  the  ex- 
cision of  a wedge  and  the  fascia  sutured  to  the 
raw  muscle,  there  was  an  attempted  union  which 
was  complete  in  only  one  instance.  When  a 
pedicle  flap  was  passed  through  a tunnel  in  the 
muscle,  they  found  that  at  the  places  where  the 
fascia  came  into  contact  with  intramuscular  con- 
nective tissue  (perimysium)  it  fused  and  became 
firmly  anchored.  Where  the  perimysium  was 
scanty,  however,  the  fascia  strip  lay  in  its  tunnel 
with  practically  no  evidence  of  union.  They 
claimed  that  it  was  useless  to  suture  the  internal 
oblique  and  transversalis  muscles  to  Poupart’s 
ligament  because  they  would  fail  to  unite  unless 
the  muscles  had  been  vigorously  traumatized.  If 
they  did  unite  it  would  not  be  permanent  because 
of  the  inevitable  tension  that  would  occur  when 
these  structures  were  approximated. 

EXPERIMENTS  OF  KOONTZ  AND  OTHERS 

Naturally  these  rather  sweeping  assertions 
aroused  considerable  interest  and  discussion, 
from  the  clinical  as  well  as  from  the  experimental 
standpoint.  Ivoontz  2 was  one  of  the  first  to  fur- 
ther investigate  this  important  subject.  In  1926, 
in  a paper  entitled  “Muscle  and  Fascia  Suture 
With  Relation  to  Hernia  Repair,’’  he  gave  the 
results  of  his  experiments  on  dogs.  He  endeav- 
ored to  imitate  an  ordinary  hernia  repair,  except 
that  there  was  no  sac  to  tie  off,  making  the  sutur- 
ing of  the  internal  oblique  to  Poupart’s  ligament 
the  main  feature  of  the  operation.  He  obtained 
firm  union  in  every  instance.  Ivoontz  repeated 
the  experiments  of  Seelig  and  Chouke,  elaborat- 
ing upon  them  to  the  extent  of  removing,  on  one 
side,  the  loose  areolar  tissue  from  the  undersur- 
face of  the  fascia  lata,  while  on  the  opposite  side 
of  the  animal  it  was  not  disturbed.  The  experi- 
ments in  which  the  areolar  tissue  was  removed 
resulted  in  firm  union  with  the  underlying  muscle, 
while  in  those  in  which  it  remained  there  was 
no  union.  It  was  claimed  that  the  failures  of 
Seelig  and  Chouke  were  due  to  the  fact  that  they 
did  not  remove  this  thin  layer  of  areolar  tissue. 

Seelig  and  Chouke 3 independently  repeated 
their  previous  experiments,  scraping  the  adipose 
layer  from  the  fascia  lata,  as  they  had  done  in 
their  first  experiments,  but  had  failed  to  state 
specifically  in  their  article.  They  obtained  the 
same  results  as  in  the  first  instance,  namely,  that 
the  reduplicated  fascia  failed  to  unite  with  the 
muscle. 

Rosenblatt  and  Cooksey  * made  the  same  ex- 
periments that  Seelig  and  Chouke  had  found  un- 
successful and  obtained  exactly  opposite  results. 
They  found,  as  had  Koontz,  that  in  the  cases 
where  they  removed  the  areolar  tissue  from  the 
fascia  there  was  a firm  union,  while  in  those 
where  it  was  allowed  to  remain  there  was  but  a 
slight  union.  They  also  sutured  the  rectus  muscle 
to  Poupart’s  ligament  after  removing  the  loose 
areolar  tissue,  and  secured  firm  union  in  every 
instance. 


It  is  difficult  to  explain  the  discrepancies  in 
the  results  obtained  by  these  investigators  who 
performed  the  same  experiments  with  the  same 
technique.  Hertzler,5  in  commenting  on  these  dif- 
ferences, offered  the  following  suggestions,  using 
his  experiments  and  clinical  observations  as  the 
foundation  for  his  opinions.  He  found,  in  study- 
ing the  healing  of  wounds,  that  the  proximity  of 
any  fat-bearing  tissue  prevented  the  process  of 
regeneration  because  fibrin  bundles  could  not 
form  in  the  presence  of  fat.  He  stated  that  it 
was  the  traumatic  reaction  which  actuated  the 
fibrin  formation.  This  in  turn  resulted  in  the 
generation  of  fibrous  tissue  which  performed 
the  union.  Therefore,  he  claimed,  to  obtain  a 
union  between  Poupart’s  ligament  and  muscle  the 
sutures  must  be  tied  tightly  enough  to  trauma- 
tize the  muscle.  He  believed  that  the  difference 
in  the  results  obtained  by  Seelig  and  Koontz  was 
due  to  the  fact  that  Seelig  made  his  sutures  loose 
while  Koontz  made  his  very  tight.  The  pre- 
ponderance of  proof,  however,  seems  to  favor 
the  positive  findings  that  a union  does  take  place 
between  fascia  and  muscle. 

Regardless  of  this  belief  that  muscle  and  fascia 
will  unite  there  have  been  a number  of  recurrences 
after  herniotomies.  Because  of  these  circum- 
stances, some  supplementary  method  of  operation 
was  sought  which  would  give  more  satisfactory 
and  lasting  results.  This  was  achieved  by  Gallie 
and  Le  Mesurier  by  using  fascia  in  the  repair 
of  hernia.  It  is  also  to  be  noted  that  McArthur  6 
as  early  as  1901  had  utilized  strips  of  the  tendin- 
ous portion  of  the  external  oblique  muscle  for 
suture  purposes  in  hernioplasty.  He  found,  ex- 
perimentally, that  the  tissue  healed  in  situ  with- 
out absorption  or  sloughing. 

TRANSPLANTATION  OF  FASCIA 

The  transplantation  of  fascia  was  placed  on  a 
firm  clinical  basis  by  Kirschner 7 twenty  years 
ago.  There  has  always  been,  however,  some  doubt 
as  to  whether  this  transplant  survived  as  such, 
or  whether  it  was  replaced  by  ingrowing  tissue. 
A vast  amount  of  experimentation  has  been  done 
on  this  subject,  some  of  which  will  be  reviewed, 
briefly,  in  this  paper. 

Kleinschmidt 8 found,  as  a result  of  his  work, 
that  grafts  placed  under  the  skin  showed  little 
replacement  while  those  put  into  muscle  defects 
and  subject  to  tension  showed  alterations  in  thick- 
ness, partial  disappearance  of  portions  not  under 
tension,  and  partial  replacement. 

Kornew  9 observed  similar  changes  and  found 
that  fascia  transplanted  into  defects  in  a tendon 
was  transformed  into  a fibrous  tissue  intimately 
interwoven  with  and  practically  indistinguishable 
from  the  tendon. 

Gallie  and  Le  Mesurier 10  found  that  a re- 
implanted piece  of  fascia  lata  showed  practically 
no  change  and  remained  alive.  In  the  early  stages 
there  was  a little  inflammatory  edema  which  dis- 
appeared in  three  weeks,  while  in  specimens  ex- 
amined after  a year  there  was  nothing  to  indicate 
that  the  cells  or  fibers  had  changed  in  any  way. 
These  two  men  emphasize  the  importance  of  re- 


June,  1930 


FREE  FASCIAL  GRAFTS — HAAS 


389 


moving  the  areolar  tissue,  because  if  it  be  allowed 
to  remain  the  strength  of  the  union  will  not  ex- 
ceed that  of  the  fat  tissue.  As  a result  of  their 
work  the  use  of  fascia  suture  in  hernia  repair 
has  become  a successful  clinical  procedure. 

Neuhoff 11  concluded  from  his  experiments  that 
the  transplanted  fascia  was  not  preserved  as  such 
but  was  gradually  replaced  by  fibrous  connective 
tissue  which  closely  resembled  the  fascia.  He  be- 
lieved that  the  replacement  was  gradual  and  often 
might  not  be  complete  a year  after  the  operation. 
The  end  result  appeared  to  be  a cellular  connec- 
tive tissue  which  occupied  the  framework  and 
largely  maintained  the  form  of  the  original  graft. 

The  proof  of  permanent  viability  of  the  graft 
has  not  been  established.  The  replacement  phe- 
nomena are  of  very  gradual  evolution,  the  size 
of  the  graft  is  maintained  and  the  result  and 
purpose  for  which  the  transplantation  has  been 
performed  is  ordinarily  achieved. 

The  clinical  applications  of  transplanted  fascia 
cover  a wide  field  in  surgical  practice.  It  is  suffi- 
cient, however,  to  call  attention  to  its  uses  as 
suture  material  in  herniotomy,  in  joint  capsule 
repair,  filling  in  dura  and  pleural  defects,  ventral 
hernia,  the  repair  of  hollow  viscera  and  the 
organs  of  the  body,  arthroplasty,  and  in  tendon 
and  muscle  repair,  to  indicate  its  clinical  sig- 
nificance. 

USE  OF  PRESERVED  FASCIA 

These  and  other  applications  of  transplanted 
fascia  were  followed  by  the  institution  of  the 
use  of  preserved  fascia  as  a surgical  procedure. 
This  development  was  stimulated  by  the  work  of 
Nageotte  and  Sencert.12  Nageotte,  as  a result  of 
his  experiments,  concluded  that  the  fibers  of  con- 
nective tissue  were  inert  coagula  formed  from 
living  cells,  and  that  when  these  were  transplanted 
after  preservation  they  did  not  act  as  a foreign 
body.  The  preservation  did  not  change  either 
their  physical  or  chemical  characteristics  because 
they  were  lifeless  in  the  animal  just  as  they  were 
in  the  alcohol.  The  dead  cells  of  the  graft  were 
indistinguishable  from  the  normal  tissues. 

Ivoontz,13  in  a series  of  experiments,  found 
that  fascia  preserved  in  alcohol  and  then  trans- 
planted into  a defect  in  fascia  intermingled  so 
closely  that  it  was  almost  impossible  to  distinguish 
the  dead  from  the  living  tissue.  Heterografts 
took  just  as  well  as  homografts.  Because  of  the 
success  which  he  attained  in  his  experimental 
work  he  felt  justified  in  utilizing  preserved  fascia 
for  the  cure  of  hernia  in  man.  He  followed, 
in  general,  the  method  used  by  Gallie  and  Le 
Mesurier  10  in  applying  the  preserved  fascia  lata 
of  the  ox  for  suture  material  in  hernia  repair, 
and  obtained  successful  results. 

Rosenblatt  and  Meyers 14  performed  a series 
of  experiments  in  which  they  sutured  the  edge 
of  the  rectus  muscle  to  Poupart’s  ligament  with 
preserved  ox  fascia  and  tendon  sutures.  1 he 
muscle  united  firmly  with  Poupart’s  ligament.  By 
that  time  the  preserved  fascia  sutures  appeared 
slightly  smaller  than  at  the  time  of  the  operations, 
and  there  was  some  evidence  of  foreign  body 
reaction.  This  absorption  and  foreign  body  re- 


action of  the  transplanted  preserved  fascia  is 
contradictory  to  the  findings  of  Nageotte  and 
Koontz. 

It  would  not  have  been  surprising  if  a dispute 
had  arisen  regarding  the  union  of  transplanted 
fascia  with  muscle,  because  in  cases  of  this  kind 
the  conditions  are  entirely  different  from  those 
in  which  the  tissues  to  be  united  are  in  their 
normal  environment  with  their  nerve  and  blood 
supply  intact.  Where  transplanted  fascia  is  util- 
ized its  vitality  is  affected  by  the  severance  of  its 
normal  blood  and  nerve  supply  and  its  power  to 
proliferate  is  accordingly  diminished.  However, 
although  Nageotte  claims  that  fascia  is  an  inert 
tissue,  we  know  that  healing  does  occur  when 
fascia  is  sutured  to  fascia  in  the  repair  of  a 
wound,  or  when  a fascial  transplant  is  placed  in 
a fascia  defect. 

WHAT  CONSTITUTES  UNION  BETWEEN 
FASCIA  AND  MUSCLE 

The  question  may  arise  as  to  whether  or  not  the 
muscle  cells  are  expected  to  take  an  active  part 
in  uniting  the  muscle  with  the  transplanted  fascia. 
In  order  to  create  uniform  criteria  and  avoid  con- 
fusion, it  seems  advisable  to  state  definitely  what 
is  to  be  interpreted  as  constituting  a union  be- 
tween fascia  and  muscle.  The  muscle  cells  or 
fibrils,  which  are  arranged  in  bundles  and  groups 
of  bundles,  are  highly  specialized  and  possess 
limited  powers  of  proliferation  and  regeneration. 
On  the  other  hand,  the  connective  tissues  which 
surround  the  muscle’s  cells  and  fibrils  and  the 
muscle’s  bundles  (respectively,  endomysium  and 
perimysium)  are  nonspecialized  and  do  possess 
the  properties  of  active  proliferation.  Because  of 
this  fact  they  quite  naturally  would  be  expected 
to  play  the  major  role  where  a reparative  response 
is  necessary.  However,  regardless  of  whether  it  is 
the  connective  tissue  elements  or  the  muscle  cells 
themselves  which  are  most  actively  engaged  in 
the  process,  a union  between  muscle  and  trans- 
planted fascia  is  considered  successful  whenever 
the  two  tissues  are  intimately  and  completely 
united. 

EXPERIMENTS  MADE  IN  THIS  STUDY 

The  stimulus  for  the  work,  which  will  be  re- 
ported presently,  on  the  subject  of  transplanted 
fascia  was  produced  by  the  institution  of  the 
Mayer  operation.15  This  procedure  depended 
upon  the  ability  of  a piece  of  transplanted  fascia 
lata  to  unite  with  a raised  portion  of  the  trapezius 
muscle. 

In  order  to  study  the  results  of  suturing  trans- 
planted fascia  to  muscle,  a series  of  six  experi- 
ments were  performed,  under  general  ether  anes- 
thesia, upon  dogs.  In  each  of  these  experiments 
an  incision  was  made  on  the  outer  side  of  the 
thigh  through  the  skin  and  fat  to  the  fascia  lata, 
and  a section  of  fascia  of  the  desired  length  and 
width  removed  for  use  as  a free  graft.  This  was 
followed  by  a second  incision  which  exposed  the 
tendons  of  either  the  semitendinosus  or  semi- 
membranosus muscle  on  the  inner  side  of  the 
knee-joint.  A section  of  muscle  and  tendon  was 
then  excised  where  the  muscle  merged  into  the 


390 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


■Jr 


m, 

-Jlx*  ✓ - 


Fig.  1.  (Experiment  1.  Sixteen  days). — 
Union  of  transplanted  fascia  lata  with 
muscle.  There  is  a close  intermingling  of 
the  endomysium  with  the  fascia.  Notice  the 
changes  in  the  muscle  fibrils.  A.  Muscle. 
B.  Transplanted  fascia. 


Fig.  2 (Experiment  3.  Sixty-six  days). — 
High  magnification  to  show  the  changes  in 
the  muscle  fibrils  at  the  site  of  union. 
A.  Muscle.  B.  Transplanted  fascia. 


tendon.  A piece  of 
folded  free  fascia 
graft  was  sutured 
into  the  gap  which 
had  been  made  be- 
tween the  belly  of 
the  muscle  and  the 
cut  end  of  the  ten- 
don. The  animals 
were  killed  under  an- 
esthesia after  the 
desired  time  had 
elapsed  and  the  speci- 
mens fixed  for  mi- 
croscopic study. 

Experiment  1.— Dog 
T4,  left,  sixteen  days. 

Operation.  — A piece 
of  fascia  lata,  from 
which  the  fat  had  been 
removed  by  scraping 
both  surfaces  with  a 
scalpel,  was  taken 
from  the  outer  side  of 
the  thigh.  Through  a 
second  incision  on  the 
inner  side  of  the  leg, 
just  above  the  knee- 
joint,  the  tendon  of 
the  semimembranosus  muscle  was  exposed  and  sev- 
ered at  the  point  of  its  junction  with  the  belly  of  the 
muscle.  The  piece  of  fascia  was  then  attached  with 
silk  sutures  to  the  muscle,  on  one  end,  and  to  the 
tendon  on  the  other. 

Gross  Findings. — The  fascia  lata  was  found  firmly 
united  at  its  upper  end  to  the  muscle,  and  at  its  lower 
end  to  the  tendon.  It  was  impossible,  even  with  the 
application  of  a considerable  amount  of  force,  to  tear 
the  transplanted  fascia  from  the  muscle.  The  fascia 
was  swollen  and  somewhat  edematous. 

Microscopic  Findings. — At  that  early  period  there 
was  a close  union  between  the  transplanted  fascia  and 
the  muscle,  there  having  been  a gradual  transgression 
from  one  to  the  other.  At  the  site  of  the  union  the 
muscle  fibers  were  broken  up.  The  cross  striations 
were  much  less  distinct  and  gave  the  muscle  a 
hyaline-like  structure.  At  the  ends  of  the  muscle  fibers 
there  was  a marked  multiplication  of  the  nuclei,  which 
appeared  to  be  the  result  of  the  proliferation  of  the 
nuclei  of  the  muscle  fibrils  themselves  as  well  as  of  the 
endomysium.  In  places  the  ends  of  the  muscle  fibrils 
were  broken  up  into  strand-like  areas  which  joined 
the  fibers  of  the  transplanted  fascia.  (Fig.  1).  There  was, 


A B 


Fig.  3 (Experiment  6.  Eighty-five  days). — Gross  speci- 
mens showing  normal  tendon  (A)  and  artificial  tendon  (B) 
formed  by  suturing  free  fascia  graft  into  muscle. 


likewise,  an  increase  in  nuclear  elements  of  the  fascia 
at  the  place  of  union.  The  transplanted  fascia  showed 
no  evidence  of  degeneration.  Some  remnants  of  the 
transplanted  fascia  were  found  near  the  junction.  One 
cannot  say  definitely,  but  it  appeared  that  the  muscle 
fibrils  may  have  shared  in  forming  the  union  be- 
tween the  muscle  and  the  fascia.  The  endomysium 
(surrounding  the  muscle  fibrils)  and  the  perimysium 
(surrounding  the  bundles  of  muscle  fibrils)  most 
likely  took  the  greatest  part  in  the  process,  but  there 
was  evidence  that  the  viable  elements  of  the  trans- 
planted fascia  had  multiplied  and  shared  in  the  fusion. 

r i i 

Experiment  2.- — Dog  1,  left,  twenty-four  days. 

Operation. — A piece  of  fascia  lata  was  removed  from 
the  outer  side  of  the  thigh.  The  tendon  of  the  semi- 
tendinosus  muscle  was  exposed  and  severed  at  the 
point  of  its  junction  with  the  muscle.  The  piece  of 
fascia  lata  was  sutured  into  the  gap. 

Gross  Findings. — The  fascia  had  healed  in  so  well 
that  the  line  of  union  was  hardly  discernible. 

Microscopic  Findings. — There  was  a closer  and  denser 
intermingling  of  the  muscle  and  fascia  at  the  line  of 
union  than  was  found  at  the  earlier  period.  There 
were,  as  in  the  earlier  stages,  signs  of  the  degenera- 
tion of  the  muscle  ends,  and,  in  places,  fibrous  strands 
extending  into  the  fascia  suggested  that  a direct  at- 
tempt was  being  made  by  the  fibrils  to  share  in  the 
union.  The  transplanted  fascia  appeared  denser  than 
in  previous  stages  and  was  assuming  a more  tendi- 
nous structure.  The  vascularity  of  the  tissue  was 
increased. 

Experiment  3. — Dog  5,  left,  thirty-six  days. 

Operation. — The  semimembranosus  tendon  was  ex- 
posed and  a section  of  tendon  and  muscle  was  removed 
at  the  junction  of  the  two.  A piece  of  fascia  lata  was 
sutured  into  the  gap. 

Gross  Findings. — The  fascia  was  united  firmly  to  the 
muscle.  The  fascia  was  spread  out  and  appeared  to 
have  stretched. 

Microscopic  Findings. — At  that  stage  there  was  a 
close  penetration  of  one  tissue  into  the  other.  There 
was,  however,  a noticeable  amount  of  fat  at  the  site 
of  the  union  and  upon  the  muscle.  There  was  the 
same  evidence  as  found  in  experiment  two  that  the 


June,  1930 


FREE  FASCIAL  GRAFTS — HAAS 


391 


muscle  was  taking  an  active  part  in  the  union  (Fig.  2). 
The  fascia  was  transformed  and  appeared  more  tendi- 
nous than  in  the  previous  stage. 

/ i i 

Experiment  4. — Dog  3',  left,  sixty-three  days. 

Operation. — The  tendon  of  the  semitendinosus  muscle 
was  exposed  and  severed  just  above  its  origin  in  the 
muscle,  and  again  about  two  centimeters  from  its 
insertion.  A piece  of  fascia  lata  was  sutured  into 
the  gap. 

Gross  Findings.  — The  transplanted  fascia  was  at- 
tached to  the  muscle  on  one  side  only. 

Microscopic  Findings. — There  was  a very  close  union 
of  the  fascia  and  muscle  elements.  In  some  places 
there  was  evidence  of  the  direct  outgrowth  of  the 
muscle  fibers  into  the  fascia.  The  transplanted  fascia 
was  dense  in  appearance  and  more  tendinous  than  in 
earlier  stages. 

i i i 

Experiment  5.— Dog  2,  left,  eighty-two  days. 

Operation. — The  tendon  of  the  semimembranosus 
was  exposed  and  a section  about  one  and  five-tenths 
centimeters  in  length  removed  at  the  junction  of  the 
tendon  and  muscle.  A folded  piece  of  fascia  lata  was 
inserted  into  the  gap  and  sutured,  with  silk,  to  the 
muscle  at  one  end  and  to  the  tendon  at  the  other. 

Gross  Findings. — The  transplanted  fascia  was  found 
united  firmly  to  the  muscle  at  the  upper  end  and  to 
the  tendon  at  the  lower.  In  general  appearance  it  had 
assumed  the  likeness  of  a tendon. 

Microscopic  Findings. — The  muscle  and  fascia  were 
closely  united.  It  was  noticed  that  the  muscle  near 
the  site  of  the  union  appeared  unusually  wavy,  a con- 
dition which  suggested  a transformation  into  tendon. 
The  cross  striations  were  still  present  in  the  muscle 
that  had  acquired  this  wavy  structure.  The  trans- 
planted fascia  was  denser  than  in  the  earlier  stage  and 
appeared  tendinous. 

i i i 

Experiment  6. — Dog  5,  right,  eighty-five  days. 

Operation. — The  semitendinosus  muscle  was  exposed 
and  a segment  of  muscle  one  and  five-tenths  centi- 
meters in  length  was  removed  at  the  junction  of  the 
tendon  and  muscle.  A piece  of  fascia  lata  was 
sutured,  with  silk,  into  the  gap. 

Gross  Findings. — The  fascia  lata  was  found  united 
firmly  to  the  muscle  and  tendon  (Fig.  3). 

Microscopic  Findings. — There  was  a very  close  inter- 
mingling of  the  muscle  and  fascia.  The  muscle  had 
a slight  wavy  structure  in  places,  but  not  to  the  pro- 
nounced degree  of  that  found  in  the  former  experi- 
ment. In  places  there  were  collections  of  fat  cells 


Fig.  4. — Patient  from  the  Shriners’  Hospital  with  par- 
alysis of  the  deltoid  muscle.  A.  Range  of  motion  of  the 
left  arm  before  operation.  Full  abduction  on  the  right. 
B.  Showing  almost  complete  abduction  after  the  Mayer 
operation. 


Fig  5 (Case  2). — Specimen  removed  from  patient  five 
months  after  Mayer  operation.  There  is  a close  inter- 
mingling of  the  muscle  with  the  transplanted  fascia. 
Compare  with  Fig.  t from  experimental  series.  A.  Muscle. 
B.  Transplanted  fascia. 

which  were  most  likely  transplanted  with  the  fascia. 
The  fascia  resembled,  somewhat,  a normal  tendon  in 
histological  appearance. 

CONCLUSIONS  IN  EXPERIMENTAL  INVESTIGATION 

On  gross  examination,  evidence  of  strong  union 
between  the  transplanted  fascia  lata  and  the 
muscle  was  found  in  every  experiment. 

It  is  difficult  to  determine  definitely  the  exact 
part  played  by  the  various  cellular  elements  of 
the  fascia  and  muscle  in  forming  the  union.  The 
connective  tissue  cells  of  the  transplanted  fascia 
showed  definite  evidence  of  viability  throughout 
the  experimental  period.  There  was  considerable 
evidence  of  proliferation  of  the  cellular  elements 
of  the  transplanted  fascia  at  the  site  of  the  union. 
The  endomysium  and  perimysium  appeared  to 
have  contributed  the  greatest  amount  of  tissue 
response  in  forming  the  union,  while  the  muscle 
cells  proper  showed  some  cellular  activity  and 
possibly  took  a minor  part  in  the  process. 

CLINICAL  STUDY 

According  to  Mayer,  Lange  claimed  that  trans- 
planted fascia  could  not  be  used  to  construct  an 
artificial  tendon  because  the  fascia  would  not 
unite  firmly  with  the  muscle  fibers.  Notwith- 
standing this  declaration  made  by  Lange,  Payr 
had,  as  early  as  1913,  reported  successful  clinical 
results  which  involved  the  union  of  a piece  of 
transplanted  fascia  lata  with  the  cut  end  of  the 
trapezius  muscle  on  one  end  and  the  tendon  of 
the  long  head  of  the  biceps  on  the  other.  Gallie 
interwove  strips  of  fascia  lata  into  the  trapezius 
muscle  and  then  inserted  the  ends  of  the  fascia 
into  the  humerus,  in  the  treatment  of  a case  of 
paralysis  of  the  abductors  of  the  arm. 

The  successful  results  obtained  by  Mayer  with 
his  improved  operation  for  deltoid  paralysis  added 
further  evidence  to  substantiate  the  claims  that 
transplanted  muscle  will  unite  with  muscle.  In 
this  operation  he  sutured  the  piece  of  transplant 
to  a portion  of  raised  insertion  of  the  trapezius 
muscle.  After  preparing  a canal  just  posterior  to 


392 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


the  acromion  process  he  passed  the  artificial 
tendon  through  it,  and  downward  beneath  the 
deltoid,  to  a slot  in  the  humerus  near  the  inser- 
tion of  the  deltoid  muscle.  Mayer’s  explanation 
of  the  principle  of  his  operation  is  that  the  pull 
of  the  trapezius  muscle  with  its  new  prolonged 
fascia  insertion  holds  the  head  of  the  humerus 
firmly  into  the  glenoid  cavity.  Then  as  the  scapula 
rotates,  the  arm  being  fixed  into  the  glenoid 
cavity,  the  arm  is  carried  to  the  horizontal  posi- 
tion. After  this  the  accessory  muscles  complete 
the  abduction  to  the  vertical  position. 

Further  successful  results  have  been  obtained 
with  this  operation  at  the  Shriners’  Hospital  for 
Crippled  Children  in  San  Francisco  (Fig.  4).  In 
two  of  these  operations  it  was  found  that  the 
fascia  tendon,  in  its  passage  through  the  canal 
in  the  acromion  process,  had  become  adherent 
to  its  side,  thereby  preventing  the  pull  on  the 
humerus.  This  necessitated  a second  operation 
and  afforded  an  opportunity  to  study  the  site  of 
union  between  the  muscle  and  tendon. 

REPORT  OF  CASES 

Case  1. — R.  O.  Reoperation,  three  months  after 
original  operation.  An  incision  was  made  into  the 
old  operative  scar,  down  through  the  fat  and  fascia, 
to  the  site  of  the  transplantation. 

Operative  Findings. — The  muscle  and  transplanted 
fascia  were  firmly  united.  There  was  a close  inter- 
mingling of  the  two  tissues,  with  a gradual  grading 
off  into  the  tissue  which  resembled  a normal  tendon. 
Where  the  artificial  tendon  passed  through  the  canal, 
in  the  acromion  process  it  was  found  adherent,  on 
one  side,  to  the  bone.  The  fascia  transplant  was  freed 
from  the  bone  and  a piece  of  transplanted  fat  wrapped 
around  the  fascia  to  prevent  further  adhesions. 

i i i 

Case  2. — N.  A.  Reoperation,  five  months  after  origi- 
nal Mayer  operation.  An  incision  was  made  into  the 
old  operative  scar,  through  the  fat  and  fascia,  to  the 
site  of  the  transplantation. 

Operative  Findings. — The  suture  line  of  the  fascia 
and  muscle  could  hardly  be  distinguished.  There  was 
a gradual  transition  from  the  muscle  to  the  artificial 
tendon.  The  union  was  very  firm.  Within  the  outer 
layer,  where  the  muscle  projected  down  into  the  tube, 
the  merging  of  the  two  tissues  was  not  so  close.  The 
transplanted  fascia  was  found  adherent  to  the  sides 
of  the  bony  canal  through  the  acromion  process.  The 
artificial  tendon  was  freed  and  wrapped  with  a free 
graft  of  fat.  A small  piece  of  muscle  and  fascia  was 
removed  at  the  site  of  union  for  miscroscopic  study. 

Microscopic  Findings. — There  was  a close  intermin- 
gling of  transplanted  fascia  and  muscle.  The  endo- 
mysium  and  perimysium  were  closely  united  to  the 
fascia  (Fig.  5).  A portion  of  the  muscle  close  to  the 
line  of  union  was  of  hyaline-like  structure  with  loss 
of  the  cross  striations.  This  same  appearance  was 
seen  in  sections  of  similar  cases  in  the  experimental 
study.  It  is  possible  that  the  muscle  cells  proper  were 
undergoing  a fibrous  transformation  and  shared  in 
the  uniting  process.  The  transplanted  fascia  was  well 
stained  throughout,  and  in  places  appeared  very  much 
like  a normal  tendon. 

CONCLUSIONS  FROM  CLINICAL  CASES 

The  results  derived  from  this  clinical  study 
prove  conclusively  that  transplanted  fascia  will 
unite  firmly  with  muscle. 

The  microscopical  study  revealed  that  there  was 
a close  intermingling  of  the  tissues  involved  and 
that  the  most  active  agents  in  the  uniting  process 
were  the  perimysium,  the  endomysium,  and  the 


viable  cellular  elements  of  the  transplanted  fascia. 
There  was  even  a suggestion  that  the  muscle  cells 
themselves  may  have  shared  in  the  process. 

SUMMARY 

1.  Muscle  will  unite  with  transplanted  fascia. 

2.  The  perimysium  and  endomysium  of  the 
muscle  play  the  major  role  in  forming  the  union 
with  the  fibrous  tissue  element  of  the  fascia. 

3.  The  transplanted  fascia  seems  to  engage 
actively  in  the  process  of  union. 

4.  There  is  some  evidence  that  the  muscle  cells 
may  undergo  a fibrous  transformation  and  share 
in  the  union. 

Four  Fifty  Sutter. 

REFERENCES 

1.  Seelig,  M.  G.,  and  Chouke,  K.  S.:  A Funda- 
mental Factor  in  the  Recurrence  of  Inguinal  Hernia, 
Arch.  Surg.,  vii,  553-572,  November  1923. 

2.  Koontz,  A.  R. : Muscle  and  Fascia  Suture  with 
Relation  to  Hernia  Repair,  Surg.,  Gynec.  and  Obst., 
xlii,  222-227,  February  1926. 

3.  Seelig,  M.  G.,  and  Chouke,  K.  S.:  Fundamental 
Principles  Underlying  the  Operative  Cure  of  In- 
guinal Hernia,  J.  A.  M.  A.,  Ixxxviii,  529-532,  February 
1927. 

4.  Rosenblatt,  M.  S.,  and  Cooksey,  W.  B.:  Muscle 
Fascia  Suture  in  Hernia,  Ann.  Surg.,  lxxxvi,  71-77, 
1927. 

5.  Hertzler,  A.:  Healing  of  Muscle  to  Fibrous 
Tissue,  J.  A.  M.  A.,  Ixxxviii,  1098,  April  1927. 

6.  McArthur,  L.  L.:  Autoplastic  Suture  in  Hernia 
and  Other  Diastases,  J.  A.  M.  A.,  xxxvii,  1162,  No- 
vember 1901. 

7.  Kirschner  (quoted  from  Neuhof):  fiber  freie 
Sehnen  aus  Fasciatransplantation,  Beitr.  z.  klin.  Cnir., 
lxii,  539,  1909. 

8.  Kleinschmidt,  O.:  Experimentelle  Untersuchun- 
gen  fiber  die  Veranderungen  der  frei  transplantierten 
Faszie  unter  verschiedener  functioneller  Beanspruch- 
ung,  Langenbeck’s  Arch.,  civ,  933,  1914. 

9.  Kornew  (quoted  from  Neuhof):  liber  die  Faszien 
transplantation,  Beitr.  z.  klin.  Chir.,  lxxxv,  144,  1913. 

10.  Gallie,  W.  E.,  and  Le  Mesurier,  A.  B.:  The  Use 
of  Living  Sutures  in  Operative  Surgery,  Canad.  M. 
Assn.  J.,  xi,  504-513,  1921. 

11.  Neuhoff,  H.:  The  Transplantation  of  Tissues. 
Appleton,  N.  Y.,  1923,  and  also  complete  bibliography 
to  1923. 

12.  Nageotte,  J.,  and  Sencert,  L.  (quoted  from 
Koontz) : See  literature  in  reference  13. 

13.  Koontz,  A.  R. : Experimental  Results  in  the 
Use  of  Dead  Fascia  Grafts  for  Hernia  Repair,  Ann. 
Surg.,  lxxxiii,  523-536,  1926. 

14.  Rosenblatt,  M.  S.,  and  Meyers,  M.:  Muscle- 
Fascia  Suture  with  Preserved  Fascia  and  Tendon, 
Surg.,  Gynec.  and  Obst.,  xlvii,  836-841,  1928. 

15.  Mayer,  L. : Transplantation  of  the  Trapezius 
for  Paralysis  of  the  Abductors  of  the  Arm,  J.  Bone 
and  Joint  Surg.,  ix,  412-420,  July  1927. 

DISCUSSION 

John  Hunt  Shephard,  M.  D.  (Medico-Dental  Build- 
ing, San  Jose). — Doctor  Haas’  experiments  and  his 
microscopic  studies  of  the  results  beautifully  show 
that  fascia  and  muscle  will  unite  when  placed  in 
proper  apposition. 

From  a practical  point  of  view,  it  matters  not 
whether  in  this  union  the  perimysium  and  endo- 
mysfum  of  the  muscle  or  the  muscle  cells  themselves 
play  the  important  role.  Like  the  debated  question 
of  the  fate  of  bone  transplants,  the  desired  end  is 
accomplished,  though  the  academic  question  of  the 
exact  part  played  by  the  various  cells  is  not  com- 
pletely answered. 

The  use  of  fascial  strips  for  suture  material  in  the 
repair  of  herniae  seems  to  me  to  be  based  upon  a 
misconception  of  the  true  function  of  sutures. 


June,  1930 


FREE  FASCIAL  GRAFTS — HAAS 


393 


Without  entering  into  a discussion  of  the  relative 
importance  of  the  proper  treatment  of  the  hernial  sac 
and  the  rearrangement  of  the  fascial  relationship,  we 
do  desire  to  secure  firm  union  throughout  the  entire 
line  of  fascial  approximation. 

Sutures,  whether  they  be  of  catgut,  animal  tendons, 
fascial  strips,  silk,  or  silver  wire,  serve  a purpose 
similar  to  the  screw  clamps  used  by  the  cabinetmaker 
in  veneering  wood,  and  unless  union  of  the  coaptated 
tissues  takes  place  between  the  sutures  as  well  as  at 
their  site,  the  union  will  be  very  weak.  Any  non- 
irritating suture  material  which  will  retain  the  tissues 
in  proper  apposition  sufficiently  long  for  union  to 
occur  accomplishes  all  that  can  be  asked  of  it. 

I believe  that  the  careful  removal  of  the  areolar 
tissue  from  the  fascia  along  the  line  of  coaptation, 
as  emphasized  by  Koontz,  is  a very  important  detail 
in  hernial  repair. 

The  use  of  fascia  for  the  repair  of  defects  in  tendons 
and  joint  capsules,  for  the  establishment  of  accessory 
supporting  ligaments  or  in  arthroplasty  is  another 
matter. 

* 

Leo  Eloesser,  M.  D.  (490  Post  Street,  San  Fran- 
cisco).— Doctor  Haas  has  again  presented  us  with  a 
careful  and  interesting  piece  of  work.  The  evolution 
from  living  fascial  sutures  to  preserved  ones  is  curi- 
ous. It  seems  to  me  a rather  complicated  way  of 
getting  back  to  catgut;  for  this  material,  consisting 
of  the  tough  intestinal  submucous  tissue,  cannot  much 
differ  in  biologic  properties  from  preserved  fascial 
strips. 

I should  like  to  know  from  Doctor  Haas  under 
what  tension  the  fascial  strips  were  implanted,  and 
what  part  immediate  resumption  of  function  has  in 
the  fasciomuscular  union.  Will  union  persist  if  the 
fascia  is  implanted  under  a tension  considerably 
greater  than  that  of  the  normal  tendon,  or  will  it 
give?  What  becomes  of  the  fascia  if  no  demands  are 
made  upon  it;  if  it  is  attached  to  the  muscle  and  one 
end  left  free? 

Many  substances  seem  to  unite  with  muscle  in  a 
clinically  satisfactory  way.  Thus  Lexor  and  Eden 
used  tough  strips  of  subcutis. 

Doctor  Haas’  paper  gives  food  for  reflection  on  a 
number  of  still  unsolved  problems. 


Sterling  Bunnell,  M.  D.  (516  Sutter  Street,  San 
Francisco). — The  free  fascial  or  tendon  graft  has 
passed  the  experimental  stage  sufficiently  to  be  more 
generally  used  than  it  is.  Certain  aspects,  however, 
are  still  to  be  learned,  and  Doctor  Haas’  contribu- 
tion is  an  excellent  one.  He  has  tackled  the  problem 
in  his  usual  careful  and  scientific  way  and  found  out 
the  facts  for  himself.  I entirely  agree  with  his 
conclusions. 

From  my  personal  experience  in  the  last  fifteen 
years  I have  records  of  four  hundred  and  sixty-one 
free  grafts  of  fascia  and  tendon,  but  have  had  no 
experience  in  using  dead  prepared  fascia.  This  in- 
cludes their  use  in  repairing  torn  ligaments  (as  in 
the  knee  or  ankle  joints),  correcting  chronic  disloca- 
tions, reconstructing  crucial  ligaments,  replacing  dam- 
aged tendons,  connecting  muscles  to  tendons  in- 
cluding large  tendons  (as  biceps,  hamstrings,  and 
Achilles),  repairing  annular  ligaments  and  hernias 
and  in  tenodesis. 

I have  frequently  exposed  these  grafts  at  subse- 
quent operations  and  determined  their  condition.  In 
the  first  few  weeks  the  grafts  are  swollen  and  edema- 
tous, but  later  have  the  normal  appearance  of  fascia 
or  tendon.  I am  convinced  that  they  live  as  such 
though  some  cells  in  the  depth  of  the  graft  may 
undergo  replacement.  The  surface  cells  are  better 
located  for  nutrition  during  the  first  week.  Practi- 
cally the  grafts  have  normal  appearance  and  normal 
function  over  years  and  hypertrophy  in  response  to 
use. 

They  grow  solidly  to  bone,  tendon  or  muscle  if 
properly  contacted.  For  this  no  areolar  tissue  should 


intervene,  and  if  lateral  union  is  desired  the  fascia  or 
tendon  should  be  scraped  or  cut  clean.  For  union 
with  bone  an  osteoperiosteal  contact  is  necessary. 
Muscles  have  a large  connective  tissue  constituent 
near  their  tendinous  attachment  which  gives  firm 
union.  A lateral  union  of  a belly  of  an  unscraped, 
untraumatized  muscle  is  weak.  A union  to  the  cut 
end  of  muscle  bundles  is  strong  in  proportion  to  the 
percentage  of  connective  tissue  constituent  such  as 
endomysium  and  perimysium,  as  muscle  itself  has 
very  poor  regenerative  power.  Therefore  a stronger 
union  results  near  the  end  of  a muscle,  as  in  Doctor 
Haas’  experiments,  than  in  the  fleshy  belly.  If  a 
natural  tendon  or  a tendon  graft  is  left  unattached 
at  one  end  it  will  in  about  two  months  become 
swollen,  yellowish,  brittle  and  weak  from  the  de- 
generation of  disuse.  A tendon  or  fascial  graft  which 
is  given  the  function  of  resisting  repeated  tension  will 
hypertrophy  in  response  to  the  demand.  If,  however, 
the  force  to  which  it  is  subjected  is  too  great  and 
too  constant,  the  tissue,  whether  natural  or  a graft, 
will  atrophy  and  yield.  In  supplying  tendon  grafts 
for  large  muscles,  I have  found  very  large  grafts  to 
be  necessary.  Doctors  Gallie  and  Le  Mesurier  report 
that  under  the  extreme  and  constant  strain  imposed 
after  certain  tenodeses  about  the  foot  that  the  tendon 
yielded.  In  contrast,  tendon  grafts  in  the  fingers, 
which  have  less  constant  strain,  show  a slight  tend- 
ency to  shorten. 

In  using  fascial  grafts  it  is  important  not  to  make 
them  in  the  form  of  a tube,  as  the  inner  surface  will 
have  no  contact  with  the  surrounding  tissue  for  nour- 
ishment by  blood  and  lymph.  Serum  will  collect  and 
the  cells  lining  the  uncontacted  surface  will  degener- 
ate. The  transmutation  of  muscle  tissue  into  tendon, 
as  Doctor  Haas  observed  in  experiment  five,  is  fre- 
quent in  the  sternocleidomastoid  in  wry-neck,  as 
shown  in  the  strong  cord  of  tendon  found  running 
through  the  length  of  the  muscle. 

Doctor  Haas  (Closing). — In  Doctor  Shephard’s  dis- 
cussion he  says  that  the  material  used  for  suturing, 
whether  it  be  catgut,  animal  tendon,  silk  or  silver 
wire,  is  not  important  as  long  as  the  union  is  ulti- 
mately accomplished.  However,  if  the  statistics  show 
more  successful  unions  where  fascia  rather  than  other 
suture  material  has  been  employed  it  must  be  ad- 
mitted that  fascia  has  advantages  over  other  sutures. 
Gallie  and  other  operators  claim  these  advantages, 
both  in  primary  repairs  and  the  treatment  of  recur- 
rences of  cases  in  which  other  suture  material  had 
been  used. 

If  the  live  sutures  (fascia  grafts)  take  an  active 
share  in  the  uniting  process,  the  advantage  in  using 
them  is  obvious  and  the  analogy  between  them  and 
the  clamps  in  veneered  wood  fails  to  be  convincing. 

In  reply  to  Doctor  Eloesser’s  questions,  the  fascia 
sutures  are  implanted  under  very  slight  tension. 
When  the  subject  recovers  from  the  anesthetic  the 
tension  increases.  Function  is  then  established,  but 
in  spite  of  the  early  use  the  suture  line  holds  firmly. 

In  placing  the  individual  sutures,  an  effort  is  made 
to  avoid  cutting  through  the  muscle  fibers  in  the 
same  manner  as  one  would  in  closing  an  abdominal 
wound  or  other  muscular  defect.  If  the  fascia  is 
placed  under  too  much  tension  there  is  the  chance  of 
a tearing  at  the  line  of  suture.  A fascia  strip  attached 
at  one  end  only,  will  perform  in  the  same  manner  as  a 
covering  fascia,  while  the  fascia  under  muscle  pull 
develops  a tendon-like  structure. 

The  use  of  preserved  fascia  has  not  been  covered 
in  this  paper.  My  experimental  work  on  that  subject 
tends  to  illustrate  that  it  is  a less  favorable  suture 
material  than  living  fascia.  A review  of  this  work 
has  not  been  published. 

I was  pleased  with  Doctor  Bunnell’s  discussion 
because  of  his  extensive  clinical  experience  in  the  use 
of  transplanted  fascia.  After  all,  it  is  only  by  cor- 
relating the  clinical  and  experimental  results  that  a 
definite  and  practical  conclusion  may  be  obtained. 


394 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


INTRAVENOUS  INFUSION  OF  GLUCOSE — 
WITH  REPORT  OF  ANAPHYLACTOID 
REACTION 

REPORT  OF  CASE 

By  E.  Vincent  Askey,  M.  D. 
and 

Ernest  M.  Hall,  M.  D. 

Los  Angeles 

Discussion  by  P.  J.  Hanzlik,  M.D.,  San  Francisco; 
Jean  Oliver,  M.D.,  Brooklyn;  R.  IV.  Lamson,  M.D., 
Los  Angeles. 

A GREAT  deal  of  literature  is  available  in  the 
study  of  anaphvlaxsis.  It  is  rather  meager, 
however,  concerning  those  reactions,  somewhat 
similar,  which  are  elicited  by  a variety  of  non- 
protein substances.  Such  phenomena  have  been 
named  anaphylactoid  reactions.  Reports  of  the 
study  of  these  reactions  and  theories  as  to  their 
causes  are  confined  to  the  last  ten  years. 

PAST  EXPERIMENTAL  WORK 

It  has  been  shown  by  Rowntree  1 that,  by  the 
administration  of  excessive  amounts  of  water,  a 
so-called  water  intoxication  can  be  developed. 
This  condition  is  manifested  by  restlessness,  nau- 
sea, tremors  and  twitching  of  the  muscles,  con- 
vulsions, collapse,  stupor,  and  coma.  Unless  relief 
be  provided,  death  occurs.  It  is  thought  to  be 
due  to  a disturbance  in  the  salt  to  water  equili- 
brium of  the  body.  Experimental  work  by  Greene 
and  Rowntree  2 along  this  line  has  shown  that  in 
such  conditions  there  is  a change  in  surface  ten- 
sion ; plasma  and  hemoglobin  volumes ; and  slight 
disturbance  in  the  albumin-globulin  ratio.  Salt 
changes  of  the  serum  and  hemoglobin  show  great 
differences.  There  is  a noted  decrease  in  heat 
production  with  resultant  lower  temperature  of 
the  body.  That  such  marked  changes  occur  with 
a variation  of  water  content  only,  suggests  that 
perhaps  that  factor  alone  may  be  causative  of 
reactions  that  have  otherwise  been  blamed  on 
specific  alien  substances. 

It  is  interesting  to  note  the  results  where  sub- 
stances known  to  have  caused  anaphylactoid  re- 
actions have  been  tested  in  vitro,  and  in  vivo,  on 
blood,  plasma,  and  serum. 

Karsner  and  Hanzlik 3 have  shown  that  ars- 
phenamin  and  various  colloids,  such  as  acacia  and 
gelatin,  produce  agglutination  of  red  blood  cells 
in  vitro.  They  believe  that  reactions  following 
the  use  of  such  substances  are  due,  not  to  the 
mechanism  of  anaphylaxis,  but  more  likely  be- 
cause of  the  agglutination  of  cells  in  vivo.  Fur- 
ther work  by  Oliver  and  Yamada4  has  shown, 
in  experimentation  on  the  nature  of  reactions 
found  following  the  use  of  arsphenamin,  that 
such  reactions  are  the  result  of  the  agglutination 
of  the  red  blood  cells.  Following  the  agglutina- 
tion there  occurs  embolism  and  the  picture  seen 
is  one  such  as  follows  multiple  fat  embolism. 
They  state  that  reactions  occurring  later,  where 
nonlethal  doses  were  given,  were  the  result  of 
parenchymatous  degeneration  of  the  tissues  fol- 
lowing embolism. 


Fig.  1. — Vein  in  epicardium  showing  agglutinated  red 
blood  corpuscles,  (x  630.) 


The  theory  that  agglutination  of  the  cells  is 
dependent  on  the  physical  properties  of  the  ars- 
phenamin solution  has  been  advanced  by  Oliver 
and  Douglas.5  Agglutination  occurs  only  in  the 
presence  of  an  electrolyte  which  in  some  way 
causes  a change  in  the  degree  of  dispersion  of  the 
arsphenamin  which  has  been  absorbed  by  the  red 
blood  cells. 

The  action  of  arsphenamin,  however  (i.  e.,  the 
agglutination  action)  is  inhibited  by  many  hy- 
drophilic colloids ; which  may  be  explained  by 
adsorption  of  the  arsphenamin  by  the  protective 
colloid,  according  to  Oliver  and  Yamada.6 

Agglutination  is  a process  separate  and  dis- 
tinct from  coagulation,  a point  which  is  empha- 
sized by  the  work  of  Oliver  and  Douglas.7  They 
have  shown  that  arsphenamin  produces  incoagu- 
ability  of  blood,  both  in  vitro  and  in  vivo,  and 
that  such  action  is  chiefly  on  the  fibrinogen  rather 
than  on  the  thrombin. 

In  the  studies  of  Hanzlik  and  others  8 the  most 
important  change  found  was  uniform,  though 
quantitatively  variable,  lowering  of  the  surface 
tension,  without  relationship  to  physical  and 
chemical  properties  of  the  agents  used  (copper, 
arsphenamin,  pepton,  acacia,  agar,  and  toxified 
serum).  The  agent  most  efficient  in  lowering  sur- 
face tension  is  also  the  most  efficient  agent  for 
eliciting  anaphylactoid  reactions.  The  next  most 
important  change  is  a general  increase  in  the 
albumin-globulin  ratio,  regardless  of  the  agent 
used. 

Careful  study  by  Hanzlik9  of  the  clinical  symp- 
toms, objective  and  autopsy  findings,  in  cases 
showing  anaphylactoid  reactions  discloses  that 
such  reactions  are  characterized  by  many  changes 
not  only  in  the  physical  state  of  the  blood,  but 
in  the  functional  activity  of  the  cells  of  the  other 
tissues  of  the  body  as  well.  Due  to  physical 
changes  in  the  blood,  are  found  thrombosis,  frag- 
mentation and  agglutination  of  the  corpuscles, 
flocculation  of  the  plasma,  production  of  fibrin, 


June,  1930 


INTRAVENOUS  INFUSION  OF  GLUCOSE — ASKEY  AND  HALL 


395 


and  increase  of  blood  platelets.  Among  the  func- 
tional changes  of  the  tissue  cells  are:  increased 
permeability  and  the  production  of  faulty  metabo- 
lites. These  are  the  result  of,  or  produce,  great 
changes  in  osmotic  pressures  and  changes  in  sur- 
face tension. 

Hence,  we  may  find,  besides  the  agglutination 
and  other  changes  of  the  blood  itself,  perivascular 
edemas,  hemorrhage  and  congestion  in  all  the  tis- 
sues of  the  body.  If  death  does  not  occur  early, 
the  later  signs,  due  to  parenchymatous  degenera- 
tion, elsewhere  referred  to,  may  be  found.  These 
different  findings  put  together  agree  with  the  idea 
that  direct  contact  of  blood  with  foreign  agents 
results  in  a disturbance  of  the  blood  colloidal 
equilibrium. 

This  disturbance  may  be  of  slight  or  severe 
degree,  depending  on  the  amount  of  foreign  agent 
involved,  the  manner  of  administration,  and  the 
idiosyncrasies  of  the  patient.  It  may  be  mani- 
fested clinically  by  only  the  slightest  symptom, 
such  as  a chill  of  short  duration ; or  it  may  result 
in  death  either  from  the  sudden  shock,  primarily; 
or  secondarily  from  one  or  more  of  the  physical- 
chemical  reactions  detailed  above. 

We  wish  to  report  the  findings  in  an  autopsy 
of  a patient  who  died  forty-eight  hours  after  an 
intravenous  infusion  of  glucose  solution. 

REPORT  OF  CASE 

The  patient — a white  woman,  age  thirty-seven 
years,  the  mother  of  two  children,  the  youngest  four- 
teen months  old — had  been  admitted  to  the  hospital 
complaining  of  abdominal  pain,  fever,  and  occasional 
chills.  Provisional  diagnosis  was  made  of:  (1)  Acute 
pelvic  infection.  (2)  Large  cystic  ovary.  (3)  Ad- 
enoma of  thyroid.  She  was  placed  on  temporary 
symptomatic  treatment  for  pelvic  peritonitis.  After 
two  days  she  was  better,  but  her  urine  examination 
showed  abundant  acetone  and  diacetic  acid.  She  was 
quite  nauseated  and,  due  to  inability  to  absorb  suf- 
ficient fluid  by  rectal  drip  and  in  order  to  combat 
apparent  acidosis,  the  resident  physician  was  ordered 
to  give  the  patient,  slowly,  1000  cubic  centimeters  of 
10  per  cent  glucose  solution  intravenously.  This  was 


Fig.  2. — Coronary  arteriole  and  venule  containing 
hyaline  thrombi,  (x  430.) 


Fig.  3. — Coronary  vessel  containing  clumps  of  hyaline 
thrombus,  (x  150.) 


done  uneventfully.  About  twenty  minutes  following 
this  procedure  the  patient  had  a severe  rigor,  lasting 
twenty  minutes,  the  heart  rate  rising  to  140.  Hot 
water  bags  were  applied  and  stimulation  was  given. 
The  patient  then  reacted,  with  her  temperature  rising 
to  105  degrees.  She  passed  a good  night,  however, 
and  her  temperature  the  next  day  was  normal.  At 
2 o’clock  in  the  afternoon  the  resident  physician  re- 
ported that  she  was  feeling  well.  At  3:15  p.  m.  she 
was  suddenly  taken  with  shock,  extreme  cyanosis  and 
complete  right-sided  hemiplegia,  with  labored  ster- 
torous breathing  and  coma.  This  continued  until 
about  6 p.  m.,  when  the  patient  came  out  of  coma  and 
began  to  clear  mentally,  but  was  unable  to  talk,  pro- 
trude tongue,  or  use  muscles  of  right  face,  right  arm, 
and  right  leg.  She  could,  by  movement  and  use  of 
her  left  side,  however,  show  that  she  understood 
questions. 

This  condition  continued  throughout  the  next  day, 
with  slight  improvement  of  tongue  movement  and 
ability  to  swallow.  Her  temperature,  following  the 
stroke,  was  subnormal  but  later  began  to  rise.  About 
forty-eight  hours  following  the  stroke,  the  patient 
stopped  breathing,  though  the  heart  continued  to  beat 
under  artificial  respiration  for  one  hour.  Permission 
for  an  autopsy  was  obtained. 

Clinical  Diagnosis. — (1)  Embolism,  left  internal  cap- 
sule of  the  brain,  with  right-sided  hemiplegia.  (2) 
Acute  pelvic  infection  with  local  peritonitis.  (3)  Ova- 
rian cyst.  (4)  Adenoma  of  the  thyroid. 

Anatomical  Diagnosis. — Oophoritis,  acute,  purulent 
(streptococcal) ; early  malignant  cystadenoma  of 
ovary,  papillary,  bilateral;  thrombosis,  multiple,  cere- 
bral arteries  with  softening  of  brain;  thrombosis, 
coronary  vessels  with  necrosis  of  heart  muscle;  throm- 
bosis of  heart  (mural  thrombi);  embolism  of  renal 
artery  with  infarction  of  kidney;  goiter,  adenomatous. 

Autopsy  Report. — The  body  is  that  of  a strongly 
built,  well-nourished  woman  of  about  thirty-five  years. 
The  body  is  still  warm.  The  right  pupil  is  slightly 
wider  than  the  left.  Teeth  contain  many  fillings. 
There  is  a moderate  enlargement  of  the  thyroid  in 
the  midline  of  the  neck,  a slight  enlargement  on  the 
right  side.  No  enlargement  of  the  superficial  lymph 
nodes  and  no  edema. 

Marked  adiposity  of  abdomen  and  chest. 

The  liver  projects  four  centimeters  in  the  right 
midclavicular  line.  The  omentum  is  slightly  adherent 
in  the  pelvis.  There  is  a cyst  of  the  right  ovary  the 
size  of  a grapefruit  which  completely  fills  the  pelvis. 


396 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Figs.  4 and  5. — Cerebral  vessels  containing  hyaline  thrombi,  (x  100.) 


The  appendix  is  adherent  to  the  cyst  and  also  to  the 
sigmoid.  The  peritoneum  is  smooth.  No  excess  fluid 
in  the  peritoneal  cavity. 

The  left  lung  is  free  of  adhesions  and  no  excess 
fluid  is  present  in  the  pleural  cavity.  The  right  pleural 
cavity  is  almost  obliterated  by  fibrous  adhesions. 

The  pericardium  contains  a moderate  amount  of 
blood-stained  fluid.  The  heart  is  enlarged  about  one 
and  a half  times.  The  right  auricle  is  greatly  dilated 
and  contains  some  small  antemortem  clots  in  the 
auricular  appendage.  The  pulmonary  artery  contains 
fluid  blood.  The  tricuspid  and  mitral  orifices  are 
normal.  There  are  two  small  masses  of  thrombus  on 
the  free  margins  of  the  tricuspid  valve  and  some  small 
antemortem  clots  clinging  to  the  posterior  surface  of 
mitral  valve  extending  upward  toward  the  aorta. 
Aortic  valve  is  normal.  Both  the  right  and  left  ventri- 
cles appear  to  be  somewhat  dilated.  The  inner  two- 
thirds  of  the  muscle  of  the  left  ventricle  has  a pale, 
yellowish  color  apparently  due  to  early  necrosis. 

The  left  lung  is  air-containing  except  for  a small 
area  of  collapse  in  the  lower  lobe.  No  evidence  of 
embolism.  The  bronchi  and  peribronchial  lymph 
nodes  are  normal.  The  right  lung  is  similar  to  the 
left  except  for  a-  small  Ghon  tubercle  in  the  upper 
lobe. 

The  spleen  is  slightly  larger  than  normal,  measur- 
ing 12.5x9x4  centimeters.  The  cut  surface  shows 
prominent  markings,  is  pale  red  and  firm  in  con- 
sistency. The  capsule  is  smooth. 

The  left  adrenal  is  normal.  Left  kidney  of  normal 
size,  surface  smooth  and  congested.  On  the  cut  sur- 
face the  cortex  appears  very  opaque,  .while  the  pyra- 
mids are  congested.  Toward  the  upper  pole  there  is 
a pale  yellow,  recently  formed  infarct  3x3  centi- 
meters. The  right  adrenal  and  kidney  are  similar  to 
those  on  the  left  except  that  no  infarct  is  present  in 
the  right  kidney. 

The  urinary  bladder  is  normal. 

The  cervical  canal  is  somewhat  dilated;  measures 
0.5  to  1 centimeter  in  diameter.  The  uterus  is  small, 
mucous  membrane  is  very  thin.  Very  small  amount 
of  thin  exudate  over  the  surface.  A small  peduncu- 
lated, subserous  fibroid  is  attached  near  the  level  of 
the  internal  os.  A cyst  of  the  left  ovary,  about  7.5 
centimeters  in  diameter,  is  imperfectly  multilocular 
and  contains  two  or  three  small  (1  to  1.5  centimeters) 
papillomatous  excrescences  attached  to  the  inner  wall. 
There  is  a small  quantity  of  thick  yellow  pus  in  two 
of  the  compartments.  The  left  tube  is  adherent  to 
the  ovary.  The  larger  cyst  of  the  right  ovary  meas- 
ures 12  centimeters  in  diameter.  There  are  six  to 
eight  rough  papillary  nodules,  0.5  to  1 centimeter  in 


diameter  and  3 to  4 millimeters  high,  attached  to  the 
outer  surface  of  the  cyst.  The  cyst  is  filled  with  clear 
straw-colored  fluid.  The  lining  is  smooth  except  for 
one  papillary  nodule  about  one  centimeter  in  diameter. 

The  duodenum,  stomach,  pancreas,  gall  bladder, 
and  liver  are  essentially  normal. 

The  small  and  large  intestine  and  contents  appear 
to  be  normal. 

The  skull  cap  is  normal.  The  convolutions  over 
both  cerebral  hemispheres  are  distinctly  flattened  and 
the  pia  is  congested.  The  left  hemisphere  is  larger 
than  the  right  and  distinctly  softer.  The  vessels  at 
the  base  of  the  brain  are  normal.  Gross  sections  of 
the  brain  reveal  a large  rather  indefinite  area  of  begin- 
ning softening  in  the  region  of  the  internal  capsule 
on  the  left  side,  involving  the  major  part  of  the 
nucleus  lentiformis,  the  anterior  portion  of  the  thala- 
mus and  a part  of  the  hippocampus.  The  cortex  is 
involved  in  a similar  way  in  the  upper  two-thirds  of 
the  motor  area  on  the  left  side.  The  pons,  cerebellum, 
and  medulla  are  normal.* 

COM  MENT 

It  is  reasonable  to  conclude  that  these  findings 
are  consistent  with  the  anaphylactoid  reactions 
discussed.  In  this  case  examination  of  the  clots 
found  in  the  heart  showed  the  red  cells  very 
tightly  clumped  in  small  aggregates,  indicating 
that  agglutination  had  taken  place  (Figure  1). 
Smears  from  an  ordinary  clot  reveal  closely 
packed  but  evenly  distributed  corpuscles. 

Early  necrosis  of  the  inner  two-thirds  of  the 
heart  muscle  of  the  left  ventricle  was  distinguish- 
able grossly.  Histological  examination  of  the 
heart  muscle  revealed  small  hyaline,  pink-staining 
thrombi  (hematoxylin  and  eosin)  in  most  of  the 
small  arteries  (Figures  1,  2,  and  3).  Such  hyaline 
thrombi  have  been  shown  by  Flexner 10  to  be 
caused  by  the  agglutination  and  later  fusion  of  red 
blood  cells  in  the  capillaries.  The  muscle  cells 
showed  changes  seen  in  early  necrosis,  viz.,  swell- 
ing,  pycnosis  of  nuclei  and  brick-red  staining  of 
the  cytoplasm. 

Large  areas  of  early  softening  were  discernible 
grossly  in  the  left  cerebral  hemisphere,  involving 

* Histologic  and  baeteriologie  findings  will  be  presented 
in  reprint. 


June,  1930 


INTRAVENOUS  INFUSION  OF  GLUCOSE — AS  KEY  AND  HALL 


397 


the  internal  capsule,  nucleus  lentiformis,  and  the 
anterior  part  of  thalamus.  A more  superficial  area 
was  found  involving  most  of  the  cortex  in  the 
upper  two-thirds  of  the  motor  area.  Sections  of 
the  cortex  revealed  softening  of  the  brain  sub- 
stance. The  smaller  arterioles,  including  many  of 
the  capillaries,  are  filled  with  hyaline  thrombi 
(Figures  4 and  5),  and  small  collections  of  poly- 
morphonuclear leukocytes  are  present  in  the  peri- 
vascular tissues. 

SUMMARY 

1.  A resume  of  data  regarding  so-called  ana- 
phylactoid reactions  is  given  wherein  it  is  shown 
that  all  the  different  findings  agree  with  the  theory 
that  direct  contact  of  blood  with  foreign  agents 
results  in  a disturbance  of  the  blood  colloidal 
equilibrium.  Such  disturbances  cause  varying  de- 
grees of  clinical  symptoms  from  slight  chills  to 
severe  reactions  which  may  result  in  death. 

2.  Autopsy  findings  are  presented  which  are 
consistent  with  those  anaphylactoid  reactions  dis- 
cussed. 

1501  South  Figueroa  Street.  (E.  V.  A.) 

St.  Vincent’s  Hospital.  (E.  M.  H.) 

REFERENCES 

1.  Rowntree,  L.  G.:  Effects  on  Mammals  of  Ad- 
ministration of  Excessive  Quantities  of  Water,  J. 
Pharmacol,  and  Exper.  Therap.,  xxix,  135-159,  1926. 

2.  Greene,  Carl  H.,  and  Rowntree,  L.  G. : Effects 
of  the  Experimental  Administration  of  Excessive 
Amounts  of  Water,  Am.  J.  of  Physiol.,  lxxx,  209-229, 
1927. 

3.  Karsner,  H.  T.,  and  Hanzlik,  P.  J.:  J.  Pharmacol, 
and  Exper.  Therap.,  xiv,  479,  1920. 

4.  Oliver,  Jean,  and  Yamada,  Sabro:  J.  Pharmacol, 
and  Exper.  Therap.,  xix,  393,  1922. 

5.  Oliver,  Jean,  and  Douglas,  Ethel:  J.  Pharmacol, 
and  Exper.  Therap.,  xix,  199,  1922. 

6.  Oliver,  Jean,  and  Yamada,  Sabro:  J.  Pharmacol, 
and  Exper.  Therap.,  xix,  187,  1922. 

7.  Oliver,  Jean,  and  Douglas,  Ethel:  Arch.  Dermat. 
and  Syph.,  vii,  573-585,  1923. 

8.  Hanzlik,  P.  J.,  DeEds,  F.,  Empey,  L.  W.,  and  Farr, 
W.  F. : Hemoclastic  Changes  in  Vitro  From  Agents 
Causing  Anaphylactoid  Reactions,  J.  Pharmacol,  and 
Exper.  Therap.,  xxxii,  273-274,  1928. 

9.  Hanzlik,  P.  J.,  and  others:  Anaphylactoid  Re- 
actions, California  and  West.  Med.,  February  1925. 

10.  Flexner,  S.:  J.  Med.  Res.,  viii,  316,  1920. 

DISCUSSION 

P.  J.  Hanzlik,  M.  D.  (Stanford  University  School 
of  Medicine,  San  Francisco). — Whether  the  cause  of 
the  reactions  and  result  in  this  case  are  to  be  at- 
tributed solely  to  the  use  of  the  dextrose  solution  or 
not,  Doctors  Askey  and  Hall  have  directed  the  atten- 
tion of  physicians  to  possible  dangers  from  intra- 
venous injections.  This  they  have  done  by  making 
the  fullest  use  of  data  whose  significance  might  easily 
have  escaped  the  attention  of  others. 

The  train  of  events  in  the  case  recapitulates  well- 
known  phenomena  in  animals  injected  with  anisotonic 
and  unbalanced  solutions.  The  dextrose  solution  was 
hypertonic,  lacked  ions,  and  the  volume  employed 
diluted  the  blood  perhaps  25  per  cent.  The  short 
period  in  which  the  typical  symptoms  appeared  and 
the  generalized  thrombosis,  together  with  hemaggluti- 
nation in  the  absence  of  bacteria  at  autopsy,  which 
in  this  case  was  made  early,  are  important  items  in 
the  immediate  cause  of  the  reaction.  Collectively, 
these  considerations  support,  if  not  prove,  the  authors’ 
contention  that  the  injection  caused  an  anaphylactoid 
reaction.  Even  if  due  allowance  be  made  for  the  con- 
tributory role  of  the  patient’s  clinical  condition  to  her 
death,  the  rather  sudden  onset  and  the  rapid  and 
characteristic  progress  of  the  reaction  following  the 


intravenous  dextrose  would  require  an  unusual  expla- 
nation. The  condition  of  the  patient  suggests  another 
possibility  which  indicates  the  need  of  caution  before 
proceeding  with  intravenous  injection.  I refer  to  the 
well-known  disturbed  physical  state  of  the  blood  in 
infectious  disease,  characterized  by  an  increased  sedi- 
mentation rate,  a phenomenon  which  indicates  cell 
surface  changes  preceding,  or  concomitant  with,  ag- 
glutination. It  is  probable  that  the  intravenous  injec- 
tion of  a hypertonic  solution,  under  these  conditions, 
would  accelerate  and  complete  the  processes  tending 
to  disturb  the  colloidal  phases  of  the  blood.  The 
occurrence  of  the  reaction  is,  therefore,  not  at  all  sur- 
prising. The  variations  in  degree  and  kind  of  the 
physical  and  chemical  changes  are  considerable;  for 
this  reason  the  resultant  disturbances  range  from 
scarcely  demonstrable  or  moderate  to  marked,  and 
even  death,  as  appears  to  have  been  the  case  in  this 
patient.  Unfortunately  the  changes  are  not  predict- 
able or  controllable.  All  the  more  reason,  therefore, 
to  appreciate  the  axiomatic  principles  of  physiology — 
specifically,  the  physical-chemical  changes  which  occur 
from  the  sudden  introduction  of  foreign  agents  into 
the  blood  stream — and  to  exercise  great  caution  in 
the  administration  and  choice  of  remedial  agents  for 
intravenous  use. 

Jean  Oliver,  M.  D.  (The  Hoagland  Laboratory  of 
Pathology,  Long  Island  College  Hospital,  Brooklyn). 
The  case  described  by  Doctors  Askey  and  Hall  is  of 
especial  interest  in  that  it  supplements  and  extends 
the  findings  of  experimental  work  in  animals.  The 
anatomical  changes  which  have  been  described  in 
such  work  are  chiefly  vascular  ones,  namely,  aggluti- 
nation of  red  blood  cells  with  immediate  death,  a 
result  of  capillary  embolism.  Tissue  changes  are  as 
a rule  absent,  as  there  is  insufficient  time  for  their 
development. 

In  the  present  case  the  clinical  symptoms  of  the 
first  reaction  following  the  injection  of  glucose  seem 
to  mark  the  time  of  red  cell  agglutination  and  capil- 
lary embolism,  but  since  death  did  not  occur  until 
some  forty-eight  hours  later  a secondary  complica- 
tion of  arterial  thrombosis  had  sufficient  time  to  de- 
velop, and  the  gross  tissue  changes  of  brain  softening, 
heart  necrosis  and  infarct  formation.  These  were 
doubtless  the  immediate  cause  of  the  second  “stroke” 
and  subsequent  death  of  the  patient. 

£3 

fir 

R.  W.  Lamson,  M.  D.  (1930  Wilshire  Boulevard, 
Los  Angeles). — A decreased  coagulability  of  the  blood 
of  the  experimental  animal  during  anaphylactic  shock 
has  been  observed  in  dogs,  rabbits,  guinea-pigs,  and 
recently  in  pigeons.  In  the  animal  last  mentioned, 
however,  it  appears  that  the  primary  change  in  the 
blood  is  actually  an  increase  in  coagulability  and  that 
the  decrease  in  this  function  is  always  secondary. 
Another  worker  has  suggested  that  true  anaphylaxis 
is  due  to  a colloidal  change  taking  place  in  the  blood 
of  the  nature  of  precipitation  and  flocculation  of  the 
particles.  It  must  be  admitted  that  animal  experi- 
mentation may  not  correctly  explain  reaction  patterns 
in  man,  though  these  observations  suggest  that  a 
similar  mechanism  was  operative  in  the  case  reported 
above. 

In  certain  other  serious  or  fatal  reactions  that  have 
followed  infusion,  the  major  substance  injected  did 
not  come  under  suspicion.  In  some  of  these  the  re- 
action was  attributed  to  sulphur  or  other  substance 
dissolved  from  the  rubber  tubing  which  formed  a part 
of  the  apparatus.  In  others  an  unfavorable  hydrogen 
ion  concentration  of  the  solution  was  thought  to  be 
the  causative  factor.  Another  possibility  is  that  a 
shock  may  follow  the  use  of  water  that  has  been  dis- 
tilled a day  or  more  before  it  was  sterilized;  it  has 
been  shown  that  certain  bacteria  will  multiply  in  dis- 
tilled water  and  in  a day  or  more  sufficient  foreign 
protein  may  be  present  to  produce  a shock  even 
though  it  is  sterilized  before  injection.  It  would  ap- 
pear that  these  factors  were  not  concerned  in  this 
case. 


398 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


QUINIDIN — SOME  TOXIC  EFFECTS* 

REPORT  OF  CASES 
By  Harry  Spiro,  M.  D. 

AND 

William  W.  Newman,  M.  D. 

San  Francisco 

Discussion  by  Garnett  Cheney,  M.D.,  San  Francisco ; 
John  J.  Sampson,  M.D.,  San  Francisco. 

1H) AUL  WHITE  of  Boston,  in  effect,  has  said 
that  quinidin  (with  the  possible  exception  of 
the  nitrites)  is  the  most  valuable  cardiac  drug 
since  Wirthering  introduced  digitalis.  Men  such 
as  Thomas  Lewis,  S.  A.  Levine,  R.  L.  Levy, 
Oppenheimer,  and  others,  write  with  enthusiasm 
of  this  drug.  We  firmly  believe  in  its  great  value, 
and  yet  despite  its  undoubted  great  worth  quini- 
din is  being  only  slowly  appreciated  and  used  by 
the  profession  in  general.  I think  that  this  lack 
of  use  is  due  largely  to  the  fact  that  it  is  a drug 
that  cannot  be  used  in  any  hit-or-miss  fashion  to 
treat  a variety  of  indefinite  cardiac  ailments.  It 
may  be  recalled  that  for  a century  after  Wirther- 
ing, the  ineffectual  dosage  of  digitalis  and  its 
indiscriminate  use  concealed  its  real  value. 

HOW  QUINIDIN  ACTS 

Unlike  digitalis  and  caffein,  quinidin  is  not  of 
the  least  value  in  treating  heart  failure  in  general, 
since  it  is  of  use  only  in  those  cases  in  which  heart 
failure  is  dependent  upon  the  presence  of  certain 
arrhythmias.  Quinidin  has  no  favorable  influence, 
as  have  those  drugs,  on  cardiac  tone  and  the  vigor 
of  the  heart  muscle  contraction.  It  acts  by  its 
influence  on  the  refractory  period  and  conductiv- 
ity of  the  heart  muscle  in  such  a way  as  to  abolish 
certain  irregularities  of  the  heart  beat,  usually 
by  stopping  of  the  so-called  circus  movement,  and 
that  is  all.  Therefore  it  is  far  from  a panacea 
for  all  heart  diseases.  On  the  contrary,  the  indi- 
cations for  its  use  are  absolutely  clear-cut,  but 
the  treatment  with  it  must  be  well  thought  out 
and  vigorously  applied,  and  the  results,  if  success- 
ful, are  definite  and  unequivocal.  Its  use,  there- 
fore, requires,  in  the  first  place,  the  ability  to 
diagnose  accurately  the  more  common  cardiac 
arrhythmias. 

It  is  not  unusual  when  inquiring  of  a physician 
as  to  his  feeling  in  regard  to  the  value  of  quinidin 
to  get  a very  half-hearted  reply,  and  to  discover, 
on  closer  inquiry,  that  he  has  been  using  it  per- 
haps in  pitifully  inadequate  doses  to  treat  a car- 
diac condition  the  exact  nature  of  which  is  not 
clear  in  his  own  mind. 

In  addition  to  the  discouragement  incident  to 
the  ineffectual  dosage  and  ill-advised  application 
of  the  drug,  there  is  the  further  deterrent  to  its 
use  that  its  administration  is  known  to  be  at 
times  dangerous  and  that  fatal  results  occasion- 
ally follow  its  use,  so  that  some  physicians  are 
afraid  even  to  try  it.  It  is  with  the  hope  that  a 
better  understanding  of  its  indications,  dosage, 
and  dangers  will  result  in  its  more,  effectual  use 
that  this  paper  is  presented. 

* Read  before  the  General  Medicine  Section  of  the 
California  Medical  Association  at  the  fifty-eighth  annual 
session  at  Coronado,  May  6-9,  1929. 


INDICATIONS  FOR  QUINIDIN 

The  indications  for  the  use  of  quinidin  are,  as 
I have  said,  clear-cut,  and  they  are,  for  all  practi- 
cal purposes,  the  following : 

1.  To  control  extrasystoles  (except  those  as- 
sociated with  heart  failure)  when  they  are  caus- 
ing distressing  symptoms. 

2.  As  a prophylactic  against  attacks  of  parox- 
ysmal auricular  tachycardia  when  the  attacks 
come  often  enough  to  annoy  or  incapacitate  the 
patient. 

3.  As  a prophylactic  against  paroxysms  of 
auricular  fibrillation. 

4.  Most  important,  for  the  cure  of  certain  care- 
fully selected  cases  of  chronic  auricular  fibrilla- 
tion. 

5.  It  has  been  used  successfully  in  ventricular 
tachycardia. 

If  the  use  of  the  drug  is  confined  to  the  above 
enumerated  conditions  there  will  be  less  dissatis- 
faction with  the  results.  As  to  the  proper  dosage, 
and  so  far  as  any  danger  associated  with  its 
administration  is  concerned,  there  need  be  no 
apprehension  in  treating  the  first  three  conditions 
named : i.  e.,  for  paroxysmal  tachycardia,  extra- 
systoles, and  paroxysmal  auricular  fibrillation, 
four  grains  of  quinidin  sulphate  in  capsules,  three 
times  a day,  will  usually  fill  the  requirements  and 
there  is  no  danger  in  such  dosage.  It  is  only  with 
the  attempt  to  stop  auricular  fibrillation  itself  that 
the  practitioner  enters  onto  dangerous  ground, 
and  it  is  largely  with  these  dangers  and  how  to 
avoid  them  that  this  paper  will  deal. 

QUINIDIN  FOR  AURICULAR  FIBRILLATION 

It  must  be  clearly  understood,  in  the  first  place, 
that  in  treating  auricular  fibrillation,  quinidin  is 
not  to  be  considered  a drug  of  last  resort;  it  must 
be  used  only  in  carefully  selected  patients,  and  the 
first  point  in  their  selection  is  that  they  must  be 
reasonably  well  compensated ; that  is,  they  must 
be  able  to  move  about  the  room  without  obvious 
dyspnea,  there  must  be  no  edema  or  effusion 
present,  the  pulse  rate  must  be  84  or  less,  and 
there  must  be  no  pulse  deficit.  If  these  require- 
ments are  not  fulfilled  the  likelihood  of  a favor- 
aide  outcome  is  poor.  But  even  when  these  re- 
quirements are  fulfilled  it  is  found  that  there  are 
still  some  fatalities.  A majority  of  these  fatalities 
are  embolic  in  nature,  and  in  a paper  presented 
last  year 1 we  attempted  to  show  a method  by 
which  patients  could  be  selected  so  as  to  avoid 
those  likely  to  have  an  embolic  accident.  That 
method  was  to  select  only  those  patients  for 
treatment  who  had  a vigorous  heart  action,  as  seen 
fluoroscopically,  and  I might  say  that  none  of  our 
patients  selected  on  that  basis  have  had  an  em- 
bolic accident  during  the  course  of  their  treat- 
ment. But  even  when  the  danger  of  embolism  has 
been  eliminated  we  have  had  some  rather  start- 
ling experiences  (three  in  the  last  year)  with  the 
use  of  the  drug.  These  occurrences  were  due,  in 
the  strictest  sense,  to  the  toxic  effect  of  quinidin 
on  the  heart  muscle,  and  it  is  with  this  element 
of  the  danger  in  the  use  of  quinidin  that  the  rest 
of  this  paper  will  consider. 


June,  1930 


QUINIDIN — SPIRO  AND  NEWMAN 


399 


TOXIC  SYMPTOMS  OF  QUINIDIN 

As  stated  before,  it  is  only  in  the  attempt  to 
correct  auricular  fibrillation  that  toxic  symptoms 
need  be  feared,  as  we  have  never  seen  them 
amount  to  more  than  a slight  buzzing  in  the  ears 
or  an  urticaria  with  the  twelve-grain  daily  doses 
necessary  to  fulfill  the  other  indications  for  its 
use.  I have  heard  men  say  that  they  have  seen 
alarming  effects  from  five  to  ten  grains  of  the 
drug.  We  have  never  seen  bad  effects  from  such 
small  doses  in  a hundred  or  more  patients  treated 
in  the  last  two  years,  and  we  are  firmly  of  the 
opinion  that  such  occurrences  are  coincident  with 
its  use  rather  than  caused  by  it. 

While  susceptibility  to  the  drug  varies  consider- 
ably, we  have  never  seen  serious  toxic  symptoms 
from  less  than  a thirty-grain  daily  dose.  The 
reason  that  the  ability  to  recognize  the  earliest 
signs  of  toxicity  is  important  is  that  it  is  fre- 
quently necessary  to  push  the  dose  well  above 
thirty  grains  into  the  realm  of  possible  danger 
before  a successful  outcome  is  reached.  Because 
of  the  slight  but  definite  danger  of  toxicity  as 
the  thirty-grain  limit  is  exceeded,  some  make  it  a 
rule  not  to  go  beyond  this  dosage,  but  unless  one 
is  willing  to  push  well  up  beyond  this  point  many 
successes  will  be  missed.  Our  records  show  that 
thirty  out  of  forty  successive  patients  with 
auricular  fibrillation  and  treated  with  quinidin, 
became  regular  and  remained  so  for  more 
than  one  month,  sixteen  of  the  thirty,  or 
over  50  per  cent,  requiring  well  over  a thirty- 
grain  daily  dose ; and,  moreover,  there  was  no 
relation  between  the  size  of  the  dose  necessary  to 
produce  regularity  and  the  time  that  the  patient’s 
pulse  remained  regular  after  normal  rhythm  was 
established.  Hence  it  is  important  that  the  stop- 
ping point  be  set  not  at  some  arbitrary  dosage, 
but  be  regulated  largely  by  the  appearance  of 
toxicity,  making  the  recognition  of  its  onset  of 
the  utmost  importance. 

WARNING  SYMPTOMS  OF  TOXICITY 

The  warning  symptoms  of  toxicity  as  the  dos- 
age is  increased  are : increasing  symptoms  of  cin- 
chonism,  i.  e.,  buzzing  in  the  ears,  dizziness,  and 
later  nausea  and  vomiting.  If  the  patient  is  much 
distressed  by  such  symptoms  it  is  well  to  decrease 
the  dose  for  the  time  being  at  least.  A majority 
of  the  patients  experience  some  slight  distress 
before  sinus  rhythm  is  restored,  this  distress 
often  amounting  to  a distinct  nausea,  while  a few 
may  even  vomit  a time  or  two.  It  is  only  when 
the  vomiting  becomes  more  persistent  or  the  pa- 
tient is  distinctly  dizzy  and  uncomfortable  that 
we  deem  it  wise  to  slack  up  in  our  dosage. 

There  are  other  signs  giving  more  direct  evi- 
dence of  heart  muscle  poisoning  which  usually 
go  more  or  less  hand  in  hand  with  the  above 
mentioned  symptoms.  The  first  of  these  is  a 
speeding  up  of  the  ventricular  rate.  By  a “speed- 
ing up  of  the  rate”  we  do  not  mean  an  occasional 
rapid  run  of  ten  or  fifteen  beats ; such  short  rapid 
runs  are  often  the  precursor  of  the  establishment 
of  sinus  rhythm  and  are  not  to  be  viewed  with 
alarm.  It  is  a persistently  rapid  rate,  a pulse  of 
125  or  more,  lasting  for  minutes  or  hours,  that 


calls  for  a reduction  of  dosage  and  more  caution. 
A second  sign  is  a distinct  decrease  in  the  volume 
of  the  pulse  which  may  occur  with  or  without  a 
speeding  up.  Nurses  are  often  prone  to  report 
changes  in  pulse  volume  which  closer  investiga- 
tion fails  to  verify,  so  we  physicians  are  apt  to 
disregard  their  alarm  cry  of  “Wolf !”  However, 
with  a patient  under  quinidin  it  is  well  to  check 
up  any  such  report  by  a blood  pressure  reading. 

Another  occurrence  upon  which  we  look  with 
some  apprehension  is  the  appearance  of  extra- 
systoles. When  extrasystoles  become  more  fre- 
quent as  the  dosage  of  quinidin  is  increased,  we 
think  it  best  to  stop  the  drug  as  we  have  never 
seen  a favorable  outcome  under  these  circum- 
stances ; and  we  feel  that  under  large  doses  of 
quinidin,  extrasystoles,  especially  with  a rapid 
pulse,  are  evidence  of  toxicity,  probably  a pre- 
cursor of  ventricular  tachycardia  which  latter  is 
an  absolute  indication  for  discontinuing  quinidin. 
Make  note  that  above  we  mentioned  quinidin  as 
a cure  for  ventricular  tachycardia,  but  if  this 
arrhythmia  occurs  during  the  course  of  quinidin 
therapy  for  other  irregularities  it  then  becomes  a 
danger  sign. 

VALUE  OF  ELECTROCARDIOGRAMS  IN 
TOXICITY  CASES 

We  have  found  in  the  cases  that  are  not  going 
smoothly,  where  the  symptoms  of  toxicity  are 
increasing  and  the  pulse  rate  is  going  up,  that 
the  electrocardiogram  gives  valuable  evidence  of 
heart  muscle  poisoning,  so  that  in  those  cases 
where  we  are  in  doubt  as  to  whether  to  push  the 
drug  or  to  reconcile  ourselves  to  failure  in  restor- 
ing sinus  rhythm,  we  take  an  electrocardiogram 
and  if  it  shows  unfavorable  changes  from  the 
tracing  taken  before  starting  treatment  we  feel 
that  it  is  best  to  stop. 

REPORT  OF  CASES 

Case  1. — The  first  is  Mr.  D.,  age  fifty-four,  with 
rheumatic  valvular  heart  disease  and  auricular  fibril- 
lation of  several  years  standing,  first  seen  October  1, 
1928.  At  that  time  the  first  electrocardiogram  was 
taken  (Fig.  1,  a)  showing  auricular  fibrillation  with- 
out any  intraventricular  block  or  other  evidence  of 
delayed  conduction.  The  patient  was  under  small 
doses  of  digitalis  at  this  time.  He  was  hospitalized, 
the  digitalis  slowly  reduced  and  stopped,  and  quinidin 
started  and  slowly  increased,  so  that  for  the  seven 
days  preceding  the  next  electrocardiogram  he  had 
averaged  60  grains  daily  and  had  received  a total  of 
490  grains,  the  highest  single  dose  being  30  grains  and 
highest  daily  dose  70  grains,  both  occurring  on  the 
day  before  this  second  record.  The  patient  did  not 
appear  to  be  doing  well;  he  was  quite  dizzy,  his  head 
ached,  he  became  nauseated  and  vomited;  finally  the 
pulse  became  perceptibly  weaker  and  somewhat  more 
rapid  although  not  over  120  to  130,  and  seemingly 
almost  regular.  We  were  worried  about  his  con- 
dition so  took  an  electrocardiogram,  which  showed 
the  following  profound  changes: 

The  rate  in  this  record  is  relatively  slow  (about 
100),  and  almost  although  not  exactly  regular.  The 
most  striking  change  is  the  profound  delay  in  intra- 
ventricular conduction,  the  Q R S interval  having 
increased  from  the  former  .08  seconds  to  .20  seconds. 

No  “P”  wave  can  be  identified.  The  complexes  are 
very  different  in  design  from  those  of  the  tracing 
taken  before  the  administration  of  quinidin,  resem- 
bling a run  of  left  ventricular  extrasystoles,  thus  con- 
stituting a run  of  ventricular  tachycardia.  Thomas 


4U0 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


mr.  p.  age  54  RHEUMATIC  VALVULAR  HEART  DISEASE 

BEFORE  QUINIDINE  l0-1-'28  on  small  doses  Digitalis 

LEAD  III 


a. 


QUIN1DINE  TOXICITY  10-15-’28  No  Digitalis  10  days  Total  Quimdine  in  12  days  490  g r. 
LEAD  III  Largest  single  dose  Quimdine  30  gr.  Total  in  24  hrs.  before  E KG  70  gr. 


b. 


An-1  ^ — ! r^'  *\j  •A<s__ 


\T 


PARTIAL  RECOVERY  1 0 - 1 6 • ' 28  Quinidine  stopped  12  hours 

LEAD  III 


c;  aj  rvt  r~j  ^ C-1  r-1'  ■ ~ nj  ,~j  . pj  r-j  < 

, t I | ~T' 


y il  il 


RECOVERY  10-19-*28  on  small  doses  Digitalis.  Quimdine  stopped  for  2 days 

LEAD  III 


cf. 


• !-fh  J ..." 


' . 


Electrocardiogram  of  Case  1 

Lewis  2 and  Oppenheimer  and  Mann 3 consider  the 
possibility  of  the  development  of  ventricular  tachy- 
cardia in  cases  of  auricular  fibrillation  treated  with 
quinidin  and  “consider  this  development  an  indication 
for  the  immediate  discontinuance  of  the  drug.”  S.  A. 
Levine  and  M.  N.  Fulton  4 mention  this  possibility. 
R.  L.  Levy  5 has  published  electrocardiograms  show- 
ing ventricular  tachycardia  occurring  in  the  treatment 
of  auricular  fibrillation  with  quinidin,  and  Maynard  * 
reports  a case  of  ventricular  tachycardia  due  to  quini- 
din poisoning.  These  are  the  only  references  to  the 
subject  we  have  found. 

The  patient’s  pulse  at  this  time  was  so  slow  and 
so  nearly  regular  that  had  we  not  had  this  electro- 
cardiographic evidence  of  poisoning  we  would  doubt- 
less have  pushed  the  drug  perhaps  to  the  point  of 
producing  ventricular  fibrillation.  However,  with  this 
evidence  of  toxicity  at  hand  the  quinidin  was  dis- 
continued, the  patient  placed  on  digitalis,  and  twelve 
hours  later  the  next  electrocardiogram  (Fig.  1,  c) 
was  taken,  showing  some  disappearance  of  the  signs 
of  toxicity;  that  is,  the  con- 
duction time  had  returned 
to  .14  seconds  and  some 
of  the  Q R S complexes 
had  resumed  their  diphasic 
form,  as  in  the  tracing  be- 
fore the  administration  of 
quinidin.  The  patient  con- 
tinued to  improve  subjec- 
tively and  the  next  record 
(Fig.  1,  d),  taken  three 
days  later,  shows  a return 
to  practically  the  identical 
condition  as  before  quini- 
din was  started.  The  pa- 
tient has  been  up  and  about 
on  digitalis  in  the  inter- 
vening eight  months  and 
is  fairly  active  and  a bit 
better  than  before  his  treat- 
ment with  quinidin. 


seen  August  2,  1928,  when 
the  first  electrocardiogram 
(Fig.  2,  a)  was  taken.  A 
total  of  only  182  grains  of 
quinidin  was  given  in  seven 
days,  eight  grains  every 
four  hours,  for  the  twenty- 
four  hours  preceding  the 
next  electrocardiogram 
taken  September  2,  1928. 
On  this  day  the  pulse  be- 
came regular  for  periods  of 
a few  minutes  but  always 
at  a rapid  rate,  around  100. 
The  patient  had  lost  his 
appetite,  was  slightly 
nauseated  and  dizzy,  and 
complained  of  slight  but 
persistent  precordial  pain. 
We  were  doubtful  as  to 
whether  to  continue  with 
our  attempt,  so  we  took  an 
electrocardiogram,  which 
revealed  a markedly  nega- 
tive “T”  in  Leads  1 and  2 
(Fig.  2,  b),  evidence  of 
much  damage.  We  felt 
that  caution  was  the  better 
part  of  valor  and  discon- 
tinued the  quinidin.  The 
patient  was  replaced  on 
digitalis  and  has  been  carry- 
ing on  an  active  practice  since.  Eight  months  later 
the  electrocardiogram  showed  a return  to  more  nearly 
its  previous  form,  the  “T”  negativity  having  nearly 
disappeared  (Fig.  2,  c). 

iii 

Case  3. — The  last  case,  Mrs.  McL.,  age  fifty-four, 
with  a mitral  valve  defect  and  auricular  fibrillation, 
illustrates  how  profound  muscle  damage  may  develop 
with  little  or  no  premonitory  symptoms.  The  first 
electrocardiogram  (Fig.  3,  a),  taken  before  starting 
quinidin,  shows  an  essentially  normal  ventricular  com- 
plex. Having  received  during  a period  of  six  days  a 
total  of  128  grains  of  quinidin,  she  complained  of  a 
slight  headache,  but  was  otherwise  not  distressed.  She 
was  receiving  six  grains  of  the  drug  every  three  to 
four  hours  when  at  3 a.  m.  of  the  seventh  day  she 
received  six  grains  of  quinidin  and  the  pulse  was 
charted  100,  whereas  it  had  averaged  about  80;  at 
7 a.  m.  it  was  charted  as  “very  rapid,”  the  rate  not 
being  specified,  and  instead  of  the  house  physician 
being  notified,  six  grains  of  quinidin  was  again  given. 


Dr.  T.  Age  57  HYPERTENSION-FIBRILLATION 


BEFORE  QUINIDINE  8-2- *28  on  small  doses  Digitalis 


LEAD  III 


a. 


'll  ! I 


I i ' 


! I 


4 —— 1 


QUINIDINE  TOXICITY  9-2-’28  no  Digitalis  7 days  Total  Quinidine  in  9 days  182  gr. 

Largest  single  dose  Quinidine  S gr.  Total  in  24  hrs.  before  EKG  46  gr. 


Ill 

Case  2. — The  second  case 
shows  a similar  but  less 
profound  toxicosis.  Dr.  T., 
age  about  fifty-seven,  with 
mild  hypertension  and  au- 
ricular fibrillation,  was  first 


Electrocardiogram  of  Case  2 


June,  1930 


QUINIDIN — SPIRO  AND  NEWMAN 


401 


M.  ace  54  MITRAL  DEFECT-FIBRILLATION 

BEFORE  OUINIDINE  5-21‘27  on  small  doses  Digitalis 


QUINIOINE  TOXICITY  7-24-  27  no  digitalis  7 days.  Total  Quin 
Largest  single  dose  Quinidine  6 gr.  Total  dose 


idlne  128  gr.  in  6 days 
n 24  hrs.  before  EKG  48  gr. 


LEAD  III 


■V  • 


RECOVERY  . 7-25-'27  No  Digitalis  nor  Qumidii 


Electrocardiogram  of  Case  3 

The  same  thing  occurred  at  10  a.  m.  At  10:30  a.  m., 
while  talking  to  her  husband,  and  in  no  apparent  dis- 
tress, she  suddenly  fell  back  unconscious  and  pulse- 
less. Respiration  stopped.  The  house  physician,  who 
luckily  was  just  outside  the  door,  gave  artificial  res- 
piration and  intravenous  caffein,  and  very  slowly 
natural  breathing  recommenced  and  the  pulse  became 
obtainable  although  the  patient  did  not  recover  con- 
sciousness for  two  hours.  While  the  patient  was  still 
unconscious  the  next  electrocardiogram  (Fig.  3,  b) 
was  taken  which  shows  evidence  of  marked  muscle 
poisoning.  At  first  glance  it  appears  to  be  merely 
coupled  rhythm,  each  supraventricular  beat  followed 
by  a right  ventricular  extrasystole,  but  the  decreased 
amplitude  and  broadening  of  the  upright  complexes 
and  their  negative  “T”s  make  it  uncertain  whether 
these  also  are  not  of  ventricular  origin,  making  this 
record  like  the  first  one  shown,  a case  of  ventricular 
tachycardia  except  that  here  the  complexes  are  of 
alternating  directions — one  up,  one  down — similar  to 
the  bidirectional  ventricular  tachycardia  reported  by 
W.  Carter  Smith 7 of  which  this  author  states  there 
are  only  eight  cases  on  record  and  most  of  which  he 
attributes  to  overdigitalization.  Our  first  impression 
of  this  attack  was  that  the  patient  had  had  a stroke, 
but  in  two  hours  she  had  regained  consciousness, 
and  in  three  hours  the  use  of  her  voice  and  limbs, 
and  the  next  day  was  apparently  as  well  as  ever  with 
no  evidence  of  a cerebral  accident.  As  in  the  other 
cases,  quinidin  was  discontinued  and  the  following 
day  the  electrocardiogram  (Fig.  3,  c)  showed  a re- 
turn toward  normal  although  the  Q R S complexes 
were  still  low  and  the  “T”s  negative.  In  the  past 
year  the  patient  has  been  on  digitalis  and  has  felt 
well  as  before. 

CONCLUSIONS 

We  may  then  conclude  by  saying  that  if  one  is 
going  to  treat  auricular  fibrillation  with  quinidin. 
one  should  carefully  push  the  dose  until  sinus 
rhythm  is  restored  or  until  the  above  enumerated 
symptoms  of  toxicity  become  alarming.  When  in 
doubt,  one  should  take  an  electrocardiogram  and 
if  evidence  of  heart  muscle  poisoning  is  present 
the  drug  should  be  discontinued. 

870  Market  Street. 

REFERENCES 

1.  Spiro,  H.,  and  Newman,  William  W.:  Quinidin 
in  Auricular  Fibrillation — A Fairly  Safe  Indication 
for  Its  Use,  J.  A.  M.  A.,  91,  1268-1274,  October  1928. 

2.  Lewis,  Thomas:  Am.  J.  M.  Sc.,  73,  781,  June 
1922. 


3.  Oppen  he  inter  and 
Mann:  Abstract.  J . A. 
M.  A.,  78,  1752,  June  3, 
1922. 

4.  Levine,  S.  A.,  and  Ful- 
ton, M.  N.:  J.  A.  M.  A., 
92,  1162,  April  6,  1929. 

5.  Levy,  R.  L. : Arch.  Int. 
Med.,  30,451,  October  1922. 

6.  Maynard:  Am.  Jr.  Med. 
Sc.,  1928. 

7.  Smith,  W.  Carter:  Am. 
Heart  J.,  August  1928. 

DISCUSSION 

Garnett  Cheney,  M.  D. 
(210  Post  Street,  San  Fran- 
cisco).— Quinidin  is  a very 
valuable  cardiac  drug.  It 
is  insufficiently  used  not 
only  by  the  general  practi- 
tioner, but  also  by  many 
cardiologists,  largely  for 
three  reasons.  First,  the 
cf  ' indications  for  its  use,  its 
limitations  and  its  dangers 
are  not  as  generally  known 
as  is  necessary  in  order  to 
obtain  the  desired  bene- 
ficial effect.  Second,  everyone  who  has  heard  of  quini- 
din has  also  heard  that  it  may  set  loose  emboli.  But 
the  likelihood  of  such  an  untoward  effect  has  been 
greatly  overemphasized.  Third,  the  pharmacologists 
have  shown  that  the  drug  has  a toxic  effect  on  the 
myocardium.  It  has  been  stated  that  no  ultimate 
good  can  come  from  poisoning  the  heart.  Such  a 
radical  stand  is  unjustified.  However,  any  paper 
which  increases  our  knowledge  of  the  toxic  effects  of 
quinidin  deserves  commendation.  Doctors  Newman 
and  Spiro  have  had  a large  experience  with  quinidin 
and  we  should  all  benefit  by  their  study  of  its  toxicity. 

In  cases  of  persistent  auricular  fibrillation  which 
have  not  responded  satisfactorily  to  digitalization  and 
prolonged  bed  rest,  quinidin  should  be  given  a trial. 
Decompensation  is  not  a contraindication  to  such 
therapy,  although  a fewer  number  of  patients  will 
improve  than  if  no  decompensation  is  present.  But, 
as  Paul  White  has  pointed  out,  some  brilliant  suc- 
cesses occur  in  the  decompensated  group.  The  matter 
of  dosage  is  a most  important  one.  Some  of  our  best 
results  occur  in  patients  who  require  larger  doses 
than  those  conventionally  given.  The  percentage  of 
cases  made  regular  would  be  far  higher  if  doses  were 
increased  until  regular  rhythm  were  established  or 
signs  of  cinchonism  precluded  further  therapy.  Of 
course  some  patients  cannot  take  much  quinidin 
while  others  can  tolerate  large  amounts.  I have  had 
patients  on  0.8  grams,  five  times  a day,  before  they 
became  regular.  Such  patients  would  be  classed  as 
failures  if  the  usual  plan  of  treatment  was  followed. 
Most  patients  are  clinically  benefited  by  their  regular 
rhythm. 

The  risk  of  emboli  has  been  too  greatly  exagger- 
ated, which  has  proved  a big  handicap  for  quinidin 
therapy.  Certainly  such  a risk  exists,  but  large  groups 
of  cases  have  been  reported  in  which  no  such  serious 
complication  has  been  proved  to  occur.  Emboli  occur 
in  cases  of  heart  failure  with  regular  rhythm,  and  not 
infrequently  in  cases  of  auricular  fibrillation  untreated 
or  under  digitalis  therapy.  As  far  as  I know,  no  one 
has  compared  their  incidence  in  these  conditions  with 
their  incidence  following  quinidin  therapy,  and  no 
one  withholds  digitalis  for  fear  of  producing  emboli. 

The  toxic  effects  of  quinidin  vary  from  the  symp- 
toms of  mild  cinchonism  to  possibly  death  itself  from 
cardiac  standstill.  Fatalities  proved  to  have  been  due 
to  the  drug  itself  are  extremely  rare.  Just  what  clini- 
cal and  electrocardiographic  findings  should  contra- 
indicate continuance  of  its  use  is  still  a debatable 
question,  and  that  is  why  a paper  such  as  this  is  so 


402 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


welcome.  Cases  developing  extrasystoles  and  tachy- 
cardia may  go  into  regular  rhythm  if  the  drug  is 
pushed  further,  and  such  patients  may  go  unhelped 
if  we  are  too  cautious.  The  internist’s  position  is 
much  like  that  of  the  surgeon  confronted  with  an 
“acute  abdomen.”  Courageous  treatment  is  indicated 
although  one  may  meet  with  failure  or  actually  feel 
that  harm  has  been  done.  We  should  know  all  there 
is  to  know  about  quinidin  and  then  use  it. 


John  J.  Sampson,  M.  D.  (490  Post  Street,  San  Fran- 
cisco).— Doctors  Newman  and  Spiro  have  admirably 
defined  the  indications  for  the  use  of  quinidin  and  I 
believe  worthily  attempted  to  dispel  much  of  the  awe 
in  which  this  drug  is  held.  Thus  it  is  practically  free 
of  danger  in  the  doses  used  to  prevent  attack  of 
paroxysmal  auricular  tachycardia,  in  which  field  it  has 
a high  percentage  of  effectivity.  Likewise  doses  up  to 
two  grams  per  day  are  shown  to  be  practically  free 
of  any  serious  toxic  effect,  unless  a quinin  idiosyn- 
crasy exists,  which  of  course  would  be  determined  by 
the  test  dose. 

There  are  two  types  of  toxic  phenomena  which  I 
have  observed  other  than  those  mentioned  in  this 
paper:  First,  permanent  auricular  flutter  from  which 
the  patient  did  not  recover,  and  second,  ventricular 
fibrillation,  with  the  recovery  of  the  patient,  a case 
of  which  was  published  by  Doctors  Kerr  and  Bender. 

It  is  worthy  of  mention  that  both  quinidin  and 
quinin,  especially  in  paroxysmal  auricular  fibrillation, 
may  be  advantageously  administered  intravenously. 

I have  had  much  success  in  administering  quinin 
dihydrochlorid  in  10  per  cent  solution,  taking  five  min- 
utes for  the  introduction  of  each  cubic  centimeter,  and 
stopping  if  the  rhythm  became  normal,  or  if  a maxi- 
mum of  five  cubic  centimeters  had  been  injected. 

Following  the  suggestion  in  this  paper,  I consider 
it  advisable  to  hospitalize  all  patients  requiring  more 
than  two  grams  of  quinidin  a day  in  order  to  have 
them  under  constant  observation  and  immediately 
available  for  an  electrocardiogram  record. 

The  clinical  pictures  drawn  by  Doctors  Newman 
and  Spiro  of  toxic  quinidin  poisoning  are  excellent, 
and  I believe  their  observation  of  ventricular  ectopic 
rhythm  of  special  prognostic  importance. 


SPHENOIDITIS — ITS  DIAGNOSIS  AND 
TREATMENT* 

REPORT  OF  CASES 

By  Dean  E.  Godwin,  M.  D. 

Long  Beach 

Discussion  by  J.  Frank  Friesen,  M.D.,  Los  Angeles; 
Robert  C.  Martin,  M.  D.,  San  Francisco. 

JLJriSTORICALLY  the  sphenoid  was  the  last 

^ of  the  nasal  accessory  sinuses  to  be  recog- 
nized as  of  importance  and  as  susceptible  of 
treatment.  As  late  as  the  year  1882,  Hyrtl  wrote 
that  the  sphenoid  was  entirely  beyond  the  range 
of  manual  and  instrumental  attack.4  In  the  same 
year,  however,  the  brilliant  work  of  Zukerkandl, 
followed  by  that  of  such  men  as  Killian  and 
Hajek,1  entirely  changed  this  conception,  until 
today  the  sphenoid  should  be  recognized  as  possi- 
bly the  most  important  of  the  sinuses  demanding 
treatment. 

In  the  experience  of  each  individual  rhinolo- 
gist  the  same  chronology  of  recognition  is  apt  to 
take  place.  The  frontal  sinus,  because  of  the  in- 

*  Read  before  the  Eye,  Ear,  Nose,  and  Throat  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session  at  Coronado,  May  6-9,  1929. 


sistence  of  its  symptoms,  demands  and  receives 
attention ; the  maxillary  sinus,  being  most  accessi- 
ble to  diagnosis  and  to  instrumentation,  is  not  apt 
to  be  neglected ; the  ethmoid  cells,  by  the  very 
frequency  of  their  involvement  in  all  acute  nasal 
infections,  are  not  easily  overlooked;  but  the 
sphenoid  sinus,  deeply  placed,  difficult  of  access, 
and  with  symptoms  often  inconstant,  indefinite 
and  bizarre,  is  often  ignored,  its  infections  passed 
undiagnosed,  and  its  complaining  owner  classed 
as  a hopeless  neurasthenic. 

ANATOMY  OF  SPHENOID  SINUS 

The  importance  of  the  sphenoid  sinus  lies  in  its 
peculiar  anatomic  relations,  and  many  of  the 
symptoms,  as  well  as  the  dangerous  complications 
of  its  infections,  are  due  to  the  involvement  of 
the  structures  with  which  it  is  in  relation.  In  fact 
it  is  the  recognition  of  symptoms  from  these 
structures  that  often  first  leads  to  the  diagnosis 
of  sphenoiditis.  If  the  sinus  is  small,  and  the 
walls  consequently  thick,  the  only  symptoms  of 
infection  may  be  increased  secretion.  On  the 
other  hand,  the  sinus  is  often  surprisingly  large, 
the  walls  thin  or  even  in  places  dehiscent,  and  if 
such  a sinus  becomes  infected,  and  the  small 
ostium  highly  placed  in  the  anterior  wall,  gives 
insufficient  drainage,  the  ease  of  involvement  of 
adjacent  structures  is  obvious. 

The  superior  wall  of  the  sinus  separates  it  from 
the  meninges  above,  and  on  this  wall  lies  the 
pituitary  body,  the  optic  commissure,  and  the  optic 
canals  which  may  actually  project  into  the  sinus. 
The  lateral  wall  separates  the  sinus  from  such 
structures  as  the  carotid  artery,  the  cavernous 
sinus,  the  third,  fourth,  and  sixth  cranial  nerves, 
and  the  first  and  second  divisions  of  the  fifth 
nerve.  If  these  walls  are  invaded,  the  serious 
complications  of  meningitis,  epidural  abscess,  or 
cavernous  sinus  thrombosis,7  may  first  point  to  an 
infection  of  the  sphenoid  sinus.1  2 Retrobulbar 
neuritis  and  orbital  abscess  show  invasion  of  the 
optical  canals,  while  defects  of  the  temporal 
halves  of  the  visual  fields  show  involvement  of 
the  chiasm.  Ocular  paralyses,  combined  with 
other  evidences  of  sphenoid  infection,  indicate  an 
involvement  of  the  third,  fourth,  or  sixth  nerves, 
probably  in  the  carotid  canal. 

Sluder  4 has  shown  that  in  a large  sinus  one  or 
all  three  divisions  of  the  fifth  nerve  may  be  para- 
lyzed by  cocainizing  the  interior  of  the  sphenoid 
cavity.  He  concludes  that  infection  in  the  sinus 
may  cause  pain  in  the  brow  through  involvement 
of  the  first  division,  pain  in  the  upper  jaw  and 
temple  through  involvement  of  the  second  divi- 
sion, and  pain  in  the  lower  jaw  with  stiffness  of 
the  muscles  of  mastication  through  involvement 
of  the  third  division  of  this  nerve. 

If  the  sinus  extends  downward  and  laterally 
into  the  pterygoid  process,  it  comes  into  intimate 
relation  with  the  vidian  canal,  which,  like  the 
optic  canal,  may  project  like  a ridge  into  the 
cavity  of  the  sinus.  Involvement  of  the  vidian 
nerve  may  cause  the  pain  recognized  as  the 
sphenopalatin-ganglion  syndrome,  but  is  not  re- 
lieved by  cocainizing  the  ganglion  itself.  It  is 


June,  1930 


SPHENOIDITIS — GODWIN 


403 


probable  that  the  pain  in  the  upper  parietal  re- 
gion— that  in  the  experience  of  the  writer  has 
seemed  most  typical  of  sphenoid  sinus  infection — 
is  also  transmitted  through  the  vidian  nerve. 

Prolongation  of  the  sinus  downward  and  later- 
ally may  also  bring  it  into  relation  with  the 
eustachian  tube,  and  thus  ear  symptoms  from 
sphenoid  infection  are  explained.5  In  a recent  case 
under  treatment,  a young  woman  complained  of 
constant  pain  and  tinnitus  in  the  right  ear  of 
several  months’  duration,  beginning  at  the  time 
of  an  acute  rhinitis.  She  had  had  various  forms 
of  treatments,  including  the  extraction  of  an  im- 
pacted upper  third  molar  tooth  without  relief. 
The  drum  was  normal  and  there  was  some  ob- 
struction of  the  eustachian  tube,  but  inflation  of 
the  tube  gave  little  relief.  Pain  and  tinnitus  both 
stopped  suddenly,  however,  on  the  application  of 
cocain  and  astringents  to  the  orifice  and  interior 
of  the  sphenoid  sinus. 

In  many  cases  of  acute  rhinitis  the  sphenoid 
sinus  is  acutely  involved,  and  the  chief  symptom 
determining  this  is  pain.  The  pain  in  these  cases 
is  often  indefinite  in  location.  The  patient,  while 
apparently  acutely  uncomfortable,  seems  at  a loss 
in  localizing  his  symptoms  and,  when  pressed  for 
a reply,  points  vaguely  to  various  parts  of  the 
head.  The  principal  locations  of  these  headaches 
are  in  the  glabella  region,  the  temples,  the  vertex, 
the  occiput,  the  upper  parietal  regions,  and  deep 
in  or  behind  the  orbits.  There  may  be  tenderness 
on  pressure  on  the  eyeballs.  There  is  often  vague 
discomfort  in  the  ears,  differing  from  that  caused 
by  occlusion  of  the  eustachian  tubes.  Vague,  dizzy 
sensations  may  be  present,  accentuated  by  change 
of  position.  In  the  individual  case  any  one  or 
several  of  these  locations  may  be  complained  of, 
and  Hajek  emphasizes  the  fact  that  in  successive 
attacks  the  patient  always  refers  his  pain  to  the 
same  area. 

In  subacute  and  chronic  cases,  headaches  in  the 
same  locations,  recurring  daily  or  at  irregular 
intervals,  are  indicative  of  deficient  or  intermit- 
tent obstruction  in  drainage  at  the  sphenoid 
ostium. 

SIGNS  OF  SPHENOIDITIS 

The  objective  symptoms  diagnostic  of  sphe- 
noiditis  are  secretion  and  localized  redness  and 
swelling.  A careful,  nonhurried  examination  is 
necessary,  using  a brilliant  light  in  a semidarkened 
room.  The  largest  throat  mirror  possible  to  use, 
the  nasopharyngoscope ; the  Killian  long-bladed 
nasal  speculum ; a long,  slender,  flexible  sinus 
cannula ; and  an  efficient  suction  apparatus  are 
all  of  value.  The  olfactory  fissure  is  shrunk  as 
far  as  possible  by  successive  applications  of 
cocain  and  ephedrin,  the  area  being  inspected 
as  shrinking  progresses.  In  a surprising  number 
of  cases  the  sphenoid  ostium  can  be  probed  and 
cannulized  when,  at  the  beginning  of  the  examina- 
tion, it  appears  impossible.  The  finding  of  a polyp 
or  edematous  tissue  in  the  region  of  the  ostium, 
with  or  without  secretion,  is  of  diagnostic  impor- 
tance, and  if  borne  out  by  repeated  examination 
the  diagnosis  of  hyperplastic  or  purulent  sphe- 
noiditis  is  established. 


The  demonstration  of  pus  exuding  from  the 
ostium,  or  the  ability  to  obtain  it  from  the  sinus 
on  irrigation  or  suction,  is  conclusive,  but  is  often 
impossible.  Purulent  secretion  in  tbe  olfactory 
fissure  and  in  the  nasopharynx  may,  of  course, 
originate  in  the  posterior  ethmoid  cells  as  well 
as  in  the  sphenoid  sinus,  and  it  is  impossible  in 
every  case  to  be  assured  that  the  condition  is  a 
sphenoiditis,  an  ethmoiditis,  or  a combination  of 
the  two. 

A pharyngitis  sicca,  an  epipharyngitis  with 
glairy  tenacious  mucus  or  with  persistent  crust- 
ing, often  of  a foul  nature,  are  significant  con- 
ditions, while  a lateral  pharyngitis  with  a band 
of  reddened  and  hypertrophied  lymph  tissue  on 
the  posterolateral  wall,  particularly  if  unilateral, 
has  long  been  considered  as  diagnostic  of  sphe- 
noiditis on  that  side. 

The  x-ray  seems  less  useful  in  the  diagnosis  of 
sphenoiditis  than  of  infections  of  other  sinuses, 
though  much  may  be  learned  by  its  use  regarding 
the  size  and  extent  of  the  sinus.  A lateral  view 
shows  this  well,  but  does  not  distinguish  the  right 
from  the  left  sinus.  An  anteroposterior  stereo- 
scopic skiagram  shows  the  two  sinuses,  but  in 
this,  as  in  the  vertical  view,  the  sinus  is  so  far 
from  the  film  and  so  overshadowed  by  other 
structures  that  only  the  grosser  variations  in  den- 
sity are  shown.  The  Granger  technique  has  been 
found  useful  but,  in  the  experience  of  the  writer, 
seems  to  present  fallacies  that  detract  from  its 
dependability.  The  Proetz  method  of  instilling 
lipiodol  during  intermittent  suction  gives  a beauti- 
ful demonstration  of  the  anatomy  of  the  sphe- 
noids.6 7 However,  it  shows  pathology  only  by  a 
filling  defect  in  the  case  of  the  presence  of  a poly- 
poid mass  in  the  sinus,  or  by  a prolonged  period 
of  time  necessary  for  the  sinuses  to  become  empty 
of  lipiodol,  and  the  normal  for  this  has  not  yet 
been  established. 

While  none  of  these  methods  of  x-ray  exami- 
nation is  ideal,  and  while  a diagnosis  of  sphenoid- 
itis should  not  be  made  on  a skiagram  alone,  the 
x-ray  should  be  considered  as  a valuable  adjunct 
in  giving  definite  facts  that,  taken  together  with 
other  information,  leads  to  a diagnosis. 

TREATMENT  OF  SPHENOIDITIS 

The  treatment  of  sphenoidal  infections  depends 
on  the  type  and  stage  of  the  disease.  In  the  acute 
cases  the  usual  measures  used  to  combat  the  acute 
rhinitis,  together  with  local  treatment  about  the 
ostium  with  cocain,  ephedrin  and  a weak  silver 
solution,  are  usually  all  that  are  necessary  to  give 
early  relief.  In  the  hyperplastic  cases,  aeration 
of  the  sinuses  is  essential.  This  may  be  accom- 
plished in  some  cases  simply  by  repeated  topical 
applications,  while  in  others  removal  of  poly- 
poid tissue,  partial  resection  of  the  middle  turbi- 
nate body,  and  enlargement  of  the  ostium  are 
necessary. 

In  the  suppurative  cases  the  desideratum  is 
free  drainage,  and  this  may  be  secured  by  more  or 
less  radical  measures.  It  seems  logical  to  attempt 
the  least  radical  procedure  that  gives  reasonable 
promise  of  attaining  this  end.  The  sphenoid 


404 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


ostium  should  be  enlarged  as  extensively  as  possi- 
ble laterally  and  downward  with  a sphenoid  punch 
forcep,  removing  practically  all  of  the  pars 
nasalis.  In  the  case  of  a large  sinus,  it  may  be 
possible  to  remove  a part  of  the  floor  of  the  sinus. 
Occasionally  the  ostium  can  be  enlarged  without 
sacrificing  the  middle  turbinate  body,  but  usually 
the  posterior  portion,  or  often  the  whole  of  this 
structure,  must  be  removed  to  gain  access  to  tbe 
sphenoid  and  to  give  better  drainage.  If  more 
extensive  opening  seems  necessary,  the  sinus  is 
entered  by  way  of  the  posterior  ethmoidal  cells, 
and  the  pars  ethmoidalis,  as  well  as  the  pars 
nasalis  of  the  anterior  wall,  is  removed  by  use  of 
the  Hajek  hook,  or  the  more  effective  Sluder 
angular  knife. 

There  is  a great  tendency  for  the  opening  to 
close,  and  watchful  after-care  is  necessary,  with 
the  occasional  cauterization  or  removal  of  granu- 
lations from  the  wound  edges  until  epidennatiza- 
tion  is  complete.  Even  then,  healing  may  be  a 
prolonged  process,  and  irrigations,  the  use  of  suc- 
tion, and  the  applications  of  weak  silver  solutions 
to  the  interior  of  the  sinus,  may  be  necessary  for 
some  time  until  the  mucous  membrane  lining 
approaches  the  normal ; but  in  no  branch  of  intra- 
nasal work  are  patience  and  persistence  more 
rewarded  than  in  the  treatment  of  these  cases. 

REPORT  OF  CASES 

Two  case  histories  are  briefly  summarized. 

Case  1. — Mrs.  O.  E.  B.,  age  thirty-three,  was  seen 
in  August  1927,  with  the  complaint  of  frequent  nasal 
colds  and  constant  severe  diffuse  head  pains,  but  par- 
ticularly of  a frequently  recurring  agonizing  pain  in 
the  upper  right  parietal  region.  The  findings  were 
essentially  negative  except  for  congestion,  edema,  and 
slight  secretion  in  both  olfactory  fissures.  The  usual 
stereoscopic  x-rays  were  negative,  but  the  view  taken 
by  the  Granger  technique  was  reported  as  suspicious 
of  involvement  of  the  sphenoids.  The  patient  was 
operated,  portions  of  both  middle  turbinates  being 
removed  and  both  sphenoids  opened  widely.  There 
was  immediate  relief  from  the  typical  pains  com- 
plained of,  and  these  have  remained  absent  since 
except  on  several  occasions  during  the  early  post- 
operative treatment,  when  the  sphenoid  openings  be- 
came occluded  by  granulations  or  swelling.  On  one 
occasion  the  patient  complained  of  a return  of  the 
typical  severe  pain  in  the  upper  right  parietal  region. 
Tbe  right  sphenoid  opening  was  found  to  be  occluded 
by  granulations,  and  on  passing  a probe  through  them 
into  the  sinus  there  was  instantaneous  relief  from  the 
pain.  The  cessation  of  pain  was  so  prompt  and  defi- 
nite as  to  be  remarkable  and,  in  the  absence  of  secre- 
tion in  the  sinus  at  that  time,  could  only  be  explained 
by  a so-called  vacuum  sinus  condition.  Following 
further  treatments,  the  wound  edges  healed  and  the 
sphenoid  sinuses  remained  open,  and  though  the  pa- 
tient has  been  treated  for  several  subsequent  attacks 
of  acute  rhinitis,  she  has  remained  free  from  the 
typical  sphenoidal  pains. 

1 i 1 

Case  2. — Mrs.  S.  B.,  age  forty-three,  was  seen  June  5, 
1928.  She  had  had  a greenish  yellow  postnasal  dis- 
charge for  years.  Several  months  previously  she  had 
had  a submucous  resection  of  the  septum  with  partial 
turbinectomy  on  account  of  impaired  hearing.  Follow- 
ing this  she  began  to  have  severe  pains  in  the  upper 
left  parietal  and  occipital  regions.  These  occurred  in 
attacks  lasting  from  one  to  several  days,  with  short 
intermissions,  and  were  so  severe  that  the  patient 
feared  insanity  and  brain  tumor.  She  had  lost  weight 
and  there  was  a variable  tachycardia  up  to  140.  Re- 


peated thorough  physical  and  neurological  examina- 
tions had  been  negative  except  for  the  nasal  findings, 
and  pulmonary  tuberculosis  and  thyroid  involvement 
had  been  apparently  ruled  out.  X-rays  showed  an 
exceptionally  large  sphenoid  sinus  on  the  left  side 
and,  when  injected  by  the  Proetz  method,  this  was 
seen  to  extend  far  down  into  the  pterygoid  process. 
Irrigation  of  this  sinus  produced  a thick  mucopus  and 
gave  relief  for  several  days  from  the  parietal  and  oc- 
cipital pain.  A large  window  opening  was  made  in  the 
anterior  wall.  The  mucous  membrane  lining,  viewed 
directly,  appeared  normal,  but  the  nasopharyngo- 
scope  introduced  into  the  sinus  showed  swollen  and 
edematous  membrane  far  down  in  the  lower  portion. 
The  condition  has  been  stubborn  and  the  patient  is 
still  under  treatment.  There  has  been  great  improve- 
ment, but  with  several  relapses.  At  times  suction  has 
proved  effective  in  removing  thick  secretion  from  the 
sinus  after  irrigation  has  been  negative,  but  always 
the  removal  has  been  followed  by  relief  of  symptoms, 
and  the  involvement  of  the  Vidian  nerve  seems  to 
have  been  proved. 

CONCLUSIONS 

1.  Infections  of  the  sphenoid  sinus  rank  high 
among  conditions  demanding  intranasal  treatment. 

2.  Diagnosis  is  made:  (a)  by  finding  of  ab- 
normal secretion  or  visible  pathological  changes 
about  or  in  the  cavity,  but  principally  ( b ) by  the 
recognition  of  the  symptoms  of  involvement  of 
adjacent  structures. 

3.  Treatment  by  medical  or  surgical  means, 
while  more  difficult  than  that  of  other  sinuses  pro- 
duces marked  relief  of  symptoms  often  unrecog- 
nized as  related  to  this  sinus. 

910  Security  Building. 

REFERENCES 

1.  Hajek,  M.:  Path,  and  Treat.  Nasal  Accessory 
Sinuses,  fifth  edition,  1926,  Vol.  1,  p.  76;  Vol.  2, 
p.  496. 

2.  Skillern,  R.  H.:  Accessory  Sinuses  of  Nose,  1913, 
p.  340. 

3.  Loeb,  H.  W.:  Operative  Surgery  of  Nose,  Throat, 
and  Ear,  Vol.  2,  p.  81. 

4.  Sluder,  Greenfield:  Nasal  Neurology,  Headaches, 
and  Eye  Disorders,  1927,  pp.  139-270. 

5.  Year  Book,  1925,  Lyman,  H.  W.  Laryngoscope, 
December  1924. 

6.  Proetz,  Arthur  W.:  Visualization  of  Sinus  Drain- 
age, Ann.  Otol.  Rhin.  and  Laryng.,  December  1927. 

7.  Eagleton,  W.  P. : The  Carotid  Venous  Plexus  as 
the  Path  of  Infection  in  Thrombophlebitis  of  the 
Cavernous  Sinus,  Arch.  Surg.,  August  1927. 

DISCUSSION 

J.  Frank  I'riesen,  M.  D.  (1208  Roosevelt  Building, 
Los  Angeles). — The  sphenoid  sinus  as  a center  of 
infection  has  not  been  given  sufficient  emphasis,  and 
the  subject  is  well  worthy  of  our  attention. 

When  we  consider  the  sphenoid,  located  posteriorly, 
almost  completely  surrounded  by  vital  structures,  we 
can  readily  see  why  a sphenoiditis  will  cause  ocular 
symptoms,  nerve  pains,  and  intracranial  infections. 

In  the  diagnosis  of  a sinus  disease,  pain  is  more  or 
less  a dominant  symptom.  In  a sphenoiditis  there  are 
two  different  types  of  pain,  and  these  two  types  each 
present  a different  picture.  A dull,  heavy  pain  in  the 
back  of  the  head,  produced  by  pressure  from  secre- 
tion and  the  interference  of  drainage,  which  Doctor 
Godwin  has  aptly  described.  The  other  picture  is  a 
pain  along  the  branches  of  the  vidian  nerve  referred 
to  the  face,  teeth,  neck,  or  shoulder  which  may  come 
in  the  course  of  a mild,  acute  or  chronic  posterior 
sinus  infection.  The  infection  or  coryza  in  these  cells 
may  be  so  slight  that  the  patient  is  not  aware  of  it, 
and  yet  have  the  headache  and  referred  pains  that 
come  from  the  maxillary  and  vidian  nerves.  This 
syndrome  is  very  similar  to  that  of  a sphenopalatine 


June,  1930 


CATARACT  OPERATIONS — MILLS 


405 


neurosis,  and  often  explains  the  failures  in  the  treat- 
ment of  the  sphenopalatine  ganglion.  These  symp- 
toms promptly  disappear  if  the  treatment  is  directed 
to  the  posterior  sinuses. 

This  is  best  accomplished  by  shrinking  the  posterior 
nasal  fossae  and  applying  an  argyrol  tampon.  I have 
also  had  good  results  in  using  the  one  per  cent  aque- 
ous solution  of  ephedrin  by  the  suction  displacement 
method  suggested  by  Proetz. 

Robert  C.  Martin,  M.  D.  (384  Post  Street,  San 
Francisco). — Disease  of  the  sphenoid  alone  is  prob- 
ably very  rare  because  of  the  intimate  relationship  of 
the  posterior  ethmoids.  We  can  recall  but  two  cases 
of  involvement  of  this  sinus  which  were  not  accom- 
panied by  demonstrable  posterior  ethmoiditis.  In 
these  the  upper  parietal  pain  described  by  Doctor 
Godwin  was  marked,  and  was  associated  with  mental 
confusion.  These  symptoms  cleared  with  shrinking 
and  irrigation.  It  is  our  impression  that  sphenoiditis 
is  perhaps  not  so  frequent  as  stated. 

The  chronic  spheno-ethmoidal  infections  are  sub- 
ject to  frequent  relapses,  whether  the  treatment  be 
conservative  or  radical.  A thorough  medical  exami- 
nation and  general  therapy  are  indicated  in  order  to 
eliminate  allergic  or  glandular  conditions  which,  un- 
detected, will  defeat  the  purpose  of  local  therapy. 

The  relationship  of  sphenoiditis  or  spheno-ethmoid- 
itis  to  retrobulbar  neuritis  should  be  emphasized  since 
aeration  in  these  cases  is  often  followed  by  strik- 
ing improvement.  The  difficulty  in  these  cases  lies 
in  determining  the  presence  or  absence  of  an  early 
multiple  sclerosis. 

Doctor  Godwin  (Closing). — In  closing,  I wish  to 
emphasize  the  importance  of  infections  of  the  sphe- 
noid sinus.  It  is  large;  it  is  deeply  placed;  it  has  poor 
drainage,  and  it  is  in  intimate  relation  with  important 
structures.  It  is  reasonable  to  believe  that  it  is  at 
least  as  frequently  infected  as  any  other  sinus.  If 
these  facts  are  borne  in  mind,  I believe  that  many 
vague  symptoms  will  be  explained,  and  many  more 
cases  will  be  diagnosed. 


INTRACAPSULAR  CATARACT  OPERATIONS’*' 

By  Lloyd  Mills,  M.  D. 

Los  Angeles 

Discussion  by  Raymond  J . Nutting , M.  D.,  Oakland ; 
Roderic  O’Connor,  M.  D.,  Oakland;  IVilliam  A.  Boyce, 
M.  D.,  Los  Angeles. 

A NEW  spirit  is  abroad  in  cataract  surgery,  as 
a result  of  the  patient  study  of  the  operative 
methods  and  results  of  the  last  four  generations 
of  ophthalmic  surgeons.  The  present  generation 
recognizes  that  there  is  no  single  operative  method 
of  removing  cataract  which  is  uniformly  safe  and 
certain  of  beneficent  results.  Every  surgeon  of 
experience,  therefore,  has  several  methods  of  cata- 
ract delivery,  as  well  as  a well-grounded  knowl- 
edge of  their  indications.  Not  even  a Barraquer, 
probably  the  outstanding  ophthalmic  surgeon  of 
this  decade,  attempts  to  deliver  all  lenses  in  their 
capsules,  and  he  has  been  the  first  to  go  on  record 
as  to  the  limitations  of  his  own  method  (Ignacio 
Barraquer,  September  1922,  Archiv.  Ophthal.) . 

The  reason  why  certain  operative  fashions  in 
medicine  have  been  discredited  is  nowhere  more 
apparent  than  in  the  case  of  the  generally  aban- 
doned Smith-Indian  expression  of  cataract.  This 
particular  fiasco  led  to  almost  universal  interest 

* Read  before  the  Eye,  Ear,  Nose,  and  Throat  Section 
of  the  California  Medical  Association  at  the  fifty-eighth 
annual  session,  May  6-9,  1929. 


in  delivery  of  the  cataractous  lens  within  its  cap- 
sule and  a number  of  methods  of  intracapsular 
delivery  in  vogue  owe  their  position  more  or  less 
definitely  to  this  stimulus.  The  unyielding  opposi- 
tion of  a number  of  men  to  all  intracapsular 
methods,  an  active  opposition  which  will  last  as 
long  as  they  live,  likewise  is  based  upon  the  stream 
of  tragedies  which,  in  their  experience  or  observa- 
tion, interspersed  the  brilliant  successes  of  this 
one  method.  Fortunately  for  the  progress  of  cata- 
ract surgery  these  opponents  are  much  in  the 
minority  and  their  retarding  influence  is  but 
transitory. 

THE  DEMANDS  OF  INTRACAPSULAR  TECHNIQUE 

There  has  been  much  criticism  in  the  past  that 
the  men  who  have  set  themselves  up  as  outstand- 
ing cataract  surgeons,  generally  championing  some 
especial  method,  have  given  the  impression  that 
only  those  possessed  of  some  divine  spark  could 
ever  perform  the  given  method  creditably.  I have 
had  the  privilege  of  seeing  and  reviewing  the 
work  of  many  eye  surgeons  of  all  grades  of 
capacity  and  experience,  and  I am  convinced  that 
the  chief  differences  which  exist  between  them 
are  accounted  for  by  differences  in  surgical  op- 
portunity more  than  by  any  other  single  factor. 
The  expert  in  any  medium  must  subject  himself 
to  a prodigious  amount  of  training  before  the  fine 
frenzy  of  the  artist  is  attained.  Great  ophthalmic 
surgeons  are  no  more  common  than  the  great  in 
other  fields  and,  as  in  the  case  of  Barraquer,  they 
probably  represent  the  conjunction  of  a distin- 
guished heredity,  early  and  intensive  specializa- 
tion, real  surgical  genius  and  flawless  dexterity. 
Not  every  man  has  native  surgical  instinct  or  can 
be  made  into  a surgeon,  but  too  often,  when  the 
native  ability  is  present,  both  opportunity  and 
material  are  lacking. 

It  is  obvious  that  the  delivery  of  a lens  within 
its  unbroken  capsule,  and  especially  if  this  de- 
livery is  to  be  made  by  the  ideal  way  of  an  intact 
pupil,  makes  the  greatest  possible  demands  upon 
the  surgeon’s  judgment  as  well  as  upon  his  tech- 
nical ability.  All  cases  must  be  selected.  The  in- 
cisions must  be  larger  and  placed  well  toward  the 
sclera,  the  pressures  must  be  nicely  regulated  in 
the  expression  methods,  the  traction  on  the  cap- 
sule in  the  forceps-traction  method  requires  a 
masterful  gentleness  reached  only  by  training, 
while  the  most  technical  procedure  of  all,  the 
vacuum  extraction  of  Barraquer,  demands  a deli- 
cacy of  execution  which  must  be  perfect  in  its 
smallest  details  if  consecutive  successes  are  to  be 
obtained.  Is  it  any  wonder,  then,  that  intelligent 
training  is  asked  of  men  who  would  engage  in 
these  more  highly  specialized  surgical  measures? 
A common  belief  exists  among  men  who  use  the 
combined  extraction  only  that  the  statements  of 
the  difficulties  met  in  doing  these  more  compli- 
cated operations  are  made  in  the  selfish  hope  of 
deterring  their  more  general  adoption.  Such  be- 
lief is  unworthy  and  has  no  basis  in  fact.  The 
truth  is  that  the  loss  of  an  eye  represents  to  the 
eye  surgeon  what  the  loss  of  a life  does  to  the 
general  surgeon.  Consequently  the  exponent  of 
any  method  is  careful  that  he  be  not  made  in- 


406 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


directly  responsible  for  measures  which  cannot 
fail  to  be  hazardous  in  unpracticed  hands,  or 
when  entered  upon  without  a fitting  sense  of  their 
risks. 

These  risks,  in  the  expression  and  forceps-trac- 
tion operations,  and  to  a much  less  extent  in 
facoeresis,  are  those  of  loss  of  vitreous,  occasion- 
ally in  considerable  amounts,  and  of  rupture  of 
the  capsule  before  delivery  of  the  lens.  The  inci- 
dence of  these  complications  and  their  gravity 
usually  have  a direct  relation  to  the  ability  and 
experience  of  the  operator. 

EXPRESSION  OPERATIONS 

The  expression  methods  most  used  today  are 
modifications  of  the  Smith-Indian  operation  with 
incisions  embracing  half,  or  more,  of  the  corneal 
circumference,  usually  without  conjunctival  flap, 
the  zonule  being  broken  by  the  pressure  of  a hook 
either  on  the  cornea,  or,  as  in  the  use  of  the 
Schwartz  hook,  on  the  sclera. 

Colonel  Smith,  dissatisfied  with  the  reception 
of  his  earlier  operation,  returned  to  the  Punjab 
in  1925-26  and  developed  an  intracapsular  method 
which  he  modestly  states  will  make  Daviel’s 
operation  “but  a tradition  of  the  fathers,”  and 
which  will  place  Barraquer’s  vacuum  spoon  on  a 
shelf  in  the  museum  with  all  the  forms  of  Kalt 
forceps,  “to  be  inspected  as  objects  of  historical 
interest”  (Lieutenant-Colonel  Henry  Smith.  The 
Treatment  of  Cataract.  London,  1928).  This 
revolution  is  to  be  effected  by  tumbling  the  lens 
between  the  combined  pressure  of  a lens  hook 
and  a spatula.  The  corneal  wound,  including  at 
least  half  of  the  circumference,  is  kept  closed  by 
the  pressure  of  a broad  spatula,  while  the  zonule 
is  being  ruptured  by  pressure  of  a lens  hook  ap- 
plied so  far  below  the  cornea  that  the  sclera  is 
indented  behind  the  lens.  The  lower  edge  of  the 
lens  thus  is  forced  upward  and  forward  to  the 
wound  without  loss  of  vitreous,  a maneuver  pre- 
viously limited  to  soft  and  mainly  Morgagnian 
cataracts.  Colonel  Smith’s  claims  for  his  disas- 
trous earlier  method  were  no  less  extravagant 
and  the  situation  would  appear  to  have  justified 
the  scathing  remarks  of  one  reviewer  that,  “The 
inexperienced  ophthalmic  surgeon  will  read  and 
believe  it  and,  on  attempting  to  practice  the 
maxims,  will  wallow  in  vitreous  until  experience 
has  ripened  him.”  I have  had  no  practice  with 
this  method,  but  have  used  the  Schwartz  hook 
successfully  in  several  cases,  using  scleral  pres- 
sure, and  it  is  within  the  bounds  of  possibility 
that  the  combination  of  this  flat  hook  with  the 
counterpressure  by  spatula  over  the  wound  might 
simplify  this  particular  operation.  The  forces  in 
any  expression  operation  must  be  so  accurately 
balanced  that  only  one  with  experience  should 
attempt  it  and,  unless  this  new  method  clearly 
proves  to  have  outstanding  merit,  with  a mini- 
mum of  complication,  I am  of  the  opinion,  from 
an  experience  of  about  seventy-five  such  opera- 
tions, that  intracapsular  expression  methods  per  se 
should  never  be  used.  In  this,  of  all  intracapsular 
operations,  when  vitreous  is  lost,  it  often  is  lost 
in  serious  amounts;  and  there  is  often  marked 
deformity  of  the  whole  anterior  segment  with 


great  astigmatism,  an  updrawing  of  the  pupil  and 
dislocation  of  the  vitreous.  The  occasional  bril- 
liant results  never  justify  the  high  incidence  of 
these  complications.  Racial  factors  may  modify 
the  ease  of  rupture  of  suspensory  ligaments  but 
if  such  factors  do  exist  they  are  far  more  likely 
to  have  relation  to  the  greater  development  of 
strength  in  the  zonules  of  the  hyperopes  among 
the  more  educated  peoples  and  consequently  to 
their  greater  resistance  to  rupture.  This  same 
factor  may  influence  at  times  the  difficulty  of  rup- 
ture of  the  zonule  in  the  Barraquer  method  in 
hyperopes  of  more  than  small  degree. 

EXTRACTION  OPERATIONS 

The  capsule-traction  methods  of  Knapp,  Torok, 
and  Stanculeanu  are  similar  in  method  and,  as 
generally  used,  consist  in  grasping  the  anterior 
capsule  of  the  lens  with  some  form  of  nontearing 
capsule  forceps  in  cases  where  study  gives  the 
impression  that  the  capsule  is  likely  to  be  more 
resistant  to  traction  than  the  zonule.  Traction 
from  side  to  side,  up  and  down  and  in  circular 
forms  breaks  the  zonule  and  expression  is  com- 
pleted by  pressure  through  the  cornea  by  a hook, 
the  lens  tumbling,  as  its  upside-down  reversal  of 
position  is  called.  This  method  is  successful  in 
about  50  to  60  per  cent  of  the  selected  cases  upon 
which  it  is  tried  and  has  a loss  of  vitreous,  usu- 
ally of  no  significant  amount  in  from  2 to  18  per 
cent,  depending  upon  the  operator’s  judgment  in 
the  selection  of  cases,  upon  his  experience,  upon 
the  completeness  of  the  anesthesia,  and  upon 
whether  he  sutures  his  incision  or  leaves  them  to 
the  mercy  of  all  the  physicomental  stresses  to 
which  early  convalescence  is  subjected.  Recent 
improvements  in  technique  are : the  full  closure 
of  wounds,  and  the  perfect  absence  of  pain  or  of 
squeezing  during  operation  which  are  assured  by 
facial  nerve  blocking  and  direct  intra-ocular  an- 
esthesia. There  is  every  reason  to  believe  that 
these  particular  methods  will  reduce  the  loss 
of  vitreous  to  an  incidence  which  will  equal 
or  better  that  of  the  combined  method.  Logically 
the  only  cases  of  loss  of  vitreous  by  this  method, 
in  expert  hands,  should  be  those  where  there  are 
adhesions  between  the  lens  and  its  bed  in  the 
patellar  fossa  or  hyaloid  defects,  and  these  are 
believed  to  be  rare. 

The  most  superior  form  of  intracapsular  cata- 
ract operation,  in  my  experience,  is  the  vacuum 
extraction.  Adequate  technical  training  and  a 
knowledge  of  the  limitations  of  the  method  are 
essential.  The  same  types  of  cases  are  excluded 
as  in  the  selection  of  material  for  other  intra- 
capsular methods : Increased  intra-ocular  tension, 
the  history  of  old  retinal  hemorrhage,  very  scler- 
osed lenses  with  friable  capsules,  senility  or  other 
mental  intractability,  are  reasons  for  not  using 
this  method.  Barraquer  states : “One  should  not 
intervene  in  subjects  under  forty,  because  in  them 
the  zonule  is  very  resistant,  nor  in  a complicated 
cataract  or  in  one  occurring  in  myopia,  in  a sub- 
luxated lens,  in  traumatic  cataract,  or  in  one 
ripened  artificially  by  means  of  a preparatory 
iridectomy.”  Of  course,  there  are  exceptions  to 
these  exceptions.  The  method  is  too  widely  known 


June,  1930 


CATARACT  OPERATION S — M I LLS 


407 


and  used  to  require  description,  but  its  main  ele- 
ment is  gentleness  from  the  moment  of  fixation 
of  the  globe  to  the  point  where  the  lens  is  ex- 
tracted quietly  and  without  the  least  pressure 
upon  the  patellar  fossa.  Pressure  anywhere  is 
avoided  at  all  costs.  The  correct  performance  of 
this  operation  gives  the  most  beautiful  immediate 
result  in  all  cataract  surgery.  Nobody  has  yet 
published  results  equaling  those  of  Barraquer, 
but  men  in  many  places  are  finding  a degree  of 
success  with  this  method,  modified  to  their  indi- 
vidual needs,  such  as  they  have  never  before 
found  in  cataract  surgery. 

After  mastering  the  technique,  both  with  Barra- 
quer and  at  home,  I gave  up  the  use  of  this  method 
several  years  ago  because  I was  not  satisfied  with 
the  fundamental  principles  of  the  treatment  of 
cataract  wounds  in  general.  It  appeared  to  me  that 
cataract  surgery  was  being  done  without  regard 
to  those  basic  rules  of  surgery  which  require  that 
“all  presumably  clean  wounds  shall  be  fully 
closed  (by  suture)  without  drainage  in  order  to 
prevent  infection  of  the  wound  from  without, 
and  that  wounds  made  and  closed  in  more  than 
one  plane  afford  less  chance  of  infection,  are 
surer  protection  against  hernia  of  the  structures 
which  they  enclose,  and  are  stouter.”  Full  suture 
of  a complete  conjunctival  flap  by  long  and  ex- 
acting trial  in  four  hundred  and  sixty-three  cases, 
associated  latterly  with  a routine  form  of  com- 
plete intra-ocular  anesthesia  and  hemostasis  de- 
tailed elsewhere,1  proved  that  this  assumption  was 
correct.  Iris  prolapse,  delayed  healing,  painful 
wounds,  secondary  infection,  glaucoma  and  high 
astigmatism  were  reduced  greatly,  or  wholly  elimi- 
nated, and  the  incidence  of  secondary  cataract 
slightly  reduced.  The  full  coverage  of  the  wound 
by  a conjunctival  flap  and  its  full  suture  have 
brought  the  extracapsular  extraction  of  cataract, 
in  its  combined,  simple  and  peripheral  iridectomy 
forms,  to  a point  of  safety  and  of  visual  excel- 
lence which  compares  most  favorably  with  those 
obtained  by  any  intracapsular  method  save  that  of 
Barraquer.  The  future  history  of  complications 
following  extracapsular  cataract  extraction  after 
the  generalization  of  this  method  of  complete  pro- 
tection of  the  wound,  in  the  main  should  be  the 
history  of  after-cataract,  for  only  in  this  matter 
of  after-cataract  should  any  form  of  intracapsular 
extraction  finally  prove  superior  to  this  modifi- 
cation of  the  combined  method  in  equally  experi- 
enced hands. 

SUMMARY 

1.  No  method  of  removing  cataract  is  uni- 
formly safe  and  certain  of  success,  and  because 
of  this,  most  experienced  ophthalmic  surgeons 
now  deliver  lenses  in  or  out  of  their  capsules  and 
with  or  without  iridectomies,  according  to  the 
indications  of  each  case. 

2.  Successful  intracapsular  surgery  requires  es- 
pecial knowledge  of  the  risks  and  contraindica- 
tions and  a mastery  of  the  more  complicated 
technique. 

3.  All  forms  of  cataract  surgery  in  which  the 
wound  is  left  unsutured  are  subject  to  the  dis- 
asters of  delayed  healing,  hernia  of  the  ocular 


contents,  infection  and  secondary  glaucoma,  as 
well  as  to  increased  corneal  astigmatism. 

4.  Full  closure  of  the  incision  by  full  suture 
of  a conjunctival  flap  in  a different  plane  pre- 
vents or  reduces  these  disasters  to  a minimum 
and  lessens  postoperative  astigmatism  in  all  forms 
of  cataract. 

5.  The  correct  extracapsular  operation,  in  which 
the  full  flap  and  suture  are  employed,  should  rival 
the  intracapsular  operation  in  all  ways  save  the 
complication  of  after-cataracts,  peculiar  to  the 
extracapsular  method,  whose  incidence  largely  is 
a matter  of  technique  and  experience. 

609  South  Grand  Avenue. 

REFERENCE 

1.  Mills,  Lloyd:  Modern  Cataract  Surgery,  Jour. 
A.  M.  A.,  December  22,  1928. 

DISCUSSION 

Raymond  J.  Nutting,  M.  D.  (1904  Franklin  Street, 
Oakland). — Doctor  Mills’  article  on  intracapsular 
cataract  operations  is  most  timely  and  interesting. 
I certainly  agree  with  him  that  no  method  of  remov- 
ing cataracts  is  uniformly  safe  and  certain  of  success, 
but  I feel  that  the  old  classical  extracapsular  opera- 
tion is  safer  in  both  skilled  and  unskilled  hands.  I 
can  only  say  that  if  I had  to  have  a cataract  removed 
I would  go  to  a man  who  would  first  do  a prelimi- 
nary iridectomy,  followed  later  by  the  old  operation. 

Personally  I feel  that  the  lids  should  be  completely 
paralyzed  and  then  that  a complete  anesthetic  should 
be  given  before  making  an  incision.  Lately  I have 
been  using  the  undetached  conjunctival  flap  and  so  far 
have  no  reason  to  give  it  up,  but  on  the  contrary  my 
results  have  been  better  and  the  patients  are  able  to 
leave  the  hospital  from  four  to  seven  days  earlier. 

After  one  sad  experience  with  the  speculum,  I now 
use  double-armed  sutures  in  the  upper  and  lower  lid, 
and  at  the  finish  these  same  sutures  can  be  used  to 
keep  the  lids  closed  under  the  patch,  especially  after 
using  complete  facial  nerve  paralysis. 

I certainly  agree  with  Doctor  Mills  that  in  private 
practice  the  correct  extracapsular  operation  should 
rival  the  intracapsular  operation. 

* 

Roderic  O’Connor,  M.  D.  (1904  Franklin  Street, 
Oakland). — All  intracapsular  operations  remove  the 
diaphragm  that  serves  to  protect  the  vitreous  from 
infection  as  well  as  loss.  This  diaphragm  is  made  up 
of  the  posterior  lens  capsule  and  the  zonular  ligament 
and  its  removal  seems  poor  surgery  to  those  of  us 
who  have  the  “unyielding  opposition”  he  mentions. 
Our  numbers  are  possibly  a few  more  than  the  minus 
quantity  he  implies. 

Intracapsular  operators  are  fond  of  stating  that  a 
small  loss  of  vitreous  is  of  no  importance.  It  is  well 
established  that  late  retinal  detachments  occur  more 
frequently  in  cases  complicated  by  such  loss.  An- 
other important  point  is  that  , any  loss  is  more  likely 
to  become  excessive  than  if  it  had  not  started.  1 he 
loss  cannot  start  unless  the  above  mentioned  dia- 
phragm is  ruptured.  There  can  be  no  denial  of  the 
fact  that  vitreous  loss  is  much  less  frequent  in  the 
capsulotomy  operation.  Doctor  Mills  hopes  that  he 
has  developed  a method  that  will  show  as  good  a 

record.  . r ,.  „ 

Personal  experience  with  the  stream  of  tragedies 
he  mentions  has  not  been  necessary  to  persuade  me 
that  all  such  methods  are  not  only  needless  but  that 
their  performance  is  inexcusable.  This  because  no  such 
operation,  even  in  the  hands  of  the  most  divinely 
endowed  operator,  has  yet  produced  average  results 
equal  to  those  by  the  capsulotomy  method  in  the 
hands  of  capable  and  careful  operators. 

His  whole  argument  is  negatived  in  his  fifth  con- 
clusion, for  there  he  admits  that  prevention  of  the 
disscission  of  secondary  membranes  is  the  only  reason 


+08 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


for  the  intracapsular  procedure.  The  “unyielding  op- 
position” sees  no  sense  in  subjecting  all  cases  to  a 
difficult  and  risky  operation  merely  to  avoid  a simple 
one  in  some. 

I agree  with  him  that  a lens  should  be  lifted  out, 
not  expressed.  My  way  of  doing  this  is  by  using  a 
very  flexible  shell  spatula  which  permits  a visual,  as 
well  as  a tactile,  judgment  of  pressure. 

Practically  none  is  required  to  tilt  the  upper  edge 
of  the  lens  forward  after  a large  piece  of  the  capsule 
has  been  removed  by  forceps.  At  this  point  a Fischer 
needle  is  used  to  lift  or  tease  it  out  from  under  an 
undetached  conjunctival  flap.  Since  lid  paralysis  has 
been  made  routine  I have  not  had  one  vitreous  loss. 

The  cataract  incision  is  important  enough  to  call 
for  the  best  use  of  one’s  master  hand.  The  percent- 
age is  diminishing  of  those  who,  in  a sheeplike  way, 
have  tried  to  imitate  the  so-called  masters  in  always 
standing  at  the  patient’s  head,  making  the  incision  in 
the  right  eye  with  the  right  hand  and  in  the  left  eye 
with  the  left  hand. 

Frequently,  in  cataract  discussions,  is  heard  a state- 
ment that  preliminary  iridectomy  is  not  needed  if 
the  patient  has  two  good  eyes.  Such  a statement 
should  be  considered  equal  to  a confession  of  unfit- 
ness. One  who  will  not  use  all  the  safety  precautions 
all  the  time  is  not  worthy  of  the  responsibility. 

Doctor  Mills  lists  many  types  of  patients  not  suit- 
able for  the  intracapsular  operation.  So,  of  course, 
in  these  the  relatively  safe  old  capsulotomy  is  the 
operation  of  choice. 

His  scheme  of  five  sutures  does  not  appeal.  No  one 
in  any  line  of  surgery  can  hope  to  attain  100  per  cent 
freedom  from  stitch  infection.  Placement  of  stitches 
calls  for  much  time  and  manipulation.  The  shorter 
an  operation  the  less  chance  for  misbehavior,  which 
is  the  usual  cause  of  mishaps  when  the  operator  is 
manually  skillful.  If  tight  closure  is  necessary,  why 
are  we  taught  to  open  the  eye  in  cases  of  nonunion 
and  permit  the  tarsal  cartilage  to  give  its  normal 
gentle  support  to  the  wound?  Only  in  the  past 
month,  I had  such  an  occurrence  in  a case  of  non- 
union, following  extraction  in  a glaucomatous  eye, 
the  patient  being  also  diabetic.  The  wound  promptly 
united  after  removal  of  dressings.  If  he  has  markedly 
reduced,  by  sutures,  the  “incidence  of  iris  prolapse, 
delayed  healing,  painful  wounds,  secondary  infections, 
glaucoma,  and  high  astigmatism,”'  are  all  those 
troubles  necessary?  His  enthusiasm  has  given  the 
discusser  a wonderful  chance  to  comment. 

I am  glad  he  dismisses  the  Smith  operation  as  a 
fiasco. 

In  regard  to  the  Barraquer  operation,  its  success 
depends  upon  the  unfailing  action  of  an  electric 
vacuum  pump.  Electrical  apparatus  is  notoriously 
temperamental  (witness  automobile  ignition  sys- 
tems). I would  prefer  to  have  the  responsibility  for 
failure  rest  with  me  after  I had  started — at  least  as 
far  as  cataract  surgery  is  concerned. 

The  Knapp  type  of  operation  appeals  to  me  more 
than  any  because  in  the  50  per  cent  of  cases  where 
it  fails,  the  operation  can  be  completed  by  ordinary 
capsulotomy  technique.  Doctor  Knapp,  who  is  one 
of.  our  most  expert  operators,  has  just  reported  his 
third  series  of  one  hundred  operations.  He  lists  the 
following  mishaps:  vitreous  loss  in  seven,  iritis  in 
eight,  reopening  of  wound  in  ten,  expulsive  hemor- 
rhage in  two,  and  late  retinal  detachment  in  two. 
I would  hate  to  look  forward  to  such  a gloomy  pros- 
pect in  my  cataract  work. 

& 

William  A.  Boyce,  M.  D.  (1210  Roosevelt  Build- 
ing, Los  Angeles). — I want  to  compliment  Doctor 
Mills  upon  his  excellent  paper.  I agree  with  him  that 
the  intracapsular  is  the  ideal  cataract  operation  and 
can  be  successfully  done  in  selected  cases  by  those 
who  are  doing  sufficient  work  to  have  mastered,  as 
he  expresses  it,  that  masterful  gentleness,  reached 
only  by  training. 

Someone  has  said  that  the  truly  great  surgeon  is 
the  one  who  knows  when  not  to  operate.  The  truly 
great  eye  surgeon  knows  when  not  to  attempt  an 


intracapsular  operation.  If  the  intracapsular  opera- 
tion is  determined  upon,  a method  should  be  selected 
that  will  insure  the  least  amount  of  traumatism  and 
possibility  of  vitreous  loss.  I do  not  believe  that  any 
pressure  should  ever  be  made  upon  the  eye  in  the 
intracapsular  operation.  In  my  opinion,  the  safest 
method  is  with  some  form  of  dull  capsule  forceps,  as 
advocated  by  Knapp.  If  the  zonule  breaks,  the  intra- 
capsular operation  is  done.  If  the  capsule  ruptures  an 
extracapsular  operation  is  done. 

I do  the  extracapsular  operation  except  in  selected 
cases,  because  I think  the  danger  is  less.  Using  a 
capsule  forceps,  taking  off  a large  bite  of  capsule  with 
a thorough  anterior  chamber  irrigation  and  keeping 
up  atropin  until  the  eye  is  white,  prevents  the  forma- 
tion of  an  after-cataract,  except  in  a small  percentage 
of  cases. 

I also  agree  with  Doctor  Mills,  regarding  the 
stitch.  I use  it  in  all  of  my  cases,  and  the  advantage, 
I find,  is  that  when  the  lens  is  delivered  the  suture 
can  be  pulled  taut  and  held  while  the  irrigation  and 
replacement  of  the  iris  is  done.  The  toilet  can  be 
made  with  more  deliberation,  and  elderly  patients  can 
be  gotten  out  of  bed  sooner. 

& 

Doctor  Mills  (Closing). — Doctor  O’Connor  mis- 
understands me  merely  for  the  joy  of  argument.  He 
knows  that  I have  no  quarrel  with  anybody  who 
closes  cataract  wounds  after  operation,  regardless  of 
the  form  of  intra-ocular  procedure.  My  campaign,  in 
and  out  of  the  United  States,  has  been  to  the  end 
that  eye  surgeons  should  recognize  that  eye  wounds 
differ  in  no  sense  from  other  wounds  save  that  their 
risk  of  postoperative  infection  is  greater  than  in  the 
usual  clean  surgical  wound,  and  that  the  mechanics 
of  ocular  muscle  action  tend  to  produce  gaping  in 
the  unprotected  wound.  I have  no  brief  for  any  par- 
ticular method  of  extraction  of  cataract  in  or  without 
its  capsule,  believing  that  there  are  several  excellent 
methods  of  meeting  the  indications  in  particular  cases 
and  that  many  surgeons,  including  myself,  are  using 
these  methods  in  safety. 

There  is  no  longer  any  justification  for  the  surgeon 
who  presents  a series  of  one  hundred  consecutive 
cataract  cases  performed  by  a single  method.  Some- 
where he  has  been  unjust  to  somebody  who  could 
have  been  served  better  by  other  means. 

The  irreducible  percentage  of  complications  which 
followed  the  combined  extraction  without  flap  or 
suture,  even  in  master  hands,  has  led  to  two  general 
protective  measures;  undetached  or  pocket  flaps  of 
conjunctiva  and  full  conjunctival  flaps,  partly  or 
wholly  sutured.  Doctor  O’Connor’s  own  excellent 
results  are  a tribute  to  the  former,  but  he  is  not  clear 
when  he  prefaces  the  statement  that  he  has  neither 
poor  healing  of  wounds  nor  other  complications  by 
the  sketch  of  a case  of  nonunion.  I have  not  had  a 
single  case  of  delayed  healing  or  reopening  of  the 
wound  in  over  five  hundred  cases  of  all  kinds,  includ- 
ing diabetes  and  glaucoma,  in  which  suture  was  used. 

“Stitch  abscess,”  as  seen  in  skin  wounds,  does  not 
occur  in  the  eyes,  probably  from  better  blood  supply 
and  the  cleansing  effect  of  drops  and  antiseptic  eye 
salves.  How  often  does  Doctor  O’Connor  get  “stitch 
abscess”  after  work  on  the  ocular  muscles? 

My  particular  quarrel  is  with  that  group  of  men 
who  still  make  a limbic  incision,  a breathless  irid- 
ectomy, capsulectomy  and  expression,  all  within  a 
minute,  and  who  leave  the  unprotected  wound  open 
to  those  savage  mercies  of  mischance  which  follow 
this  very  method  in  definite  and  irreducible  percent- 
ages. The  greatest  eye  surgeons  of  the  recent  past 
could  not  reduce  these  percentages  of  real  disaster 
and  too  frequent  blindness  below  definite  levels.  The 
average  eye  surgeon  who  has  made  present-day  prog- 
ress has  reduced  these  levels  almost  to  zero.  How, 
then,  do  these  others  dare  maintain  their  attitude  in 
the  face  of  the  widely  known  and  effective  measures 
which  positively  will  exclude  such  tragedies  from 
their  work,  and  continue  to  ascribe  their  failures  to 
imperfect  sterilization  of  instruments,  faulty  prepa- 
ration, and  similar  self-delusions! 


June,  1930 


1 1 VPERSENSITIVENESS — MATZGER 


409 


The  results  of  the  Knapp  operation  referred  to  by 
Doctor  O’Connor  are  incomprehensible  to  me,  for 
with  the  use  of  the  flap  and  suture,  wounds  do  not 
reopen,  expulsive  hemorrhage  and  detachment  of  the 
retina  are  practically  unknown,  and  iritis,  other  than 
that  due  to  lens  protein  reaction  and  the  rare  endoge- 
nous infection,  does  not  occur.  These  facts  will  be 
confirmed  by  every  man  who  sutures  his  wounds. 
Such  results  seem  inexcusably  bad,  as  they  are  due 
mainly  to  failure  to  close  the  incision  correctly.  Sev- 
eral years  ago  somebody  gave  an  involved  mathe- 
matical explanation  of  the  impossibility  of  delivering 
a lens  in  its  capsule  if  a conjunctival  flap  was  used. 
Barraquer’s  outstanding  work,  confirmed  by  many 
lesser  surgeons,  squarely  proved  the  absurdity  of  this 
theory.  If  operators  by  any  method  find  difficulty  in 
fashioning  their  flaps  at  the  time  of  incision,  they 
may  be  preformed  at  will.  My  personal  opinion  and 
practice  are  that  every  form  of  operative  work  inside 
the  eyeball  should  be  done  under  a flap  which  should 
be  fully  closed  by  suture  after  such  work.  About 
90  per  cent  of  my  cataract  work  is  done  with  capsul- 
ectomy,  expression,  and  irrigation  where  needed. 
About  two-thirds  of  these  cases  have  peripheral  irid- 
ectomies. A very  few  are  simple  extractions.  The 
balance  have  regular  iridectomies  which  I use  only 
where  there  are  mechanical  obstacles  to  delivery  such 
as  large  lenses  and  small  eyes.  The  rest  of  my  cata- 
ract work  is  intracapsular  in  several  forms.  Because 
of  the  use  of  flap  and  suture,  the  disasters  which  all 
cataract  operations  have  in  common  from  unclosed 
wounds  have  been  reduced  equally  in  this  form  of 
surgery. 


DISEASES  OF  HUMAN  HYPERSENSI- 
TIVENESS* 

THE  IMPORTANCE  OF  PROPER  DOSAGE  IN 
THEIR  SPECIFIC  TREATMENT 

By  Edward  Matzger,  M.  D. 

San  Francisco 

Discussion  by  George  Piness,  M.  D.,  Los  Angeles; 
Albert  H.  Rowe,  M.D.,  Oakland. 

HPHERE  were  two  deaths  in  California  during 
the  year  1928  which  were  attributed  sup- 
posedly to  the  “specific  treatment”  of  hay  fever. 
From  the  meager  case  reports  obtainable  such 
results  might  be  accounted  for  by  the  use  of 
extracts  that  were  far  too  concentrated  for  the 
treatment  of  these  undoubtedly  markedly  hyper- 
sensitive individuals. 

A better  understanding  of  some  of  the  funda- 
mental facts  will  serve  us  in  our  effort  to  avoid 
untoward  reactions.  Clinically  the  severity  of  re- 
actions seems  to  bear  an  almost  unbelievable  rela- 
tionship to  the  amount  of  excitant.  The  excitant 
may  be  present  in  minute  quantities,  yet  the  re- 
action to  it  in  hypersensitive  individuals  may 
manifest  itself  by  extremely  severe  symptoms.  It 
would  seem  as  though  the  excitant  acts  simply  as 
a trigger  in  setting  off  a reaction.  Keeping  this 
clinical  fact  in  mind,  we  must  proceed  with  ex- 
treme care  in  testing  as  well  as  treating  hyper- 
sensitive individuals. 

It  is  a fact  that  a large  dose  of  a specific  sub- 
stance in  a hay  fever  patient  may  produce  both 
urticaria  and  an  attack  of  the  disease.  While  this 
will  confirm  the  specificity  of  our  therapy,  it  is, 

* Read  before  the  General  Medicine  Section  of  the  Cali- 
fornia Medical  Association  at  the  Fifty-Eighth  Annual 
Session,  at  Coronado,  May  6-9,  1929. 


however,  attended  by  many  obvious  disadvan- 
tages. A still  larger  dose  in  the  same  individual 
may  lead  to  the  precipitation  of  this  patient’s  first 
attack  of  asthma.1 2 This  is  to  be  rigidly  guarded 
against  since  the  asthma  so  induced  may  persist. 

There  are  very  well-established  guides  at  our 
disposal,  the  observance  of  which  permits  one  to 
obviate  these  disagreeable  results  as  well  as  pro- 
cure data  for  outlining  a safe  ascending  dosage. 

The  enormous  amount  of  literature  sent  by 
commercial  houses,  in  the  hope  that  physicians 
will  buy  their  pollen  and  other  treatment  extracts, 
places  almost  its  entire  emphasis  on  a “specific 
diagnosis.”  There  is  a fine  disregard  of  dosage, 
yet  this  factor  alone  will  determine  the  difference 
between  successful  and  unsuccessful  treatment. 
Underdosage  of  a specific  agent  will  lead  to  in- 
complete results.  Overdosage,  on  the  other  hand, 
will  lead  to  an  aggravation  of  the  symptoms  we 
are  attempting  to  relieve  or  to  a very  severe  re- 
action and  very  rarely  a fatality. 

Since  it  is  the  principal  purpose  of  this  paper 
to  emphasize  the  importance  of  proper  dosage  in 
the  specific  treatment  of  the  diseases  of  human 
hypersensitiveness,  the  several  cardinal  points  that 
must  be  observed  in  order  to  arrive  at  a specific 
diagnosis  will  only  be  outlined. 

CARDINAL  POINTS  IN  DIAGNOSIS 

Assuming  a pollen  sensitive  patient  with  asthma 
to  be  skin-sensitive  to  mugwort  pollen,  brome 
grass  pollen,  and  black  walnut  pollen,  and  upon 
consulting  a chronology  chart  of  pollination  and 
finding  that  the  patient’s  symptoms  coincide  with 
the  mugwort  pollination  season  only,  one  deter- 
mines to  use  only  the  mugwort  pollen  extract  in 
treatment.  This  furnishes  a complete  clinical  pic- 
ture, skin  sensitiveness  coinciding  with  clinical 
exposure.  Only  those  positive  skin  tests  which 
check  directly  with  the  clinical  history  are  inter- 
preted as  important  and  the  other  positive  skin 
tests  are  considered  as  potential  possibilities  in 
causing  symptoms. 

TECHNIQUE 

The  ordinary  procedure  is  well  known  to  you. 
A set  of  skin-test  extracts  is  used  for  diagnosis 
and  the  extract  giving  the  most  strongly  positive 
reactions  is  usually  purchased.  This  treatment 
extract  is  as  a rule  different  in  its  activity  from 
the  diagnostic  extract.  It  may  have  been  made 
from  a different  gathering  of  material,  kept  under 
more  favorable  conditions,  or  prepared  in  differ- 
ent concentration.  It  is,  therefore,  essential  that 
the  patient  be  retested  with  the  solution  to  be  used 
for  active  immunization. 

It  has  been  observed  that  general  reactions 
occur  from  tests.  These  are  more  frequent  after 
using  the  intradermal  method  than  when  the 
scratch  method  is  used  because  the  reaction  from 
the  intradermal  test  is  far  more  intense  than  from 
the  scratch  test.  This  apparent  objection  becomes 
an  advantage  upon  realizing  that  the  very  inten- 
siveness of  the  intradermal  method  reduces  the 
number  of  previously  considered  insensitive  indi- 
viduals. The  danger  of  general  reactions  can  be 
avoided  by  testing  with  more  dilute  solutions. 


410 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


This  dilution  can  be  extended  to  1-10,  1-100  and 
1-1000  with  normal  salt  solution.  A test  can  be 
made  with  the  weakest  of  these  dilutions,  and  if 
negative,  the  next  stronger  dilution  can  be  used 
after  a few  minutes. 

The  response  to  varying  dilutions  gives  the  key 
to  the  individual  degree  of  sensitiveness  of  the 
patient.  Dr.  R.  A.  Cooke  3 clearly  emphasizes  this 
important  advantage  in  his  use  of  the  intradermal 
method.  Dr.  I.  Chandler  Walker  4 makes  use  of 
this  same  principle  in  adapting  it  to  the  scratch 
technique. 

KEY  TO  PROPER  DOSAGE 

This  evaluation  of  the  patient’s  individual  de- 
gree of  sensitiveness  furnishes  the  key  to  proper 
dosage.  It  is  generally  agreed  that  the  initial 
therapeutic  dose  should  be  one-tenth  of  a cubic 
centimeter  of  the  specific  agent  of  the  dilution 
giving  a minimum  skin  reaction.  This  dose  is  to 
be  increased,  not  according  to  a printed  schedule 
outline,  but  in  the  amount  that  each  individual 
patient  can  tolerate.  It  is  important  that  the  treat- 
ment injections  be  given  just  under  the  skin  so 
that  the  injected  solution  raise  a lump.  This  pre- 
caution has  at  least  two  distinct  advantages : first, 
the  avoidance  of  puncturing  a venule,  whereby  the 
extract  would  be  given  intravenously ; second, 
the  reaction  to  the  extract  is  directly  under 
inspection. 

A violent  reaction  can  be  combated  by  the  ap- 
plication of  a tourniquet  about  the  arm  above  the 
site  of  injection  and  by  the  administration  of 
liberal  doses  of  epinephrin  above  and  below  the 
tourniquet.  The  use  of  strophanthin,  intrave- 
nously, is  sometimes  indicated.  So  much  for  the 
safety  factor  in  avoiding  severe  reactions  with 
the  first  injection,  but  there  are  other  dangers. 

When  the  next  higher  concentration  of  the 
treatment  extract  is  used,  dilutions  should  be 
made  and  skin-testing  done  to  confirm  the  con- 
centration as  indicated  by  the  label.  Dilutions  for 
this  confirmatory  test  may  be  made  in  the  hypo- 
dermic barrel.  As  the  maximum  dose  is  ap- 
proached the  dangers  of  violent  reactions  again 
occur.  These  reactions  may  be  guarded  against 
if  the  following  general  fact  is  kept  in  mind. 
Before  maximum  doses  are  reached,  therapeutic 
benefits  are  already  obvious  for  specificity  in 
treatment  is  uniformly  characterized  by  the  strik- 
ing fact  that  if  an  agent  be  truly  specific,  whether 
pollen  extract,  dander  extract,  or  bacterial  vac- 
cine, a beneficial  influence  will  be  experienced  by 
the  patient  immediately.  These  effects  are  always 
temporary  and,  therefore,  repeated  doses  are 
necessary.  Should  benefit  not  become  objectively 
evident  in  the  course  of  a few  weeks,  one  sus- 
pects that  the  agent  used  is  not  the  proper  one 
and  further  increase  of  dosage  is  both  futile  and 
dangerous. 

There  is,  unfortunately  no  satisfactory  method 
of  standardizing  the  active  principle  nor  is  it  even 
known  definitely  what  the  specific  agents  are. 
We  must  therefore  view  very  guardedly  all  con- 
venient arbitrary  standards,  such  as  pollen  units, 


dilutions,  nitrogen  content,  remembering  that  the 
patient’s  individual  reaction  must  be  the  only 
indicator. 

GUIDE  TO  DOSAGE 

The  answers  to  two  very  simple  questions  serve 
as  guides : “JTow  do  you  feel  ?”  This  will  be  an- 
swered : “Worse,”  “Same,”  or  “Feeling  great.” 
Hypersensitive  people  know  no  happy  mediums. 
This  question  is  to  be  followed  by,  “Was  your 
arm  sore?”  If  the  answer  to  this  question  be 
“Yes,”  then  an  inquiry  is  made  as  to  the  duration 
of  the  soreness. 

If  the  patient  has  a sore  arm  and  is  feeling 
worse,  it  is  to  be  interpreted  as  the  sequelae  of 
overdosage.  Do  not  then  increase  the  next  dose. 
If  the  arm  is  sore  and  the  patient  is  unimproved, 
repeat  the  dose.  If  the  patient  has  a sore  arm 
and  is  “feeling  good,”  the  chances  are  that  this 
patient’s  optimum  dose  has  been  reached.  As  the 
patient  becomes  symptom  free  the  interval  be- 
tween treatments  rather  than  the  dose  is  in- 
creased. If,  at  any  time,  increase  in  dosage  leads 
to  a return  of  symptoms,  drop  back  to  the  pre- 
ceding dose  to  obtain  the  maximum  results. 
Should  the  patient  tell  you  that  his  arm  is  not 
sore  and  that  he  feels  worse,  he  undoubtedly  is 
underdosed.  Increase  then  the  next  dose  and 
increase  the  frequency  of  the  treatments.  Con- 
tributing factors  to  failure  are,  constant  nasal 
pathology  or  food  sensitiveness. 

It  is  apparent  that  proper  dosage  can  usually 
be  determined  when  a single  antigen  is  used 
though  this  problem  becomes  more  complicated 
as  attempts  are  made  to  relieve  multiple  sensitive- 
ness. Each  antigen  to  be  used  must  be  separately 
tested  for  and  individually  dosed. 

CONCLUSIONS 

The  specific  treatment  of  human  hypersensi- 
tiveness results  in  spectacular  relief  when  the  cor- 
rect diagnosis  is  attained  and  the  correct  dosage 
used. 

Since  antigens  are  potent  for  good  when  used 
properly,  it  must  be  thoroughly  understood  they 
are  likewise  potent  to  do  harm  when  used  im- 
properly. It  is  necessary  for  one  who  uses  these 
specific  agents  to  realize  their  activity  and  danger. 

909  Hyde  Street. 

REFERENCES 

1.  Sampson,  J.  W. : Asthma,  Med.  Klin.  Woch. 
Berlin,  April  1927. 

2.  Piness,  George;  and  Miller,  Hyman:  Allergy  and 
Its  Relation  to  the  Otolaryngologist,  California  and 
West.  Med.,  August  1925. 

3.  Cooke,  R.  A.:  Diseases  of  Allergy,  page  476, 
Textbook  of  Medicine,  Cecil,  W.  B.  Saunders,  1928. 

4.  Walker,  I.  C.:  Frequent  Causes  and  the  Treat- 
ment of  Seasonal  Hay  Fever,  Arch.  Int.  Med.,  Vol. 
xxviii,  p.  71,  1921. 

DISCUSSION 

George  Piness,  M.  D.  (1136  West  Sixth  Street,  Los 
Angeles). — Doctor  Matzger’s  paper  is  a very  timely 
one  and  should  be  of  particular  interest  at  this  time 
when  hay  fever  is  so  prevalent,  and  especially  to  the 
general  practitioner  who  may  occasionally  treat  hay 
fever.  It  is  true  that  several  deaths  have  been  attrib- 
uted to  overdosage  of  pollen  antigen,  but  I do  not 
think  that  we  should  become  unduly  alarmed  because 
reports  of  such  reactions  are  rare,  and,  as  suggested  by 


June,  1930 


MELOTHERAPY — CODELLAS 


411 


Doctor  Matzger,  if  one  will  be  careful  in  determining 
the  initial  dose  when  treatment  is  commenced  these 
may  be  avoided.  Also  if  one  is  acquainted  with  the 
reactions  that  may  occur  from  treatment  with  pollen 
antigen  he  can  usually  combat  them  very  readily  with 
the  administration  of  adrenalin  chlorid  in  doses  0.5  cubic 
centimeters  to  1 cubic  centimeter.  It  has  never  been 
necessary  in  our  own  practice  to  use  strophanthin.  An- 
other point  is  that  these  reactions  of  a serious  nature 
may  be  avoided  by  insisting  that  the  patient  remain  in 
the  office  for  at  least  twenty  minutes  after  the  injection 
of  the  pollen  antigen.  Should  any  reactions  occur  of 
a severe  nature  they  will  occur  within  that  period  of 
time  and,  as  mentioned  above,  can  be  combated  by 
the  means  suggested.  The  commonest  reactions  that 
occur  following  the  treatment  of  hay  fever  with 
pollen  antigen  are  those  of  a marked  redness  and  swell- 
ing about  the  site  of  injection,  or  hay  fever,  or  urti- 
caria immediately  following  the  injection.  These  re- 
actions may  occur  despite  any  attempt  made  to  deter- 
mine dosage.  They  may  occur  early  in  the  course  of 
treatment,  or  late  when  high  concentration  of  antigen 
is  used,  but  in  our  own  experience  we  have  found 
that  reactions  do  not  cause  any  harmful  effect  other 
than  the  discomfort  and  symptoms,  such  as  hay  fever, 
urticaria  or  asthma,  that  may  result  from  them.  They 
are  only  temporary,  and  we  have  found  in  a large 
number  of  cases  studied  that  usually  reactions  such 
as  these  go  hand  in  hand  with  good  results. 

The  procedure  suggested  by  Doctor  Matzger  for 
determining  initial  dosage  in  treatment  of  hay  fever 
is  not  a new  one,  and  has  been  described — as  stated 
by  him — by  Cooke  and  Walker,  but  insofar  as  we 
know  at  the  present  time  there  is  no  other  method 
by  which  quantitative  test  of  the  patient’s  sensitivity 
can  be  made,  and  therefore  it  is  suggested  that  all 
who  are  treating  hay  fever  with  pollen  antigen  employ 
this  method,  as  it  is  the  best  we  have  at  hand  at  this 
time. 

In  regard  to  the  treatment  of  patients  who  give 
reactions:  It  is  advisable,  as  suggested  by  Doctor 
Matzger,  and  others,  that  the  dose  be  repeated  at  the 
following  visit  instead  of  increasing  the  same  because 
of  the  possibility  of  severe  constitutional  reactions 
that  might  ensue  following  an  increase  in  the  dose 
of  pollen  antigen.  One  should  not  hesitate  to  repeat 
this  dose  as  many  times  as  the  patient  has  reactions; 
in  fact  the  patient  will  appreciate  your  doing  so. 
However,  if  the  period  between  the  anticipated  sea- 
sons is  short  in  view  of  the  number  of  treatments 
planned  for  the  patient,  increase  the  frequency  of 
treatment  so  that  the  course  may  be  completed  by 
the  time  the  season  begins. 

* 

Albert  H.  Rowe,  M.  D.  (242  Moss  Avenue,  Oak- 
land).— Doctor  Matzger’s  emphasis  on  the  necessity 
of  a thorough  understanding  of  pollen  dosage  by  all 
physicians  who  assume  the  responsibility  of  pollen 
therapy  is  most  important.  To  obtain  results  strong 
extracts  must  be  used,  but  the  doses  of  these  extracts 
should  be  adjusted  to  the  sensitiveness  of  each  patient 
to  the  specific  antigen.  A printed  schedule,  such  as 
is  furnished  by  commercial  houses,  cannot  be  blindly 
followed.  The  initial  dose  must  be  determined  by  a 
skin-testing,  as  outlined  by  Doctor  Matzger.  I have 
found  that  .025  or  .05  cubic  centimeters  of  the  dilu- 
tion, which  just  fails  to  give  a three-hour  reaction  by 
the  scratch  method,  is  safe  in  the  average  patient. 
Certain  very  sensitive  patients  demand  a solution  of 
1 to  25,000  or  even  1 to  100,000.  As  the  treatment 
progresses,  the  dose  must  be  determined  entirely  by 
the  patient’s  local  reaction.  Doses  must  be  repeated 
if  the  reaction  is  larger  than  three  or  four  inches  and 
constitutional  reactions  must  be  guarded  against  with 
care.  Patients  who  are  sensitive  should  be  told  about 
such  constitutional  reactions  and  instructed  to  return 
to  the  office  immediately  if  any  general  itching, 


coughing,  or  the  slightest  asthma  occurs.  Fresh  ad- 
renalin 1 to  1000  must  be  at  hand  and  liberal  doses 
must  be  given  every  five  to  fifteen  minutes  if  general 
reaction  develop. 

There  is  no  therapeutic  measure  which  requires 
more  care  than  pollen  therapy.  It  is  safe,  as  evi- 
denced by  the  extensive  use  of  it  by  specialists  for 
several  years.  It  is  an  agent  for  the  greatest  good 
if  used  correctly,  but  if  used  without  due  care  and 
experience  severe  and  even  fatal  results  may  occur. 
I have  not  found  the  necessity  of  strophanthin  in  any 
general  reaction.  Those  which  have  occurred  in  my 
practice  have  been  rapidly  controlled  by  adrenalin  be- 
cause the  patients  are  all  instructed  about  returning 
to  the  office. 

Physicians  who  wish  to  use  pollen  therapy  should 
do  so  because  of  the  tremendous  relief  given,  but  their 
understanding  of  proper  dosage  is  absolutely  neces- 
sary if  the  patient  is  to  be  given  the  result  he  deserves 
and  is  to  be  protected  against  serious  reactions. 

* 

Doctor  Matzger  (Closing). — I thank  Doctor  Rowe 
for  further  emphasizing  the  necessity  of  individually 
dosing  each  patient’s  treatment.  As  Doctor  Piness 
indicated,  Doctor  Cooke  and  Doctor  Walker’s  tech- 
nique of  determining  individual  sensitiveness  should 
be  thoroughly  understood  and  borne  in  mind  by  all 
doctors  attempting  to  treat  diseases  of  human  hyper- 
sensitiveness. 

We  can  look  forward  to  the  future  with  the  hope 
that  biological  standardization  of  pollen  extract  ac- 
tivity may  be  determined  which  would  enable  one  accu- 
rately to  determine  the  proper  dosage. 


THE  LURE  OF  MEDICAL  HISTORY 


THE  EVOLUTION  OF  MELOTHERAPY 

MUSIC  IN  THE  CURE  OF  DISEASE 

By  Pan.  S.  Codellas,  M.  D. 

San  Francisco 

THE  term  “melotherapy,”  I believe,  was  coined 
by  Dr.  Mousson  Launage  in  1924  to  signify 
the  effect  of  music  on  the  progress  or  cure  of 
disease.  The  word  is  not  found  in  the  general 
or  medical  dictionaries.  It  may  be  accepted  as 
a perfect  etymological  creation  to  the  content  even 
of  the  ultragrammarian. 

It  is  derived  from  melos,  of  the  same  root  as 
melody,  and  of  therapy.  Melos,  according  to 
Plato,  was  composed  of  three  parts : of  words, 
harmony,  and  rhythm  (Rep.  368D)  ; also  it  means 
the  music  to  which  a song  is  set,  an  air,  melody, 
melas : tune.  Therapeia,  as  defined  by  Liddell  and 
Scott,  denotes  service  done  to  the  sick,  tending ; 
remedy,  cure.  Therefore,  we  may  say,  melo- 
therapy means  the  treatment  of  disease  by  music 
as  a therapeutic  agent.  A new  term  for  an  old 
therapy. 

Sound  is  the  principal  medium  by  which  most 
of  the  higher  animals  both  express  and  excite 
emotion;  it  is  used  as  a warning  to  effect  self- 
preservation,  precedes  language,  and  is  an  instant, 
instinctive,  prehuman  phenomenon. 

Darwin  sufficiently  studied  the  biological  basis 
of  tone  and  established  that  the  strong  appeal  of 
sound  to  emotions  is  founded  in  the  life  history 
of  the  higher  animals. 


412 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


With  such  intimately  interwoven  existence  and 
deeply  rooted  origin  of  the  significance  of  sound 
and  life,  the  genesis  and  growth  of  both  music 
and  medicine  and  their  association  is  lost  in  the 
adumbrated  past,  wherein  only  a single  but 
bright  beam  of  crystallized  tradition  has  survived 
and  passed  on  summated  in  Orpheus. 

MUSIC  AND  MEDICINE  IN  MYTHOLOGY 

The  Greeks  ascribed  the  invention  of  the  lyre 
to  their  Hermes.  The  latter  after  inventing  the 
lyre  gave  it  to  Apollo,  and  received  from  him  in 
exchange  the  “golden  three-leaf  rod,”  the  giver 
of  wealth  and  riches,  the  Caduceus. 

The  relation  of  music  and  medicine  is  not  new. 
Apollo  is  god  of  both.  We  may  consider  them 
as  sister  arts.  Apollo  was  the  father  and  the 
leader  of  the  Muses,  hence  called  Musagetes. 
Apollo  in  Homer  is  the  god  of  archery,  prophecy, 
and  music ; to  his  arrows  were  ascribed  all  sudden 
deaths.  By  his  shafts,  Apollo  was  the  god  of 
pestilence,  which  he  removed  when  duly  propi- 
tiated. He  is  named  in  mythology  as  the  father 
of  Aesculapius,  god  of  healing.  Cheiron,  the 
centaur,  was  the  teacher  of  Aesculapius  in  medi- 
cine. With  music,  Aesculapius  procured  sleep, 
relieved  pain,  and  to  the  tune  of  epodes  com- 
pounded medicines.  Machaon  and  Podalirius, 
sons  of  Aesculapius,  and  the  other  hero-physicians 
of  the  times  and  later  ages,  applied  medicines  and 
prepared  the  same  while  reciting  and  singing 
certain  formulae. 

Orpheus  is  presented  to  us  as  a poet,  a rhapso- 
dos,  priest,  theologian,  magician,  physician,  apostle 
of  civilization,  prophet,  philosopher  and  benefac- 
tor of  humanity.  Traditions  relating  to  him  are 
very  obscure.  His  native  country  was  Thrace ; 
here  we  see  the  Thracian  civilization  and  culture 
descending  southerly  toward  Greece.  His  time 
is  placed  not  long  before  the  Trojan  War,  or  at 
the  period  of  the  Argonaut  expedition : twelve  to 
thirteen  centuries  B.  C.  He  is  the  son  of  Apollo. 
He  was  one  of  the  Argonauts ; the  enchanting 
tones  of  his  lyre  moved  the  Argo  smoothly  into 
the  water.  His  skill  to  strike  that  instrument 
was  fabled  and  many  legends  have  been  created 
around  it. 

It  is  said  to  have  been  such  as  to  move  the  very 
trees  and  rocks,  and  the  beasts  of  the  forest  as- 
sembled round  him  as  he  touched  its  chords,  and 
to  so  charm  the  Infernal  Powers  as  to  stay  their 
immutable  functions  and  torments. 

He  had  for  his  wife  a nymph  named  Eurydice, 
who  died  from  the  bite  of  a serpent.  Disconso- 
late at  the  death  of  his  wife,  he  determined  to 
descend  to  the  Lower  World  and  endeavor  to 
mollify  its  rulers  and  obtain  permission  for  his 
beloved  Eurydice  to  return  to  the  Region  of  the 
Light.  Armed  only  with  his  “golden  shell,”  he 
gained  admission  to  the  palace  of  Pluto.  This 
myth  has  been  the  subject  of  many  poems,  those 
of  Virgil  and  Ovid  giving  the  most  graphic  con- 
ception. As  Orpheus  pleaded  his  case  and  touched 


the  strings  to  his  words,  the  bloodless  spirits 
wept.  Tantalus  did  no  longer  try  to  catch  at  the 
retreating  water,  and  the  wheel  of  Ixion  stood 
still,  as  though  in  amazement ; the  vultures  did 
not  tear  the  liver  and  entrails  of  Tityus;  and  the 
granddaughters  of  Belus  paused  at  their  urns ; 
Sisyphus  did  seat  himself  on  the  stone  instead  of 
rolling  it.  All  the  shades  at  endless  tasks  had  a 
rest  and  relief.  The  story  is,  that  then,  for  the 
first  time  the  cheeks  of  the  Eumenides,  overcome 
by  his  music,  were  wet  with  tears ; nor  could  the 
royal  consort,  nor  he  who  rules  the  Infernal  Re- 
gions endure  to  deny  him  his  request.  Pluto  and 
Proserpina  granted  the  request,  and  called  for 
Eurydice.  She  was  among  the  shades  newly 
arrived,  and  she  advanced  with  a slow  pace  by 
reason  of  her  wound.* 

Amphion,  a Theban  prince,  it  is  said,  built  the 
walls  of  Thebes,  causing  the  stones  to  take  their 
respective  places  in  obedience  to  the  tones  of  his 
golden  lyre. 

Achilles,  to  relax  his  anger,  picks  up  his  lyre 
and  plays  upon  it. 

Ulysseus,  wounded  in  Parnassus  by  the  wild 
boar,  with  music  stopped  the  bleeding,  pain  and 
sufferance,  and  obtained  a quick  and  perfect  heal- 
ing with  a very  small  scar. 

MUSIC  IN  HISTORY 

Pythagoras  regards  music  as  an  admirable 
remedy  for  body  and  mental  ailments. 

Democritus  states  that  “in  many  diseases  the 
sounds  of  flute  have  been  a sovereign  remedy.” 

Aulus  Gellus  relates : “It  is  a belief  widely 
scattered  that  a man  afflicted  with  an  attack  of 
sciatica  feels  the  intensity  of  his  illness  sensibly 
diminish  if  anyone  playing  close  to  him  elicits 
soft  and  melodious  sounds  from  a flute.” 

Celsus  recommends  flutes,  cymbals,  trumpets, 
and  other  noisy  instruments  for  the  demented. 

Theophrastus  cured  a snake  bite  using  music. 

According  to  the  iatrohistorian  Hecker,  the 
effect  of  music  as  a healing  agent  on  the  dancing 
mania  of  the  Middle  Ages  was  very  efficacious. 
The  governments  of  the  afflicted  countries  learned 
that  music  was  a specific  remedy  in  these  epi- 
demics and  actually  hired  musicians  to  play 
before  the  populace  in  order  to  dispel  the  attacks. 

Spencer,  Diderot,  Rabelais,  and  the  late  Sir 
Frederick  Mott,  all  acknowledged  the  force  and 
therapeutic  value  of  music. 

Music,  with  the  present-day  means  of  broad- 
casting, reappears  in  her  old  association  with 
medicine,  serving  as  a useful  auxiliary  at  the  bed- 
side of  the  sick,  convalescent,  and  rehabilitating. 

Dr.  Robert  Schauffler,  American,  has  suggested 
a veritable  musical  pharmacopeia. 

240  Stockton  Street. 


* Ovid,  x,  1-147.  Adapted  from  the  translation  of  H.  T. 
Riley. 


June,  1930 


CASE  REPORTS 


413 


CLINICAL  NOTES  AND  CASE 
REPORTS 


RECTOVAGINAL  FISTULA  IN  INFANCY 

REPORT  OF  CASE 

By  Lloyd  A.  Clary,  M.  D. 

San  Francisco 

ID  ECTOVAGINAL  fistula  is  sufficiently  rare 
in  infancy  that  a case  of  this  kind  is  of  in- 
terest, especially  when  the  cause  seems  apparent. 
Its  rarity  is  evidenced  by  the  fact  that  a care- 
ful search  of  recent  medical  literature  fails  to 
disclose  any  reference  to  rectovaginal  fistula  in 
infancy.  Standard  textbooks  on  proctology,  pedi- 
atrics, and  gynecology  either  do  not  mention  this 
condition  at  all  or  pass  it  over  with  the  explana- 
tion that  it  is  congenital. 

REPORT  OF  CASE 

On  July  11,  1929,  a Chinese  baby,  eight  months  old, 
was  referred  to  me  for  examination.  The  mother  gave 
a history  of  difficult  defecation,  pain  and  bleeding 
occurring  with  each  bowel  movement  since  the  baby 
was  one  month  old.  She  was  quite  emphatic  and 
seemingly  very  sure  of  herself  as  to  this  point,  stat- 
ing that  during  the  first  month  her  baby  had  no  pain 
or  bleeding  from  the  rectum.  The  only  concurrent 
trouble  was  a skin  rash  on  the  buttocks  which  she 
said  a visiting  health  nurse  attributed  to  improper 
care  of  the  diapers — a very  logical  and  likely  explana- 
tion. She  had  used  various  ointments  and  medicines 
the  exact  nature  of  which  I was  unable  to  learn.  The 
baby  was  fretful,  slept  poorly,  seemed  to  have  ex- 
treme pain  with  each  bowel  movement  (three  or  four 
daily),  and  was  not  gaining  in  weight.  The  weight 
at  this  time  was  fourteen  pounds  six  ounces. 

Examination  in  the  office  obviously  was  very  diffi- 
cult. There  was  a swollen  area,  hard  to  the  touch,  on 
the  perineum.  A small  reddened  area  was  visible  in 
the  posterior  commissure  of  the  vulva.  The  anal 
canal,  of  course,  was  narrow  but  I was  able  to  insert 
my  little  finger  into  the  rectum,  where  a mass  of 
hardened  feces  was  felt.  Likewise  the  swelling  of 
perineal  area  was  quite  apparent  to  the  touch  and  a 
number  of  enlarged  anal  papillae  were  palpable.  I 
was  quite  sure  that  a rectovaginal  fistula  was  present 
but  did  not  wish  to  base  my  opinion  on  one  exami- 
nation, so  instructed  the  mother  to  irrigate  the  rectum 
through  a catheter  daily  and  to  return  in  a few  days 
for  further  examination.  Wassermann  was  ordered 
and  proved  negative. 

The  second  examination  convinced  me  that  my 
diagnosis  was  correct.  However,  I could  not  use  an 
anoscope  without  undue  roughness  and  was  unable 
to  find  either  the  anal  or  vaginal  opening  of  the 
fistula,  though  the  reddened  area  posteriorly  just 
within  the  vagina  seemed  undoubtedly  one  point  of 
opening.  I then  advised  examination  under  anesthetic 
in  the  hospital,  with  the  proviso  that  I would  operate 
at  that  time  if  I found  definite  indication  for  operation. 

Operation. — July  19,  1929,  at  Saint  Francis  Hospital, 
San  Francisco.  Anesthetic  used  was  ether.  Patient 
was  placed  in  the  lithotomy  position,  a nurse  support- 
ing the  legs.  On  inserting  a Hirschman  anoscope  the 
anal  opening  was  apparent  at  once,  located  between 
two  enlarged  papillae  in  a torn-down  crypt  of  Mor- 
gagni in  the  midline  anteriorly.  It  was  easy  to  enter 
this  opening  with  an  ordinary  crypt  hook.  Through 
this  opening  a small  probe  was  inserted  and  the  tract 
followed  to  the  opening  just  within  the  posterior 
vaginal  commissure.  The  probe  was  bent  upon  itself 
and  anchored  out  of  the  way  so  that  the  enlarged 
anal  papillae  could  be  dealt  with  first. 

There  were  five  of  these  papillae,  each  enormously 
enlarged  as  compared  to  the  size  of  the  baby.  They 


would  have  been  large  even  in  an  adult.  All  five  were 
excised.  . 

The  entire  fistulous  tract  then  was  excised  and  the 
perineum  repaired  in  layers.  This  was  nerve-trying 
work,  owing  to  the  extreme  delicacy  of  these  baby 
tissues.  A very  small,  curved  eye  needle  was  used 
and  the  finest  of  plain  catgut.  I used  catgut  through- 
out because  I anticipated  discomfort  on  the  part  of 
the  patient,  with  consequent  crying  and  struggling 
as  well  as  difficulty  in  removal  of  sutures,  should  I 
use  a nonabsorbable  material  such  as  silkworm  gut. 
I now  believe  this  was  an  error,  for  the  tension 
sutures  and  part  of  the  skin  sutures  gave  way  too 
soon,  with  some  separation  of  the  external  layer.  I 
would  use  silkworm  gut  for  skin  and  tension  sutures 
just  as  in  the  adult,  should  I repeat  this  operation, 
even  at  the  expense  of  certain  difficulty  for  a few  days. 

However,  the  parts  healed  rapidly  and  result  was 
good.  There  was  no  pain  at  all  with  bowel  move- 
ments after  the  third  postoperative  day.  The  patient 
left  the  hospital  on  the  eleventh  day  and  could  have 
left  days  sooner,  but  was  kept  there  to  allow  a proper 
diet  to  be  established.  The  baby  had  received  only 
unmodified  milk  and  water  prior  to  entry  to  hospital. 
There  cereals  were  added  and  the  mother  instructed 
as  to  proper  feeding. 

Two  days  after  entering  the  hospital,  July  21,  1929, 
the  weight  was  fourteen  pounds  six  ounces.  Nine  days 
later  the  baby  had  gained  one  pound  three  ounces. 

Examination  at  the  office  August  2,  1929,  showed 
the  parts  entirely  healed,  anal  canal  not  tender  on 
insertion  of  finger,  and  perineum  firm.  The  mother 
reported  there  was  no  pain  or  bleeding  with  bowel 
movements,  and  the  baby  looked  well  and  happy.  By 
September  13,  1929,  the  weight  had  increased  to 
eighteen  pounds. 

This  case  is  especially  interesting  from  the  fact 
that  the  cause  of  the  fistula  was  quite  apparent, 
namely,  the  breaking  down  of  an  anal  crypt  an- 
teriorly— most  likely  following  passage  of  hard 
fecal  matter — thus  starting  a fistulous  tract  which 
eventually  opened  in  the  vagina.  Evidently  it  was 
not  congenital. 

Pain  at  defecation  may  have  been  due  to  two 
causes : 

Firstly:  Pain  produced  by  passage  of  feces 
over  the  fissured  area  in  the  anal  canal. 

Secondly : Sphincter  spasm  induced  by  irrita- 
tion of  the  enlarged  papillae.  This  latter  condi- 
tion, with  consequent  hypertrophy  of  the  sphinc- 
ter and  subsequent  tightening  of  the  anal  canal, 
is  seen  frequently  in  the  adult  and  is  the  cause 
of  a form  of  constipation  (or  more  properly 
obstipation)  that  is  very  common. 

909  Hyde  Street. 


Eleven  Colleges  Require  Internship  for  Degree. — 
Eleven  medical  colleges  have  adopted  the  requirement 
of  a fifth  year  to  be  spent  by  the  student  as  an  intern 
in  an  approved  hospital  or  in  other  acceptable  clinical 
work  before  the  M.  D.  degree  will  be  granted.  These 
colleges  and  the  years  when  the  requirement  became 
effective  for  matriculants  and  graduates  are  as  follows: 

Affects  Affects 

Matricu-  Gradu- 
lants  ates 

University  of  Minnesota  Medical  School..  1910-11  1915 

Stanford  University  School  of  Medicine....  1914-15  1919 

Rush  Medical  College  (University  of 

Chicago)  . 1914-15  1919 

University  of  California  Medical  School..  1914-15  1919 

Marquette  University  School  of  Medicine  1915-16  1920 

Northwestern  University  Medical  School  1915-16  1920 

University  of  Illinois  College  of  Medicine  1917-18  1922 

Loyola  University  School  of  Medicine 1917-18  1922 

Detroit  College  of  Medicine  and  Surgery  1919-20  1924 

University  of  Cincinnati  College  of  Medi- 
cine   1922-23  1926 

College  of  Medical  Evangelists 1922-23  1927 

— The  Diplomate,  May  1930. 


BEDSIDE  MEDICINE  FOR  BEDSIDE  DOCTORS 

An  open  forum  for  brief  discussions  of  the  workaday  problems  of  the  bedside  doctor.  Suggestions  for  subjects 

for  discussion  invited. 

THE  TREATMENT  OF  JUVENILE 
TUBERCULOSIS 

Lloyd  B.  Dickey,  San  Francisco. — The 
amount  of  infection  and  the  degree  of  immunity 
and  resistance  are  primary  factors  determining 
the  outcome  of  tuberculous  infection  in  children. 
We  have  several  aids  in  our  treatment  of  such 
cases,  the  rationale  of  which  is  based  on  an 
endeavor  to  influence  these  primary  factors. 
Three  items  are  of  importance,  the  removal  of 
the  patient  from  all  contact  with  open  tubercu- 
losis, the  application  of  heliotherapy,  and  the  gen- 
eral hygienic  treatment.  The  first  mentioned  is 
by  far  the  most  important,  as  a large  percentage 
of  tuberculous  infants  and  children  will  recover 
with  no  other  change  in  their  environment,  even 
though  in  some  the  infection  may  be  rather  heavy. 
Heliotherapy  may  be  a two-edged  sword,  and 
cases  for  this  type  of  treatment  should  be  care- 
fully selected,  and  the  treatment  begun  and  con- 
tinued with  great  caution.  Cases  of  hilar  node  in- 
fection and  cases  of  surgical  tuberculosis  respond 
well,  the  exudative  types  rather  poorly  in  compari- 
son. Under  the  general  hygienic  treatment  should 
be  included  the  proper  amount  of  rest;  the  proper 
diet,  which,  because  of  the  growth  factor,  is  more 
important  in  children  than  in  adults ; the  correc- 
tion of  any  faulty  habits  and  the  establishment  of 
a regular  regime  of  existence ; the  proper  treat- 
ment of  any  nontuberculous  disease  that  may  be 
present.  In  the  surgical  cases  it  should  be  remem- 
bered that  bones,  joints,  and  lymph  nodes  are 
usually  only  local  manifestations  of  a more  or 
less  generalized  disease,  and  that  these  children, 
in  addition  to  any  surgical  measures  instituted, 
should  have  the  accepted  treatment  of  juvenile 
tuberculosis.  The  statement  that  time  is  not  a 
factor  to  be  considered  in  treating  children  is  an 
argument  often  advanced  against  surgical  proced- 
ures on  tuberculous  children.  I believe  that  any 
surgical  procedure  that  really  hastens  the  recov- 
ery from  active  tuberculous  disease  is  justified. 
The  longer  the  disease  is  active  the  more  apt  are 
other  tuberculous  foci  to  appear,  the  more  apt  are 
the  cases  to  end  in  meningitis,  miliary  tuberculo- 
sis, or  in  amyloid  disease. 

In  the  last  three  years  we  have  had  the  oppor- 
unity  to  watch  the  results  of  treatment  of  seventy- 
one  patients  in  a municipal  ward  for  tuberculous 
children,  where  the  treatment  has  been  similar  to 
that  which  has  just  been  outlined.  Thirty-four 
of  these  seventy-one  children  had  uncomplicated 
hilum  node  tuberculosis,  and  the  others  had  vari- 
ous additional  foci.  There  have  been  six  deaths, 
four  from  meningitis,  and  two  from  amyloid  dis- 
ease. Two  of  these  had  the  meningitis  when 
admitted  to  the  ward,  and  in  the  two  cases  of 


amyloid  disease,  the  condition  was  present  on 
admittance.  One  child  with  a tuberculous  peri- 
carditis developed  the  meningitis  later,  and  the 
other  after  going  home  against  advice.  In  two 
children  the  prognosis  is  still  doubtful.  Sixty- 
three  of  the  total  of  seventy-one  children,  or 
89  per  cent,  are  well,  and  thirty-nine  of  these 
have  been  dismissed  from  the  ward  as  being  no 
longer  actively  tuberculous. 

* * * 

Clifford  Sweet,  Oakland.— In  all  human 
affairs  the  pendulum  of  thought  or  opinion 
swings  too  far,  first  in  one  direction  and  then  in 
the  other.  A few  years  ago  we  were  ready  to  label 
as  tuberculous  any  reaction  to  infection  which 
caused  a prolonged  low  grade  fever,  especially 
if  the  additional  symptom  of  fatigue  and  sign  of 
weight  loss  were  also  present.  Then,  upon  find- 
ing that  many  of  the  patients  having  such  signs 
and  symptoms  recovered  without  displaying  any 
recognizable  signs  of  tuberculosis,  and  being  in 
addition  greatly  comforted  and  reassured  by  the 
simultaneous  and  almost  complete  disappearance 
of  bone  tuberculosis  from  our  practice  and  clinics, 
we  reached  a conclusion  well  toward  the  other  end 
of  the  pendulum  swing  and  became  much  more 
loath  to  think  of  early  tuberculous  infection  in 
interpreting  such  signs. 

Within  the  past  few  years  we  are  again  return- 
ing a considerable  way  toward  our  earlier  view 
and  are  convinced  that  tuberculosis  cannot  be  dis- 
missed except  by  exclusion  in  considering  any 
child  ( 1 ) who  has  prolonged  low  grade  fever 
otherwise  not  explained,  (2)  who  fails  to  recover 
completely  within  normal  limits  from  an  acute 
infection  especially  of  the  respiratory  tract  or 
from  such  an  infection  as  measles,  (3)  who  has 
an  infectious  process  of  long  standing  within  the 
confines  of  the  respiratory  tract  with  readily  de- 
monstrable pathological  changes  such  as  enlarged 
peribronchial  glands  with  infiltration  of  the  peri- 
bronchial lymphatic  structures  or  a bronchiec- 
tasis. 

In  attacking  the  problem  of  determining 
whether  or  not  tuberculosis  is  present  in  the 
child-patient,  a history  of  exposure  is  of  the 
greatest  importance.  If  the  child  has  at  any  time 
during  his  life  spent  any  time  living  with  an 
individual  who  was  known  to  have  open  tubercu- 
losis, we  can  be  almost  certain  that  living  tubercle 
bacilli  gained  admission  to  his  body,  whether  or 
not  they  are  now  playing  any  part  in  his  health 
problem.  Long  and  intimate  association  generally 
produces  massive  infection. 

Inability  to  obtain  any  record  of  exposure 
while  valuable  cannot  be  given  too  great  weight. 
Sources  of  infection  with  which  casual  contact  is 


414 


June,  1930 


BEDSIDE  MEDICINE 


415 


made  are  too  well  known  to  need  detailed  descrip- 
tion. However,  an  elderly  relative  who  is  said 
to  have  a “chronic  bronchitis’’  or  “asthma”  and 
who  has  an  intermittently  open,  chronic  fibrous 
phthisis  must  not  be  dismissed  from  one’s  mind 
too  lightly. 

Also  in  considering  this  problem  one  must  have 
clearly  in  mind  the  nature  of  the  body’s  response 
to  tuberculosis.  Except  in  the  presence  of  massive 
or  very  virulent  infection  the  disease  makes 
inroads  slowly  and  between  periods  of  activity 
there  are  in  the  beginning  long  periods  of  quies- 
cence any  one  of  which  may  not  be  succeeded  by 
activity  but  by  complete  and  lasting  healing. 

There  is  no  field  of  medicine  which  calls  for 
more  careful,  painstaking  and  detailed  clinical 
work  followed  by  thoughtful  clinical  interpreta- 
tion than  does  the  diagnosis  of  early  tuberculosis 
in  young  children.  Only  as  an  extension  of  our 
best  clinical  efforts  and  as  an  aid  to  our  best  clin- 
ical judgment  should  we  think  of  such  valuable 
aids  as  the  tuberculin  test  and  the  roentgenogram. 
* * * 

Donald  Iv.  Woods,  San  Diego. — Early  diag- 
nosis of  latent  cases  and  more  active  interest  in 
the  so-called  pretuberculous  child,  I believe  are 
the  two  most  important  factors  in  the  juvenile 
tuberculosis  problem. 

All  undernourished  children  and  those  suffer- 
ing from  recurrent  colds,  chronic  fatigue  and 
other  chronic  symptoms,  should  be  carefully 
examined  and  reexamined  for  a possible  tubercu- 
lous infection.  Intradermal  tuberculin  tests 
should  be  used  as  the  Von  Pirquet  type  of  tuber- 
culin test  when  negative  is  not  reliable  in  these 
latent  cases  in  children.  Stereoscopic  x-ray  of 
the  chest  should  be  routine  in  all  below  par  chil- 
dren who  come  under  our  observation. 

The  pretuberculous,  undernourished  type  of 
child,  and  the  child  with  a proven  glandular  or 
other  quiescent  tuberculous  infection,  both 
respond  well  to  accepted  methods  for  improving 
general  health  and  increasing  weight.  Children 
of  this  type  may  be  cared  for  in  the  home,  but 
I have  found  that  in  most  cases  more  rapid  results 
in  building  them  up  may  be  obtained  if  they  are 
treated  in  groups  in  a small  institution.  Home 
conditions  and  contacts,  regardless  of  the  social 
status  of  the  family,  often  defeat  efforts  toward 
rapid  improvement  in  appetite,  gain  in  weight  and 
proper  routine. 

This  short  article  has  for  its  purpose  the 
emphasizing  of  the  need  of  more  interest  in 
chronic  conditions  in  children,  particularly  those 
in  children  who  appear  as  private  patients  at  our 
office.  These  little  patients  do  not  often  receive 
the  same  suspicion  or  searching  investigation  that 
our  clinic  patients  do.  I feel  that  we  are  there- 
fore overlooking  a great  many  cases  of  juvenile 
tuberculosis  with  a sweeping  diagnosis  of  mal- 
nutrition, chronic  anorexia,  or  recurrent  upper 
respiratory  infection. 

I feel  certain  that  it  is  possible  to  bring  prac- 
tically all  underpar  children,  even  those  with  an 


early  or  quiescent  tuberculosis,  up  to  what  would 
be  considered  normal  for  each  individual  child. 
This,  however,  can  only  be  accomplished  when 
we  spend  less  time  writing  about  and  working  on 
acute  illness,  which  with  children  is  usually  self- 
limiting,  and  devote  more  thought  and  time  to 
the  child  who  is  under  par,  and  either  suffering 
from  chronic  or  potential  illness. 

* * * 

William  M.  Happ,  Los  Angeles. — The  treat- 
ment of  tuberculous  infection  in  infants  and 
children  may  be  briefly  summarized  as  follows : 

1.  Removal  of  the  infant  or  child  from  the 
focus  of  contact.  This  is  most  important,  as  no 
amount  of  care  will  avail  if  repeated  fresh  infec- 
tions take  place  through  contact  with  an  open 
case.  This  contact  may  come  from  a parent, 
relative,  nurse,  or,  not  infrequently,  from  a 
servant,  particularly  a cook. 

2.  Prevention  of  upper  respiratory  infections. 
These  infections  serve  to  activate  quiescent  tuber- 
culosis and  delay  healing.  Important  items  in  pre- 
vention are : 

(a)  Removal  of  foci  of  infection  in  nose  and 
throat  as  tonsils,  adenoids,  paranasal  sinuses. 

(&)  The  beneficial  effects  of  a high  dry  cli- 
mate are  chiefly  due  to  the  lessened  amount  of 
upper  respiratory  disease. 

(c)  Prevention  of  contact  with  children  or 
adults  with  acute  respiratory  infections.  School 
attendance  should  be  prohibited  during  active 
infection. 

3.  Rest.  Absolute  bed  rest  is  not  possible  with 
infants  and  young  children,  but  their  activity  can 
be  controlled.  With  older  children  rest  is  essen- 
tial and  their  cooperation  can  nearly  always  be 
obtained.  Prevention  of  fatigue  is  essential. 

4.  Sunlight.  In  general,  direct  exposure  should 
be  withheld  during  febrile  periods  and  active  pul- 
monary disease.  It  is  beneficial  in  other  forms  of 
tuberculous  infections ; e.  g.,  skin  and  bone  dis- 
ease during  active  stages.  The  exposures  should 
be  carefully  regulated.  The  same  applies  to  ultra- 
violet radiation. 

5.  Diet.  Overfeeding  or  “stuffing”  should  be 
avoided  and  a well  balanced  diet  offered;  allow- 
ing the  appetite  to  guide  quantity.  The  diet 
should  include  ample  protein  and  should  be  rich 
in  minerals  and  vitamins.  Cod  liver  oil  or  vios- 
terol  should  be  added.  Milk  should  not  be  over- 
emphasized, as  drinking  too  much  milk  tends  to 
dull  the  appetite  for  other  food. 

6.  Tuberculin  therapy.  This  is  useful  in  cer- 
tain forms  of  the  disease,  particularly  phlyctenular 
kerato-conjunctivitis.  Its  use  is  very  limited  and, 
in  certain  forms  of  active  infection,  may  actually 
be  harmful. 

7.  Treatment  of  tuberculosis  of  special  organs 
by  surgical  or  other  measures  as  the  situation 
demands. 


416 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


California  and  Western  Medicine 

Owned  and  Published  by  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

Officidl  Orgdn  of  the  Cdlifornid,  Utdh  dnd  Tlenjdda  SMedicdl  oAssocidtions 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 


Telephone  TDouglds  0062 


Editors 

Associate  Editor  for  Nevada  . 
Associate  Editor  for  Utah 


( GEORGE  H.  KRESS 
• ' (EMMA  W.  POPE 

. . HORACE  J.  BROWN 

J.  U.  GIESY 


Subscription  prices,  $5.00  ($6.00  for  foreign  countries)  ; 
single  copies,  50  cents. 

Volumes  begin  with  the  first  of  January  and  the  first  of 
July.  Subscriptions  may  commence  at  any  time. 

Change  of  Address. — Request  for  change  of  address  should 
give  both  the  old  and  the  new  address.  No  change  in  any 
address  on  the  mailing  list  will  be  made  until  such  change  is 
requested  by  county  secretaries  or  by  the  member  concerned. 

Advertisements. — The  journal  is  published  on  the  seventh  of 
the  month.  Advertising  copy  must  be  received  not  later  than 
the  15th  of  the  month  preceding  issue.  Advertising  rates  will 
be  sent  on  request. 

Responsibility  for  Statements  and  Conclusions  in  Original 
Articles. — Authors  are  responsible  for  all  statements,  conclu- 
sions and  methods  of  presenting  their  subjects.  These  may  or 
may  not  be  in  harmony  with  the  views  of  the  editorial  staff. 
It  is  aimed  to  permit  authors  to  have  as  wide  latitude  as  the 
general  policy  of  the  journal  and  the  demands  on  its  space  may 
permit.  The  right  to  reduce  or  reject  any  article  is  always 
reserved. 

Contributions — Exclusive  Publication. — Articles  are  accepted 
for  publication  on  condition  that  they  are  contributed  solely 
to  this  journal. 

Leaflet  Regarding  Rules  of  Publication.. — California  and 
Western  Medicine  has  prepared  a leaflet  explaining  its  rules 
regarding  publication.  This  leaflet  gives  suggestions  on  the 
preparation  of  manuscripts  and  of  illustrations.  It  is  suggested 
that  contributors  to  this  journal  write  to  its  office  requesting 
a copy  of  this  leaflet. 


EDITORIALS 


INFLUENCE  OF  “PRE-CONVENTION 
BULLETIN”  AT  DEL  MONTE 
SESSION 

“Pre-Convention  Bulletin’’  and  the  Minutes  of 
House  of  Delegates  and  Council. — This  issue  of 
California  an-d  Western  Medicine  presents 
the  minutes  of  recent  meetings  of  the  House  of 
Delegates  and  of  the  Council  of  the  California 
Medical  Association,  and  also  the  reports  of  its 
officers  and  standing  committees  as  printed  in  the 
“Pre-Convention  Bulletin.”  It  is  hoped  that  the 
many  readers  of  this  journal — as  members  of 
the  California  Medical  Association — will  take  the 
time,  if  not  to  carefully  read,  to  at  least  scan 
these  presentations  of  the  activities  of  our  state 
medical  association,  as  reported  on  for  the  period 

of  the  last  year. 

J * * * 

Conclusions  to  Be  Drazvn  Therefrom. — An  in- 
spection of  these  many  reports,  no  matter  in  what 
form,  must  make  it  at  once  apparent:  (1)  that  a 
vast  amount  of  work  is  constantly  under  con- 
sideration by  the  officers  and  committees  of  the 
California  Medical  Association;  and  (2)  that 
with  whatever  honor  may  be  attached  to  state 
medical  society  office-holding  as  an  officer  or  com- 
mitteeman goes  also  a responsibility  for  service 
that  cannot  easily  be  avoided. 

In  making  possible  for  the  members  of  the 
California  Medical  Association  the  orientation  of 


its  many  professional  and  organization  problems, 
the  “Pre-Convention  Bulletin”  seems  to  have  been 
a happy  innovation.  It  was  especially  valuable  to 
the  members  of  the  supreme  governing  body  of 
the  Association — its  House  of  Delegates — -because 
it  gave  to  the  delegates  that  detailed  information 
which  it  was  necessary  for  them  to  have  when 
they  took  up  the  consideration  of  the  society’s 
business.  The  “Pre-Convention  Bulletin”  is  also 
valuable  because,  through  its  pages,  it  at  once 
becomes  evident  from  the  nature  or  lack  of  proper 
reports,  what  officers  or  committees  are  seemingly 
laggard  or  negligent  in  their  work. 

* * * 

Day  of  Make-Believe  Medical  Organization  Is 
Disappearing. — The  day  for  platitudinous  com- 
pliment to  outgoing  officers  of  a medical  society, 
who  may  or  may  not  have  done  their  work  well, 
is  fortunately  rapidly  fading  into  the  misty  past. 
Today  the  world — and  the  medical  profession  in 
its  own  little  world  is  no  exception  to  the  rule — - 
demands  real  service.  That  this  demand  is  every- 
where so  insistently  in  evidence  in  medical  organi- 
zations, bodes  well  for  the  morrow  in  medical 
practice.  Great  and  grave  as  are  the  problems 
confronting  medical  practice  and  organization  to- 
day, there  need  be  little  fear  of  the  outcome,  if 
the  guiding  policies  be  outlined  and  executed  by 
representative  and  experienced  officers  and  com- 
mitteemen who  place  a high  grade  of  service  for 
the  profession  above  self-seeking  or  personal 
interests. 

* * * 

The  Del  Monte-Fifty-Ninth  Annual  Session  a 
Happy  One. — At  the  recent  Del  Monte  session — 
the  fifty-ninth  of  the  California  Medical  Asso- 
ciation— the  thought  was  frequently  voiced  that 
a splendid  mutual  understanding  seemed  to  be  one 
of  its  outstanding  characteristics.  The  reasons 
for  this  better  understanding  may  be  said  to  have 
resulted  from  the  improvement  in  organization 
work,  whereby  members  attending  the  session 
were  able  to  visualize  their  problems  from  the 
same  fundamental  background  of  more  accurate 
knowledge.  The  California  Medical  Association 
may  feel  grateful  that,  through  the  institution  of 
“Pre-Convention  Bulletin”  and  other  changes  pro- 
vided in  the  revised  Constitution  and  By-Laws, 
it  was  largely  possible  to  make  this  fifty-ninth 
annual  session  notable  for  its  unity  of  thought  and 
action.  May  this  year’s  experience  be  only  the 
first  of  many  such  annual  reunions  at  which  such 
splendid  group  spirit  will  be  in  evidence. 


COMMENTS  ON  SOME  WORK  PHASES  OF 
THE  1930  DEL  MONTE-FIFTY-NINTH 
ANNUAL  SESSION  OF  THE  C.  M.  A. 

Nonattending  Members  Should  Familiarize 
Themselves  With  the  Proceedings. — Brief  com- 
ment on  some  of  the  many  resolutions  and  sub- 
jects considered  at  the  recent  session  may  be  of 


June,  1930 


EDITORIALS 


417 


interest  to  members  of  the  California  Medical 
Association  who  were  unable  to  attend  the  Del 
Monte  meetings,  and  accordingly  are  here  given. 
The  detailed  reports  are  printed  in  the  regular 
California  Medical  Association  columns  in  this 


Next  Year’s  Annual  Session  to  Convene  at  San 
Francisco. — Seven  years  have  passed  since  an  an- 
nual session  of  the  California  Medical  Associa- 
tion was  held  in  San  Francisco.  Next  year, 
however,  California  Medical  Association  members 
again  will  gather  in  the  city  by  the  Golden  Gate. 
The  exact  hotel  headquarters  have  not  yet  been 
determined,  but  the  time  of  the  meeting  has  been 
set  for  Monday,  April  27  to  Thursday,  April  30, 
inclusive. 

Since  the  last  meeting  in  San  Francisco  in  the 
year  1923,  many  physicians  have  come  to  Cali- 
fornia to  join  the  California  Medical  Association 
through  its  county  medical  societies.  A very  con- 
siderable number  of  such  colleagues  have  not 
visited  San  Francisco,  and  will  no  doubt  be  very 
glad  of  next  year’s  opportunity  to  partake  of  the 
atmosphere  which  makes  San  Francisco  known 
everywhere  as  one  of  the  great  cosmopolitan  cen- 
ters of  the  world.  In  addition  to  the  usual  scien- 
tific and  social  programs,  opportunity  will  be 
given  by  the  medical  schools  of  the  Universities 
of  California  and  Stanford,  and  by  the  Hooper 
Foundation,  for  clinics  and  other  demonstrations. 
Members  of  the  California  Medical  Association 
will  do  well  to  make  a note  on  their  calendars 
of  these  dates,  and  to  determine  to  attend  this 
San  Francisco  session.  It  should  be  our  banner 
year  for  a record-breaking  registration  at  an 
annual  session. 

* * * 

Incorporation  of  the  “Trustees  of  the  California 
Medical  Association.” — For  the  last  several  years 
the  minutes  of  the  House  of  Delegates  and  Coun- 
cil have  made  references  to  tentative  plans  for 
incorporation.  More  than  a half  century  ago, 
when  our  state  medical  association  came  into 
existence,  it  was  incorporated.  That  incorpora- 
tion, which  was  made  under  the  then  name  of  the 
California  Medical  Association — “The  Medical 
Society  of  the  State  of  California” — at  the  end 
of  fifty  years  was  permitted  to  lapse.  The  Cali- 
fornia Medical  Association  as  it  now  exists  is 
not  incorporated.  The  name  “Medical  Society  of 
the  State  of  California” — in  order  to  safeguard 
and  protect  the  same — was  taken  over  by  a sub- 
sidiary organization  or  department  of  the  Cali- 
fornia Medical  Association,  namely,  that  which 
carries  on  its  Optional  Medical  Defense. 

As  stated  in  the  report  of  the  Council,  votes 
of  more  than  two-thirds  of  the  members  of  the 
California  Medical  Association  authorized  in- 
corporation after  the  plans  discussed  by  the  Coun- 
cil and  the  House  of  Delegates  at  the  1929  San 
Diego  annual  session.  The  final  step  was  taken 
by  the  Council  at  its  last  meeting  at  the  Del  Monte 


session,  when  the  Articles  of  Incorporation  were 
signed.  The  formal  filing  was  made  with  the 
Secretary  of  State  May  8,  1930,  when  the  corpo- 
ration, “Trustees  of  the  California  Medical  As- 
sociation,” came  into  existence.  At  a special 
meeting  of  the  Council  held  at  San  Francisco 
May  17,  1930,  the  by-laws  were  approved  and 
the  organization  of  the  corporation  was  practi- 
cally consummated.  In  proper  time  a full  report 
on  this  subject  will  be  made.  Among  other  ad- 
vantages of  such  incorporation  it  will  now  become 
possible  for  all  persons  wishing  to  make  provision 
for  medical  or  public  health  bequests  or  legacies 
in  their  wills  to  do  so  in  favor  of  this  corpora- 
tion, in  full  knowledge  that  through  the  same  the 
provisions  of  such  trusts  will  be  faithfully  carried 
out  in  perpetuity. 

* * * 

Medical  Service  Plans. — The  publicity  given  to 
the  various  plans  which  were  being  studied  by 
the  Council  of  the  California  Medical  Associa- 
tion to  give  proper  medical  and  surgical  care  to 
those  lay  citizens,  who  under  modern-day  living 
conditions  are  confronted  with  incomes  of  such 
amounts  as  to  make  sickness  or  injury  a most 
serious  drain  on  financial  resources,  brought  out 
during  the  year  a very  considerable  amount  of 
interest  and  discussion.  At  this  time  it  is  only 
possible  to  report  that  different  plans  are  still 
being  studied,  and  that  no  one  plan  has  been  suffi- 
ciently elaborated  to  give  indication  of  early  adop- 
tion. It  was  first  necessary  to  know  exactly  what 
were  the  legal  problems  involved,  and  to  that  end 
the  opinions  of  both  the  general  counsel  of  the 
California  Medical  Association  and  of  another 
noted  firm  of  California  barristers  were  secured. 

The  studies  and  reports  by  Doctors  John  H. 
Graves  of  San  Francisco  and  John  C.  Ruddock 
of  Los  Angeles,  to  be  printed  in  the  July  issue 
of  California  and  Western  Medicine,  will 
bring  additional  interesting  facts  and  figures  to 
the  attention  of  the  profession.  The  subject  of 
proper  medical  service  for  all  citizens  is  of 
great  importance,  and  the  problems  involved 
therein  are  many  and  difficult  of  solution ; but 
it  is  the  intention  of  the  officers  of  the  California 
Medical  Association  to  carry  on  as  accurate  and 
comprehensive  studies  as  possible  in  the  hope 
that  ways  and  means  may  be  found  for  a better- 
ment in  the  present  state  of  affairs.  If  those 
efforts  are  successful,  the  county  units  and  the 
members  of  the  California  Medical  Association 
later  on  will  be  given  full  information. 

* * * 

Formation  of  a Council  on  Medical  Economics 
Recommended  to  the  American  Medical  Associa- 
tion.— A recommendation  from  the  California 
Medical  Association  will  be  submitted  to  the 
American  Medical  Association  House  of  Dele- 
gates at  its  annual  session  in  Detroit,  requesting 
that  body  to  authorize  the  formation  of  an  Ameri- 


418 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


can  Medical  Association  Council  on  Medical  Eco- 
nomics. It  certainly  seems  reasonable  to  expect 
that  our  national  medical  organization  will  not 
be  averse  to  deputizing  to  a committee  of  its  mem- 
bers, to  be  known  as  the  Council  on  Medical 
Economics,  the  responsibility  of  getting  informa- 
tion and  submitting  the  same  to  the  proper  au- 
thorities of  the  American  Medical  Association  so 
that  a more  active  interest  may  be  taken  in  these 
many  phases  of  medical  economics,  which  in  many 
of  the  state  units  of  the  American  Medical  As- 
sociation, as  well  as  in  lay  newspapers  and  peri- 
odicals, and  through  self-appointed  organizations 
outside  the  American  Medical  Association,  have 
been  receiving  so  much  attention  and  publicity. 

Why  should  not  the  American  Medical  Asso- 
ciation, with  its  splendid  central  organization  and 
facilities,  take  the  lead  in  such  an  important 
matter  and,  through  its  intimate  contacts  with 
the  state  medical  societies,  secure  cooperation  in 
the  study  and  solution  of  the  serious  economic 
problems  which  almost  everywhere  seem  to  con- 
front medical  practice  of  the  today  and  the  to- 
morrow? If  the  American  Medical  Association 
can  have  a “Council  on  Physical  Therapy,”  for 
instance,  why  should  it  hesitate  to  have  a “Council 
on  Medical  Economics,”  which  could  make  sur- 
veys and  reports  on  the  matters  coming  within 
such  a jurisdiction?  The  California  delegates  to 
the  American  Medical  Association  have  been  in- 
structed to  present  at  the  Detroit  session  of  the 
American  Medical  Association  the  proper  resolu- 
tions and  amendments  for  the  formation  of  such 
a council.*  We  shall  await  with  interest  the  action 
of  that  organization  thereon. 

* * * 

Resolutions  Concerning  Treatment  of  Narcotic 
Addicts. — One  of  the  resolutions  makes  the  sug- 
gestion that  the  Committee  on  Public  Policy  and 
Legislation  of  the  California  Medical  Association 
take  steps  at  the  1931  session  of  the  legislature 
to  bring  into  being  such  amendments  of  our  state 
laws  as  would  make  possible  the  appointment  of 
a “medical  narcotic  commission.”  Under  present 
conditions,  the  California  laws,  if  stringently  and 
literally  construed  by  the  lay  directors  and  inspec- 
tors having  charge  of  this  work,  are  of  such  form 
as  to  easily  subject  to  arrest,  and  to  resultant 
humiliation  and  disgrace,  any  medical  man  who 
gives  treatment  to  a border-line  narcotic  patient. 
Such  a state  of  affairs  is  obnoxious  to  the  in- 
terests of  the  public  health  and  of  the  medical 
profession  and  should  be  properly  modified. 
Members  of  the  Association  who  are  interested 
should  feel  free  to  communicate  any  suggestions 
to  the  chairman  or  members  of  the  State  Com- 
mittee on  Public  Policy  and  Legislation.  (See 
front-page  index  for  proper  reference  page,  for 
personnel  of  all  committees.) 

* * * 

Suggestion  of  the  Committee  on  Public  Policy 
and  Legislation. — The  report  of  the  Committee 

* See  Medical  Economics  column  in  this  issue. 


on  Public  Policy  and  Legislation  ends  with  the 
statement  that  1930  is  a state  election  year.  In 
other  words,  many  candidates  for  the  state  legis- 
lature, in  either  the  senate  or  assembly,  who  will 
submit  their  names  in  the  primary  election  are 
already  looking  after  their  personal  campaign 
interests.  In  equal  measure,  it  behooves  the  medi- 
cal profession  to  also  look  after  its  own  interests, 
to  the  end  that  persons  known  to  be  inimical  to 
sane  public  health  measures  shall  be  opposed  by 
citizen  candidates  who  are  known  to  favor  con- 
structive measures  in  conservation  of  human 
health  and  life. 

The  officers  of  every  county  medical  society 
have  a special  responsibility  in  this  matter.  That 
responsibility  cannot  be  shifted.  Lack  of  interest 
in  this  important  matter  is  almost  akin  to  dis- 
loyalty to  public  health  and  organized  medicine 
standards.  Every  county  medical  society  should 
have  an  active  local  committee  on  public  policy 
and  legislation.  If  it  does  not  have  such,  the 
president  and  secretary  of  each  society  should 
jointly  take  on  this  work.  The  members  of  make- 
believe  county  committees  on  legislation  should 
resign  and  give  way  to  colleagues  who  are  willing 
to  do  service. 

A survey  of  the  political  situation,  in  relation 
to  assembly  and  senate  candidates,  should  be  in- 
stituted at  once  and  a report  made  at  an  early 
meeting  of  each  county  society  or  of  its  executive 
board.  If  this  be  done,  the  local  situations  can 
be  clarified  with  far  less  work  and  worry  than 
later  on.  Every  member  of  the  California  Medi- 
cal Association  should  make  it  his  business  to 
know  who  are  the  candidates  to  the  assembly 
from  the  district  in  which  he  has  his  residence. 
In  the  future  the  problem  with  senators  will  be 
simpler,  although  not  less  important,  because  state 
senators  will  hereafter  be  limited  to  one  for  each 
of  the  larger  counties  instead  of  numbers  based 
on  proportional  population,  as  in  the  past.  The 
smaller  county  medical  societies  can  therefore  be 
of  distinct  and  powerful  service  when  they  use 
their  influence  to  elect  state  senators  who  are 
kindly  disposed  to  proper  public  health  standards. 
In  due  time,  more  on  this  important  subject. 

* * * 

Many  Other  Matters  Worthy  of  Mention. — It 
would  be  possible  to  continue  comment  on  many 
of  the  other  matters  which  were  mentioned  in 
the  reports  of  officers  and  of  standing  committees 
and  in  the  minutes  of  the  House  of  Delegates 
and  of  the  Council.  Space  requirements  for 
other  departments  of  California  and  Western 
Medicine  make  it  impossible  to  make  such  in 
this  issue.  Should  occasion  arise,  comment  will 
be  made  on  special  subjects  in  subsequent  issues. 
In  the  meantime,  every  member  of  the  California 
Medical  Association  who  desires  to  know  what 
his  colleagues,  who  are  his  elected  or  appointed 
representatives,  are  doing  in  the  transaction  of 
the  business  of  the  California  Medical  Associa- 


June,  1930 


EDITORIALS 


419 


tion  and  its  county  units  should  make  an  effort 
to  look  through  the  Del  Monte  session  proceed- 
ings as  printed  in  this  issue.  If  that  is  done, 
organization  work  during  the  coming  year  will 
receive  a real  impetus  because  of  the  greater 
cooperative  interest  and  efforts  of  a larger  number 
of  its  members.  

DR.  HOLMAN  OF  STANFORD  IS  AWARDED 
THE  SAMUEL  D.  GROSS  PRIZE 

A Middle-lV cst  Group  of  Nineteenth  Century 
Physicians. — From  the  Ohio  valley,  especially 
from  the  Cincinnati  and  Louisville  medical 
schools,  in  the  early  days  of  the  nineteenth  cen- 
tury went  forth  a notable  group  of  physician 
teachers  and  leaders.  Included  among  such  were 
Daniel  Drake,  the  elder  and  the  younger  Gross, 
Bartholow  and  others,  who  not  only  left  a deep 
impress  upon  the  medical  thought  of  their  period, 
but  whose  high  standards  of  research  and  service 
still  exert  an  influence  on  modern-day  practice. 
Philadelphia,  home  of  one  of  America’s  pioneer 
physicians — Dr.  Benjamin  Rush,  he  who  was  one 
of  the  signers  of  the  Declaration  of  Independence 
by  the  Colonies — still  honors  the  memory  of 
Samuel  D.  Gross  by  a prize  which  is  awarded 
every  five  years  through  the  Philadelphia  Acad- 
emy of  Surgery  for 

“the  best  original  essay,  not  exceeding  one  hundred 
and  fifty  printed  pages,  octavo,  in  length,  illustrative 
of  some  subject  in  surgical  pathology  or  surgical  prac- 
tice founded  upon  original  investigations,  the  candi- 
dates for  the  prize  to  be  American  citizens.” 

“It  is  expressly  stipulated  that  the  competitor  who 
receives  the  prize  shall  publish  his  essay  in  book  form, 
and  that  he  shall  deposit  one  copy  of  the  work  in 
the  Samuel  D.  Gross  Library  of  the  Philadelphia 
Academy  of  Surgery,  and  that  on  the  title  page  it 
shall  be  stated  that  to  the  essay  was  awarded  the 
Samuel  D.  Gross  Prize  of  the  Philadelphia  Academy 
of  Surgery.”  * * * 

Doctor  Holman’s  Essay  on  “Abnormal  Arterio- 
venous Communications.” — Californians  may  be 
proud  in  the  knowledge  that  the  1930  award  of 
the  Samuel  D.  Gross  Prize  of  $1500  was  awarded 
to  a California  Medical  Association  colleague — 
Dr.  Emile  Holman,  whose  work  in  the  Stanford 
University  Hospital  has  long  been  well  known 
in  this  state.  Doctor  Holman’s  essay  was  entitled 
“Abnormal  Arteriovenous  Communications.”  It 
deals  with  the  effects  upon  circulation  of  the  blood 
of  unusual  openings  between  the  large  arteries  and 
veins  produced  by  gunshot  wounds,  knife  thrusts, 
and  congenital  abnormalities  of  development. 

California  and  Western  Medicine  takes 
pleasure  in  calling  attention  to  this  recently  an- 
nounced award.  On  behalf  of  his  colleagues  in 
California,  California  and  Western  Medicine 
extends  congratulations  to  Doctor  Holman  on  this 
honor  which  he  has  brought  to  himself  and  to  the 
medical  profession  of  the  Golden  State.  May  his 
good  example  be  emulated  by  others  so  that,  in 
the  passing  of  the  years,  the  record  of  California 
in  research  studies  may  be  such  as  to  compare 


favorably  with  that  of  other  states  and  countries ; 
and  also  be  of  the  kind  one  has  a right  to  expect 
from  the  physicians  of  a commonwealth  where 
the  joy  of  living  and  service  is  cast  in  as  excep- 
tional surroundings  as  exist  in  California. 


Cerebrospinal  Meningitis. — In  the  one  hundred  and 
twenty-three  years  since  cerebrospinal  meningitis 
first  swept  “like  a flood  of  mighty  waters,  bringing 
along  with  it  the  horrors  of  a most  dreadful  plague” 
into  the  little  town  of  Goshen,  Connecticut,  where 
Dr.  Elisha  North  was  in  practice,  many  observers 
have  noted  the  variable  death  rate  of  the  disease.  In 
reading  North’s  book,  “A  Treatise  on  a Malignant 
Epidemic,  Commonly  Called  Spotted  Fever,  etc.,” 
New  York,  1811,  which  was  the  first  publication  on 
cerebrospinal  meningitis,  we  are  astounded  at  the  suc- 
cess with  which  this  Connecticut  doctor  attended  his 
patients,  for  out  of  about  two  hundred  he  lost  only 
two.  This  record  set  by  North  has  never  been  sur- 
passed, and  certainly  today  a physician  whose  mor- 
tality rate  is  under  50  per  cent  considers  himself  a 
most  successful  practitioner.  In  a series  of  cases 
treated  at  one  of  our  metropolitan  hospitals  in  the 
last  few  years,  the  death  rate  was  about  that  figure. 
Prior  to  the  introduction  of  serum  the  mortality  rates 
in  the  country,  as  a whole,  were  about  75  per  cent, 
and  during  the  World  War  it  was  not  uncommon  for 
a physician  to  lose  one-half  of  his  patients  when  the 
disease  broke  out  in  an  Army  camp  or  hospital.  On 
the  other  hand,  during  certain  epidemics  the  mortality 
has  been  remarkably  low,  and  we  presume  that  this 
must  have  been  the  case  during  the  Connecticut  epi- 
demic of  1807-1811  described  so  vividly  by  North. 
That  there  is  such  a wide  variation  in  the  mortality 
of  patients  with  this  disease  is  one  of  the  outstanding 
features  of  its  epidemiology. — The  New  England  Jour- 
nal of  Medicine,  April  10,  1930. 


State  Fund’s  New  Method  of  Paying  Dividends. — 

1.  Since  the  doors  of  the  State  Compensation  Insur- 
ance Fund  were  opened  on  January  2,  1914,  the  large 
sum  of  over  $17,500,000  has  been  returned  in  the  form 
of  dividends  to  employers  in  California.  This  is  one 
of  the  main  reasons  why  employers  patronize  the 
State  Fund  in  increasing  numbers.  While  the  rates 
charged  for  compensation  coverage  have  to  be  the 
same  as  the  charges  of  the  private  companies,  under 
the  law,  the  cost  of  administering  the  State  Fund  is 
low  and  this  enables  the  returns  to  be  made  to  Cali- 
fornia’s employers.  Incidentally,  the  premiums  re- 
ceived pay  all  costs,  and  the  state  treasury  does  not 
contribute  money  to  the  Fund’s  upkeep. 

2.  There  are  employers  who  fail  to  recognize  the 
truth  that  they  are  important  factors  in  setting  the 
compensation  premiums.  The  latter  are  based  on 
the  industrial  deaths  and  injuries.  The  reductions  in 
accidents  to  workers  mean  lower  premiums.  Those 
industries  with  comparatively  few  injuries  pay  low 
premiums.  There  is  need  to  emphasize  this  truism, 
because  it  shows  the  financial  values  in  preventing 
accidents,  and  the  lower  the  premium  the  smaller  the 
cost  that  has  to  be  charged  to  consumers. 

3.  The  dividends  now  payable  to  employers  by  the 
State  Compensation  Insurance  Fund  will  be  dis- 
tributed on  the  basis  of  accident  experience.  This  will 
give  an  added  impetus  to  safety  activities,  because  the 
loss  ratio  of  policyholders  will  be  taken  into  con- 
sideration. This  new  plan  gives  a larger  reward  to 
those  employers  who  have  helped  produce  the  sur- 
plus earnings  out  of  which  dividends  are  paid.— Cali- 
fornia Department  of  Industrial  Relations.  Report  to 
Governor’s  Council. 


Urology 

Experimental  Perfusion  of  the  Frog's  Kid- 
ney.— In  view  of  the  very  valuable  and 
interesting  studies  of  Richards  and  co-workers 
in  this  country  with  the  frogs  kidney,  some 
recent  studies  by  Hartwich  1 are  of  interest. 
When  the  pressure  of  a Ringer's  solution  perfused 
through  an  isolated  frog’s  kidney  is  raised,  there 
is  an  increase  in  the  amount  of  urine  secreted  but 
this  is  not  always  proportional.  When  the  iliac 
artery  is  ligated,  the  amount  of  urine  is  greater 
but  the  flow  less  than  when  open,  a condition  that 
is  explained  by  the  fall  in  the  pressure  in  the  aorta 
and  not  by  a reabsorption  in  the  tubular  cells. 
The  perfusion  pressure  by  way  of  the  portal  vein 
must  be  raised  to  about  8 to  10  centimeters  before 
urine  is  secreted,  which  is  then  due  to  the  back- 
flow  through  the  anastomotic  vessels  of  the 
tubules  to  the  glomeruli.  The  chlorids  of  the 
urine  were  found  to  be  less  than  of  the  fluid 
perfused  and  the  urine  is  sugar-free  so  long  as 
the  sugar  percentage  in  the  perfusion  fluid  is  not 
above  0.05  to  0.06  per  cent.  And  Hartwich  con- 
cludes that  this  result  is  due  to  the  low  perme- 
ability of  the  kidney  filter  and  not  to  reabsorption 
of  sugar.  Increasing  the  acidity  promotes  the 
rate  of  perfusion  and  secretion,  whereas  changing 
the  hydrogen  ion  concentration  towards  the 
alkaline  side  diminishes  both.  Hypertonic  perfu- 
sion fluids  diminish  perfusion  and  secretion, 
whereas  hypotonic  fluids  increase  both.  Increase 
of  the  calcium  ions  increases  the  perfusion  rate 
and  amount  of  urine  but,  if  the  increase  is  great, 
then  urine  secretion  stops  altogether.  Grape  sugar 
in  different  concentrations,  as  well  as  other  kinds, 
has  no  action  upon  the  perfusion  rate  or  diuresis 
of  the  isolated  frog’s  kidney.  Magnesium  and 
sodium  sulphate  in  certain  concentrations  slow 
the  perfusion  rate  and  increase  the  amount  of 
urine.  It  was  found  that  a low  concentration  with 
sodium  sulphate  diminished  the  rate  of  flow  and 
secretion,  and  magnesium  sulphate  was  active 
only  when  the  iliac  artery  was  tied.  The  action 
failed  with  an  open  artery  because  of  the  antag- 
onistic calcium  salts  transported  in  the  kidney. 
In  no  experiment  was  a diuretic  action  noted 
except  when  there  was  a corresponding  change 
of  the  rate  of  flow,  so  that  it  is  concluded  that 
secretion  of  the  urine  is  dependent  to  a high 
degree  upon  the  rate  of  blood  flow  through  the 
kidney. 

Perfusion  with  a caffein  solution  of  about 
1 :250,000  with  the  iliac  artery  tied  off  increased 
the  rate  of  flow  and  secretion.  With  open  vessels 
the  amount  of  urine  was  proportional  to  the  in- 
creased flow.  With  high  caffein  concentrations, 
420 


the  diuresis  lasted  longer  than  the  increase  of 
perfusion  rate.  The  effect  of  caffein  did  not  wear 
off  with  repeated  use,  and  its  different  effects  were 
more  or  less  proportional  to  the  size  of  the  dose 
used.  Theophyllin  gave  results  similar  to  caffein. 
Urea  solutions  of  1 TOO  to  1 :500  increased  the 
rate  of  flow  and  the  amount  of  urine  and  the 
increased  secretion  never  outlasted  the  increased 
perfusion  rate.  Urea  diuresis,  therefore,  seemed 
wholly  due  to  the  result  of  effect  on  the  blood 
vessels.  Perfusion  with  sublimate  and  nova- 
surol  solutions  increased  urinary  flow,  which  to 
some  extent  was  independent  of  the  rate  of  per- 
fusion. Cadmiumchlorid,  closely  allied  in  its  ac- 
tion to  quicksilver,  usually  produced  an  increase 
which,  in  contrast  to  quicksilver  diuresis,  was  usu- 
ally parallel  to  the  rate  of  perfusion.  Strophan- 
thin  solutions  increased  the  rate  of  flow  and 
produced  diuresis,  whereas  perfusion  with  atropin 
and  pilocarpin  had  no  effect.  Phloridzin  in  con- 
centrations of  1 :50,000  to  1 :5000  produced  diffu- 
sion and  in  still  higher  amounts  increased  secre- 
tion. In  concentrations  of  1 :3000  there  was  a 
diminished  secretion  and,  under  certain  condi- 
tions, complete  cessation  of  the  formation  of 
urine.  Glycosuria  appeared  even  in  concentrations 
of  1:10  million  up  to  1 :1  million.  Glycosuria  of 
phloridzin  and  diuresis  have  no  interrelation  as 
the  glycosuria  seems  undoubtedly  due  to  an 
increased  permeability  of  the  glomerulus.  Chlo- 
rid  secretion  seemed  in  no  way  affected  by 

phloridzin.  „ TT  „ „ . 

uranic  Hinman,  San  hrancisco. 

REFERENCE 

1.  Hartwich:  Einfluss  pharmakologisch  wirksamer 
Substanzen  auf  die  isolierte  Froschniere.  I.  Mittei- 
lung: Methodik,  Einfluss  des  mechanischen  und  osmo- 
tischen  Druckes,  der  Wasserstofflonenkonzentration, 
des  Zuckers  and  des  Magnesium  und  Natriumsulfats, 
Arch.  f.  exper.  Path.  u.  Pharm.,  Ill,  81-98,  1926. 
II.  Mitteilung:  Diuretika  und  andere  Substanzen, 
Ibid.,  206-217.  III.  Mitteilung:  Die  Wirkung  des 
Phlorrhizins,  Ibid.,  115,  328-333,  1926. 


Medicine 

Pituitary  Tumors  and  Diabetes  Insipidus. — 

While  diabetes  insipidus  is  not  a common 
condition,  it  is  occasionally  met  with  in  general 
practice  and  in  some  of  the  early  or  less  marked 
cases  it  may  be  easily  overlooked.  The  condition 
is  characterized  by  the  excretion  of  large  amounts 
of  watery  but  otherwise  normal  urine  associated 
with  excessive  thirst.  The  patient  may  present 
no  other  symptoms  and  be  apparently  in  excellent 
general  health. 

All  the  etiological  factors  in  the  production  of 
diabetes  insipidus  are  not  clear,  particularly  in 


June,  1930 


MEDICINE  TODAY 


421 


the  so-called  primary  or  idiopathic  cases  which 
seem  to  be  of  the  nature  of  an  hereditary  defect 
transmitted  by  parent  to  offspring.  In  many 
instances,  however,  it  is  due  to  a lesion  affect- 
ing the  floor  of  the  third  ventricle  about  the 
stalk  of  the  pituitary  body  ( secondary  diabetes 
insipidus) . It  may  be  produced  by  fractures  of 
the  base  of  the  skull,  primary  or  secondary  ven- 
tricular hemorrhage,  or  by  tumors  of  the  optic 
chiasm,  the  pituitary,  or  of  the  structures  form- 
ing the  walls  of  the  third  ventricle.  It  may  be 
produced  in  experimental  animals  by  puncture  of 
the  parainfundibular  region,  which  suggests  that 
in  this  situation  there  is  a center  which  controls 
the  excretion  of  fluid  by  the  kidneys. 

In  pituitary  adenomas,  diabetes  insipidus  is  not 
a common  symptom  until  late  in  the  course  of 
the  disease  when  extension  of  the  tumor  through 
the  diaphragma  sellae  may  result  in  a disturb- 
ance of  the  parainfundibular  region.  It  may  also 
occur  after  operative  procedures,  possibly  due  to 
trauma  incident  to  the  attempted  extirpation  of 
the  tumor.  In  cranio  pharyngeal  pouch  cysts  its 
appearance  is  earlier  and  more  characteristic,  due 
to  the  distortion  of  the  floor  of  the  third  ventricle 
incident  to  the  upward  extension  of  the  tumor. 
It  may  be  the  only  symptom  present  for  some 
time.  When  associated  with  failing  vision,  dwarf- 
ism, and  increasing  adiposity  in  a child,  this 
tumor  should  be  kept  in  mind  as  the  possible 
cause.  Tumors  of  the  optic  chiasm,  originating 
just  anterior  to  the  pituitary  stalk,  are  also  a 
cause  of  the  condition.  Symptoms  of  pituitary 
hypoactivity  may  not  be  marked,  progressive  loss 
of  vision  associated  with  primary  optic  atrophy 
being  more  characteristic. 

In  view  of  the  frequent  association  of  diabetes 
insipidus  with  tumors  in  the  region,  it  is  impor- 
tant to  investigate  each  case  carefully  in  the  at- 
tempt to  determine  its  exact  cause.  A radio- 
graphic  study  of  the  skull  should  be  made  in  each 
instance  with  particular  attention  to  possible  bony 
changes  in  the  region  of  the  sella  or  the  presence 
of  calcareous  particles  within  or  above  it.  Di- 
minished visual  acuity  and  alterations  in  the  peri- 
metric fields  should  be  looked  for.  Ophthalmo- 
scopic examination  in  tumor  cases  will  usually 
show  some  degree  of  primary  optic  atrophy.  The 
attainment  of  symptomatic  relief  by  the  use  of 
nasal  packs  moistened  with  pituitrin  can  in  no 
sense  replace  the  examination  for  the  etiological 
factor.  Cyril  B.  Courville, 

College  of  Medical  Evangelists. 


Dermatology 

Blood  Chemistry  in  Diseases  of  the  Skin. — 

Empirical  observation  has  long  ago  estab- 
lished the  importance  of  metabolic  factors  in  the 
causation  of  systemic  dermatoses,  such  as  eczema, 
psoriasis,  acne,  seborrhea,  pruritus,  etc.  Dietetic 
restrictions  of  various  groups  of  foods,  sugars, 
carbohydrates  and  fats  or  proteids  were  prac- 
ticed at  random  in  a purely  experimental  fashion. 


Only  recently  systematic  study  of  blood  chemistry 
in  systemic  dermatoses  has  been  taken  up  by 
various  observers.  The  most  comprehensive  and 
outstanding  contribution  has  been  recently  re- 
ported by  J.  Schamberg  1 of  Philadelphia.  Com- 
ing from,  so  competent  and  conservative  an  ob- 
server with  unexcelled  facilities  for  research,  this 
study  is  of  particular  interest  and  informative 
value. 

Schamberg  reports  results  of  blood  chemistry 
study  of  more  than  1000  cases  of  systemic  derma- 
toses of  which  875  cases  furnished  complete  blood 
study. 

The  blood  was  taken  always  in  the  forenoon, 
within  one  to  four  hours  after  breakfast.  One  of 
the  most  important  deductions  drawn  by  Scham- 
berg from  this  study  with  respect  to  the  nitrogen 
constituents  of  blood  is  that  it  is  perhaps  unscien- 
tific to  inquire  what  is  the  maximum  normal  of 
nonprotein  nitrogen,  urea  nitrogen  or  uric  acid  in 
the  blood,  but  rather  what  is  normal  for  a male 
or  female  of  a given  age.  Speaking  generally, 
men  between  the  age  of  twenty  and  seventy  have 
an  average  about  0.6  milligram  more  uric  acid 
per  hundred  cubic  centimeters  than  women.  The 
study  shows  a steady  rise  in  uric  acid,  uria  nitro- 
gen, and  nonprotein  nitrogen  from  the  third  to 
the  eighth  decade  of  life. 

Whereas  at  the  age  of  thirty  the  average  uric 
acid  for  men  is  about  3.5  milligrams,  the  urea 
nitrogen  between  15  and  16  milligrams  and  non- 
protein nitrogen  33  milligrams,  at  the  age  of 
eighty  the  respective  figures  were  4.2,  20,  and  38 
milligrams.  In  contrast  to  the  prevailing  ideas 
and  several  recent  publications,  Schamberg  found 
only  a small  number  of  instances  where  eczema 
was  caused  by  a pathologic  increase  of  dextrose  in 
the  blood. 

Moderate  increases  of  blood  sugar  were  often 
due  to  the  fact  that  the  blood  was  taken  too  soon 
after  breakfast.  On  reexamination  after  fasting, 
the  blood  was  usually  normal. 

On  the  other  hand,  an  excess  of  nonprotein 
nitrogen,  urea  nitrogen,  and  uric  acid  was  dis- 
tinctly more  common  in  eczema  than  in  other 
dermatoses,  with  the  exception  of  generalized 
pruritus.  The  maximum  normal  of  nonprotein 
nitrogen  in  the  blood  is  40  milligrams  per  100 
cubic  centimeters  of  blood.  Twenty-two  and  six- 
tenths  per  cent  of  452  cases  of  eczema  had  40 
milligrams  or  more.  The  cases  of  general  pruritus 
showed  36  per  cent. 

Maximum  normal  amount  of  blood  urea  nitro- 
gen is  20  milligrams  per  100  cubic  centimeters  of 
blood.  Twenty-one  per  cent  of  eczema  cases 
showed  20  milligrams  or  more  of  urea  nitrogen 
in  the  blood.  In  cases  of  generalized  pruritus  the 
proportion  was  44.4  per  cent. 

There  is  some  difference  of  opinion  as  to  the 
maximum  of  normal  amount  of  uric  acid  in  the 
blood.  Of  455  cases  of  eczema  217  or  47.7  per 
cent  showed  4 milligrams  or  more  per  100  cubic 
centimeters  of  blood.  The  highest  amount  found 
was  7.6  milligrams.  Of  143  cases  of  pruritus 
fifty-nine,  or  41.3  per  cent,  showed  an  excess; 


422 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


of  fifty-two  cases  of  psoriasis  seventeen,  or  37 
per  cent,  were  pathologic;  of  thirty-five  cases  of 
generalized  pruritus  seventeen,  or  50  per  cent, 
showed  an  excess.  In  other  dermatoses  uric  acid 
was  perceptibly  less. 

Schamberg  draws  the  following  conclusions : 

1.  Age  exerts  a distinct  influence  on  the  aver- 
age nitrogenous  content  of  the  blood. 

2.  Males  exhibit  more  nonprotein  nitrogen, 
urea  nitrogen,  and  uric  acid  in  the  hlood  than 
females. 

3.  In  eczema  and  pruritus,  particularly  general- 
ized, there  is  found  a perceptibly  higher  percent- 
age of  patients  with  an  excess  of  nonprotein 
nitrogen,  urea  nitrogen,  and  uric  acid  than  in 
other  dermatoses. 

4.  A study  of  the  blood  chemistry  in  patients 
with  refractory  dermatoses  is  of  material  aid  in 
prescribing  appropriate  diets. 

M.  Scholtz,  Los  Angeles. 

REFERENCE 

1.  Schamberg,  J.  Arch,  of  Dermatology  and  Syphi- 
lology,  January  21,  1930. 

Gynecology 

Cervicitis. — Trauma  and  the  inflammatory 
change  connected  with  it  involving  the  short 
length  of  the  cervical  canal  is  one  of  the  most 
common  conditions  afflicting  multiparous  women, 
and  results  not  only  in  producing  discomfort  but 
frequently  serves  as  a focus  of  infection  or  even 
predisposes  to  cancer.  Injuries  incurred  during 
childbirth  and  specific  infections  account  for  the 
majority  of  these  cases;  patients  presenting 
themselves  for  relief  of  a troublesome  discharge, 
which  is  the  most  common  symptom. 

However  deeply  the  cervix  is  involved  the 
treatment  attempts  to  achieve  the  same  end, 
namely  to  destroy  the  chronically  infected  and 
diseased  tissue  and  to  restore  the  normal  anatomic 
relations.  While  hospital  care  combined  with 
operative  procedures  has  been  the  ideal  treatment 
for  cases  of  cervicitis  yet  treatment  that  is  simple 
and  which  may  be  safely  applied  in  office 
practice,  will  benefit  a large  percentage  of  cases 
that  would  otherwise  receive  no  attention.  A 
brief  review  of  some  of  the  newer  methods  which 
may  be  so  used  shows  commendable  progress 
along  this  line. 

Destruction  of  diseased  tissue  may  be  produced 
by  chemicals  or  by  heat,  either  cautery  or  coagu- 
lation diathermy.  Chemical  agents  such  as  acids 
or  astringents  have  been  employed  for  many  years 
and  still  are  widely  used,  but  leave  much  to  be 
desired,  probably  because  of  inability  to  bring 
them  in  actual  contact  with  the  tissue  to  be 
destroyed  and  because  of  their  failure  to  penetrate 
to  the  deeper  portions  of  the  mucosa  and  stroma 
which  are  so  often  involved. 

Destruction  by  heat  received  a great  impetus 
from  Dickinson,1  who  introduced  the  nasal  tip 


cautery  for  cauterization  of  the  cervix.  The 
use  of  the  cautery  in  “cartwheel”  cauterization 
of  the  cervix  is  well  established.  Coagulation- 
diathermy  is  well  adapted  to  application  in  a sim- 
ilar manner.2  The  inactive  electrode  is  applied 
on  the  sacrum  or  abdomen  and  the  active  electrode, 
which  is  about  the  size  of  a darning  needle  and 
protected  to  within  three-eighths  inch  of  its  tip 
is  applied  to  the  cervical  canal. 

With  the  above  two  methods  the  amount  of 
heat  applied  and  depth  of  destruction  cannot 
always  be  accurately  estimated.  Variations  are 
due,  when  the  nasal  cautery  is  used,  to  quenching 
action  of  the  mucus  in  the  canal  and,  in  the  active- 
inactive  electrode  method,  to  the  variation  in 
resistance  between  the  two  electrodes. 

This  uncertainty  may  be  obviated  and  uniform 
results  achieved  in  a large  degree  by  the  use  of 
a bipolar  electrode.3  Two  wires  spaced  one-eighth 
inch  apart  serving  as  electrodes  are  attached  to 
one  side  of  an  insulated  tip  which  may  be  intro- 
duced into  the  cervical  canal.  Since  the  pathway 
of  the  current  is  between  the  two  electrodes  and 
the  action  local,  the  resistance  to  the  current  is 
therefore  constant  and  by  using  the  same  amount 
of  current  in  each  case,  practically  the  same  depth 
of  tissue  will  be  destroyed,  thus  making  for  more 
uniform  results. 

Tissue  destruction  by  cautery  and  by  diathermy 
may  be  done  without  local  anesthesia  and  in  this 
respect  diathermy  probably  causes  less  pain  than 
the  cautery. 

SUMMARY 

Cervicitis  is  a common  condition  and  often  a 
forerunner  of  more  serious  complications  and 
needs  simple  and  widely  applied  treatment. 

Destructive  heat  offers  the  surest  means  of 
eradicating  the  diseased  tissue  and  bipolar  coagu- 
lation diathermy  allows  of  uniform  destruction. 

John  E.  Potts,  Los  Angeles. 

REFERENCES 

1.  Dickinson,  R.  L. : Am.  J.  Obst.  and  Gynec.,  1921, 
17,  68. 

2.  Harriman,  Walter  F. : Am.  J.  Obst.  and  Gynec., 
1929,  18,  250. 

3.  Elide,  Frank  M.:  Am.  J.  Obst.  and  Gynec.,  1929, 
17,  78. 


Syphilology 

Mercury  “Rubs.” — In  the  treatment  of 
chronic  lues  the  time-honored  inunction  of 
mercury  still  has  a very  definite  sphere  of  useful- 
ness. This  method,  however,  is  frequently  dis- 
carded for  some  other  because  of  inconvenience 
of  administration.  A six-ounce,  smooth,  oval 
bottle  filled  with  water  as  warm  as  can  be  com- 
fortably held  in  the  hand  makes  an  excellent  im- 
plement for  rubbing.  The  heat  softens  the  ointment 
and  reddens  the  skin,  the  smoothness  of  the  glass 
minimizing  irritation  so  that  the  same  area  be- 
tween the  shoulders  may  be  used  over  and  over 
again  without  pustulation.  The  skin  may  be 
wiped  clean  at  the  end  of  the  treatment  without 
loss  of  therapeutic  efficiency. 

F.  F.  Gundrum,  Sacramento. 


TRANSACTIONS  OF  THE  FIFTY-NINTH  ANNUAL  SESSION 
CALIFORNIA  MEDICAL  ASSOCIATION 

DEL  MONTE,  CALIFORNIA,  APRIL  28-MAY  1,  1930 
I.  Pre-Convention  Bulletin  Reports;  II.  Minutes  of  the  House  of  Delegates;  III.  Minutes  of  the  Council. 


PRE-CONVENTION  BULLETIN  REPORTS* 

REPORTS  OF  DISTRICT  COUNCILORS 

FIRST  COUNCILOR  DISTRICT 
Imperial.  Orange.  Riverside  and  San  Diego  Counties 

To  the  President  and  House  of  Delegates : 

The  President-elect  and  I made  a visit  to  the 
Orange  County  Medical  Society  March  11,  at  which 
time  a dinner  was  served  to  about  ninety  members, 
following  which  a business  meeting  and  scientific 
session  was  held.  A number  of  new  members  were 
voted  in  and  a great  deal  of  enthusiasm  was  shown 
by  the  members  toward  their  county  society  and  their 
state  organization.  They  have  one  of  the  most  enthu- 
siastic county  societies  it  has  ever  been  my  pleasure  to 
visit.  They  have  recently  established  a medical  library 
and  have  subscribed  to  the  Barlow  medical  library  of 
Los  Angeles  so  that  the  members  can  get  reference 
books  and  magazines  on  a very  short  notice.  The 
meeting  was  very  enjoyable  and  was  greatly  appre- 
ciated by  Dr.  Kinney  and  myself. 

The  San  Diego  County  Medical  Society  still  main- 
tains a high  personnel  of  membership  among  the 
licensed  physicians  in  the  county.  Regular  meetings 
are  held  on  the  second  Tuesday  of  each  month  at 
which  time  a dinner  is  served  and  a scientific  program 
given.  The  attendance  at  these  meetings  runs  from 
one  hundred  to  one  hundred  twenty-five  members 

regularly.  , . , 

Respectfully  submitted, 

Mott  H.  Arnold,  Councilor. 

eSr 


SECOND  COUNCILOR  DISTRICT 
Los  Angeles  County 


To  the  President  and  House  of  Delegates: 

As  Councilor  for  the  Second  District  of  the  Cali- 
fornia Medical  Association,  I have  no  extensive  report 
to  make,  but  a few  observations  may  be  of  interest. 

At  this  date  (April  4)  I am  informed  that  the  paid 
membership  for  the  year  1930,  number  1550,  with  247 
delinquent  which,  I am  informed,  is  about  the  aver- 
age of  delinquency  at  this  date.  Fifty-one  new  mem- 
bers have  been  admitted  since  January  1,  1930,  and 
forty-eight  are  now  listed  as  applicants. 

It  would  seem  from  this  information  that  there  has 
been  a gain  in  membership,  though  not  a large  one. 
Inasmuch  as  there  are  approximately  3,500  medical 
men  and  women  in  Los  Angeles  County  eligible  to 
membership  in  this  organization,  it  would  seem  that 
the  Association  is  not  sufficiently  active  in  its  ex- 
tension efforts. 

It  will  be  of  interest  to  study  the  membership  of 
the  various  branches  and  sections,  all  of  which  are 
active  and  are  of  value  in  their  several  spheres. 

The  Branches  are  as  follows: 


Alhambra  25 

Glendale  — 51 

Harbor  Branch  — 98 


* In  addition  to  the  reports  which  follow,  the  Pre-Con- 
vention Bulletin  contained  the  reports  of  the  Council  and 
other  general  officers.  As  those  reports  were  read  to  the 
House  of  Delegates,  they  will  be  found  in  the  minutes  of 
the  House,  which  follow. 


Monrovia  Branch  17 

Pasadena  Branch  100 

Pomona  Branch  39 

San  Fernando  Valley  Branch  26 

Santa  Monica  Branch  56 

Southwest  Branch  14 


426 

It  will  be  seen  that  these  nine  branches  have  a 
membership  of  426 — an  average  of  47  members. 

The  Sections  are  as  follows: 


Anaesthesia  Section  64 

Clinical  and  Statistical  Section 135 

Dermatology  and  Syphilology  Section....  13 

Eye  and  Ear  Section 100 

Industrial  Accident  Section 90 

Internal  Medicine  Section 59 

Obstetrical  Section  71 

Radiological  Section  35 

Surgical  Section  130 

Tuberculosis  Section  85 

Urological  Section  27 


809 

The  total  membership  of  the  sections  is  809,  with 
an  average  membership  of  73  plus.  Just  what  pro- 
portion are  members  of  both  branches  and  sections 
is  not  determined.  These  figures  are  furnished  by 
the  secretary  of  the  County  Association. 

In  the  organization  of  the  Association  the  Council 
is  composed  of  nine  Councilors-at-Large,  each  of 
whom  serves  for  three  years,  and  one  Councilor 
comes  from  each  Branch  or  Section  and  serves  for 
one  year.  This  plan  worked  very  well  when  there 
were  but  two  or  three  branches  and  two  or  three 
sections.  Now  twenty  Councilors  come  in  with  in- 
considerable experience  or  knowledge  of  the  working 
or  history  of  the  organization,  and  in  the  nine  regular 
meetings  of  the  year  (if  they  attend  that  many)  they 
cannot  acquire  that  knowledge  of  organization  work 
which  is  really  necessary  for  the  needs  and  demands 
of  this  great  association.  Moreover  after  a year  of 
service  when  these  members  have  learned  somewhat 
of  the  intricacies  of  the  organization  they  pass  out  to 
be  succeeded  by  others  who  in  turn  usually  have  only 
a limited  knowledge  of  its  organization  needs  and 
responsibilities. 

The  problems  before  organized  medicine  were  never 
so  great  as  they  now  are.  Men  and  women  who 
are  sincere  in  their  desire  to  maintain  high  standards 
in  the  profession  of  medicine  must  give  their  time, 
their  thought  and  their  strength  to  the  solution  of 
these  problems  for  the  betterment  of  mankind  and 
for  the  preservation  of  professional  honor. 

The  great  difficulty  is  to  interest  our  fellows  in 
the  importance  of  these  official  positions. 

It  is  to  be  hoped  that  some  plan  of  a closer  and 
more  powerful  organization  may  be  evolved  in  the 
near  future. 

The  numerous  meetings  of  sections,  branches,  hos- 
pital staffs  and  other  special  societies  have  had  a 
most  disastrous  effect  upon  the  general  meetings  of 
the  County  Association.  Often  when  outstanding 

423 


42+ 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


speakers  with  big  messages  are  presented  there  will 
be  an  attendance  of  not  over  one  hundred  fifty  or 
two  hundred.  Dr.  George  Hunter,  who  was  President 
of  the  Association  last  year,  tells  me  that  he  believes 
the  attendance  did  not  average  over  fifty  or  seventy- 
five  at  the  general  meetings  for  that  year.  It  is 
somewhat  better  this  year,  but  nothing  that  it  should 
be  for  this  Association  of  1,800  members. 

This  is  regrettable  for  it  is  at  the  general  meetings 
that  the  fellowship  and  community  of  interest  is  best 
fostered.  This  statement  is  not  given  in  a spirit  of 
carping  criticism,  but  it  is  given  in  the  hope  that 
some  plan  may  be  devised  for  this  Association  and 
for  all  large  ones  in  the  State  whereby  a greater  in- 
terest may  be  aroused.  The  small  groups  are  liable 
to  lose  touch  with  their  fellows  of  other  groups,  and 
the  Association  fall  into  a state  of  comparative  in- 
action where  important  problems  in  policy  and  action 

Respectfully  submitted, 

William  Duffield,  Councilor. 

■ 

FOURTH  COUNCILOR  DISTRICT 

Calaveras,  Fresno,  Inyo,  Kings,  Madera,  Mariposa.  Merced. 

Mono,  San  Joaquin,  Stanislaus,  Tulare  and  Tuolumne  Counties 

To  the  President  and  House  of  Delegates: 

Fresno  County  Society  is  having  regular  meetings 
well  attended.  Membership  is  in  good  condition,  the 
ratio  being  above  the  average.  As  elsewhere,  they 
are  having  a great  deal  of  discussion  relative  to  the 
high  cost  of  medical  service  (a  special  letter  on  this 
was  sent  the  Council). 

San  Joaquin  County  Society  is  quite  active  in  all  de- 
partments. Good  programs  are  being  put  on  and 
attendance  is  good.  At  the  last  meeting  they  dis- 
cussed local  radio  broadcasting.  They  were  informed 
that  that  idea  is  being  discussed  by  the  Council. 
That  county  has  been  selected  by  the  Wilbur  Com- 
mittee as  one  of  the  counties  to  use  for  survey 
purposes,  and  Dr.  Sinai,  Public  Health  Officer,  repre- 
senting the  committee,  is  there  now  making  the  sur- 
vey and  cooperating  with  a committee  from  the 
Society. 

Stanislaus  County  Society  is  active.  Membership  of 
eligible  licentiates  includes  all  but  two  men.  Regular 
meetings  are  held  and  well  attended.  Most  of  the 
programs  are  given  by  outside  men. 

Tulare  County  Society  is  having  regular  meetings 
with  good  attendance  but  the  membership  is  hardly 
so  great  as  it  should  be,  there  being  in  the  county 
58  licentiates  and  a membership  of  only  37.  The 
Society  has  inaugurated  an  annual  joint  meeting 
with  the  County  Bar  Association  at  which  a pro- 
gram interesting  to  both  professions  is  given.  This 
seems  an  excellent  idea  as  it  brings  the  two  profes- 
sions in  closer  contact. 

Tuloumne  and  Merced  will  be  visited  within  the  next 
ten  days. 

This  comprises  all  organized  societies  in  District 
No.  4. 

Respectfully  submitted, 

Fred  R.  DeLappe,  Councilor. 

* 

FIFTH  COUNCILOR  DISTRICT 

Monterey,  San  Benito,  San  Mateo,  Santa  Clara  and 
Santa  Cruz  Counties 

The  Santa  Clara  County  Society,  having  the  largest 
membership  in  the  District,  is  carrying  out  the  most 
extensive  program,  and  has  a very  creditable  attend- 
ance at  meetings.  The  annual  tri-county  meeting, 
composed  of  Santa  Clara,  San  Benito  and  Monterey 


Counties,  was  held  at  Gilroy  on  September  18,  and 
was  well  attended.  The  principal  speaker  of  the  eve- 
ning was  Dr.  J.  H.  Woolsey,  who  spoke  on  the  early 
diagnosis  of  gastric  carcinoma. 

Reports  from  the  San  Mateo  County  Society  indi- 
cate the  usual  activity.  A more  detailed  report  will 
be  possible  after  attendance  of  the  meeting  to  be 
held  on  April  23. 

Monterey  County  Society  is  showing  a fair  attend- 
ance at  meetings  considering  the  number  of  mem- 
bers. At  the  meeting  held  at  Monterey  on  April  4, 
a unit  of  the  Woman’s  Auxiliary  was  organized.  This 
is  the  first  unit  in  the  Fifth  District  and  appeared  to 
start  with  considerable  enthusiasm.  The  County  So- 
ciety is  planning  to  lend  every  effort  to  make  the 
Annual  Meeting  of  the  California  Medical  Associa- 
tion at  Del  Monte  a memorable  one. 

The  attendance  of  the  Santa  Cruz  County  Society 
during  the  past  year  has  been  somewhat  erratic.  The 
most  recent  meeting  was  held  at  Boulder  Creek,  and 
was  addressed  by  Dr.  Leo  Eloesser  on  surgery  of  the 
thorax.  The  attendance  was  only  fair. 

Respectfully  submitted, 

A.  L.  Phillips,  Councilor. 

* 

SIXTH  COUNCILOR  DISTRICT 
San  Francisco  County 

To  the  President  and  House  of  Delegates: 

The  Sixth,  or  San  Francisco  District,  reports  prog- 
ress for  the  year  just  closed.  Interest  in  the  scientific 
meetings  has  been  well  maintained. 

Conferences  held  in  past  years  led  the  society  to 
believe  it  should  own  its  own  home.  Accordingly  the 
property  at  2180  Washington  Street,  formerly  one 
of  the  most  beautiful  homes  in  San  Francisco,  was 
purchased  and  is  now  occupied  by  the  society. 

It  was  first  believed  advisable  to  finance  this  home 
through  voluntary  pledges  from  the  members,  but 
during  this  year  it  has  been  the  consensus  of  opinion 
among  leaders  of  this  organization  that,  to  make  the 
headquarters  democratic  in  ownership,  all  members 
should  have  the  privilege  of  assisting  in  financing 
this  undertaking  and  each  and  every  member  should 
know  the  pride  of  ownership.  Therefore  the  society 
increased  the  dues  so  that  in  a few  years  the  San 
Francisco  County  Medical  Society  will  own,  outright, 
one  of  the  finest  county  society  homes  in  California. 

We  believe  the  House  of  Delegates  should  com- 
mend the  activities  of  the  officers  and  the  committees 
of  the  San  Francisco  County  Society  who  have  done 
such  hard  work  during  the  past  year.  This  accom- 
plishment should  serve  to  stimulate  all  other  units  of 
our  state  society  to  similar  efforts. 

Respectfully  submitted, 

W.  B.  Coffey,  Councilor. 

SEVENTH  COUNCILOR  DISTRICT 
Contra  Costa  and  Alameda  Counties 

To  the  President  and  House  of  Delegates: 

The  Seventh  Councilor  District  contains  Contra 
Costa  and  Alameda  Counties. 

Contra  Costa  County  covers  a large  territory.  In 
order  to  make  it  possible  for  all  doctors  to  attend  the 
meetings  of  the  society,  different  towns  are  selected 
for  each  meeting.  The  Woman’s  Auxiliary  has  organ- 
ized in  Contra  Costa  County  during  the  last  few 
months  and  meets  at  the  same  time  as  the  county 
society  although  not  in  the  same  place.  After  the 
scientific  program  the  doctors  are  usually  invited  to 


June,  1930 


COMMITTEE  REPORTS 


425 


partake  of  light  refreshments  by  the  auxiliary.  In 
discussing  the  problem  of  the  cost  of  medical  care, 
it  was  found  that  rural  districts  do  not  feel  the  need 
of  any  drastic  changes. 

Alameda  County  has  a well-organized  county 
society  and  holds  interesting,  well-attended  meetings. 
At  several  of  the  meetings  during  the  past  year, 
eastern  speakers  have  addressed  the  members.  Ap- 
proximately two-thirds  of  the  eligible  physicians  in 
Alameda  County  belong  to  the  medical  society.  Dur- 
ing the  year  twenty-nine  new  members  have  been 
taken  into  the  society.  The  question  of  medical  ser- 
vice has  been  discussed  at  length  by  the  members 
both  at  the  meetings  of  the  society  and  at  the  various 
staff  meetings,  but  as  yet  no  solution  of  the  problem 
has  been  evolved. 

Respectfully  submitted, 

Oliver  D.  Hamlin,  Councilor. 

* 

EIGHTH  COUNCILOR  DISTRICT 

Alpine,  Amador,  Butte,  Colusa,  El  Dorado,  Glenn.  Lassen,  Modoc, 

Nevada,  Placer,  Plumas,  Sacramento,  Shasta,  Sierra,  Sutter, 
Tehama,  Yolo  and  Yuba  Counties 

To  the  President  and  House  of  Delegates : 

As  Councilor  of  the  Eighth  District  I beg  to  submit 
the  following  report  on  some  of  the  counties  in  my 
district: 

Yuba-Sutter  Medical  Society  is  in  very  good  condi- 
tion. There  has  been  more  interest  shown  in  the  So- 
ciety by  the  members  in  the  past  year  than  there  has 
been  for  many  years  back.  Their  meetings  are  regular, 
on  the  second  Tuesday  of  each  month,  and  they  have 
very  good  programs;  outside  speakers,  as  a rule,  with 
a get-together  and  luncheon  following  the  scientific 
meeting.  I have  visited  there  often  and  my  official 
visit  comes  next  Tuesday,  April  8,  1930,  at  which 
time  Dr.  Karl  Meyer  of  the  University  of  California 
will  be  the  speaker.  Yuba-Sutter  now  has  sixteen 
members,  two  have  been  added  to  their  roster  during 
the  year. 

Tehama  County  Medical  Society  has  eleven  mem- 
bers. They  have  no  regular  time  to  meet,  but  meet  at 
the  call  of  the  chairman  and  then  only  a few  respond. 
I am  arranging  with  Drs.  Bailey  and  Bly  for  a meet- 
ing in  the  near  future. 

Yolo-Colusa  County  Medical  Society  is  in  very 
good  condition,  meets  quarterly,  the  next  meeting 
being  held  this  summer.  They  have  most  interesting 
meetings. 

Glenn  County  Medical  Society  has  considered  unit- 
ing with  the  Yolo-Colusa  County  Medical  Society. 
I have  asked  Dr.  Brown,  Secretary,  about  what  steps 
have  been  taken  in  the  proposed  amalgamation,  but 
have  not  heard  from  him. 

I am  to  visit  the  Butte  County  Medical  Society 
next  month.  Visits  to  the  Shasta  and  Lassen-Plumas 
County  Medical  Societies  will  be  made  in  the  summer. 

Nevada-Placer  County  Medical  Society  is  in  very 
good  condition,  having  regular  meetings  which  are 
well  attended.  Dr.  Robert  Peers  will  report  on  this 
Society  as  he  has  done  in  the  past. 

Respectfully  submitted, 

J.  B.  Harris,  Councilor. 

* 

NINTH  COUNCILOR  DISTRICT 
Humboldt,  Lake,  Marin,  Mendocino,  Napa,  Siskiyou,  Solano, 
Sonoma  and  Trinity  Counties 

To  the  President  and  House  of  Delegates : 

A brief  report  of  the  Medical  Society’s  action  in 
the  Ninth  Councilor  District  is  submitted. 


During  the  past  year  the  custom  of  joint  society 
meetings  inaugurated  in  1928  has  been  continued, 
thereby  increasing  interest  and  attendance  at  the 
society  gatherings.  Napa,  Sonoma,  Marin  and  Solano 
societies,  have  had  two  of  these  joint  meetings, 
gathering  for  a seven  o’clock  dinner  and  social  hour 
followed  by  a scientific  paper,  or  symposium,  then  a 
business  session  where  the  various  problems  facing 
the  profession  were  freely  discussed. 

In  May,  the  Napa,  Solano  and  Sonoma  societies 
were  the  guests  of  Dr.  Max  Rothschild  at  this  annual 
party,  where  the  members  enjoyed  a luncheon,  after- 
noon of  golf,  then  dinner,  followed  by  a scientific 
program. 

These  get-together  joint  meetings  are  enjoyed  and 
the  good  fellowship  displayed  has  resulted  in  an  im- 
proved friendly  spirit  among  the  physicians  of  the 
different  communities. 

The  Sonoma  society  organized  an  auxiliary  and  at 
the  March  meeting  we  were  surprised  to  find  instead 
of  the  usual  sixteen  to  twenty  members  present,  that 
forty-eight  physicians  and  wives  were  gathered  about 
the  dinner  table.  Later  the  ladies  withdrew  to  hold 
their  meeting  and  played  bridge.  The  society  con- 
ducted its  usual  meeting. 

On  April  3,  at  the  Ramona  Gardens,  Napa  Society 
entertained  the  society  and  auxiliary  of  Sonoma 
County  at  a dinner,  after  which  an  auxiliary  was 
formed  for  the  Napa  Society. 

Messrs.  Hartley  Peart  and  C.  Sullivan  both  de- 
livered excellent  papers  on  Economics  and  Medico- 
Legal  Phases  of  Medical  Practice.  This  meeting  was 
attended  by  several  of  the  naval  surgeons  from  Mare 
Island  and  they  were  so  pleased  at  the  spirit  displayed 
that  they  have  requested  invitations  to  be  mailed  the 
hospital  of  other  society  gatherings  that  they  may 
participate  in  the  enjoyment  of  these  pleasant  and 
instructive  medical  meetings. 

It  has  been  impossible  for  me  to  visit  the  Hum- 
boldt County  Society  during  the  past  year,  as  this 
trip  requires  two  entire  days  and  this  time  could  not 
be  spared  at  the  dates  of  the  meetings. 

The  ninth  district  is  large  and  difficulty  is  found  in 
arranging  one’s  practice  to  attend  both  Council  and 
Society  meetings,  though  we  are  endeavoring  to  the 
best  of  our  ability  to  contact  each  Society. 

Respectfully  submitted, 

Henry  S.  Rogers,  Councilor. 


REPORTS  OF  STANDING  COMMITTEES* 

COMMITTEE  ON  ASSOCIATED  SOCIETIES  AND 
TECHNICAL  GROUPS 

To  the  President  and  House  of  Delegates: 

Herewith  find  report  of  the  Committee  on  Asso- 
ciated Societies  and  Technical  Groups: 

The  wording  of  Section  16  of  Chapter  5 of  the  new 
by-laws  indicates  that  this  committee  would  have  a 
very  large  contract  before  it  in  case  it  tried  to  cover 
its  entire  domain  during  any  one  calendar  year.  It 
should  be  possible,  nevertheless,  to  make  progress  if 
one  after  the  other  of  its  functions  is  given  attention. 

1.  During  the  last  year  the  particular  task  before 
the  committee  was  to  aid  in  the  organization  of 
county  woman’s  auxiliaries.  It  is  gratifying  to  report 
that  up  to  the  time  that  this  report  is  made  that  a 
county  woman’s  auxiliary  has  been  formed  in  the 
following  counties: 


* Members  of  Standing  Committees  are  urged  to  meet 
during  the  Annual  Session  and  organize  for  the  coming 
year  and  to  hold  at  least  one  regular  meeting  of  their 
respective  committee  during  the  Annual  Session. 


426 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Contra  Costa,  Kern,  Los  Angeles,  Orange,  San 
Bernardino,  Sonoma  and  Monterey. 

A letter  has  gone  forward  from  your  committee  to 
each  county  medical  society  urging  the  officers  of 
each  county  unit  to  get  in  back  of  this  woman’s 
auxiliary  work.  Such  an  auxiliary  organization  can 
be  made  to  develop  into  a very  strong  adjunct  of  the 
California  Medical  Association,  but  its  influence  will 
be  greatest  in  proportion  as  its  membership  repre- 
sents a fair  cross  section  of  the  state.  A leaflet  on 
organization  of  woman’s  auxiliaries  has  also  been 
compiled  by  a member  of  the  committee,  Doctor 
Kress,  and  is  being  used  in  the  further  development 
of  county  auxiliaries. 

2.  In  the  event  of  a decision  of  the  House  of  Dele- 
gates in  favor  of  a basic  science  act,  it  is  quite  pos- 
sible that  the  cooperation  of  the  professions  of 
dentistry,  pharmacy,  and  perhaps  even  of  optometry, 
might  be  enlisted  in  an  effort  to  have  each  of  those 
professions  also  come  under  the  domain  of  a basic 
science  act  which  would  demand  a high  school  edu- 
cation and  a knowledge  of  certain  fundamental  sub- 
jects before  the  final  examination  for  a special  or 
professional  license  could  be  taken. 

3.  Cooperation  and  good  understanding  with  tech- 
nical groups  such  as  x-ray  technicians,  laboratory 
technicians,  etc.,  is  in  itself  a tremendously  big  prob- 
lem. The  California  Medical  Association  several  years 
ago  attempted  to  solve  this  problem,  but  with  the 
passing  of  years  was  obliged  to  give  up  the  semi- 
intimate relationship  that  had  been  provided. 

4.  This  committee  would  suggest  that  it  would  be 
very  desirable  for  the  California  Medical  Association 
to  establish  the  custom  of  appointing  official  delegates 
to  the  annual  sessions  of  the  state  medical  societies 
of  the  commonwealths  which  border  California.  Such 
official  delegates  could  be  chosen  from  the  members 
of  the  C.  M.  A.,  one  or  more  of  whom  are  nearly 
always  on  the  program  of  such  neighboring  state 
medical  associations. 

It  is  true  that  such  an  appointment  would  be  little 
more  than  a gesture  of  good  fellowship  and  yet  after 
all  it  is  through  such  expressions  of  good  fellowship 
that  better  understanding  and  more  united  effort 
come  into  being. 

5.  It  is  interesting  to  note  that  the  need  of  a good 
understanding  between  the  learned  professions  has 
made  itself  manifest  to  such  extent  that  in  California 
a “League  for  the  Preservation  of  Professional 
Rights”  came  into  existence  during  the  last  year,  and 
said  League  consists  of  members  of  the  professions 
of  medicine,  dentistry,  law  and  pharmacy. 

The  object  of  that  League  is  to  promote  coopera- 
tive effort  in  all  endeavors  to  maintain  the  educational 
and  professional  standards  and  privileges  and  rights 
of  those  four  professions. 

In  the  year  to  come  it  is  hoped  that  this  Committee 
on  Associated  Societies  and  Technical  Groups  will 
be  able  to  continue  its  activities  along  lines  indicated 
somewhat  briefly  above  and  to  be  able  to  make  a 
report  of  continued  progress  at  the  1931  Annual 
Session  of  the  California  Medical  Association. 

Respectfully  submitted, 

Committee  on  Associated  Societies  and 
Technical  Groups, 

William  B.  Bowman,  Chairman 
George  H.  Kress 
Harold  A.  Thompson 
* 

COMMITTEE  ON  EXTENSION  LECTURES 
To  the  President  and  House  of  Delegates: 

The  Committee  on  Extension  Lectures  appointed  at 
the  last  meeting  of  the  California  Medical  Associa- 


tion, namely,  Robert  T.  Legge,  Berkeley,  chairman; 
James  F.  Churchill,  San  Diego,  and  Robert  A.  Peers, 
Colfax,  have  not  been  able  to  hold  personal  con- 
ferences due  to  the  fact  that  their  residences  are  in 
such  various  parts  of  the  state. 

It  is  the  aim  of  the  chairman  to  call  a special 
meeting  at  the  coming  Del  Monte  convention. 

At  this  conference  it  is  our  purpose  to  discuss  ways 
and  means  for  improving  the  Extension  Lecture 
service.  We  shall  attempt  to  get  in  touch  with  vari- 
ous secretaries  of  county  units  to  determine  the  need 
and  value  of  this  service  and  to  improve  the  same 
by  adding  new  lecturers  in  the  various  fields  of 
medicine. 

It  is  our  hope  to  add  to  this  group  of  lecturers  men 
who  are  doing  original  research  in  the  basic  medical 
sciences,  public  health,  medical  economics  and  juris- 
prudence. 

Our  great  universities  have  from  time  to  time 
foreign  scholars  who  are  exchange  professors  and 
who  are  brought  to  this  country  for  special  lectures 
and  research. 

We  believe  the  Extension  Committee  should  keep 
the  secretary  of  the  Society  posted  when  these  dis- 
tinguished visitors  are  here  in  our  state  with  a view 
to  ascertaining  if  they  are  available  to  talk  on  their 
particular  subjects  before  the  various  societies.  This, 
of  course,  would  apply  more  particularly  to  our  larger 
cities  in  proximity  to  the  universities. 

At  the  present  time  there  are  various  agencies,  such 
as  the  Eastman  Kodak  Company,  which  can  furnish 
at  small  rental  extraordinary  films  on  special  subjects 
relating  to  medical  science.  It  is  the  hope  of  the 
committee  that  a list  of  the  subjects  will  be  available 
and  placed  in  the  hands  of  the  secretary  of  the 
Society. 

Respectfully  submitted, 

Committee  on  Extension  Lectures, 
Robert  T.  Legge,  Chairman 
James  F.  Churchill 
Robert  A.  Peers 
The  Secretary,  ex-officio 

.V, 

etr 

COMMITTEE  ON  HEALTH  AND  PUBLIC 
INSTRUCTION 

To  the  President  and  House  of  Delegates: 

Your  committee  on  Health  and  Public  Instruction, 
appointed  after  the  Coronado  meeting  and  made  up 
of  three  members  located  at  widely  separated  points 
in  the  state,  has  had  no  opportunity  to  meet,  and  very 
little  correspondence  has  been  exchanged  because  of 
our  unanimous  feeling  that  until  the  duties  of  the 
committee  were  more  clearly  defined  by  the  Council 
of  the  Association,  there  was  nothing  for  us  to  do. 

The  only  official  act  of  the  year  was  a letter  fur- 
nishing information  to  one  Dr.  Theodore  Toepel  of 
Atlanta,  Georgia,  upon  the  activities  of  the  California 
Medical  Association  in  instructing  the  lay  public  on 
matters  of  health. 

The  committee  feels  that  the  problem  of  educating 
the  lay  public  is  an  important  one,  made  particularly 
difficult  by  the  fact  that  no  fund  is  appropriated  for 
the  purpose,  but,  if  financial  support  can  be  obtained, 
offers  the  following  suggestions: 

First:  Broadcasting  from  one  of  the  powerful  sta- 
tions in  either  Los  Angeles  or  San  Francisco.  The 
material  offered  should  be  of  such  a type  as  to  hold 
the  attention  of  the  radio  audience  and  not  a fixed 
lecture  on  hygiene  from  which  most  listeners  on  the 
air  will  quickly  turn. 

Second:  Properly  censured  newspaper  articles  on 
health  topics  appearing  weekly  and  sponsored  by  the 
local  medical  society. 


June,  1930 


COMMITTEE  REPORTS 


427 


Third:  Popular  semi-scientific  lectures  to  the  lay 
public. 

Fourth:  The  establishment  of  health  programs  in 
the  local  high  schools  illustrating  particularly  the 
problems  of  infectious  diseases. 

Fifth:  Circularizing  the  laity  by  the  aid  of  retail 
drug  stores.  Short,  pointed  articles  furnished  by  the 
medical  association  to  be  wrapped  with  purchases. 

All  of  these  activities  should  be  under  the  direct 
supervision  of  the  local  medical  society  without  the 
identity  of  any  individual  being  made  known. 

Respectfully  submitted, 

Committee  on  Health  and  Public  Instruction, 
Gertrude  Moore,  Chairman 
Fred  B.  Clarke 
Henry  S.  Rogers 

COMMITTEE  ON  HISTORY  AND  OBITUARIES 
To  the  President  and  House  of  Delegates: 

The  committee  on  History  and  Obituaries  of  the 
Association  begs  to  report  that  during  the  fourteen 
months  from  January  1,  1929  to  February  28,  1930, 
with  a membership  of  4,854,  eighty-one  deaths  have 
been  reported  as  follows: 

Deaths  Reported  from  January  1,  1929,  to  January  1,  1930 


County  Society 

Abbott,  Philip Alameda 

‘Anderson,  Jennie  H San  Francisco 

Ainsworth,  Frank  Kenley San  Francisco 

Aiken,  Ho  R Alameda 

Berndt,  Richard  M.  H San  Francisco 

Brunig,  Henry  Daniel Los  Angeles 

Berry,  Stanley  Francis Alameda 

Buckingham,  Henry  Proctor San  Francisco 

Blair,  James  C Santa  Clara 

Browning,  Frederick  W Alameda 

Bullock,  Newell  H Santa  Clara 

Brodrick,  Richard  George San  Francisco 

Cipes,  Joseph  S Los  Angeles 

Coates,  Benjamin  O Los  Angeles 

Cowan,  John  Francis San  Francisco 

Cleverdon,  Ernest San  Diego 

Crabtree,  Hezediah  T San  Francisco 

Clark,  Fred  Pope San  Joaquin 

DeLoss,  Herbert Alameda 

Emmal,  F.  S - San  Francisco 

Franklin,  Blake Santa  Clara 

Fottrell,  Michael  J San  Francisco 

Foster,  Ralph  de  Lecaire San  Diego 

Gross,  Louis San  Francisco 

Gardner,  John  Melvin Santa  Cruz 

Goetz,  Alice  L Santa  Barbara 

Haake,  Chas.  H.  G Shasta 

Hamlin,  Francis  Allen ...Kern 

Howell,  Ernest  T.  D Los  Angeles 

Huntington,  Thomas  W San  Francisco 

Hagen,  John  Chas.  Edward : Los  Angeles 

Holsclaw,  Florence  Mabel San  Francisco 

Haggart,  Fred  Stuart Los  Angeles 

Jackson,  Paul  Kingsley San  Luis  Obispo 

Jacobs,  Edward  H Los  Angeles 

Jones,  William  Farrington Marin 

Kelsey,  Arthur  Louis Los  Angeles 

Koons,  Henry  Hagus Los  Angeles 

Leisenring,  Luther  M Solano 

Maggs,  Frederic  G San  Joaquin 

*Magee,  Thomas  L San  Diego 

Mohun,  Chas.  Constantine San  Francisco 

McKinnon,  Wilfred  Chas San  Francisco 

Maine,  Alva  Frank Alameda 

Martin,  Hugh  Ralph Riverside 

McGee,  Harry  Stowe Los  Angeles 

Miller,  Ulysses  Grant Los  Angeles 

Morris,  John  Knox Stanislaus 

Mott,  George  Hervey Monterey 

Martin,  Jean  Marion San  Francisco 

Munroe,  Harrington  Bennett Los  Angeles 

Newton,  Frances  Louise Yolo-Colusa 

Nutting,  Chas.  Wilbur Siskiyou 

O’Brien,  Aloysius  Paul San  Francisco 

Oliver,  John  Edward San  Joaquin 

Royer,  Daniel  Franklin Orange 

Ritchie,  Adam  Marsden Monterey 

Reed,  Clarence  E Shasta 

Reynolds,  Clyde  G Siskiyou 

Stein,  Frederick  L San  Francisco 

Scroggs,  Gustavus  A Los  Angeles 

Six,  Clarence  Logan San  Joaquin 

Sweeney,  George  J San  Francisco 

Smith,  j.  Wesley Los  Angeles 


County  Society 

Shiels,  John  Wilson San  Francisco 

Simpson,  Frank  W Alameda 

Tate,  C.  Frances  S Los  Angeles 

Trew,  Niel  Charles Los  Angeles 

Thompson,  Roy  Oliver Imperial 

Tebbe,  William  Edward Siskiyou 

Townsend,  Vinton  Ray Los  Angeles 

Williams,  Fred  H Fresno 

Ward,  Edwin  Davis Los  Angeles 

Werner,  Carl  Otto  Eduard San  Francisco 

Wells,  Kathryn  Gunby Los  Angeles 

Yates,  William  Charles Monterey 

Young,  J.  Audley Stanislaus 

Zbinden,  D.  B Los  Angeles 

Deaths  reported  from  January  1,  1930,  to  February  28,  1930 

County  Society 

Beckwith,  Ward  M Alameda 

Draper,  Alfred  Lawrence San  Francisco 

Scholl,  Marguerite Los  Angeles 

During  these  fourteen  months  fifteen  Obituaries 


have  appeared  in  the  official  organ,  California  and 
Western  Medicine. 

History  of  State  and  Local  Associations : 

On  this  subject  we  beg  to  suggest  the  following 
for  consideration: 

1.  That  every  County  Medical  Society  be  requested 
to  appoint  a committee  to  compile  a history  of  the 
organization  and  that  a copy  of  the  same  be  sent  to 
the  California  Medical  Association  for  preservation 
in  the  historical  archives  of  the  same. 

2.  That  the  C.  M.  A.  itself  through  its  standing 
committee  compile  a history  of  the  State  Society  to 
be  printed  in  one  of  the  annual  directories  or  in  a 
separate  volume. 

3.  That  the  C.  M.  A.  through  its  standing  com- 
mittee on  history  endeavor  to  interest  the  State  Board 
of  Health  in  compiling  a history  of  its  organization 
and  development,  the  same  to  be  published  with  the 
C.  M.  A.  history. 

We  urge  that  the  Association  actively  follow  out 
these  suggestions. 

Respectfully  submitted, 

Committee  on  History  and  Obituaries, 

Charles  D.  Ball  {Chairman) , 
Percy  T.  Phillips, 

Emmet  Rixford, 

The  Secretary,  ex-officio, 

The  Editor,  ex-officio. 

*■ 

COMMITTEE  ON  HOSPITALS,  DISPENSARIES  AND 
CLINICS 

The  report  of  this  committee,  consisting  of  Doctors 
John  C.  Ruddock,  Walter  B.  Coffey  and  Gayle  C. 
Moseley,  will  be  printed  in  the  July  issue  of  Cali- 
fornia and  Western  Medicine.  This  report  covered 
a somewhat  comprehensive  survey  made  under  the 
supervision  of  Dr.  John  C.  Ruddock. 

# 

COMMITTEE  ON  INDUSTRIAL  PRACTICE 

To  the  President  and  House  of  Delegates: 

The  chairman  of  the  Industrial  Medical  Practice 
Committee  reports  that  nothing  of  special  interest 
with  reference  to  industrial  medical  practice  has  come 
up  during  the  year.  A summary  of  all  work  done  by 
the  committee  will  be  presented  at  the  annual  session. 

Respectfully  submitted, 

Committee  on  Industrial  Practice, 

Gayle  G.  Moseley  {Chairman) , 
Packard  Thurber, 

Walter  B.  Coffey. 

* 

COMMITTEE  ON  MEDICAL  ECONOMICS 

This  committee  consists  of  Doctors  John  H.  Graves 
and  Ruggles  A.  Cushman.  A full  report  outlining  the 
facts  gathered  in  a survey  made  by  Dr.  John  H. 
Graves  will  appear  in  the  July  issue  of  California  and 
Western  Medicine. 


* Affiliate  member. 


428 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


COMMITTEE  ON  MEDICAL  DEFENSE 
To  the  President  and  House  of  Delegates : 

For  years  the  California  Medical  Association  with- 
out special  charge  other  than  the  regular  Association 
dues,  furnished  legal  defense  to  any  member  who  was 
sued  for  alleged  malpractice.  Adverse  judgments, 
under  this  system,  were  paid  by  the  individual 
member. 

In  addition  to  this  legal  defense,  on  December  7, 
1916,  for  a group  who  wished  financial  protection 
also,  an  Indemnity  Defense  was  instituted.  On  pay- 
ment of  $30,  members  were  given  not  only  legal 
defense  but  protection  against  adverse  judgment  up 
to  $5,000.  That  on  so  small  an  assessment  this  pro- 
tection was  carried  for  seven  years,  was  due, 
doubtless,  to  the  amazing  record  that  no  adverse 
judgment  was  rendered  during  that  time,  though  a 
few  just  settlements  were  made  out  of  court.  Mount- 
ing costs  necessitated  an  additional  assessment  of 
$10  in  1922. 

Though  the  financial  condition  of  the  Indemnity 
Defense  Fund  was  sound,  the  steadily  mounting  court 
costs  and  vastly  increased  sums  sought  in  judgment, 
moved  the  House  of  Delegates  in  May  of  1922  to 
adopt  a resolution  which  directed  the  Council  to  ter- 
minate Legal  Defense  as  of  June  30,  1924,  and  In- 
demnity Defense  as  of  November  30,  1923. 

To  provide  for  those  members  who  desired  it,  the 
Medical  Society  of  the  State  of  California  was  organ- 
ized and  an  Optional  Defense,  effective  July  1,  1924, 
at  a figure  commensurate  with  changed  conditions, 
was  instituted. 

The  coverage  offered  the  members  of  the  Cali- 
fornia Medical  Association  through  membership  in 
the  Optional  Defense  (as  it  is  commonly  called), 
closely  resembles  the  early  legal  defense,  the  principal 
difference  being  that  insurance  through  a commercial 
company  to  cover  court  costs  and  indemnity  against 
adverse  judgments  is  a condition  precedent  to  mem- 
bership. Optional  Defense  gives  the  service  of  the 
legal  counsel  of  the  Association  and  also  of  the  group 
of  associates  who  have  been  trained  through  years  of 
activity  in  behalf  of  the  members  of  the  California 
Medical  Association  and  who  have  an  expert  under- 
standing of  the  problems  which  confront  the  phy- 
sician who  is  sued  for  alleged  malpractice — problems 
that  involve  finance  and  reputation  both. 

The  injustice  of  taxing  all  members  for  a service 
accorded  to  a minor  group  underlies  the  yearly  assess- 
ment of  $10  set  by  the  trustees  of  the  Society  for  this 
service.  On  December  30,  1929,  seven  hundred  mem- 
bers had  secured  Optional  Defense  coverage.  The 
fund  resultant  upon  the  $10  assessment  is  used  to 
carry  the  costs  of  legal  service  only.  Since  Decem- 
ber 1,  1924,  seventeen  claims  and  twenty-two  cases 
have  been  disposed  of;  eleven  claims  and  twenty-nine 
cases  are  now  pending.  Approximately,  therefore,  one 
in  ten  of  the  seven  hundred  members  covered  have 
faced  the  unpleasantness  of  suit. 

The  duties  of  your  committee  on  Medical  Defense 
are  outlined  in  the  Constitution  and  By-Laws  as 
follows: 

“The  Committee  on  Medical  Defense,  subject  to 
the  approval  of  the  council,  shall  prepare  plans  and 
establish  rules  for  the  protection  of  the  legal  rights 
of  members  of  this  Association  against  whom  suits 
for  alleged  malpractice  are  brought. 

“It  may  assist  in  the  defense  of  any  member  sued 
for  alleged  negligence  if  the  member  was  in  good 
standing  and  had  complied  with  the  rules  of  the 
council  when  the  service  on  account  of  which  suit 
was  threatened  or  brought  was  rendered — provided 


that  the  committee  determines  that  the  position  of 
the  member  merits  such  action.” 

Your  committee  finds  that  the  Medical  Society  of 
the  State  of  California,  providing  Optional  Defense 
for  those  who  desire  and  pay  for  it,  has  established 
rules  for  the  protection  of  the  legal  rights  of  members 
of  this  Association  interested,  and  strongly  commends 
the  service  now  furnished  by  Optional  Defense.  The 
committee  in  particular  is  pleased  to  thoroughly  en- 
dorse and  approve  the  work  of  the  legal  representa- 
tives of  the  Association  in  their  defense  of  our 
members  as  shown  by  the  annual  reports  of  the 
Legal  Department.  They  recommend  that  the  trus- 
tees of  this  Society,  the  officers  and  councilors  of  the 
Association,  and  the  members  of  the  House  of  Dele- 
gates, and  the  various  County  Society  officers  bring 
to  the  attention  of  the  members,  this  defense  that  is 
now  available  and  encourage  continued  enrollment 
therein. 

Respectfully  submitted, 

Committee  on  Medical  Defense, 
George  G.  Reinle,  Chairman 
J.  L.  Maupin,  Sr. 

Mott  H.  Arnold 
* 

COMMITTEE  ON  MEMBERSHIP  AND  ORGANIZATION 
To  the  President  and  House  of  Delegates: 

In  accordance  with  Section  7,  Chapter  5,  of  the 
Constitution  and  By-laws  of  the  California  Medical 
Association,  your  Committee  on  Membership  and 
Organization  begs  to  submit  the  following,  the  first 
annual  report  of  this  committee. 

According  to  the  Directory  of  the  Board  of  Medical 
Examiners  for  1929  there  were  8,974  physicians  in  the 
State  of  California  holding  certificates  to  practice 
medicine.  There  were  1,720  outside  the  State  of  Cali- 
fornia holding  certificates,  making  a total  of  10,694. 

December  1,  1930,  there  were  4,854  doctors  who 
were  members  of  the  California  Medical  Association. 
This  committee  realizes  that  there  are  many  phy- 
sicians out  of  this  5,840  nonmembers  who  are  eligible 
to  become  members  and  should  be  enlisted. 

Your  committee  has  sent  a letter  to  the  president 
and  secretary  of  each  component  society  of  the  state 
asking  that  a membership  committee  be  appointed  to 
endeavor  to  enlist  as  members  those  eligible  within 
the  boundaries  of  their  territory  and  who  are  not 
members  at  the  present  time.  However,  the  com- 
ponent societies  were  cautioned  against  lowering  the 
standards  for  membership  in  their  society.  We  have 
had  to  date  replies  from  twenty-three  of  the  com- 
ponent societies  notifying  us  that  such  committee 
has  been  appointed.  In  fact,  Los  Angeles  and  San 
Francisco  counties  have  had  for  some  time  such  a 
committee  functioning.  We  expect  ultimately  to  re- 
ceive similar  responses  from  the  remaining  com- 
ponent societies,  as  the  letter  was  sent  only  a short 
time  ago  and  we  are  receiving  replies  daily. 

This  committee  regrets  that  they  have  been  unable 
to  hold  a formal  meeting  and  have  communicated  by 
mail  only.  However,  we  expect  to  hold  a meeting 
during  the  coming  annual  session  of  the  Association 
and  formulate  a working  plan  with  the  view  of  mak- 
ing possible  a more  definite  and  quantitative  report 
in  1931. 

Respectfully  submitted, 

Committee  on  Membership  and  Organization, 
LeRoy  Brooks,  Chairman 
Harlan  Shoemaker 
Jesse  W.  Barnes 


June,  1930 


COMMITTEE  REPORTS 


429 


COMMITTEE  ON  MEDICAL  EDUCATION  AND 
MEDICAL  INSTITUTIONS 

To  the  President  and  House  of  Delegates : 

Owing  to  the  fact  that  the  members  of  the  stand- 
ing committees  were  not  notified  of  their  appointment 
until  after  the  last  annual  session  at  San  Diego,  it 
was  not  possible  for  members  from  widely  separated 
cities  to  hold  an  organization  conference.  Thursday, 
May  1,  has  been  set  for  such  organization  meeting 
at  the  Del  Monte  session. 

The  Committee  on  Medical  Education  and  Medical 
Institutions  has  no  other  report  to  submit. 

Respectfully  submitted, 

Committee  on  Medical  Education  and 
Medical  Institutions, 

George  Dock,  Chairman 
H.  A.  L.  Ryfkogel 
George  G.  Hunter 

* 

COMMITTEE  ON  PUBLICATIONS 
To  the  President  and  House  of  Delegates : 

Your  committee  was  unable  to  organize  at  the  San 
Diego  annual  session  of  1929  due  to  the  fact  that  the 
new  by-laws  which  brought  it  into  existence  were 
not  adopted  until  that  session.  Therefore,  only  a 
tentative  report  will  be  here  submitted. 

There  are  three  official  publications  provided  for 
in  the  Constitution  and  By-laws  of  the  California 
Medical  Association:  The  official  journal,  California 
and  Western  Medicine;  The  Annual  Directory,  and 
The  Pre-Convention  Bulletin.  Of  these  three  the 
Pre-Convention  Bulletin  will  make  its  first  appear- 
ance at  the  Del  Monte  meeting  of  this  year. 

Your  committee  further  begs  leave  to  submit  the 
following  suggestions  concerning  the  aforementioned 
publications: 

1.  California  and  Western  Medicine,  the  official 
journal  of  the  California  Medical  Association  is  un- 
doubtedly in  the  very  front  rank  of  State  Medical 
Society  publications.  This  is  true  both  as  to  its  form, 
the  nature  of  the  subject  matter  and  its  general  tone. 
Concerning  it  our  committee  has  neither  criticism  nor 
suggestion  because  we  believe  the  editors  have  suc- 
ceeded in  bringing  into  being  an  official  journal 
admirably  adapted  to  the  needs  of  the  members  of 
the  California  Medical  Association  and  at  the  same 
time  much  esteemed  by  members  of  our  profession 
generally  throughout  the  country. 

2.  Concerning  the  Annual  Directory,  it  is  our  be- 
lief that  this  should  contain  not  only  a list  of  the 
names  of  the  members  grouped  by  counties  so  as  to 
permit  easy  comparison  with  the  same  arrangement 
of  doctors  of  medicine  in  different  counties  as  brought 
out  by  the  California  State  Board  of  Medical  Ex- 
aminers, but  also  it  should  contain  some  general 
information  necessary  to  the  well-being  of  our  be- 
loved profession,  to  wit: 

(a)  We  would  suggest  in  addition  to  standing  in- 
formation in  the  last  edition  that  in  the  next  Di- 
rectory there  be  incorporated  “The  Rules  and  Prin- 
ciples of  Professional  Conduct,”'  either  in  form  and 
substance  as  brought  out  by  the  American  Medical 
Association  or  as  brought  out  by  the  New  York 
Medical  Society. 

(b)  The  New  York  Medical  Society  in  its  Direc- 
tory also  prints  the  Hippocratic  Oath  in  a leaflet 
containing  its  Principles  of  Professional  Conduct. 
To  our  minds  it  would  be  an  excellent  thing  to  in- 
corporate the  Hippocratic  Oath  in  our  Directory.  To 
this  may  be  added  other  great  words  of  noted  phy- 
sicians concerning  professional  conduct,  etc. 

(c)  To  our  minds  a digest  of  malpractice  laws, 
together  with  words  of  caution  and  advice  which  all 
medical  men  should  possess  will  be  invaluable. 

(d)  An  additional  item  would  be  a brief  one-page 
notice  concerning  the  Woman’s  Auxiliary  of  Cali- 
fornia. 


3.  The  Pre-Convention  Bulletin.  We  are  heartily 
in  favor  of  the  Pre-Convention  Bulletin  and  believe 
that  if  it  be  properly  conducted  it  can  be  made  of 
real  value  to  the  California  Medical  Association.  It 
will  give  the  members  of  the  House  of  Delegates  a 
much  better  idea  of  the  problems  and  needs  of  the 
State  Association  than  would  otherwise  be  possible 
and  in  that  manner  would  make  for  more  efficient 
procedure  and  action  by  the  House  of  Delegates. 

A Pre-Convention  Bulletin  would  also  perform  a 
great  service  in  making  it  possible  to  have  every 
standing  committee  do  its  work  in  due  form  and  order 
during  each  year.  The  standing  committees  which 
fail  to  make  a report  according  to  the  new  by-laws 
are  subject  to  change  in  their  membership  and 
rightly  so. 

It  is  our  belief  that  it  may  take  several  years  before 
the  full  value  of  this  Pre-Convention  Bulletin  will  be 
appreciated.  Once,  however,  it  has  had  a fair  trial 
we  are  certain  that  the  members  of  the  Association 
will  be  more  than  convinced  that  money  expended 
thereon  will  have  done  most  excellent  service. 

Respectfully  submitteed, 

Committee  on  Publications, 

Percy  T.  Magan,  Chairman 
Frederick  F.  Gundrum 
The  Secretary,  ex-officio 
The  Editor,  ex-officio 

* 

COMMITTEE  ON  PUBLIC  POLICY  AND 
LEGISLATION 

To  the  President  and  House  of  Delegates : 

The  following  annual  report  of  the  Committee  on 
Public  Policy  and  Legislation  is  respectfully  sub- 
mitted to  the  House  of  Delegates: 

Pending  Legislation:  Your  committee  has  had  under 
consideration  many  bills  which  have  been  drafted 
from  various  sources  and  which  are  to  be  submitted 
to  the  coming  Legislature,  viz.,  a proposed  amend- 
ment to  the  dental  law  permitting  dental  surgeons 
to  prescribe  veronal,  barbitol  or  any  of  its  salt  deriva- 
tives, etc.;  a bill  proposed  to  establish  a state  medical 
library;  legislation  relative  to  the  education  and  train- 
ing of  nurses  in  an  accredited  school  of  nursing;  a 
bill  proposing  the  establishment  of  a State  Board  of 
Examiners  for  nurses. 

Your  committee  has  acted  upon  federal  legislation 
wherein  bills  have  been  introduced  before  Congress 
to  create  in  the  Treasury  Department  a Federal 
Bureau  of  Narcotics  and  to  empower  the  Federal 
Commissioner  of  Prohibition  to  license  physicians  for 
prescribing  of  narcotics  and  for  the  suspension  and 
revocation  of  these  licenses  by  the  Federal  Commis- 
sioner of  Prohibition.  We  have  also  considered 
federal  legislation  before  Congress  on  the  cancellation 
of  the  yearly  allotment  of  medicinal  liquor  for  the 
emergency  use  of  doctors;  also  federal  action  brought 
out  in  the  government’s  Bosch  Magneto  suit,  relative 
to  an  alleged  attempt  to  cripple  the  American  dye 
industry  in  behalf  of  the  German  dye  monopoly. 
Your  committee  has  taken  action  on  the  federal  bill  to 
prohibit  experiments  upon  living  dogs  in  the  District 
of  Columbia  and  providing  a penalty  for  violation 
thereof. 

Your  committee  has  given  intensive  study  to  the 
proposed  Basic  Science  Law  of  the  State  of  California 
as  related  to  the  operation  of  the  Medical  Practice 
Act  and  has  also  considered  at  length  certain  phases 
of  the  economic  problems  of  our  members  and  a plan 
for  rendering  medical  service  to  the  so-called  “white 
collar  brigade.” 

Your  committee  has  considered  and  discussed  cer- 
tain features  concerning  the  advisability  of  possible 
revision  of  the  California  Medical  Practice  Act  and 
has  also  taken  up  matters  relating  to  the  inauguration 


430 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


of  an  eight-hour  schedule  for  special  nurses.  Your 
committee  has  had  submitted  to  it  items  concerning 
the  wage  earners’  bankruptcy  procedures  and  has 
discussed  the  desirability  of  a California  law  safe- 
guarding the  medical  profession  in  matters  of  this 
kind  and  has  discussed  proposed  amendments  to  the 
present  laws  relative  to  medical  expert  testimony  and 
many  other  matters  that  may  be  presented  at  the 
coming  legislature. 

Your  committee  wishes  to  quote  from  an  editorial 
in  California  and  Western  Medicine  bringing  your 
attention  to  the  fact  that  the  year  of  1930  is  a state 
election  year. 

“ The  Year  1930  Is  a State  Election  Year. — This  cap- 
tion is  presented  to  remind  us  of  our  individual  civic 
obligations  to  be  interested  in  the  complexion  of  the 
next  state  legislature,  many  of  whose  assembly  and 
senate  members  will  be  elected  in  the  fall  of  1930. 
These  particular  lay  fellow  citizens  who  will  have 
legislative  powers  should  be  contacted  with  at  an 
early  day  and  an  intelligent  effort  made  to  acquaint 
them  with  the  viewpoints  of  physicians  as  regards 
maintenance  of  proper  standards  in  medical  licensure 
and  in  public  health  activities.  It  is  not  fair  to  criti- 
cize members  of  the  assembly  and  senate  when  they 
vote  in  opposition  to  the  maintenance  of  such  stand- 
ards if  we  have  made  no  previous  attempts  to  acquaint 
them  with  some  of  our  problems  -which  may  come 
before  them,  and  to  inform  them  why  we  hold  certain 
opinions  thereon.  The  medical  profession  does  suf- 
ficient service  in  the  protection  of  the  public  health  of 
California  to  merit  careful  consideration  of  its  view- 
points. Legislators  will  be  found  to  be  glad  to  give 
such  consideration  if  proper  contacts  are  made  from 
the  beginning.  Every  member  who  knows  a state 
assemblyman  or  state  senator  or  a prospective  state 
assemblyman  or  senator  may  well  cultivate  such 
acquaintanceship  or  friendship,  for  it  later  on  might 
be  of  real  value  in  the  protection  of  public  health 
interests.  In  responsibilities  such  as  this  every  mem- 
ber of  the  California  Medical  Association  can  be  of 
service.  The  officers  of  the  Association  can  only  act 
for  and  speak  in  behalf  of  their  fellow  members.” 

Respectfully  submitted, 

Committee  on  Public  Policy  and  Legislation, 
Junius  B.  Harris,  Chairman 
William  Duffield 
Joseph  Catton 
The  President,  ex-officio 
The  President-elect,  ex-officio 

& 

COMMITTEE  ON  SCIENTIFIC  WORK 
To  the  President  and  House  of  Delegates : 

The  program  printed  in  the  April  issue  of  Cali- 
fornia and  Western  Medicine  and  reprinted  for  dis- 
tribution at  each  annual  meeting  is  the  most  tangible 
evidence  of  the  work  which  is  yearly  done  by  section 
officers  and  the  Arrangements  and  Program  commit- 
tees. Section  officers  take  up  active  work  immediately 
after  an  annual  session,  outline  the  program  that  is 
desired  for  the  various  meeting  days  and  hold  con- 
ferences in  some  instances  with  other  section  officers 
to  arrange  with  them  for  a union  meeting  of  two  or 
more  sections.  At  these  union  meetings  topics 
selected  for  consideration  can  be  presented  from  the 
viewpoints  of  the  several  specialties  represented. 

These  combined  meetings  have  much  in  their  favor. 
They  secure  larger  audiences  for  their  speakers; 
papers  there  presented  are  read  before  a group  who 
are  not  all  equally  familiar  with  the  subject,  as  is  the 
case  when  one  pathologist  addresses  his  pathological 
section  often  attended  largely  by  fellow  pathologists. 
It  is  hoped  that  other  sections  may  find  such  union 
programs  as  advantageous  as  have  surgery  and 
pathology,  pediatrics  and  general  medicine  during  this 
present  session. 


Four  invited  speakers  have  come  from  distant  cities 
to  address  the  general  sessions.  They  will  also  speak 
before  the  sections  of  their  respective  specialties. 
Much  of  the  interest  of  the  annual  session  centers 
around  the  messages  brought  by  these  guest  speakers. 
This  year  wTe  have  been  favored  by  McKim  Marriott 
of  the  Washington  University,  Fred  Weidman  of  the 
University  of  Pennsylvania,  George  Curtis  of  the 
University  of  Chicago,  and  A.  U.  Desjardins  of  Mayo 
Clinic. 

The  so-called  program  meeting  held  regularly  late 
in  January  not  only  fixes  a definite  closing  date  for 
the  completion  of  every  section  program,  but  permits 
a review  of  all  section  and  general  programs.  It  is 
our  hope  to  be  able  to  submit  mimeographed  copies 
of  section  programs  to  all  section  officers  some  days 
prior  to  the  meeting  of  the  Program  Committee 
that  comment  thereon  may  be  more  helpfully  critical 
even  than  heretofore. 

The  chairman  of  the  Committee  on  Scientific  Pro- 
gram invites  constructive  criticism  for  the  betterment 
of  this  most  important  work  of  the  Association. 
California  and  Western  Medicine  is  made  up  largely 
of  material  presented  before  the  annual  meeting. 
That  which  raises  the  standard  of  one,  raises  also  the 
standard  of  the  other;  and  the  worth  of  the  California 
Medical  Association  to  the  outside  world  is  in  large 
part  judged  by  the  worth  of  its  medical  journal. 

Respectfully  submitted, 

Committee  on  Scientific  Work, 
Emma  W.  Pope,  Chairman 
Karl  Schaupp 
Lemuel  P.  Adams 
Robert  V.  Day 
Ernest  H.  Falconer 
Sumner  Everingham 


REPORTS  OF  SPECIAL  COMMITTEES 

REPORT  OF  THE  SPECIAL  COMMITTEE  ON  REVISION 
OF  MEDICAL  PRACTICE  ACT  AND  OF  A 
POSSIBLE  BASIC  SCIENCE  ACT 

To  the  President  and  House  of  Delegates: 

At  the  186th  meeting  of  the  Council,  held  on  Sep- 
tember 28,  1929,  a special  committee  of  nine  members, 
composed  of  three  subgroups,  one  for  the  San  Fran- 
cisco Bay  region,  one  for  the  Los  Angeles  region,  and 
one  At  Large,  was  appointed,  with  instructions  to 
consider  possible  amendments  for  revision  of  the 
Medical  Practice  Act  of  California,  and  of  a possible 
basic  science  act  of  California.  . . . 

Inasmuch  as  the  next  California  legislature  will 
convene  in  January  1931,  it  is  important  that  the 
members  of  the  California  Medical  Association, 
through  its  House  of  Delegates  and  constituted  offi- 
cers, should  determine  what  changes,  if  any,  are  desir- 
able in  these  two  legislative  matters. 

1.  As  Regards  the  Medical  Practice  Act  of  California : 

The  present  Medical  Practice  Act  of  California  may 
be  said  to  have  been  slowly  and  somewhat  laboriously 
evolved.  It  is  probably  true  that  its  basic  require- 
ments could  be  put  in  much  clearer  form,  but  if  an 
attempt  were  made  to  do  this  through  new  legislation 
every  such  change  would  be  susceptible  of  attack  in 
the  courts.  As  the  law  now  stands,  its  basic  condi- 
tions have  been  tested  out  up  to  the  Supreme  Court 
of  California  during  the  last  two  decades.  Your  spe- 
cial committee,  therefore,  felt  it  desirable  to  attempt 
no  radical  revision  at  this  time  and  so  recommended. 

One  recommendation  for  an  amendment  which  is 
submitted  for  consideration  is  that  which  has  to  do 
with  a requirement  that  would  make  it  necessary  for 
all  recent  graduates  holding  the  M.D.  degree  to  have 
at  least  one  year  of  internship  or  similar  experience 
before  being  eligible  to  take  the  examination  for  a 
license  to  practice  in  California. 


June,  1930 


COMMITTEE  REPORTS 


431 


At  the  present  time  the  three  California  under- 
graduate medical  schools — the  State  University,  Stan- 
ford University,  and  the  College  of  Medical  Evan- 
gelists, each  make  such  a year  of  internship  necessary 
before  granting  the  M.D.  degree.  Until  their  gradu- 
ates receive  this  M.D.  degree,  they  are  not  eligible  to 
take  the  examination  of  the  California  Board  of 
Medical  Examiners.  However,  a goodly  number  of 
recent  graduates  come  into  California  from  eastern 
schools  who  receive  their  M.D.  degree  at  the  end  of 
their  four  years  of  professional  training,  and  these 
eastern  graduates  can  take  the  examination  for  a 
license  while  they  are  serving  internships  in  a Cali- 
fornia hospital,  and  are  thus  in  position  to  get  an 
earlier  start  in  private  practice  than  are  our  own 
California  graduates  of  practically  the  same  year  of 
graduation. 

Your  special  committee  submits  that  it  would  be 
very  proper  that  eastern  graduates  holding  the  M.D. 
degree  should  not  be  permitted  to  have  an  advantage 
over  California  graduates  of  the  same  year,  and  it  is 
proposed  to  submit  an  amendment  to  cover  this 
point.  . . . 

2.  As  Regards  a Possible  Basic  Science  Act : 

It  may  be  taken  for  granted  that  lay  citizens  who 
are  interested  in  the  maintenance  of  public  health 
standards  are  in  accord  with  the  viewpoint  of  mem- 
bers of  the  medical  profession,  when  our  profession 
insists  that  no  person  from  any  school  of  healing 
whose  graduates  seek  licensure  privileges  of  Cali- 
fornia, should  receive  a license  as  a practitioner  of  the 
healing  art,  unless  such  person  possesses  an  adequate 
amount  of  preliminary  education,  in  addition  to  what 
may  be  termed  his  purely  professional  training.  It 
may  also  be  assumed  that  a four-year  high  school 
education  in  the  way  of  preliminary  training  ought  to 
be  a very  minimum  of  such  preliminary  credits;  and 
that  the  State  of  California  should  give  no  licenses  in 
the  future  to  a person  having  any  form  of  healing  arts 
doctorate  degree,  unless  such  person  has  had  at  least 
a four-year  high  school  education  or  its  equivalent. 

A basic  science  act  such  is  is  proposed  would 
demand  such  a four-year  high  school  education  or  its 
equivalent  as  its  basic  requirement  and,  in  addition, 
proficiency  in  certain  other  basic  studies  of  collegiate 
grade. 

In  the  basic  science  act  under  consideration  it  is 
provided  that  the  examination  in  these  basic  sciences 
must  not  necessarily  be  taken  before  matriculation 
into  a medical  school,  but  may  be  taken  at  any  time 
prior  to  the  examination  to  secure  a license  in  any 
school  of  healing  art,  thus  eliminating  scholastic  hard- 
ships or  wastage  of  a year  to  an  applicant  not  having 
the  full  education  at  the  outset. 

The  determination  of  what  these  preliminary  or 
basic  science  subjects  to  healing  art  practice  are  has 
given  rise  to  much  discussion.  One  of  the  subgroups 
of  your  special  committee  recommended  as  such  basic 
subjects:  English,  chemistry,  physics,  and  biology. 
It  will  be  noted  that  three  of  the  just  mentioned 
four  subjects  are  practically  ignored  in  the  curriculum 
in  a medical  or  other  school  of  the  healing  art. 

Some  basic  science  laws  provide  subjects  such  as 
anatomy,  physiology,  bacteriology,  hygiene,  and  even 
pathology.  The  point  made  against  the  inclusion  of 
such  subjects  is  that  knowledge  in  these  subjects 
could  be  acquired  in  the  regular  healing  art  or  pro- 
fessional courses,  and  that  such  examination  would 
simply  create  duplication  and  dissatisfaction.  As  re- 
gards English,  the  fact  was  brought  out  that  recent 
experiences  of  the  California  Board  of  Medical  Ex- 
aminers had  shown  that  much  of  the  board’s  special 
troubles  with  applicants  for  licensure  has  to  do  with 
applicants  who  have  not  a good  command  of  English. 

As  to  the  make-up  of  the  examining  board  in  basic 
sciences,  it  has  been  suggested  that  there  should  be  a 
board  of  five  members,  one  each  nominated  by  the 
presidents  of  the  following  California  universities 


from  their  nonhealing  art  faculties:  the  University 
of  California,  Stanford  University,  Santa  Clara  Uni- 
versity, University  of  Southern  California,  the  Cali- 
fornia Institute  of  Technology. 

It  could  be  reasonably  assumed  that  a board  of 
examiners  so  selected  would  be  composed  of  able  men 
who  would  be  above  reproach  as  to  integrity  or  bias. 

It  is  held  by  those  who  are  believers  in  a basic 
science  act  that  such  a basic  science  act  could  be 
made  a powerful  means  of  preventing  the  organiza- 
tion of  new  cultist  schools  of  the  healing  art  in  Cali- 
fornia. When  one  remembers  that  in  a recent  five- 
year  period  some  four  hundred  M.D.  graduates  re- 
ceived licenses  to  practice  in  California,  while  during 
the  same  period  some  two  thousand  practitioners 
from  one  cultist  group  received  licenses  to  practice 
side  by  side  with  these  M.D-.  graduates,  one  can 
appreciate  what  the  effect  of  distributing  so  large  a 
number  of  cultist  doctors  must  necessarily  have  upon 
the  lay  mind  and  upon  healing  art  practice  in  general. 
The  regular  profession  has  no  special  quarrel  with 
these  cultist  physicians  and  is  willing  that  they  should 
stand  or  fall  on  their  own  merits  or  demerits. 

Practitioners  of  sectarian  medicine  should  not  seri- 
ously object  to  a basic  science  act  for  California. 
Nonsectarian  or  regular  practitioners  would  support 
such  a basic  science  act  because  it  would  work  for 
the  elevation  of  public  health  standards.  Sectarian 
practitioner  groups  ought  also  to  have  that  attitude. 
In  addition,  many  of  these  cultist  practitioners  would 
probably  be  glad  to  see  the  enactment  of  a law  since 
it  would  prevent  too  great  an  ingress  into  California 
from  other  states  of  undesirable  members  of  their 
own  schools. 

The  suggestion  has  been  made  that  it  might  be 
desirable  to  substitute  for  the  term  “Basic  Science 
Act,”  the  term  “Qualifying  Certificate  Law.”  This 
term  “Qualifying  Certificate”  is  one  that  is  used  in 
Canada  and  in  Britain.  The  phrase  or  term  has  many 
things  to  commend  it.  Lay  citizens  and  also  many 
members  of  the  medical  profession  would  get  a much 
more  rapid  and  better  understanding  of  what  this  law 
was  intended  to  do  if  it  were  spoken  of  as  a “Quali- 
fying Certificate  Law”  than  they  would  if  it  were 
referred  to  as  a “Basic  Science  Act.”  We  believe  the 
suggestion  is  worthy  of  serious  consideration. 

It  is  quite  possible  that  such  a basic  science  act,  if 
decided  upon,  should  be  presented  not  as  a legisla- 
tive but  as  an  initiative  law.  . . . This  preliminary 
report  is  submitted  to  call  attention  to  some  of  the 
points  involved  in  these  questions. 

Respectfully  submitted, 

Special  Committee  on  Possible  Revision  of  the  Medical 
Practice  Act  and  Basic  Science  Act: 

By  I.  Bay  Recion  Group 

Morton  R.  Gibbons,  Group  Chairman 

Oliver  D.  Hamlin 

T.  Henshaw  Kelly 

Emma  W.  Pope 

Walter  B.  Coffey 

Joseph  Catton 

Langley  Porter 

William  Ophuls 

Hartley  Peart 

By  II.  Los  Angeles  Group 

George  H.  Kress,  General  Chairman 
Percy  T.  Magan,  Group  Chairman 
Lyell  C.  Kinney 
William  Duffield 
William  Cutter 
William  Molony 

By  III.  At  Large  Group 

Junius  Harris,  Group  Chairman 
Percy  Phillips 
Charles  Pinkham 
Frederick  Gundrum 


+32 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


HOUSE  OF  DELEGATES 

Minutes  of  the  Fifty-Ninth  Annual  Session 
of  the  House  of  Delegates  of  the 
California  Medical  Association 

First  Meeting 

Held  in  the  Copper  Cup  Room,  Hotel  Del  Monte, 
Del  Monte,  California,  Monday,  April  28,  1930  at 
8 p.  m. 

I.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  speaker  of  the  house,  Edward  M.  Pallette  of 
Los  Angeles. 

The  president,  Morton  R.  Gibbons  of  San  Fran- 
cisco addressed  the  House  stating  that  two  new  plans 
would  be  inaugurated  at  this  session — the  Pre- 
Convention  Bulletin  and  the  first  appearance  of  the 
speaker  of  the  House  of  Delegates.  Doctor  Gibbons 
then  introduced  the  speaker,  Edward  M.  Pallette  to 
the  House  of  Delegates. 

* * * 

II.  Report  of  the  Speaker  on  Personnel  of  Creden- 
tials Committee  and  Two  Reference  Committees. — 

The  speaker  announced  that  three  committees  of  the 
House  of  Delegates  had  been  appointed:  A Com- 
mittee on  Credentials  consisting  of  George  Reinle  of 
Oakland  (chairman),  Percy  T.  Magan  of  Los  Angeles, 
and  J.  Homer  Woolsey  of  San  Francisco;  a Refer- 
ence Committee  on  Reports  of  Officers  and  Standing 
Committees  consisting  of  Joseph  King  of  Los  An- 
geles (chairman),  Edward  N.  Ewer  of  Oakland,  and 
H.  Walter  Gibbons  of  San  Francisco;  and  a Refer- 
ence Committee  on  Resolutions  and  New  and  Mis- 
cellaneous Business  consisting  of  H.  A.  L.  Ryfkogel 
of  San  Francisco  (chairman),  Percy  T.  Phillips  of 
Santa  Cruz,  and  F.  C.  E.  Mattison  of  Los  Angeles. 

* * * 

III.  Report  of  the  Credentials  Committee. — The 

speaker  announced  that  the  next  order  of  business 
would  be  the  presentation  of  the  Report  of  the 
Credentials  Committee. 

George  G.  Reinle,  chairman  of  the  Credentials 
Committee  then  submitted  the  following  report: 

1.  Your  Committee  on  Credentials  begs  leave  to 
report  that  of  the  delegates  and  alternates  listed  in 
the  corrected  official  program  of  the  fifty-ninth  annual 
session,  a total  of  seventy-eight  delegates  and  forty- 
nine  alternates  have  registered  and  have  credentials 
complying  with  the  Constitution  and  By-Laws.  We 
present  a corrected  official  program  in  which  we  have 
checked  the  names  of  all  delegates  and  alternates 
whose  credentials  have  been  submitted  to  this  com- 
mittee, either  directly  or  through  the  State  Associa- 
tion secretary  or  through  a county  society  secretary. 

2.  The  names  not  crossed  out,  of  all  delegates  and 
alternates,  on  said  corrected  official  program  are  en- 
titled to  membership  in  the  House  of  Delegates  in 
accordance  with  the  provisions  of  the  Constitution 
and  By-Laws. 

3.  The  name  of  the  alternate  for  each  delegate  is 
printed  opposite  the  name  of  each  delegate  in  said 
corrected  official  program.  If  the  delegate  is  not 
present  and  his  alternate  is  not  present,  the  com- 
mittee recommends  that  the  first  available  alternate 
appearing  on  said  official  program  be  seated,  and  if 
there  be  no  available  alternate  then  that  some  mem- 
ber of  that  respective  component  county  society  be 
selected  by  a majority  of  delegates  and  alternates 
present  of  that  respective  component  county  society, 
or  if  no  delegate  or  alternate  is  present,  the  House 
of  Delegates  may  select  a member  or  members  from 
that  component  county  society  to  act  as  delegate  or 
delegates  thereof. 

4.  It  is  our  recommendation  that  after  the  House 
has  organized  with  the  call  of  the  roll  of  those  whom 
we  certify  or  recommend  as  delegates  that  a recess  be 
called  so  that  your  Credentials  Committee  may  secure 
information  from  county  units,  of  names  of  members 
present  to  be  recommended  for  house  membership. 


Doctor  Reinle  then  moved,  in  order  to  bring  this 
matter  before  the  House,  that  this  report  as  presented 
be  accepted  as  the  basis  of  organization  of  this  House 
of  Delegates  of  the  fifty-ninth  annual  session  of 
the  California  Medical  Association  at  Del  Monte, 
California. 

Motion  of  George  G.  Reinle  was  seconded  by 
T.  Henshaw  Kelly  and  unanimously  carried. 

The  Credentials  Committee  recommended  that 
delegates  or  alternates  who  do  not  expect  to  be  pres- 
ent at  the  meeting  of  the  House  of  Delegates  on 
Wednesday  do  not  take  seats  as  acting  delegates  in 
the  House  tonight,  lest  through  such  action  there  be 
danger  of  lack  of  quorum  at  later  meetings  of  the 
House.  If  they  do  not  take  seats  tonight,  when  no 
business  other  than  the  acceptance  of  reports  and 
resolutions  will  be  considered,  it  will  be  possible  to  fill 
such  vacancies  at  a later  meeting. 

* * * 

IV.  Roll  Call. — The  secretary  called  the  roll;  one 
hundred  and  sixteen  members  of  the  House  of  Dele- 
gates consisting  of  officers,  delegates,  and  alternates 
were  seated  and  the  speaker  declared  a quorum  pres- 
ent. The  speaker  stated  that  those  who  had  been 
seated  tonight  will  make  up  the  House  Wednesday 
unless  an  alternate  desired  to  release  his  seat  to  the 
delegate  for  whom  he  is  serving. 

* * * 

V.  Report  of  the  President. — At  the  request  of  the 
speaker,  Morton  R.  Gibbons,  president,  submitted  the 
following  report: 

The  officers  present  to  you  in  the  “Pre-Convention 
Bulletin’’  much  information  about  the  affairs  of  our 
Association.  It  is  expected  that  it  will  prove  of  great 
value. 

This  bulletin  is  an  innovation,  provided  by  our  new 
by-laws.  It  is  intended  to  carry  to  more  members* 
an  understanding  of  Association  affairs. 

While  the  reports  of  your  officers  appear  therein, 
there  is  still  an  important  story  to  be  told.  The  re- 
ports omit  reference  to  the  time,  devotion,  thought 
and  ability  expended  by  your  officers  and  committee- 
men. 

In  the  last  year  your  Council  has  held  four  ses- 
sions— one  of  them  at  San  Diego  with  five  meetings, 
that  is  eight  meetings  in  all.  At  one  of  those  meet- 
ings all  councilors  were  present.  The  average  attend- 
ance at  the  principal  meetings  was  93  per  cent. 

At  some  of  the  San  Diego  meetings,  councilors 
absented  themselves  to  attend  committee  meetings  or 
section  programs.  The  average  attendance,  neverthe- 
less, was  84  per  cent  for  the  year  for  all  Council  meet- 
ings. The  Executive  Committee  held  seven  meetings 
with  average  attendance  of  87  per  cent. 

This  attendance  record  alone  indicates  a high  order 
of  devotion  in  your  behalf. 

The  reports  generally  speak  for  themselves.  The 
report  of  Dr.  Gayle  Moseley,  chairman  of  the  Com- 
mittee on  Industrial  Practice  is  absent  from  the 
bulletin.  I sincerely  regret  to  say  that  Doctor  Moseley 
has  been  ill.  His  committee  has  had  little  business  laid 
before  it  during  this  year. 

The  last  year  has  produced  some  notable  pieces  of 
work  in  behalf  of  our  Association.  I believe  that  it 
is  fitting  that  I should  give  credit  in  this  manner. 
The  work  of  the  Committee  on  Medical  Economics, 
and  especially  the  labor  of  Dr.  John  H.  Graves,  the 
chairman,  has  been  most  valuable.  The  House  of 
Delegates  last  year  directed  the  Council  to  proceed 
with  a study  of  a plan  for  health  insurance,  proposed 
by  Dr.  Walter  B.  Coffey.  Doctor  Graves’  committee 
has  made  a remarkable  contribution.  The  essentials 
of  the  report  will  probably  be  published  in  the  journal 
shortly.  An  epitome  appears  in  the  Pre-Convention 
Bulletin.  This  committee  shares  with  the  Committee 
on  Public  Policy  and  Legislation  the  most  important 
duties  of  all  of  the  standing  committees.  Its  duty  is 


June,  1930 


HOUSE  OF  DELEGATES 


433 


to  make  studies  and  to  present  to  the  Association 
information  on  such  matters  as  state  medicine. 

On  motion  of  Joseph  Catton  of  San  Francisco,  duly 
seconded  and  carried,  the  report  of  the  president  was 
referred  to  the  Reference  Committee  on  Reports  of 
Officers  and  Standing  Committees. 

* * * 

VI.  Report  of  the  Council. — At  the  request  of  the 
speaker,  Oliver  D.  Hamlin  of  Oakland,  chairman  of 
the  Council,  submitted  the  following  report  of  the 
Council: 

COUNCIL  MEETINGS  FROM  APRIL  I929  TO  APRIL  1930 

The  Council  has  held  three  regular  meetings  during 
the  past  year,  exclusive  of  the  five  daily  meetings  dur- 
ing the  annual  session.  One  of  these  was  a special 
meeting  called  on  March  1,  1930  for  consideration 
of  plans  proposed  in  regard  to  medical  care  for  per- 
sons of  small  incomes,  and  to  consider  the  advisability 
of  a basic  science  act  in  California.  Eight  Council 
meetings  have,  therefore,  been  held — five  at  the  an- 
nual session  at  Coronado,  four  of  which  took  place 
before  the  reorganization  of  the  Council  for  this 
year;  a fall  meeting  in  Los  Angeles  on  September  28; 
a spring  meeting  in  San  Francisco  on  January  18; 
and  a special  meeting  on  March  1 at  Los  Angeles. 
The  average  attendance  at  Council  meetings  was 
84  per  cent  of  the  membership. 

The  Executive  Committee  of  the  Council  has  held 
six  meetings  between  Council  meetings. 

FUNDS  OF  THE  ASSOCIATION 

The  auditor’s  report  shows  a similar  gain  during 
1929  to  that  which  has  been  reported  for  several 
sessions,  and  a reserve  on  hand  that  augurs  progress 
for  the  future  of  your  medical  association  and  that 
makes  possible  detailed  studies  of  questions  of  medi- 
cal economics. 

This  is  the  first  year  that  a budget  covering  income 
and  expenses  of  operation  has  been  prepared.  The 
chairman  of  the  Auditing  Committee  will  present  this 
budget  to  the  House  of  Delegates. 

ANNUAL  ASSESSMENT 

The  Council  recommends  that  the  annual  assess- 
ment be  as  at  present,  $10  per  annum. 

HERZSTEIN  BEQUEST 

During  1929  the  accumulated  interest  on  the  $20,000 
left  in  trust  for  the  suppression  of  nonscientific  medi- 
cine in  California,  amounting  to  $961,  was  placed  to 
our  credit  by  the  trustees  of  the  Herzstein  money. 

Believing  that  education  of  the  public  in  scientific 
medicine  is  the  most  far-reaching  and  effective  weapon 
against  cults  and  quacks,  your  Council  has  appointed 
a committee  to  investigate  and  report  on  radio  broad- 
casting of  scientific  medicine. 

INCORPORATION 

Following  the  authorization  of  the  House  of  Dele- 
gates to  secure  a mail  vote  of  the  members  on  in- 
corporation, a ballot  was  sent  to  each  member  of  the 
California  Medical  Association. 

The  official  count  taken  by  the  Executive  Com- 
mittee on  December  1,  1929,  showed  a total  vote  of 
3440  cast  out  of  an  active  membership  of  4809.  Three 
thousand  two  hundred  and  seventy-six  were  for  in- 
corporation and  164  opposed  to  incorporation,  giving 
thirty-three  affirmative  votes  over  the  required  two- 
thirds. 

The  legal  counsel,  Mr.  Hartley  F.  Peart,  has  drawn 
up  the  Articles  of  Incorporation  and  the  By-Laws 
under  which  this  corporation  is  to  function. 

CONSTITUTION  AND  BY-LAWS  OF  CALIFORNIA  MEDICAL 
ASSOCIATION 

The  Constitution  and  By-Laws,  after  careful  re- 
vision for  two  years,  was  finally  adopted  by  the  1929 
House  of  Delegates.  Copies  have  been  mailed  to  all 
members  during  the  past  year. 


CLINICAL  AND  RESEARCH  PRIZES 

To  the  surprise  of  the  Council  and  the  members  of 
the  Award  Committee,  no  papers  were  entered  for 
the  competition  at  the  1929  session.  The  Council 
authorized  wider  publicity  and  continuance  of  the 
competition.  To  date  five  papers  have  been  entered, 
proving  the  wisdom  of  the  decision  against  dis- 
continuance. 

The  five  papers  submitted  were  read  by  the  three 
members  of  the  committee,  each  of  whom  voted  in- 
dependently of  the  other.  Their  vote  coincides  in 
awarding  the  Clinical  Prize  to  the  paper  written 
under  the  pseudonym  “Philo”  by  Dr.  Emil  Bogen  of 
Los  Angeles  on  “Pulmonary  Hemorrhage”  and  the 
Research  Prize  to  that  under  the  pseudonym  “Rose- 
Trendelenburg”  by  Dr.  H.  J.  Hara  of  Los  Angeles. 
Each  of  the  prizes  is  for  $150,  and  in  addition  the 
Association  presents  a certificate  of  award  to  the 
winners. 

MEMBERSHIP 

With  the  formation  of  the  Standing  Committee  on 
Membership,  it  is  hoped  that  a larger  percentage  of 
unaffiliated  licentiates  who  are  eligible  for  member- 
ship will  become  members  of  the  Association.  The 
average  increase  in  actual  numerical  growth  for  many 
years  has  been  around  200.  This  year  showed  a gain 
of  221.  Assuming  that  one-half  of  the  California  phy- 
sicians who  are  not  members  are  eligible,  it  would 
take  twelve  years  to  round  all  strays  into  the  medical 
fold.  The  report  of  the  Standing  Committee  on  Mem- 
bership and  Organization  at  the  1930  session  will 
cover  only  organization  results.  That  of  1931  is 
awaited  with  interest. 

woman’s  auxiliary 

The  Woman’s  Auxiliary  of  the  state  society  was 
formed  at  the  annual  meeting  at  Coronado.  During 
the  past  few  months  county  auxiliaries  have  been  or- 
ganized in  Contra  Costa,  Los  Angeles,  Kern,  Orange, 
San  Bernardino,  Sonoma,  Napa,  San  Diego,  Monterey, 
and  Alameda  counties. 

YOLO-COLUSA-GLENN  COUNTY 

The  Glenn  County  society  with  seven  members  has 
voted  to  join  the  Yolo-Colusa  County  Society,  since 
meetings  of  the  combined  counties  would  be  of  added 
interest  to  the  members.  The  Council  recommends 
that  the  House  of  Delegates  cancel  the  charters  now 
held  by  the  respective  counties  and  grant  a new 
charter  to  the  Yolo-Colusa-Glenn  County  Society. 

OPTIONAL  MEDICAL  DEFENSE 

Officers  and  councilors  have  been  interested  and 
gratified  to  observe  the  increasing  interest  of  those 
members  of  the  Association  who  have  not  already 
joined  the  Medical  Society  of  the  State  of  California. 
This  society,  a suborganization  of  the  Association, 
affords  the  services  of  the  legal  department  in  cases 
where  negligence  is  alleged  in  a suit  against  the 
doctor,  arising  out  of  his  practice.  Over  seven  hun- 
dred members  of  the  Association  belong  to  this 
society,  and  one  experience  in  such  a case  immedi- 
ately furnishes  a new  recruit  for  membership.  The 
Council  commends  this  organization  to  the  attention 
of  all  members.  Full  information  can  be  obtained 
from  the  secretary’s  office. 

MEDICAL  SERVICE  PLANS 

Pursuant  to  the  instructions  of  the  House  of  Dele- 
gates at  the  last  annual  session,  your  Council,  and 
the  Committee  on  Medical  Economics  under  the 
chairmanship  of  Dr.  John  H.  Graves,  has  given  much 
thought  to  the  problem  of  the  high  cost  of  sickness 
throughout  the  year,  gathering  statistics  and  other 
information  relating  to  cost  of  hospitalization,  medical 
fees,  nursing  care  and  allied  subjects.  An  extended 
study  of  the  legal  aspects  of  the  problem  was  made 
at  the  direction  of  the  Council  by  our  general  counsel, 
who  associated  with  himself  the  firm  of  McCutchen, 
Olney,  Mannon,  and  Green. 

There  have  been  presented  to  the  Council  a number 
of  medical  service  plans  which  have  been  given 


434 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


earnest  and  thoughtful  consideration.  The  Council  is 
of  the  opinion  that  as  yet  no  plan  has  been  presented 
which  can  be  endorsed  in  its  entirety,  and  believes  it 
a wise  course  to  continue  study  of  these  very  impor- 
tant matters  before  making  recommendations  to  the 
House  of  Delegates  and  to  the  members  of  the  Asso- 
ciation as  authorized  by  the  House  of  Delegates  at 
the  last  annual  session. 

MEDICAL  PRACTICE  ACT  AND  POSSIBLE  BASIC  SCIENCE  OR 
QUALIFYING  CERTIFICATE  ACT 

The  Council  endorses  the  recommendation  of  the 
Special  Committee  that  no  changes  be  made  in  the 
Medical  Practice  Act  other  than  the  insertion  of  a 
provision  which  would  prevent  graduates  of  medical 
colleges  of  states  other  than  California  from  having 
privileges  in  acquiring  licensure  in  California  not  en- 
joyed by  graduates  of  this  state.  In  other  words,  a 
provision  requiring  all  applicants  for  M.  D.  licenses 
to  have  one  year  of  interneship  or  equivalent  training 
before  being  eligible  to  apply  for  licenses. 

As  regards  the  so-called  basic  science  law  or  quali- 
fying certificate,  the  Council  believes  that  the  Special 
Committee  should  continue  its  studies  and  that  the 
Council  shall  later  decide  what  action  shall  be  taken 
thereon. 

COUNCIL  ON  MEDICAL  ECONOMICS  OF  THE  AMERICAN 
MEDICAL  ASSOCIATION 

The  Council  recommends  that  the  House  of  Dele- 
gates of  the  California  Medical  Association  be  in- 
structed to  present  a resolution  asking  the  House 
of  Delegates  of  the  American  Medical  Association  to 
consider  the  advisability  of  forming  a council  on 
medical  economics  and  that  the  delegates  of  the  Cali- 
fornia Medical  Association  be  instructed  to  call  the 
attention  of  the  House  of  Delegates  of  the  American 
Medical  Association  to  certain  experiences. 

On  motion  of  T.  Henshaw  Kelly  of  San  Francisco, 
duly  seconded  and  carried,  the  report  of  the  Council 
was  referred  to  the  Reference  Committee  on  Reports 
of  Officers  and  Standing  Committees. 

* * * 

VII.  Report  of  the  Auditing  Committee. — At  the 

request  of  the  speaker,  T.  Henshaw  Kelly  of  San 
Francisco,  chairman  of  the  Auditing  Committee,  sub- 
mitted the  report  of  his  committee  and  a budget  of 
income  and  expenses  of  the  year  1931  as  provided  in 
the  Constitution. 


ESTIMATED  BUDGET  FOR  YEAR  1931-1932 
I ncome 


California  Medical  Association: 

County  society  dues $48,000.00 

Interest — commercial  and  savings....  3,600.00 

Directory  sales 15.00 

Interest  from  Herzstein  bequest 961.00 


Journal: 

Advertising  $40,000.00 

Subscriptions  paid  for  (including 

Utah  and  Nevada) 1,500.00 

Sale  of  books,  etc.,  to  San  Fran- 
cisco County  Library 180.00 

Estimated  returns  from  Commer- 
cial Exhibit  (net) 2,000.00 


$52,576.00 


$43,680.00 


$96,256.00 

Expenses 

California  Medical  Association: 

Salaries: 

Secretary  $ 3,600.00 

Editors  10,000.00 

Clerical  7,300.00 


Rent  $ 

Office  supplies 

Office  expense 

Telephone  

Annual  meeting 

Public  Health  Exhibit  

Transportation  

Radio  

Prizes  

Binding  journals  (23)  

Membership  directory 


$20,900.00 

3.060.00 
600.00 

150.00 

300.00 

4.000. 00 

3.000. 00 

1.800.00 
1,800.00 

300.00 

200.00 
2,700.00 


Legislative  expense,  1931  2,500.00 

Miscellaneous  cost  for  trustees — - 
books,  supplies,  traveling  ex- 
penses   300.00 

Unforeseen  miscellaneous  contin- 
gent expenses 5,000.00 

$23,910.00 

Journal: 

Publication  expense $30,000.00 

Commissions  (Adv.),  L.  J.  Flynn..  3,500.00 
Commissions,  Cooperative  Medical 

Advertising  Bureau ..  4,000.00 

Discounts  400,00 

37,900.00 

Legal  Department: 

Legal  expense $ 6,000.00 

6,000.00 

$88,710.00 

Estimated  savings  for  1931-32 $7,546.00 

On  motion  of  Joseph  Catton  of  San  Francisco,  duly 
seconded  and  unanimously  carried,  the  report  of  the 
Auditing  Committee  was  referred  to  the  Reference 
Committee  on  Reports  of  Officers  and  Standing 
Committees. 

* * * 

VIII.  Report  of  the  Secretary-Treasurer.— At  the 

request  of  the  speaker,  Emma  W.  Pope  of  San  Fran- 
cisco, secretary-treasurer,  submitted  the  following 
report: 

The  California  Medical  Association,  brought  into 
being  in  1856,  fell  into  an  unbroken  eight-year  slum- 
ber at  the  beginning  of  1862.  It  was  reawakened  by 
Dr.  T.  M.  Logan  in  1870,  and  has  continued  an  in- 
creasingly active  existence  ever  since. 

Sixty-six  years  are  therefore  the  full  span  of  its 
existence  but,  like  humans  of  similar  longevity,  the 
Association  camouflages  and  softens  the  record  of  its 
age.  This  meeting,  really  the  sixty-sixth  meeting  of 
the  California  Medical  Association,  is  called  the  fifty- 
ninth  meeting  of  the  House  of  Delegates. 

Age  rest-6  becomingly  on  the  man  whose  life  has 
been  a life  of  achievement.  For  the  same  reason,  the 
years  of  our  State  Association  should  be  acknowl- 
edged with  pride.  In  the  brief  span  of  my  association 
as  secretary,  the  membership  has  increased  by  over 
1200;  the  reserve  by  over  $85,000;  attendance  at  the 
annual  meetings  has  almost  doubled;  the  journal  is 
one-third  larger;  and  the  Association  offices  infinitely 
better  located  and  equipped  for  service  to  the  mem- 
bers. That  all  this  has  been  accomplished  by  your 
councilors,  with  dues  no  greater  and,  in  many  in- 
stances, much  less  than  the  dues  of  other  state  asso- 
ciations of  like  standing,  must  give  commendable 
satisfaction  to  every  member  of  the  California  State 
Association. 

The  past  year  is  marked  by  two  major  accomplish- 
ments— the  adoption  and  publication  of  the  present 
Constitution  and  By-Laws  with  its  unusual  calendar 
of  dates  and  careful  index;  and  the  change  in  location 
of  the  Association  offices.  From  indifferent  and  in- 
convenient quarters  in  a downtown  business  building, 
your  Association  has  now  suitably  equipped  modern 
offices  in  a Class  A medico-dental  building,  situated 
in  the  center  of  the  medical  activities  in  San  Fran- 
cisco. Your  Council  with  wise  forethought  has 
equipped  the  offices  with  modern  business  appliances 
to  facilitate  speed  and  accuracy  in  clerical  work,  and 
so  permit  a maximum  service  for  the  Association. 

The  total  number  of  members  December  31,  1929, 
was  4820.  The  net  increase  was  221.  This  net  increase 
represents  the  remainder  after  losses  by  death,  resig- 
nation, and  failure  in  payment  of  dues  have  been 
deducted.  Three  hundred  and  sixty-one  new  members 
were  enrolled  during  the  year;  fifty-three  were  lost 
by  death;  eleven  resigned,  and  seventy-six  forfeited 
membership  by  nonpayment  of  dues. 

The  report  of  the  secretary  formerly  covered  all 
society  activities.  Under  the  present  Constitution,  the 
chairmen  of  newly  established  committees,  such  as 
the  Committee  on  Publications,  Committee  on  Exten- 


June,  1930 


HOUSE  OF  DELEGATES 


435 


sion  Lecture  Service,  and  Committee  on  Membership 
and  Organizations,  make  separate  reports.  It  seems 
unnecessary  to  duplicate  the  reports  of  these  various 
chairmen  by  incorporating  into  your  secretary’s  report 
comment  on  the  work  of  the  state  office  on  these 
various  society  activities. 

A Standing  Committee  on  Placement  Bureau,  how- 
ever, seems  not  to  have  been  authorized  and  report 
thereon  is  in  order.  Fifteen  physicians  wrote  to  the 
office  that  they  had  taken  one  of  the  various  positions 
to  which  the  office  had  referred  them.  This  service 
is  usually  given  at  a time  of  emergency  in  a young 
man’s  life  and  fills  a much  needed  want.  The  calls 
for  openings  are  in  excess  of  the  calls  for  physicians. 
Thirty-five  stenographers  and  nurses  and  two  tech- 
nicians were  also  placed.  It  would  follow  that  any 
ethical  way  of  enlisting  the  interest  of  the  managers 
of  commercial  concerns  who  employ  physicians  in 
their  plants  to  care  for  their  sick  and  injured  and  of 
our  members  who  need  physician  assistants  would  be 
beneficial  to  this  worthwhile  service. 

In  a state  with  fifty-eight  comities,  forty-three 
county  societies  have  charters  with  the  California 
Medical  Association.  Six  of  these  consist  of  two 
counties  united  under  one  society  charter,  as  Lassen- 
Plumas;  Yolo-Colusa  and  Yuba-Sutter.  With  the  ex- 
ception of  Kings  with  a population  of  23,000,  Madera 
with  12,000  and  Nevada  with  11,000;  no  county  with 
a larger  population  than  9000  lacks  a county  medical 
society.  Of  the  fourteen  physicians  resident  in  Kings 
County,  seven  are  members  of  Fresno  County  and 
one  of  Tulare.  Madera  also  has  fourteen  resident  phy- 
sicians of  whom  six  are  members  of  the  Fresno 
County  Society,  two  of  Merced  and  one  of  San  Joa- 
quin, leaving  but  five  unaffiliated.  Nevada  County  has 
twelve  resident  physicians,  six  of  whom  are  members 
of  the  California  Medical  Association,  five  through 
the  Placer  County  Medical  Society  and  one  through 
the  Lassen-Plumas  Society. 

No  new  charters  have  been  asked  for.  From  the 
above  report  the  need  is  not  there,  and  no  charters 
have  been  revoked. 

The  efficient  service  of  the  secretaries  of  the  com- 
ponent county  societies  is  largely  responsible  for  the 
growth  of  the  Association,  for  the  interest  in  county 
society  meetings,  for  the  spirit  of  harmony  prevalent, 
and  for  the  loyalty  and  interest  of  the  members. 

* * * 

Doctor  Pope  then  submitted  excerpts  from  the  audit 
of  the  books  of  the  Association  as  prepared  by  Hugh 
Ross,  public  accountant,  showing  general  income  and 
expense  for  the  year  1929,  and  stated  that  the  full 
audit  was  open  to  the  inspection  of  all  members  of 
the  Association. 

On  motion  of  H.  J.  Ullmann  of  Santa  Barbara,  duly 
seconded  and  carried,  the  reports  of  the  secretary- 
treasurer  were  referred  to  the  Reference  Committee 
on  Reports  of  Officers  and  Standing  Committees. 

* * * 

VIII.  Report  of  the  Editors.— At  the  request  of 
the  speaker,  Dr.  George  H.  Kress  of  Los  Angeles, 
editor,  submitted  the  following  report  of  the  editors: 

The  first  number  of  California  and  Western  Medi- 
cine, the  official  journal  of  the  California  Medical  As- 
sociation, which  was  brought  off  the  press  by  the 
present  editors  was  that  of  April  1927.  In  the  period 
which  has  since  elapsed,  your  editors  have  striven  to 
bring  into  existence  a state  medical  society  journal 
which  would  not  only  be  an  excellent  expression  of 
the  scientific  spirit  of  the  members  of  your  Association, 
but  which  would  subserve  also  in  fullest  possible 
measure  the  various  other  aims  of  a state  medical 
society. 

At  the  same  time  an  effort  has  been  made  to  im- 
prove the  typographical  make-up  of  the  journal;  and 
to  so  arrange  its  contents  that  it  could  be  referred 
to  and  perused  with  the  same  satisfaction  that  a reader 
finds  in  his  favorite  newspaper  or  other  periodicals. 
That  these  objects  have  been  somewhat  attained  may 


be  noted  from  the  fact  that  the  different  departments 
of  California  and  Western  Medicine  are  generously 
abstracted  and  excerpted  by  other  journals;  and  that 
in  typographical  form  as  well  as  in  contents  in  com- 
pares favorably  with  the  best  journals  published  by 
other  state  medical  associations. 

Another  evidence  of  its  worth  is  to  be  found  in  the 
fact  that  the  recommendation  made  last  year  by  the 
editors  that  a 20  per  cent  increase  be  authorized  in 
the  advertising  rates,  resulted  in  no  material  loss  in 
the  number  of  firms  who  had  previously  placed  an- 
nouncements in  our  official  publication.  Even  more 
gratifying  is'  the  knowledge  that  through  such  change 
in  advertising  rates,  the  annual  income  of  California 
and  Western  Medicine  was  increased  some  $6000,  this 
extra  source  of  income  making  it  possible  for  our 
journal,  for  the  first  time  in  its  existence,  to  practi- 
cally produce  an  income  that  is  in  excess  of  the  cost 
of  its  production,  publication  and  distribution. 

So  that  California  and  Western  Medicine,  in  spite 
of  a typographical  make-up  that  is  probably  superior 
and  more  expensive  than  that  of  any  other  state  med- 
ical journal  in  the  United  States,  was,  with  its 
subscription  income,  last  year  on  a self-supporting 
basis.  By  contrast,  for  the  year  1928,  the  loss  on 
production,  publication  and  distribution  was  $3,334.84 
(that  and  somewhat  similar  sums  representing  the 
annual  loss  in  previous  years  both  under  the  present 
editors  and  their  predecessors). 

For  the  year  1929,  however,  there  was  no  loss, 
the  income  from  sources  such  as  advertisements 
($40,098.86),  subscriptions  ($12,282.63),  miscellaneous 
($180)  producing  a total  income  of  $52,561.40  as 
against  a total  expense  for  production,  printing  and 
distribution  amounting  to  $51,089.76;  thus  permitting 
a surplus  to  the  amount  of  $1,471.73  to  be  transferred 
from  the  official  journal  account  into  the  general  fund 
of  the  Association.  It  is  hoped  that  such  a surplus 
will  continue  to  increase  with  each  year. 

The  detailed  financial  account  follows: 

JOURNAL,  INCOME  AND  EXPENSE  FOR 
TEAR  1929 

Income:  1929 

Advertising  income $10,098.86 

Subscriptions  12,282.63 

Sale  of  review  books 180.00 

$52,561.49 

Expenses: 

Journal — 

Product  ion. ...$26,682.60 
Distribution..  2,329.82 

29,012.42 

Selling  expense 6,583.48 

Promotion — Complimen- 
tary and  exchange  ..  453.00 

General  expense: 

Salaries  $12,369.00 

Expense  2,671.86 

15,040.86 

Total  expense $51,089.76 

Net: 

Gain  for  year,  transferred 

to  surplus 1,471.73 

$52,561.49 

* Loss  for  1928. 

Referring  now  to  the  printed  matter  which  ap- 
peared in  the  journal  during  the  last  year,  a summary 
of  the  original,  special  article  and  case  report  papers 
which  were  received  shows  the  following  distribution: 

One  hundred  and  forty-one  papers  read  at  last  an- 
nual meeting  of  which  thirty-five  are  still  unpublished. 


Papers  published  in  1929 47 

Papers  published  in  1930 29 

Read  and  published  elsewhere,  declined,  or  not 

sent  in 30 

Remain  unpublished 35 

Total .141 


1928 

$34,839.78 

11,792.30 

180.00 


$46,812.08 


$26,422.33 

2,217.29 

28,739.62 

6,261.65 

399.00 

$12,210.00 

2,536.65 


14,746.65 

$50,146.92 


*3,334. S4 


$46,812.08 


436 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Articles  published  during  the  past  year  (May  1929 


to  May  1930); 

Papers  from  1927  meeting 1 

Papers  from  1928  meeting 17 

Papers  from  1929  meeting 63 

Prize  papers 0 

Papers  read  before  general  sessions 7 

Lure  of  Medical  History 9 

Papers  from  Utah  and  Nevada 8 

Papers  read  before  other  societies 19 

Papers  not  read 8 

Clinical  Notes  and  Case  Reports 33 

Total 163 

We  have  at  present  on  hand: 

Papers  from  1929  meeting 35 

Read  before  other  societies 9 

Original  papers  not  read 10 

Read  before  Utah  and  Nevada 4 

Lure  of  Medical  History 0 

Case  Reports  and  Clinical  Notes _ 7 

Total 65 


Commenting  now  upon  California  and  Western 
Medicine  as  a state  medical  society  journal,  in  com- 
parison with  other  medical  journals  having  somewhat 
similar  aims  and  responsibilities,  it  may  be  said  that, 
under  the  regime  of  its  present  editors,  our  own  official 
journal  in  some  of  its  columns  may  seem  to  have 
given  extra  space  to  matters  of  organization  policy 
and  needs.  No  apology  is  made  for  doing  this.  The 
fact  that  many  national  and  state  organizations  and 
committees  throughout  our  country  are  today  investi- 
gating so  many  phases  of  medical  work  and  costs,  and 
the  fact  that  in  the  lay  newspapers  and  periodicals 
there  has  been  much  unwarranted  criticism  of  the 
medical  profession,  shows  how  negligent  the  publica- 
tion mouthpieces  of  the  medical  profession  have  been 
in  the  past  in  not  presenting  economic  and  similar 
problems  of  medical  practice;  so  that  defects  could 
be  remedied  through  evolutionary  processes  from 
within,  rather  than  through  revolutionary  plans  and 
schemes  from  without.  Your  editors,  with  the  sup- 
port of  your  Council,  have  felt  that  California  and 
Western  Medicine  would  have  failed  in  some  of  its 
most  important  reasons  for  existence  if  it  had  not 
given  expression  to  policies  that  would  make  for  a 
stronger  and  more  efficient  California  Medical  As- 
sociation, both  from  the  scientific  and  organization 
standpoints. 

With  the  excellent  special  articles  and  case  reports, 
the  symposia  in  the  Bedside  Medicine  department  and 
the  practically  short  editorials  in  the  Medicine  To- 
day department,  it  may  be  assumed  that  the  scientific 
aims  of  our  Association  are  being  adequately  looked 
after,  and  that  the  space  given  to  a discussion  of  eco- 
nomic policies  and  of  organization  problems  is  not 
only  fully  warranted  but  needed.  It  is  well  to  remem- 
ber that  adulation  at  the  shrine  of  Science  should  not 
be  so  great  as  to  bring  about  neglect  of  those  eco- 
nomic and  other  needs  of  the  medical  profession 
which  have  an  important  relationship  to  its  pro- 
fessional efficiency  and  prestige. 

In  the  performance  of  their  work,  your  editors  have 
continued  their  original  arrangement  of  alternating 
all  manuscripts  for  editorial  revision,  of  assuming  spe- 
cial responsibilities  for  certain  departments  and  of 
each  going  over  all  galley  and  page  proofs.  This 
double  cross-check  has  been  found  to  be  desirable. 

To  the  many  members  of  the  California  Medical 
Association  who  in  the  last  as  in  the  previous  years 
have  given  California  and  Western  Medicine  such 
generous  and  kindly  cooperation,  the  thanks  of  the 
editors  are  again  expressed. 

To  be  permitted  to  carry  on  the  official  journal  and 
to  attempt  to  make  it  an  increasingly  better  state 
medical  society  publication  is  in  itself  a privilege  and 
an  honor,  but  for  the  editors  who  have  had  this  work 
and  responsibility,  to  receive  at  the  same  time  the 
cordial  cooperation  of  colleagues  from  every  part  of 


California,  as  well  as  from  our  affiliated  societies  in 
Nevada  and  Utah,  makes  them  very  grateful.  That 
California  and  Western  Medicine  shall  continue  to 
improve  with  each  year,  and  be  of  increasing  service 
to  the  members  of  the  California  Medical  Association, 
is  the  earnest  wish  of  your  editors. 

On  motion  of  T.  Henshaw  Kelly,  duly  seconded 
and  carried,  the  report  of  the  editors  was  referred  to 
the  Reference  Committee  on  Reports  of  Officers  and 
Standing  Committee. 

* * * 

IX.  Report  of  the  General  Counsel. — The  general 
counsel  submitted  a report  on  the  work  of  the  legal 
department  during  the  past  year.  Mr.  Peart  then  ex- 
plained the  plans  for  carrying  out  the  incorporation 
of  the  Association  authorized  at  the  last  annual  meet- 
ing of  the  House  of  Delegates. 

On  motion  of  W.  B.  Bowman  of  Los  Angeles,  duly 
seconded  and  carried,  the  report  of  the  general  counsel 
was  referred  to  the  Reference  Committee  on  Reports 
of  Officers  and  Standing  Committees. 

* * * 

X.  Reports  of  Standing  Committees. — -The  speaker 
stated  that  the  reports  of  standing  committees  were 
published  in  the  Pre-Convention  Bulletin  for  the  con- 
sideration of  the  House  of  Delegates  and  the  Refer- 
ence Committee  on  Reports  of  Officers  and  Standing 

Committees.  ^ 

* * * 

XI.  Committee  on  Hospitals,  Dispensaries,  and 
Clinics. — The  speaker  stated  that  the  next  order  of 
business  would  be  the  report  of  Dr.  John  C.  Ruddock, 
member  of  the  Committee  on  Hospitals,  Dispensaries, 
and  Clinics.  Doctor  Ruddock  then  presented  his 
report. 

Note. — Full  report  to  be  printed  in  July  issue  and 
in  reprint  form  for  distribution  to  members. 

On  motion  duly  made,  seconded  and  carried,  the 
report  of  the  Committee  on  Hospitals,  Dispensaries, 
and  Clinics  was  referred  to  the  Reference  Committee 
on  Reports  of  Officers  and  Standing  Committees. 

* * * 

XII.  New  Business: 

1.  Resolutions : 

(a)  Resolution  No.  1.  Death  of  Dr.  William  Taylor 
McArthur. — William  Duffield  of  Los  Angeles  then  pre- 
sented the  following  resolution  on  the  death  of  Dr. 
William  Taylor  McArthur: 

Whereas,  In  the  death  of  Dr.  William  Taylor 
McArthur  at  Los  Angeles  on  March  11,  1930,  the 
California  Medical  Association  loses  one  of  its  most 
beloved,  generous  and  devoted  members;  and 

Whereas,  Doctor  McArthur  served  this  Association 
as  a Councilor  and  as  President-Elect  and  President 
through  a long  period  of  its  important  growth  and 
development  with  the  highest  degree  of  ability,  devo- 
tion, patience,  and  judgment  in  a most  unselfish 
manner;  and 

Whereas,  Doctor  McArthur  as  a practicing  phy- 
sician and  surgeon  endeared  himself  to  the  public  in 
a manner  worthy  of  exemplification  by  a younger 
generation,  and  by  his  oratory  and  ready  and  kindly 
wit  in  a remarkable  degree  advanced  the  cause  of 
organized  medicine  among  the  laity  as  well  as  with 
his  colleagues,  and  as  a citizen  maintained  a civic, 
social  and  home  life  which  reflects  credit  upon  his 
profession;  therefore  be  it 

Resolved,  That  the  members  of  the  House  of  Dele- 
gates of  the  California  Medical  Association  bow  their 
heads  in  reverence  to  his  memory  and  in  gratitude 
for  their  association  with  him,  for  his  splendid  service 
and  in  the  hope  that  the  example  of  his  life  will 
stimulate  youth  to  follow  such  a life;  and  be  it  further 

Resolved,  That  a copy  of  these  resolutions  be 
spread  upon  the  minutes  of  the  House  of  Delegates 
and  the  same  be  published  in  California  and  Western 
Medicine. 

On  motion  of  Joseph  Catton  of  San  Francisco,  it 
was  stated  that  when  the  House  of  Delegates  ad- 


June,  1930 


HOUSE  OF  DELEGATES 


437 


journ,  it  do  so  in  the  honor  and  in  the  memory  of 
Dr.  William  Taylor  McArthur.  Such  motion  was  duly 
seconded  and  unanimously  carried. 

The  resolution  was  referred  to  the  Reference  Com- 
mittee on  Resolutions  and  New  and  Miscellaneous 
Business. 

* * * 

(b)  Resolution  No.  2.  Narcotic  Addicts. — William 
Duffield  of  Los  Angeles  then  presented  the  following 
resolution  on  narcotics: 

Whereas,  Physicians  and  surgeons  are  frequently 
confronted  with  the  question  of  deciding  as  to 
whether  narcotic  addicts  are  or  are  not  legitimate 
exceptions  under  Section  1 or  Section  2 of  the  Harri- 
son Narcotic  Act,  and  corresponding  clauses  under 
the  State  Poison  Act;  and 

Whereas,  Members  of  this  Association  have  not 
infrequently  been  subjected  to  humiliation  and  dis- 
grace by  being  arrested  and  prosecuted  for  prescrib- 
ing for  addicts  having  sufficient  pathology  to  make 
them  exceptions  under  the  law,  or  for  addicts  who  are 
really  incurable,  or  for  such  border-line  cases  as  need 
temporary  relief  to  alleviate  the  most  acute  suffering; 
and 

Whereas,  there  is  need  of  a better  understanding 
between  the  multiplicity  of  city,  county,  state,  and 
federal  narcotic  enforcement  officers  and  the  medical 
profession  as  to  what  are  and  are  not  exceptions; 
therefore  be  it 

Resolved,  That  the  Committee  of  Public  Policy  of 
the  California  Medical  Association  be  and  hereby  is 
instructed  to  take  steps  as  will  relieve  this  situation 
either  by  amendment  of  the  Narcotic  Law  or  other- 
wise as  will  establish  a medical  narcotic  commission 
or  commissions  to  which  may  be  referred  all  doubtful 
or  border-line  cases  for  final  decision  as  to  whether  or 
not  they  are  legitimate  exceptions,  said  commission 
or  commissions  to  be  comprised  of  medical  men  or 
women  who  have  had  practical  experience  with  ad- 
dicts and  who  have  a sufficient  knowledge  of  neu- 
rology to  enable  them  to  reach  conclusions. 

Resolution  No.  2,  Narcotic  Addicts,  was  referred  to 
the  Reference  Committee  on  Resolutions  and  New 
and  Miscellaneous  Business. 

* * * 

(c)  Resolution  No.  3.  Report  of  the  Committee  on 
Hospitals,  Dispensaries,  and  Clinics. — H.  J.  Ullmann  of 
Santa  Barbara  presented  the  following  resolution  on 
the  report  of  the  Committee  on  Hospitals,  Dispensa- 
ries, and  Clinics: 

Resolved,  That  the  report  of  the  Subcommittee  on 
Clinics  of  the  Committee  on  Hospitals,  Dispensaries, 
and  Clinics  be  referred  to  the  Reference  Committee 
with  the  request  that  the  essential  information  con- 
tained therein  be  published  in  California  and  Western 
Medicine. 

Resolution  No.  3,  report  of  the  Committee  on  Hos- 
pitals, Dispensaries,  and  Clinics  was  referred  to  the 
Reference  Committee  on  Resolutions  and  New  and 
Miscellaneous  Business. 

* * * 

(d)  Resolution  No.  4.  Use  of  Intoxicating  Liquors. — 
Rodney  Yoell  of  San  Francisco  submitted  the  follow- 
ing resolution  on  intoxicating  liquors: 

Whereas,  The  use  or  abuse  of  alcoholic  beverages 
bear  a definite  relationship  to  the  etiology  of  disease; 
and 

Whereas,  Legislation  having  to  do  with  the  use  or 
abuse  of  alcohol  bears  a definite  relation  to  such  use, 
temperate  or  intemperate;  therefore  be  it 

Resolved,  That  this  House  of  Delegates  of  the 
California  Medical  Association  do  hereby  instruct  the 
secretary  of  the  Association  to  issue  a postcard  ballot 
and  mail  it  to  the  various  members  of  this  Associa- 
tion within  thirty  days  and  publish  the  results  in  the 
state  medical  journal,  the  said  ballot  to  contain  the 
three  following  sentences: 

1.  I favor  the  repeal  of  the  Eighteenth  Amendment 
and  supporting  legislation. 


2.  I favor  the  continuance  of  the  Eighteenth 
Amendment  and  supporting  legislation. 

3.  I favor  modification  of  the  Eighteenth  Amend- 
ment and  supporting  legislation  so  as  to  permit: 

(a)  The  use  of  light  wine,  beer,  and  certain  spiritu- 
ous liquors. 

(b)  A further  action  against  the  use  of  any  alco- 
holic beverage  whatsoever. 

Resolution  No.  4,  use  of  intoxicating  liquors  was 
referred  to  the  Reference  Committee  on  Resolutions 
and  New  and  Miscellaneous  Business. 

* * * 

(e)  Resolution  No.  5.  Tax  Exemption  for  Nonprofit 
Hospitals. — Joseph  Catton  of  San  Francisco  presented 
the  following  resolution  on  nonprofit  hospitals: 

Whereas,  At  the  next  meeting  of  the  legislature  of 
the  State  of  California  there  will  be  proposed  an  act 
exempting  from  taxation  certain  nonprofit  hospitals; 
and 

Whereas,  The  Council  of  the  California  Medical 
Association,  after  thorough  consideration,  endorsed 
the  enactment  of  such  an  act;  therefore  be  it 

Resolved,  That  the  House  of  Delegates  of  the  Cali- 
fornia Medical  Association  in  fifty-ninth  convention 
assembled  endorses  and  urges  the  passage  of  Consti- 
tutional Amendment  No.  6 exempting  nonprofit  hos- 
pitals from  taxation  in  the  State  of  California. 

Resolution  No.  5,  tax-exemption  of  nonprofit  hospi- 
tals was  referred  to  the  Reference  Committee  on 
Resolutions  and  New  and  Miscellaneous  Business. 

* sfc  * 

2.  New  Business: 

(a)  Change  in  Program  of  General  Session. — The 
speaker  announced  that  a change  in  the  program  of 
the  general  session  had  been  made  necessary  by  the 
enforced  absence  of  Dr.  McKim  Marriott  of  St. 
Louis  and  that  Dr.  Ernst  A.  Sommer,  vice-president 
of  the  American  Medical  Association,  would  address 
the  members;  that  at  the  joint  meeting  of  General 
Medicine  and  Pediatrics  on  Wednesday  Dr.  Rexwald 
Brown  would  present  a paper  on  the  “Business  of 
Medicine,”  followed  by  discussion  by  Doctors  Coffey 
and  Graves. 

(b)  Amendment  to  Section  12  of  Article  10  of  the  Con- 
stitution.— The  speaker  stated  that  an  amendment  to 
the  constitution  and  by-laws  had  been  offered.  Amend- 
ment to  Section  12  of  Article  10  of  the  Constitution 
as  submitted  by  Robert  V.  Day  of  Los  Angeles  was 
read  by  the  secretary  as  follows: 

In  conformity  with  Article  XV,  Section  1,  of  the 
Constitution  of  the  California  Medical  Association,  I 
hereby  introduce  the  following  amendment  to  Sec- 
tion 11  of  Article  X of  said  Constitution,  making 
Section  11  read  as  follows: 

The  Council,  at  the  organization  meeting  thereof, 
shall  elect  a chairman,  a vice-chairman,  a secretary- 
treasurer,  an  editor,  and  in  its  discretion,  one  or  more 
associate  editors,  each  to  serve  for  the  term  of  one 
year.  Nothing  in  this  section  shall  be  construed  to 
prohibit  the  same  person  holding  at  the  same  time 
both  the  office  of  secretary-treasurer  and  the  office 
of  editor;  but  neither  the  secretary-treasurer  nor 
editor  shall  hold  any  other  office  in  the  California 
Medical  Association. 

The  speaker  announced  that  in  accordance  with  the 
provisions  of  the  Constitution  this  amendment  as 
offered  would  be  received  and  published  twice  in  the 
journal  and  then  acted  upon  at  the  next  annual 
meeting. 

(c)  Invitation  to  Members  of  Standing  Committees. — 
Joseph  King,  chairman  of  the  Reference  Committee 
on  Reports  of  Officers  and  Standing  Committees, 
stated  that  members  of  standing  committees  who  had 
submitted  reports  were  invited  to  appear  before  the 
committee  and  present  points  which  they  desired  to 
be  acted  upon. 

(d)  Caucus  for  District  Councilors. — Doctor  King 
stated  that  a caucus  for  nomination  of  district  coun- 
cilors should  be  held  prior  to  the  next  meeting  of  the 
House  of  Delegates  and  suggested  that  members  of 


438 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


the  various  districts  meet  immediately  following  the 
adjournment  of  the  House. 

(e)  Legal  Department  Report. — On  motion  of  Joseph 
Catton  of  San  Francisco,  duly  seconded,  and  carried, 
all  details  of  the  report  of  the  legal  department  which 
were  presented  for  the  information  of  members  only 
were  ordered  deleted  from  the  printed  minutes. 

* * * 

XIII.  Reading  and  Adoption  of  Minutes. — Min- 
utes of  the  meeting  were  then  read  and,  there  being 
no  objection,  were  approved. 

* * * 

XIV.  Adjournment. — There  being  no  further  busi- 
ness the  meeting  adjourned  to  meet  at  8 p.  m. 
Wednesday,  April  30,  1930. 


Second  Meeting  of  the  House  of  Delegates 

Held  in  the  Copper  Cup  Room,  Hotel  Del  Monte, 
Del  Monte,  California,  Wednesday,  April  30,  1930, 
at  8 p.  m. 

I.  Call  to  Order. — The  meeting  was  called  to  order 

by  the  speaker  of  the  House,  Edward  M.  Pallette  of 
Los  Angeles.  * * * 

II.  Roll  Call. — The  secretary  called  the  roll;  116 
members  of  the  House  of  Delegates,  consisting  of 
officers,  delegates  and  alternates,  were  seated  and  the 
speaker  declared  a quorum  present. 

* * * 

III.  Announcement  of  Place  of  1931  Meeting.— 

The  speaker  announced  that  the  Council  had  accepted 
the  invitation  of  San  Francisco  for  the  next  annual 


IV.  Resignation  of  Robert  A.  Peers. — The  speaker 
presented  the  following  resignation  of  Robert  A. 
Peers  as  councilor  at  large: 

“I  hereby  respectfully  submit  my  resignation  as 
councilor-at-large  to  be  effective  immediately.” 

On  motion  of  Joseph  Catton  of  San  Francisco,  duly 
seconded  and  unanimously  carried,  it  was 

Resolved,  That  the  resignation  of  Robert  A.  Peers 
as  councilor-at-large  be  accepted. 

* * * 

V.  Election  of  Officers: 

1.  President-Elect. — The  speaker  announced  that  the 
next  order  of  business  would  be  the  election  of  offi- 
cers, and  that  nominations  for  president-elect  were  in 
order. 

William  Duffield  of  Los  Angeles  stated  that,  in 
accordance  with  the  time-honored  custom,  the  selec- 
tion of  the  president-elect  alternated  between  the 
north  and  the  south. 

William  Duffield  then  nominated  Junius  Brainard 
Harris  of  Sacramento  as  president-elect:  such  nomi- 
nation was  seconded  by  T.  Henshaw  Kelly  of  San 
Francisco. 

Joseph  Catton  of  San  Francisco  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  unanimous  ballot  of  the  House  of  Dele- 
gates for  Junius  B.  Harris. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced Junius  B.  Harris  of  Sacramento  duly  elected 
president-elect. 

2.  Speaker  of  the  House  of  Delegates. — The  speaker 
announced  that  the  next  order  of  business  would  be 
the  election  of  a speaker  of  the  House  of  Delegates 
and  asked  that  the  president,  Morton  R.  Gibbons,  take 
the  chair.  Doctor  Gibbons  then  took  the  chair  and 
called  for  nominations  for  speaker  of  the  House  of 
Delegates. 

R.  G.  Taylor  of  Los  Angeles  nominated  Edward  M. 
Pallette  of  Los  Angeles  as  speaker  of  the  House;  such 
nomination  was  seconded  by  Oliver  D.  Hamlin  of 
Oakland. 

T.  Henshaw  Kelly  of  San  Francisco  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 


to  cast  the  ballot;  such  motion  was  duly  seconded  and 
carried. 

The  secretary  cast  the  ballot  and  the  president  de- 
clared Edward  M.  Pallette  of  Los  Angeles  duly  elected 
speaker  of  the  House  of  Delegates  for  the  term  of 
one  year.  Doctor  Pallette  then  took  the  chair. 

3.  Vice-Speaker  of  the  House  of  Delegates. — The 
speaker  announced  that  the  next  order  of  business 
would  be  the  election  of  a vice-speaker  of  the  House 
of  Delegates. 

William  Duffield  of  Los  Angeles  nominated  John 
H.  Graves  of  San  Francisco  as  vice-speaker  of  the 
House;  such  motion  was  duly  seconded. 

H.  J.  Ullmann  of  Santa  Barbara  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot;  such  motion  was  duly  seconded 
and  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced John  H.  Graves  of  San  Francisco  duly 
elected  vice-speaker  of  the  House  of  Delegates  for 
the  term  of  one  year. 

* * * 

VI.  Election  of  Councilors. — The  speaker  an- 
announced  that  the  election  of  district  councilors 
would  be  the  next  order  of  business. 

I.  Second  District. — The  secretary  announced  that 
William  Duffield  of  Los  Angeles  had  been  nominated 
as  councilor  for  the  second  district  by  written  nomi- 
nation filed  with  the  secretary,  signed  by  delegates 
Joseph  M.  King  and  A.  J.  Scott  of  Los  Angeles;  such 
nomination  was  duly  seconded. 

Ferdinand  Stabel  moved  that  the  nominations  be 
closed  and  the  secretary  be  instructed  to  cast  the 
ballot  for  William  Duffield;  such  motion  was  duly 
seconded  and  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  William  Duffield  as  councilor 
for  the  second  district  for  a term  of  three  years. 

2.  Fifth  District. — The  secretary  announced  that 
Alfred  L.  Phillips  of  Santa  Cruz  had  been  nominated 
as  councilor  for  the  fifth  district  by  written  nomi- 
nation filed  with  the  secretary,  signed  by  delegates 
L.  M.  Liles,  Santa  Cruz;  A.  H.  McFarlane,  Santa 
Clara;  R.  L.  Hull,  San  Benito;  E.  F.  Ziegelman,  San 
Mateo  and  E.  M.  Miller,  Santa  Clara;  such  nomina- 
tion was  duly  seconded  and  carried. 

A.  M.  Rogers  moved  that  the  nominations  be  closed 
and  the  secretary  be  instructed  to  cast  the  ballot  for 
Alfred  L.  Phillips;  such  motion  was  duly  seconded 
and  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Alfred  L.  Phillips  as  coun- 
cilor for  the  fifth  district  for  a term  of  three  years. 

3.  Eighth  District. — The  secretary  announced  that 
Robert  A.  Peers  of  Colfax  had  been  nominated  as 
councilor  for  the  eighth  district  by  written  nomina- 
tion filed  with  the  secretary,  signed  by  delegates 
F.  Stabel  of  Shasta  and  W.  H.  Pope  of  Sacramento; 
such  nomination  was  seconded  by  Joseph  Catton  of 
San  Francisco. 

T.  Henshaw  Kelly  moved  that  the  nominations  be 
closed  and  the  secretary  be  instructed  to  cast  the 
ballot  for  Robert  A.  Peers;  such  motion  was  duly 
seconded  and  unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Robert  A.  Peers  as  councilor 
for  the  eighth  district  for  a term  of  three  years. 

4.  Councilors- At-Large.  — The  speaker  announced 
that  the  next  order  of  business  would  be  election  of 
three  councilors-at-large  who  would  be  nominated 
from  the  floor;  two  for  a term  of  three  years,  and 
one  for  a term  of  one  year  to  fill  the  unexpired  term 
of  Robert  A.  Peers. 

(a)  Harry  E.  Zaizer  of  Orange  County  nominated 
Ruggles  A.  Cushman  of  Santa  Ana  to  succeed  him- 
self as  councilor-at-large;  such  nomination  was  sec- 
onded by  Joseph  King  of  Los  Angeles. 

William  H.  Kiger  of  Los  Angeles  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot  for  Ruggles  A.  Cushman;  such 
motion  was  duly  seconded  and  unanimously  carried. 


June,  1930 


HOUSE  OF  DELEGATES 


439 


The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Ruggles  A.  Cushman  as 
councilor  at  large  to  succeed  himself  for  a period  of 
three  years. 

(b)  Henry  W.  Gibbons  of  San  Francisco  nominated 
T.  Henshaw  Kelly  of  San  Francisco  to  succeed  him- 
self as  councilor-at-large;  such  nomination  was  sec- 
onded by  Oliver  D.  Hamlin  of  Oakland. 

Irving  Ingber  of  San  Francisco  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot  for  T.  Henshaw  Kelly;  such  motion 
was  duly  seconded  and  unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  T.  Henshaw  Kelly  as  coun- 
cilor-at-large to  succeed  himself  for  a period  of  three 
years. 

(r)  C.  A.  Dukes  of  Alameda  nominated  Edward 
N.  Ewer  of  Oakland  as  councilor-at-large  for  a period 
of  one  year  to  fill  the  unexpired  term  of  Robert  A. 
Peers;  such  nomination  was  seconded  by  Joseph 
Catton  of  San  Francisco. 

Junius  B.  Harris  of  Sacramento  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot  for  Edward  N.  Ewer;  such  motion 
was  seconded  by  Oliver  D.  Hamlin  of  Oakland,  and 
unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Edward  N.  Ewer  as  councilor- 
at-large  for  a term  of  one  year. 

* * * 

VII.  Delegates  and  Alternates  to  the  American 
Medical  Association. — The  speaker  announced  that  v 
election  of  three  delegates  and  alternates  to  the 
American  Medical  Association  was  the  next  order  of 
business,  and  that  the  elections  were  for  the  sessions 
of  1931  and  1932. 

(a)  Karl  L.  Schaupp  of  San  Francisco  nominated 
Irving  S.  Ingber  of  San  Francisco  as  delegate  to  the 
American  Medical  Association  for  the  sessions  of 
1931  and  1932;  such  nomination  was  seconded  by 
Joseph  Catton  of  San  Francisco.  William  Bowman  of 
Los  Angeles  moved  that  the  nominations  be  closed 
and  the  secretary  be  instructed  to  cast  the  ballot;  such 
motion  was  duly  seconded  and  unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Irving  S.  Ingber  of  San  Fran- 
cisco as  delegate  to  the  American  Medical  Association 
for  the  sessions  of  1931  and  1932. 

Albert  Soiland  of  Los  Angeles  stated  that  he  had 
served  as  delegate  with  Dr.  Victor  Vecki  and  that 
Doctor  Vecki  had  always  been  present  at  the  sessions 
of  the  American  Medical  Association  and  had  taken 
an  active  interest  in  the  welfare  of  the  Association. 
Doctor  Soiland  then  moved  that  a vote  of  thanks  be 
extended  to  Dr.  Victor  Vecki;  such  motion  was  duly 
seconded  and  unanimously  carried. 

( b ) H.  A.  L.  Ryfkogel  of  San  Francisco  nominated 
William  E.  Stevens  of  San  Francisco  as  alternate  to 
Irving  S.  Ingber  for  the  American  Medical  Associa- 
tion sessions  of  1931  and  1932;  such  nomination  was 
duly  seconded.  Irving  Ingber  moved  that  the  nomi- 
nations be  closed  and  the  secretary  be  instructed  to 
cast  the  ballot;  such  motion  was  duly  seconded  and 
unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  William  E.  Stevens  of  San 
Francisco  as  alternate  to  Irving  S.  Ingber  for  the 
American  Medical  Association  sessions  of  1931  and 
1932. 

(c)  George  G.  Hunter  of  Los  Angeles  nominated 
Percy  T.  Magan  of  Los  Angeles  as  delegate  to  the 
American  Medical  Association  for  the  sessions  of 
1931  and  1932;  such  nomination  was  duly  seconded. 
A.  J.  Scott  of  Los  Angeles  moved  that  the  nomina- 
tions be  closed  and  the  secretary  cast  the  ballot;  such 
motion  was  duly  seconded  and  unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Percy  T.  Magan  as  delegate 
to  the  American  Medical  Association  for  the  sessions 
of  1931  and  1932. 


(d)  A.  J.  Scott  of  Los  Angeles  nominated  Charles 
D.  Lockwood  of  Pasadena  as  alternate  to  Percy  T. 
Magan  for  the  American  Medical  Association  sessions 
of  1931  and  1932;  such  nomination  was  duly  seconded. 
T.  Henshaw  Kelly  of  San  Francisco  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot;  such  motion  was  duly  seconded  and 
unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Charles  D.  Lockwood  of 
Pasadena  as  alternate  to  Percy  T.  Magan  for  the 
American  Medical  Association  sessions  of  1931  and 
1932. 

0)  William  R.  Molony  of  Los  Angeles  nominated 
Junius  B.  Harris  of  Sacramento  as  delegate  to  the 
American  Medical  Association  for  the  sessions  of 
1931  and  1932;  such  nomination  was  duly  seconded. 

Albert  Soiland  of  Los  Angeles  moved  _ that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot;  such  motion  was  duly  seconded  and 
unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  Junius  B.  Harris  of  Sacra- 
mento as  delegate  to  the  American  Medical  Associa- 
tion for  the  sessions  of  1931  and  1932. 

(/)  E.  M.  Miller  of  Santa  Clara  nominated  John 
Hunt  Shephard  of  San  Jose  as  alternate  to  Junius  B. 
Harris  for  the  American  Medical  Association  sessions 
of  1931  and  1932;  such  nomination  was  duly  seconded. 
Edward  F.  Ziegelman  of  San  Mateo  moved  that  the 
nominations  be  closed  and  the  secretary  be  instructed 
to  cast  the  ballot;  such  motion  was  duly  seconded  and 
unanimously  carried. 

The  secretary  cast  the  ballot  and  the  speaker  an- 
nounced the  election  of  John  Hunt  Shephard  of  San 
Jose  as  alternate  to  Junius  B.  Harris  for  the  Ameri- 
can Medical  Association  sessions  of  1931  and  1932. 

* * * 

VIII.  Member  of  Program  Committee. — The  chair 
announced  that  an  error  appeared  in  the  printed  pro- 
gram. That  under  the  new  Constitution  members  of 
the  Program  Committee  were  elected  by  the  Council 
and  therefore  no  member  could  be  elected  at  this 


IX.  Resolutions  of  Appreciation. — The  chair  stated 
that  the  next  order  of  business  would  be  the  presenta- 
tion of  any  resolution  which  it  Was  desired  to  be  acted 
upon  by  the  House. 

RESOLUTIONS  ON  THE  LOS  ANGELES  AND  SAN  FRANCISCO 
CANCER  RESEARCH  FOUNDATIONS 

T.  Henshaw  Kelly  of  San  Francisco  stated  that  it 
seemed  that  it  would  be  fitting  for  the  House  of  Dele- 
gates to  express  its  appreciation  of  the  generous  dona- 
tions of  Messrs.  Paul  Shoup,  Herbert  Fleischhacker, 
Stanley  Dollar,  W.  K.  Kellogg,  and  others  for  the 
study  of  cancer. 

Doctor  Kelly  then  presented  the  following  resolu- 
tion: 

Whereas,  The  dread  scourge  of  cancer,  in  an  ever- 
mounting  toll,  is  decimating  the  population  of  our 
country  so  that  today  its  dire  death  roll  accounts  for 
the  life,  in  those  of  forty  years  of  age  and  upwards, 
of  one  woman  out  of  every  eight  and  one  man  out 
of  approximately  every  twelve,  thus  making  it  a 
sacred  duty  incumbent  upon  all  members  of  our  be- 
loved profession  to  combat  its  ravages  with  every 
arrow  in  the  armamentarium  of  the  science  and  skill 
at  our  command,  and  to  shrink  from  no  sacrifice, 
however  great,  in  order  to  halt  its  forward  march  and 
bring  to  an  end  its  almost  unveiled  threat  to  annihi- 
late mankind;  and 

Whereas,  Many  agencies  and  investigators  are  mak- 
ing researches  designed  to  add  to  man’s  knowledge  of 
this  disease  which  causes  so  much  illness,  pain,  death, 
and  other  loss  to  individual  citizens  and  to  the  nation; 
and 

Whereas,  Some  recent  studies  by  two  members  of 
the  California  Medical  Association,  Dr.  Walter  B. 


4+0 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Coffey  and  Dr.  John  D.  Humber,  are,  in  the  opinion 
of  many  of  the  leaders  of  our  profession  who  have 
had  the  opportunity  to  observe  this  work,  of  such 
nature  as  to  give  aid  in  the  solution  of  the  cancer 
problem;  and  which  work  and  investigations  of  our 
California  colleagues  are,  as  stated  by  them,  and  will 
remain  for  some  time,  in  the  research  period  and  no 
scientific  or  definite  pronouncement  can  or  should 
now  be  made  of  the  results  thereof;  and 

Whereas,  In  the  city  of  San  Francisco  Herbert 
Fleishhacker,  Paul  Shoup,  and  Stanley  Dollar,  acting 
for  themselves  and  for  other  public-spirited  citizens, 
have  arranged  to  place  the  sum  of  $500,000  at  the  dis- 
posal of  the  Better  Health  Foundation  of  California 
to  carry  on  these  investigations  and  kindred  studies; 
and  in  the  city  of  Los  Angeles  W.  K.  Kellogg  has 
given  the  Kellogg  Foundation  the  income  from  an 
endowment  of  $2,000,000  for  similar  purposes;  and 

Whereas,  This  Association  by  its  Constitution  and 
membership  is  irrevocably  committed  to  the  princi- 
ples of  the  progress  of  medical  science  and  the  un- 
prejudiced pursuit  of  truth  and  fact;  now  therefore 
be  it 

Resolved,  That  the  California  Medical  Association, 
acting  through  its  House  of  Delegates  in  its  fifty- 
ninth  annual  session  assembled  at  Del  Monte,  cor- 
dially approves  and  commends  this  generous  and 
humane  action  of  Paul  Shoup,  Herbert  Fleishhacker, 
Stanley  Dollar  and  their  associates,  and  W.  K.  Kel- 
logg, that  affords  the  necessary  means,  administered 
by  competent  authority,  to  enable  the  investigations 
to  properly  proceed,  adds  greatly  to  the  resources  of 
scientific  research  in  the  State  of  California  and  en- 
courages others  to  emulate  the  good  deeds  of  these 
men;  and  be  it  further 

Resolved,  That  a copy  of  this  resolution  be  sent  to 
each  of  the  donors  with  a suitable  letter  of  transmittal 
by  this  Association. 

Doctor  Kelly  stated  that  in  order  to  place  the  reso- 
lution before  the  House  for  action,  he  moved  for  the 
adoption  of  the  foregoing  resolution;  such  motion 
was  seconded  by  Rodney  Yoell  of  San  Francisco  and 
unanimously  carried. 

RESOLUTIONS  OF  THANKS  TO  GUEST  SPEAKERS,  PRESS, 

AND  HOSTS 

LeRoy  Brooks  of  San  Francisco  then  presented  the 
following  resolution  of  appreciation: 

Resolved,  That  the  California  Medical  Association 
express  its  appreciation  of  the  work  on  behalf  of  the 
Association  of  the  Committee  on  Arrangements  and 
extend  its  sincere  thanks  to  the  members  of  that 
committee,  especially  William  M.  Gratiot  of  Mon- 
terey; and  be  it  further 

Resolved,  That  the  California  Medical  Association 
extend  sincere  thanks  to  the  management  of  Hotel 
Del  Monte  and  staff  for  their  generous  and  obliging 
hospitality  and  entertainment,  which  has  made  this 
fifty-ninth  annual  session  of  the  California  Medical 
Association  one  of  the  most  successful  in  its  history; 
and  to  the  press  of  Monterey  for  its  cooperation  and 
interest  in  behalf  of  scientific  medicine;  and  be  it 
further 

Resolved,  That  the  thanks  of  the  California  Medical 
Association  be  extended  to  our  invited  guests:  Dr. 
A.  U.  Desjardins,  Dr.  George  M.  Curtis,  and  Dr. 
Fred  D.  Weidman;  and  also  to  Dr.  Ernst  Sommer, 
who  so  generously  took  part  in  our  program;  for  their 
presence  and  addresses,  which  have  contributed  in 
large  measure  to  the  success  of  this  fifty-ninth  session. 

On  motion  of  T.  Henshaw  Kelly,  duly  seconded 
and  carried,  the  foregoing  resolution  was  adopted. 

* * * 

X.  Report  of  the  Reference  Committee  on  Reports 
of  Officers  and  of  Standing  Committees. — The  speaker 
declared  that  the  next  order  of  business  would  be 
the  presentation  of  the  report  of  the  Reference  Com- 
mittee on  Reports  of  Officers  and  Standing  Commit- 
tees. Dr.  Joseph  M.  King,  chairman,  then  presented 


the  following  report  on  behalf  of  his  committee 
(Joseph  M.  King,  Chairman,  and  Edward  N.  Ewer 
and  H.  Walter  Gibbons): 

1.  Address  of  the  President. — The  committee  heartily 
commends  the  address  of  the  president,  Morton  Gib- 
bons, for  consideration  of  the  members  of  the  Cali- 
fornia Medical  Association  and  felicitates  President 
Gibbons  on  the  able,  forceful  and  conservative  policy 
which  he  suggests. 

2.  Report  of  the  Council. — Certain  items  in  the  re- 
port of  the  Council  were  brought  to  the  attention  of 
the  House: 

(a)  Annual  Assessment. — Your  Committee  accepts 
the  recommendation  of  the  Council  that  the  annual 
dues  be  set  at  $10. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  recommendation;  such 
motion  was  duly  seconded  and  unanimously  carried. 

(b)  Radio  Broadcasting. — Your  committee  approves 
the  action  of  the  Council  in  its  proposed  use  of  the 
income  from  the  Herzstein  bequest  for  radio  broad- 
casting. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  recommendation;  such 
motion  was  duly  seconded  and  unanimously  carried. 

(c)  Incorporation. — The  committee  commends  the 
action  of  the  Council  in  proceeding  with  the  incorpo- 
ration authorized  by  the  House  of  Delegates  at  its 
last  session. 

(d)  IV Oman’s  Auxiliary.  — The  committee  notices 
with  pleasure  the  report  of  the  Council  dealing  with 
the  formation  of  county  units  of  the  Woman's  Auxili- 
ary and  it  earnestly  recommends  to  the  members  of 
the  House  of  Delegates  and  to  the  councilors  and 
officers  of  the  Association  that  continued  cooperation 
and  aid  be  given  to  establish  as  rapidly  as  possible 
units  throughout  the  state.  It  foresees  the  possibility 
of  much  fruitful  work  by  members  of  this  organiza- 
tion in  matters  pertaining  to  health. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  recommendations  contained  in  this 
section;  such  motion  was  duly  seconded  and  unani- 
mously carried. 

(e)  Yolo-Colusa-Glenn  County  Society.  — In  accord- 
ance with  the  recommendation  of  the  Council,  your 
committee  recommends  that  the  Council  be  directed 
to  cancel  the  charters  of  the  Yolo-Colusa  and  the 
Glenn  County  societies  and  grant  a new  charter  to 
the  combined  Yolo-Colusa-Glenn  County  Society. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  above  recommendation;  such  motion 
was  duly  seconded  and  unanimously  carried. 

(f)  Medical  Practice  Act. — Your  committee  com- 
mends the  decision  of  the  Council  in  regard  to  the 
amendment  of  the  Medical  Practice  Act  at  the  next 
session  of  the  legislature  under  such  conditions  as 
they  may  approve.  Your  committee  adopts  the  recom- 
mendation of  the  Council  and  recommends  further 
study  of  the  possible  qualifying  certificate  act. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  foregoing  section;  such  motion  was 
duly  seconded  and  unanimously  carried. 

(g)  Council  on  Medical  Economics  of  the  American 
Medical  Association. — The  committee  recommends,  as 
indicated  in  the  report  of  the  Council,  that  our  dele- 
gates to  the  American  Medical  Association  be  in- 
structed to  attempt  to  secure  the  formation  of  a 
Council  on  Medical  Economics  of  the  American  Medi- 
cal Association. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  recommendation  on  a Council  on 
Medical  Economics;  such  motion  was  duly  seconded 
and  unanimously  carried. 

(h)  Medical  Service. — An  extensive  study  of  statis- 
tics and  conditions  relating  to  medical  care  has  been 
made  by  the  Committee  on  Medical  Economics  under 
the  able  leadership  of  Dr.  John  H.  Graves.  The  com- 
plete report  warrants  the  approbation  of  the  House 
of  Delegates.  Your  committee  approves  the  recom- 


June,  1930 


HOUSE  OF  DELEGATES 


441 


mendation  of  the  Council  suggesting  further  study  of 
the  question  and  recommends  that  Doctor  Graves  be 
granted  a few  moments  at  this  time  in  explanation 
of  the  work  of  his  committee. 

2.  Report  of  the  Secretary-Treasurer. — We  commend 
highly  the  report  of  the  secretary  and  we  congratulate 
Doctor  Pope  and  her  aides  upon  the  excellent  conduct 
of  the  state  office.  We  urge  the  Council  and  the  edi- 
tors of  the  journal  to  give  publicity  to  the  work  being 
done  in  placing  doctors  and  others  in  positions  for 
which  they  are  fitted.  We  recommend  to  the  House 
of  Delegates  that  a Standing  Committee  on  Place- 
ment Bureau  be  created  of  which  the  secretary  shall 
be  ex-officio  the  chairman.  We  commend  the  secre- 
tary on  the  efficient  way  in  which  she  has  corre- 
sponded with  component  county  societies,  bringing 
about  increased  interest  and  cooperation  of  the  Asso- 
ciation as  a whole.  The  report  of  the  auditor,  as  sub- 
mitted by  the  treasurer,  shows  that  the  financial  status 
of  the  Association  is  sound. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  recommendation  contained  in  the 
foregoing  paragraph;  such  motion  was  duly  seconded 
and  carried. 

3.  Report  of  the  Editors. — We  felicitate  the  editors 
of  the  state  journal  upon  bringing  California  and 
Western  Medicine  to  its  present  high  state  of  effi- 
ciency— that  of  being  the  best  state  medical  journal 
in  the  United  States,  a journal  of  which  we  are  all 
proud.  We  especially  call  attention  to  the  fact  that 
it  is  now  an  asset  and  not  a financial  liability  to  our 
membership. 

4.  Report  of  the  Auditing  Committee. — Your  commit- 
tee recommends  that  the  report  of  the  Auditing  Com- 
mittee, as  submitted  by  its  chairman,  and  the  budget 
of  income  and  expenses  for  1931  be  approved. 

The  chairman  of  the  committee  then  moved  for  the 
adoption  of  the  budget  and  report  of  the  Auditing 
Committee;  such  motion  was  duly  seconded  and 
carried. 

5.  Report  of  the  General  Counsel. — The  report  of 
the  counsel  shows  that  the  general  counsel  and  his 
associates  are  alert  to  the  best  interests  of  the  medical 
profession.  The  legal  department  deserves  the  grati- 
tude of  the  members  on  account  of  the  high  standard 
of  legal  talent  made  available  and  the  soundness  of 
opinions  and  investigations  furnished  throughout  the 
year. 

6.  District  Councilor  Reports. — The  membership  is 
particularly  fortunate  in  its  selection  of  councilors, 
as  indicated  by  the  reports,  of  the  work  done.  We 
particularly  felicitate  San  Francisco,  the  sixth  district, 
on  securing  its  own  home,  and  the  able  and  pleas- 
ing manner  in  which  it  is  being  brought  about.  It  is 
the  first  society  in  the  state  to  have  attained  this 
desirable  condition.  In  regard  to  those  districts  con- 
taining many  small,  widespread  cities,  we  praise  their 
action  in  securing  successful  joint  meetings  with  able 
speakers. 

7.  Report  of  Standing  Committees,  (a)  Committee  on 
Public  Health  and  Instruction. — The  committee  is  im- 
pressed with  the  report  furnished  by  the  Committee 
on  Public  Health  and  Instruction  and  the  work  which 
has  been  done  by  the  local  society  at  Long  Beach  as 
presented  by  Dr.  Fred  B.  Clarke,  a member  of  the 
standing  committee.  Their  suggestions  as  outlined  in 
the  report  are  interesting,  and  are  recommended  for 
consideration  of  the  Council.  The  Reference  Com- 
mittee recommends  that  the  Council  pass  a resolution 
appropriating  funds,  wherever  it  deems  wise,  to  in- 
augurate this  work  in  those  county  societies  who  are 
willing  to  carry  it  on,  and  it  suggests  that  details 
of  the  campaign  conducted  so  successfully  at  Long 
Beach  be  secured  and  studied  with  this  end  in  view. 

(b)  Committee  on  Associated  Societies  and  Technical 
Groups. — As  suggested  by  the  committee,  we  recom- 
mend that  the  Council  send  official  delegates  to  the 
annual  sessions  of  the  neighboring  state  medical 
societies,  if  in  its  judgment  it  would  promote  good 
fellowship. 


The  chairman  then  moved  for  the  adoption  of  the 
recommendation  on  official  delegates  to  neighboring 
state  societies;  such  motion  was  duly  seconded  and 
unanimously  carried. 

(c)  Committee  on  Extension  Lectures. — We  call  atten- 
tion to  the  very  excellent  work  being  done  by  the 
Committee  on  Extension  Lectures  and  commend  it  to 
the  House  of  Delegates.  We  are  fully  appreciative 
of  the  large  amount  of  valuable  work  that  is  being 
carried  on. 

(d)  Committee  on  History  and  Obituaries. — It  is  very 
desirable  that  the  medical  history  of  the  California 
Medical  Association  and  of  its  component  county 
societies  be  compiled,  as  recommended  by  the  Com- 
mittee on  History  and  Obituaries,  and  to  that  end  we 
endorse  the  three  recommendations  of  the  committee 
regarding  the  compiling  of  histories  of  county  and 
state  medical  societies  and  that  of  the  State  Board 
of  Health,  and  recommend  that  the  House  of  Dele- 
gates direct  the  Council  to  continue  its  efforts  in  this 
direction. 

The  chairman  then  moved  for  the  adoption  of  the 
recommendations  of  the  Committee  on  History  and 
Obituaries;  such  motion  was  duly  seconded  and 
unanimously  carried. 

(e)  Committee  on  Hospitals,  Dispensaries,  and  Clinics. 
Your  committee  has  considered  with  great  interest 
the  extensive  and  able  report  of  the  Committee  on 
Hospitals,  Dispensaries,  and  Clinics  presented  by  Dr. 
John  C.  Ruddock  as  chairman  of  the  Clinic  Division. 
It  recommends: 

First:  That  the  report  be  approved  and  printed 
under  the  supervision  of  the  editors  and  sent  to  all 
members  of  the  Association. 

Second:  That  copies  of  the  report  be  furnished  to 
the  Committee  on  Public  Policy  and  Legislation,  and 
to  the  National  Committee  on  the  Cost  of  Medical 
Care. 

Your  committee  recommends  that  the  Council  be 
instructed  to  study  this  report,  and  when  in  its  judg- 
ment that  step  should  be  taken,  that  the  proper 
legislation  be  prepared  and  presented  to  the  state 
legislature : 

1.  Defining  clinics  and  placing  the  licensing  and 
standardization  thereof  under  the  jurisdiction  of  a 
suitable  state  agency. 

2.  That  the  California  Medical  Association,  repre- 
sented by  the  House  of  Delegates,  approve  the  estab- 
lishment of  proper  standards  of  medical  practice  in 
connection  with  dispensaries  for  the  maintenance  of 
which  charitable  and  public  funds  are  devoted;  and 
favors  the  centralization  of  clinics,  dispensaries,  and 
health  units  in  large  communities,  thereby  avoiding 
needless  duplication  of  service. 

That  the  Council  be  further  authorized  and  in- 
structed to  appropriate  sufficient  funds  of  the  As- 
sociation to  make  an  adequate  survey  of  all  clinics, 
dispensaries,  health  centers,  and  health  units  or  other 
institutions  or  organizations  of  similar  nature  now 
being  maintained  in  the  State  of  California  wherein 
charitable  or  public  funds  are  being  used  for  the  pur- 
pose of  furnishing  medical  service  to  the  indigent 
poor,  such  survey  to  cover  among  other  subjects,  the 
following: 

1.  The  physical  plant  and  equipment  of  such  insti- 
tutions. 

2.  The  management  and  administrative  set-up. 

3.  The  personnel  of  the  staff. 

4.  The  source  of  the  funds  supporting  the  institu- 
tion. 

5.  The  social  service  structure. 

6.  The  need  of  the  institution  to  the  community  in 
which  it  exists. 

That  this  survey  be  carried  on  through  such  agen- 
cies as  the  Council  may  approve. 

That  the  Council  be  also  authorized  and  instructed 
to  direct  the  secretary-treasurer  to  bring  to  the  atten- 
tion of  all  component  county  society  secretaries  the 
desirability  of  placing  this  subject  on  the  calendars 
of  meetings  of  such  societies  for  discussion  by  the 


442 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


members.  That  upon  the  completion  of  such  survey 
the  Council  make  such  use  of  the  survey  as  it  deems 
advisable  in  order  to  aid  and  assist  charitable  and 
benevolent  people  and  communities  who  desire  to  use 
the  information  for  the  relief  and  the  interest  of  the 
indigent  poor. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  foregoing  recommenda- 
tions; such  motion  was  duly  seconded  and  unani- 
mously carried. 

(f)  Committee  on  Industrial  Medicine. — In  previous 
years  the  Committee  on  Industrial  Practice,  under  its 
present  chairman,  has  submitted  able  and  extensive 
reports  on  its  activities.  During  the  last  year  nothing 
of  special  interest  has  been  referred  to  the  committee. 

(g)  Committee  on  Medical  Defense. — Your  commit- 
tee commends  the  report  of  the  Committee  on  Medi- 
cal Defense,  especially  its  recommendation  of  the 
desirability  of  optional  medical  defense,  which  is  now 
being  taken  advantage  of  by  over  seven  hundred  of 
our  members.  This  matter  as  presented  to  the  House 
of  Delegates  by  our  very  able  counsel,  Mr.  Hartley 
Peart,  should  be  called  to  the  attention  of  members 
to  the  end  that  membership  in  optional  defense  be 
greatly  increased. 

(h)  Committee  on  Membership  and  Organizations. — 
In  considering  the  report  of  the  Committee  on  Mem- 
bership and  Organizations,  your  committee  is  grati- 
fied to  learn  that  last  year  more  doctors  affiliated 
themselves  with  the  Association  than  in  any  previous 
year,  but  we  also  recognize  the  fact  that  a large 
number  of  eligible  physicians  in  California  are  not 
members.  While  we  appreciate  and  commend  the 
work  of  the  committee,  we  urge  that  further  efforts 
be  made  to  increase  the  membership  of  our  As- 
sociation. 

(i)  Committee  on  Publications. — The  high  standard 
of  the  journal  and  the  directory  are  the  best  com- 
mendation of  the  work  of  the  Committee  on  Publica- 
tions. The  first  publication  of  the  Pre-Convention 
Bulletin  has  more  than  justified  its  inauguration. 
Your  committee  recommends  that  the  Council  con- 
sider the  suggestions  offered  for  additional  informa- 
tion in  the  directory  and  take  such  action  thereon  as 
it  feels  is  pertinent. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  foregoing  section;  such 
motion  was  duly  seconded  and  unanimously  carried. 

(j)  Committee  on  Public  Policy  and  Legislation. — We 
have  considered  the  report  of  the  Committee  on  Pub- 
lic Policy  and  Legislation  and  we  recommend  a vote 
of  commendation  to  the  members  of  this  committee 
who  have  worked  so  ardently  and  so  faithfully  on 
behalf  of  the  best  interests  of  this  Association. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  foregoing  section;  such 
motion  was  duly  seconded  and  unanimously  carried. 

(k)  The  Committee  on  Scientific  Work. — The  charac- 
ter of  the  programs  presented  at  the  last  few  meet- 
ings speak  for  themselves,  and  we  suggest  that  the 
Program  Committee  be  thanked  for  the  high  class  of 
scientific  work  it  has  brought  before  this  Association. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  recommendation  thank- 
ing the  Program  Committee;  such  motion  was  duly 
seconded  and  carried. 

(l)  Special  Committees.  — Two  special  committees, 
namely,  the  Committee  on  Clinical  and  Research 
Prize  Awards,  and  the  Committee  on  Medical  Prac- 
tice and  Basic  Science  Acts,  have  given  much  time 
and  thought  to  the  studies  of  the  problems  of  their 
respective  committees  and  deserve  the  gratitude  of 
the  Association. 

The  chairman  of  the  Reference  Committee  then 
moved  for  the  adoption  of  the  recommendation  thank- 
ing the  Committee  on  Clinical  and  Research  Prizes 
and  the  Committee  on  the  Medical  Practice  and  Basic 
Science  Acts;  such  motion  was  duly  seconded  and 
unanimously  carried. 


Joseph  M.  King,  chairman  of  the  Reference  Com- 
mittee on  Reports  of  Officers  and  Standing  Com- 
mittees, then  moved  for  the  adoption  of  the  report 
as  a whole;  such  motion  was  seconded  by  George  G. 
Hunter  and  unanimously  carried. 

Doctor  King  then  moved  that  a vote  of  thanks  be 
given  Mrs.  Talbot  for  the  assistance  rendered  the 
committee;  such  motion  was  duly  seconded  and 
carried. 

* * * 

In  accordance  with  the  action  of  the  House  of  Dele- 
gates, Dr.  John  H.  Graves,  chairman  of  the  Com- 
mittee on  Medical  Economics,  was  invited  to  address 
the  House.  Doctor  Graves  spoke  of  the  outlook  of 
the  doctor  if  state  medicine  is  inaugurated  in  Cali- 
fornia, as  follows: 

REQUESTED  ADDRESS  OF  CHAIRMAN  OF  COMMITTEE  ON 
MEDICAL  ECONOMICS  TO  HOUSE  OF  DELEGATES 

“I  have  in  my  possession  a copy  of  an  act  properly 
prepared  for  presentation  to  the  next  legislature  of 
this  state,  with  the  prediction  that  it  will  pass,  that 
proposes  to  administer  and  conduct  medical  activities 
in  this  state  just  as  the  educational  activities  are 
administered  and  conducted. 

“Full-time  salaries  for  all  physicians  and  surgeons 
range,  like  those  of  school  teachers,  from  $150  to 
$300  per  month;  private  physicians  will  be  permitted, 
but  the  legal  charge  for  services  of  the  physician  and 
surgeon  are  on  a time  basis,  the  maximum  of  which 
is  $10  per  hour.  So  that  an  operation  that  would 
require  thirty  minutes  would  net  the  surgeon  but  $5 
and  an  obstetrical  case  of  one-half  hour  would  net  the 
physician  $5;  a consultation  of  fifteen  minutes  would 
net  the  consultant  $2.50;  however  an  allowance  is  made 
for  transportation  to  and  from  the  patient’s  home. 

“Are  you  interested  in  preventing  the  passage  of 
this  and  similar  acts? 

“Do  you  think  the  character  of  the  service  rendered 
the  poor  will  be  improved  by  the  passage  of  this  act? 

“Will  you  be  satisfied  to  continue  your  practice 
under  these  conditions? 

“If  you  are  not,  listen  attentively  to  what  I am 
going  to  say. 

“For  some  time  there  have  appeared  in  the  maga- 
zines and  the  newspapers  frequent  articles  on  the 
high  cost  of  sickness  and  what  should  be  done  to 
lessen  that  cost. 

“It  is  claimed  that  while  the  rich  receive  adequate 
medical  treatment  because  they  have  the  means  to 
pay  for  it,  and  the  poor  receive  adequate  care  because 
they  do  not  have  to  pay  for  it,  that  the  large  army 
of  salary-earning,  home-owning  American  citizens, 
known  as  the  white  collar  brigade,  are  unable  to  meet 
the  excessive  cost  of  sickness,  partly  at  least  because 
of  the  exorbitant  fees  of  the  medical  profession. 

“One  year  ago  I was  appointed  chairman  of  your 
Committee  on  Medical  Economics.  I received  the 
news  of  my  appointment  in  New  York  City,  where  I 
began  immediately  the  collection  of  data  bearing  on 
this  important  point. 

“I  proceeded  to  Washington,  D.  C.,  where  my  work 
was  continued  and  I returned  to  California  where  a 
considerable  portion  of  my  time,  together  with  that 
of  other  members  of  my  committee,  has  been  given 
to  the  study  of  this  problem  in  an  earnest  effort  to 
collect  the  necessary  data  on  which  to  build  a system 
of  rendering  medical  service  that  would  place  the 
doctor  in  a sound  economic  condition  and  at  the  same 
time  relieve  the  strain  on  those  requiring  medical 
service. 

“That  report,  which  you  will  probably  never  see, 
and  probably  never  hear,  but  which  was  filed  with  the 
councilors  of  this  Association,  was  based  upon  the 
following  investigations:* 

“1.  Experience  of  foreign  countries  in  health  in- 
surance. 

“2.  Investigations  of  the  health  at  time  of  original 
examination  and  the  diseases  and  their  duration,  of 

* Full  report  will  be  published  in  July  issue. 


June,  1930 


HOUSE  OF  DELEGATES 


443 


five  millions  of  men  enlisted  by  the  United  States  for 
services  in  the  World  War. 

“3.  Study  of  incidence  of  illness,  duration  of  the 
disability,  and  the  cost  of  hospitalization  and  treat- 
ment of  various  selected  groups  in  manufacturing, 
industrial  and  transportation  activities. 

“4.  Investigation  of  certain  mutual  benevolent  hos- 
pital associations  that  were  founded  and  conducted 
with  money  secured  by  endowments,  entrance  or  initi- 
ation fees;  and  by  monthly  payment  of  dues. 

“5.  Frequency,  duration  and  character  of  illness  of 
certain  groups  of  children  of  school  age. 

“6.  The  cost  of  sickness  to  three  thousand  families 
from  January  1 to  July  1,  a period  of  six  months. 

“Certain  conclusions  were  drawn  therefrom,  which 
those  of  you  who  happen  to  possess  a copy  of  the 
Pre-Convention  Bulletin  may  read  on  page  27  thereof. 
Dr.  John  Ruddock,  chairman  of  the  Committee  on 
Clinics,  and  who  spent  nearly  two  years  investigat- 
ing this  subject  which  bears  directly  on  this  issue, 
after  taking  weeks  and  weeks  of  time  preparing  this 
report  had  no  place  on  the  program  of  this  meeting, 
and  when  he  was  finally  sandwiched  in  on  Monday 
night,  I listened  with  dismay  at  his  efforts  to  present 
to  you  the  fruits  of  two  years  work  in  fifteen  minutes; 
an  effort  obviously  futile.* 

“Gentlemen  of  the  House  of  Delegates,  something 
is  wrong  with  the  medical  society  of  California.  Mat- 
ters of  such  importance  can  no  longer  be  side-tracked 
to  consider  allergic  infantile  colic,  the  pathology  of 
hay  fever,  or  the  significance  of  postural  tensions  for 
normal  and  abnormal  human  behavior,  or  exterocep- 
tive streams  of  mentation. 

“Gentlemen,  it  is  a rapidly  moving  age.  No  man 
can  engage  in  umbilical  contemplation  with  the  auto- 
motive procession  passing  him  by. 

“My  appeal  is  this:  That  proper  provision  be  made 
upon  the  program  for  the  proper  presentation  of  this 
subject  and  I urge  especially,  gentlemen,  upon  your 
return  to  your  homes,  that  you  will  arrange  with  your 
county  society  to  devote  at  least  three  meetings  for 
the  presentation  of  this  or  allied  subjects. 

“Such  men  as  Dr.  Rexwald  Brown,  Dr.  Walter 
Coffey,  Dr.  Daniel  Crosby,  Dr.  Cushman,  Dr. 
DeLappe,  Dr.  Yoell,  and  many  others  who  are  deeply 
interested  in  these  matters  will  be  glad  to  come  to 
your  assistance  in  your  deliberations,  so  that  we  may 
proceed  with  energy,  but  with  caution;  with  enthusi- 
asm, but  with  wisdom;  to  study  every  suggestion  and 
every  plan  that  we  may  create  a system  of  delivering 
medical  service  to  the  mass  that  will  not  slit  the  throat 
of  progressive  medicine  or  assassinate  the  economic 
life  of  the  doctor. 

“The  ‘Act’  mentioned  was  imaginary  and  only  used 
to  direct  your  attentions  to  the  possibilities  of  the 
present  situation.”  % + + + 

Dr.  Rodney  Yoell  of  San  Francisco  stated  that  cer- 
tain groups  of  sociologists  are  now  preparing  an  act 
which  would  probably  bring  about  the  conditions 
which  Doctor  Graves  outlined. 

Doctor  Duffield  stated  that  Doctor  Graves’  message 
should  be  given  to  every  county  unit. 

On  motion  duly  made  and  seconded,  it  was 

Resolved,  That  the  Council  be  requested  at  the 
next  session  to  arrange  for  a general  session  for  the 
discussion  of  these  matters  and  in  the  meantime  the 
Council  use  every  endeavor  to  get  this  information 
into  the  hands  of  the  members  of  the  Association. 

John  C.  Ruddock  offered  the  following  amendment 
to  the  resolution,  which  was  accepted. 

That  Doctor  Graves’  report  be  ordered  printed  with 
the  report  of  the  survey  on  clinics  and  sent  to  every 
member  of  the  State  Association. 

The  speaker  then  called  for  objections.  Motion  car- 
ried as  amended. 

William  Duffield  of  Los  Angeles  moved  that  a 
rising  vote  of  thanks  of  the  House  of  Delegates  be 
given  Doctor  Graves  for  his  work,  and  especially  for 

* Full  report  will  be  published  in  July  issue. 


his  willingness  in  coming  before  the  House  this  eve- 
ning and  presenting  the  subject  in  this  manner;  such 
motion  was  duly  seconded  and  carried. 

* * * 

XI.  Report  of  the  Reference  Committee  on  Reso- 
lutions and  New  and  Miscellaneous  Business. — 

H.  A.  L.  Ryfkogel,  chairman  of  the  Committee  on 
Resolutions  and  New  and  Miscellaneous  Business 
then  presented  the  report  of  his  committee. 

H.  A.  L.  Ryfkogel 
Percy  T.  Phillips 
F.  C.  E.  Mathison. 

(a)  Resolution  No.  I.  Death  of  Dr.  William  T.  Mc- 
Arthur.— The  Reference  Committee  recommends  the 
adoption  of  this  resolution.  Doctor  Ryfkogel  then 
moved  for  the  adoption  of  the  resolution;  such  motion 
was  duly  seconded  and  unanimously  carried. 

(b)  Resolution  No.  2.  Narcotic  Addicts. — The  Refer- 
ence Committee  recommends  the  adoption  of  this 
resolution.  Dr.  Ryfkogel  then  moved  for  the  adoption 
of  the  resolution;  such  motion  was  duly  seconded  and 
carried. 

(c)  Resolution  No.  3.  Report  of  Committee  on  Hospi- 
tals, Dispensaries , and  Clinics. — The  Reference  Com- 
mittee recommends  the  adoption  of  this  resolution. 
Doctor  Ryfkogel  then  moved  for  the  adoption  of 
the  resolution;  such  motion  was  duly  seconded  and 
carried. 

(d)  Resolution  No.  4-.  Intoxicating  Liquors. — The  Ref- 
erence Committee  feels  that,  since  the  subject-matter 
of  this  resolution  involves  the  opinions  of  so  many 
which  of  necessity  must  be  varied,  it  should  make  no 
recommendation. 

Rodney  Yoell  of  San  Francisco  moved  that  the 
resolution  be  amended  to  include  “that  the  ballot  be 
sent  within  thirty  days”;  such  motion  was  seconded 
by  Joseph  Catton  of  San  Francisco. 

Katherine  Close  of  Los  Angeles  moved  that  the 
resolution  on  use  of  intoxicating  liquors  be  placed  on 
the  table;  such  motion  was  duly  seconded.  A rising 
vote,  was  then  taken  on  the  motion  to  table.  Motion 
carried. 

(e)  Resolution  No.  5.  Tax  Exemption  for  Nonprofit 
Hospitals. — The  Reference  Committee  recommends  the 
adoption  of  this  resolution.  Doctor  Ryfkogel  then 
moved  for  the  adoption  of  the  resolution;  such  motion 
was  duly  seconded  and  carried. 

* * * 

XII.  Presentation  of  the  President.— The  speaker 

asked  President  Morton  R.  Gibbons  to  take  the  chair. 
Doctor  Gibbons  took  the  chair  and  appointed  as 

escorts  to  the  incoming  president,  James  F.  Macpher- 
son,  and  Charles  M.  Fox  of  San  Diego.  Lyell  C. 
Kinney  was  then  presented  to  the  House,  and  thanked 
the  Association  for  the  honor  conferred  on  him. 
Doctor  Kinney  suggested  that  the  Council  give  fur- 
ther consideration  of  the  question  of  medical  eco- 
nomics during  the  next  year. 

* * * 

XIII.  Presentation  of  the  President-Elect. — Wil- 
liam Duffield  escorted  Junius  Brainard  Harris  to  the 
platform.  Doctor  Harris  expressed  his  appreciation 
of  the  high  honor  conferred  upon  him. 

* * * 

XIV.  Resolution. — John  Homer  Woolsey  of  San 
Francisco  moved  that  all  reference  to  the  resolution 
presented,  by  A.  J.  Scott  be  deleted  from  the  minutes; 
such  motion  was  seconded  by  Fred  R.  DeLappe,  and 
carried. 

* * * 

XV.  Reading  and  Adoption  of  the  Minutes. — The 

minutes  of  this  second  meeting  were  then  read,  and 
there  being  no  objection  were  approved. 

* * * 

XVI.  Adjournment. — There  being  no  further  busi- 
ness the  meeting  adjourned. 


444 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


COUNCIL  MINUTES 

Minutes  of  the  One  Hundred  and  Eighty-Seventh 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Eighty-Ninth 
Meeting  of  the  Council  of  the  California 
Medical  Association,  April  27,  1930 

Held  in  the  offices  of  the  Association,  Room  2004, 
450  Sutter  Street,  San  Francisco,  Saturday,  Janu- 
ary 18,  1930,  at  10  a.  m. 

Present. — Drs.  Gibbons,  Kinney,  Pallette,  Hamlin, 
Duffield,  DeLappe,  Phillips,  Coffey,  Harris,  Rogers, 
Hunter,  Cushman,  Kress,  Catton,  Kelly,  Peers,  Pope, 
and  General  Counsel  Peart;  and  John  H.  Graves, 
chairman  of  the  Medical  Economics  Committee. 

Absent. — Drs.  Arnold  and  Moseley. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Minutes  of  the  Council.- — Minutes  of  the  186th 
meeting  of  the  Council  were  presented  for  approval. 
The  chairman  stated  that  since  the  minutes  had  been 
mailed  to  all  councilors,  if  there  were  no  objections, 
he  would  entertain  a motion  for  their  approval  with- 
out further  reading. 

Action  by  the  Council. — On  motion  of  Pallette,  sec- 
onded by  DeLappe,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  minutes  of  the  186th  meeting 
of  the  Council,  as  mailed  to  all  councilors,  be  ap- 
proved. 

3.  Minutes  of  the  Executive  Meeting. — Minutes  of 
the  116th  and  117th  meetings  of  the  Executive  Com- 
mittee were  presented  for  approval.  The  chairman 
stated  that  since  the  minutes  had  been  mailed  to  all 
councilors,  if  there  were  no  objections,  he  would 
entertain  a motion  for  their  approval,  without  further 
reading. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Kress,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  minutes  of  the  116th  and  117th 
meetings  of  the  Executive  Committee,  as  mailed  to 
all  councilors,  be  approved. 

4.  Retired  Members. — Article  IV  of  the  Constitu- 
tion, which  states  that  the  dues  of  retired  members 
shall  be  fixed  by  the  Council,  was  called  to  the  atten- 
tion of  the  Council.  It  was  felt  that  since  this  retired 
status  was  given  in  recognition  of  long  membership  in 
the  Association,  no  dues  should  be  assessed. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Pallette,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  no  dues  be  charged  retired  members. 

5.  William  LeMoyne  Wills.- — The  secretary  advised 
that  William  LeMoyne  Wills,  former  president  of  the 
Association,  was  at  present  an  honorary  member  of 
the  Los  Angeles  County  Medical  Association,  but 
held  no  membership  status  in  the  State  Association. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Peers,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  William  LeMoyne  Wills,  former 
president  of  the  California  Medical  Association,  be 
granted  honorary  membership  in  the  Association. 

6.  M.  W.  Fredrick. — Letter  from  the  San  Francisco 
County  Medical  Society  stating  that  M.  W.  Fredrick 
had  been  granted  retired  membership  in  the  county 
society  and  recommending  that  he  be  granted  the 
same  status  in  the  State  Association  was  presented. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Kinney,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  M.  W.  Fredrick,  member  of  the  San 
Francisco  County  Medical  Society,  be  granted  retired 
membership  in  the  California  Medical  Association. 


7.  Invited  Guests. — Dr.  T.  Henshaw  Kelly,  chair- 
man of  the  Arrangements  Committee  for  the  1930 
annual  meeting,  reported  on  the  invited  guests,  stating 
that  invitations  had  been  extended  and  acceptances 
received  from  Dr.  W.  McKim  Marriott,  St.  Louis; 
Dr.  Fred  Weidman,  Philadelphia;  and  Dr.  A.  U.  Des- 
jardins, Minnesota.  Mr.  Chester  Rowell  had  been 
invited  to  address  the  Association  on  some  phase  of 
the  question  of  the  cost  of  medical  care  and,  although 
no  definite  acceptance  had  been  received  on  account 
of  his  absence  from  the  city,  it  was  very  probable  that 
he  would  accept. 

Discussion  was  then  had  of  the  number  of  general 
sessions  to  be  held  at  Del  Monte,  and  it  was  decided 
that  at  least  three  general  sessions  should  be  held. 

Discussion  of  the  question  of  inviting  Dr.  Morris 
Fishbein  to  speak  before  one  of  the  general  sessions 
was  had. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Peers,  the  following  resolution  was 
adopted: 

Resolved,  That  Dr.  Morris  Fishbein  be  invited  to 
address  the  Association  at  one  of  the  general  sessions 
of  the  annual  meeting  at  Del  Monte. 

8.  Medical  Service  Plans. — Dr.  John  H.  Graves, 
chairman  of  the  Medical  Economics  Committee,  stated 
that  Dr.  Martin  M.  Ritter  of  Los  Angeles  had  gath- 
ered actuarial  statistics  on  the  cost  of  operation  of  a 
medical  service  plan  which  he  was  organizing  in  Los 
Angeles,  and  that  he  had  been  invited  to  address 
the  Council.  Doctor  Ritter  then  spoke  on  the  plan, 
which  he  stated  had  the  cooperation  of  some  of  the 
wealthiest  men  in  the  South.  The  plan  embodied  fur- 
nishing medical  care  to  the  middle  classes  at  a reason- 
able fee,  with  justice  to  both  the  hospital  and  the 
doctor,  according  to  Doctor  Ritter’s  statement.  Doctor 
Ritter  stated  that  the  initiation  fee  was  $5  and  if  upon 
examination  the  applicant  was  found  to  be  in  an  un- 
healthy condition  the  $5  was  returned  and  he  was 
referred  to  his  family  physician;  that  yearly  dues  were 
$24,  payable  annually,  semiannually,  or  monthly;  that 
a yearly  examination  was  required;  that  the  patient 
had  the  choice  of  his  own  physician  and  his  own  hos- 
pital; that  if  he  desired  extra  facilities  at  the  hospital, 
he  would  be  permitted  the  usual  allowance  by  the 
company  and  would  pay  the  difference  himself;  and 
that  the  requirements  for  physicians  were  that  they 
be  graduates  of  a recognized  school  of  medicine. 
Doctor  Ritter  stated  that  the  organization  would  have 
a lay  board  of  managers  and  that  it  was  formed  under 
the  law  for  nonprofit  corporations. 

Action  by  the  Council. — On  motion  of  Kress,  duly 
seconded  and  unanimously  carried,  it  was 

Resolved,  That  a vote  of  thanks  be  accorded  Doctor 
Ritter  and  that  Doctor  Graves  and  his  committee  be 
instructed  to  get  in  further  touch  with  Doctor  Ritter. 

Dr.  Rodney  Yoell  of  San  Francisco  then  addressed 
the  Council  outlining  a plan  for  medical  service  which 
had  been  presented  to  the  Commonwealth  Club.  The 
plan  embodied  the  idea  of  levying  a state  tax  to  care 
for  the  medical  requirements  of  individuals.  The 
money  collected  would  be  placed  in  a fund  and  util- 
ized to  buy  insurance. 

It  was  felt  that  it  would  be  well  to  have  the  plan 
outlined  by  Doctor  Yoell  put  in  form  for  presentation 
to  and  study  by  all  councilors. 

Action  by  the  Council. — On  motion  of  Kress,  duly 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  a vote  of  thanks  be  accorded  Dr. 
Rodney  Yoell. 

Doctor  Graves  was  instructed  to  secure  an  outline 
of  Doctor  Yoell’s  plan  so  that  it  could  be  mimeo- 
graphed and  mailed  to  all  councilors. 

9.  Tax  Exemption  of  Nonprofit  Hospitals. — Mr. 

G.  W.  Curtis,  general  chairman  of  the  Committee  on 
Tax  Exemption  of  Nonprofit  Hospitals,  outlined  to 
the  Council  the  merits  of  the  plan  for  tax  exemption 


June,  1930 


COUNCIL  MINUTES 


445 


of  nonprofit  hospitals  and  stated  that  the  general 
committee  was  very  anxious  to  have  the  Association 
endorse  the  measure  when  it  comes  up  at  the  next 
general  election.  The  question  was  then  discussed  by 
the  Council. 

Action  by  the  Council. — On  motion  duly  made, 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  the  California  Medical  Association 
endorse  the  measure  for  the  tax  exemption  of  non- 
profit hospitals. 

10.  Budget. — Budget  of  estimated  expenses  for  the 
year  1931-32,  as  prepared  by  the  Auditing  Committee 
and  revised  by  the  Executive  Committee,  was  pre- 
sented. 

It  was  the  sense  of  the  Council  that  the  budget  be 
brought  up  for  further  consideration  at  the  first  meet- 
ing of  the  Council  at  the  Del  Monte  session. 

11.  Commercial  Exhibits.  — The  secretary  stated 
that  she  had  received  a visit  from  a member  of  the 
management  of  the  Hotel  Del  Monte,  who  had  dis- 
cussed the  question  of  exhibits  at  the  annual  meeting 
at  Del  Monte  and  that  a satisfactory  room  on  the 
second  floor  had  been  provided  for  the  commercial 
exhibit. 

12.  Principles  of  Professional  Ethics. — Letter  from 
Doctor  Kress  regarding  the  printing  of  the  principles 
of  professional  ethics  was  referred  to  the  Executive 
Committee. 

13.  Professional  Services  of  Doctors  to  Each  Other. 

Discussion  was  had  of  the  case  of  professional  ser- 
vices rendered  by  one  member  of  the  Alameda  County 
Society  to  another  member.  Doctor  Hamlin  reported 
that  the  Council  of  the  Alameda  County  Society  was 
investigating  the  case  and  that  it  was  very  probable 
the  suggestion  that  settlement  be  made  by  arbitration 
through  a committee  of  three  would  be  followed  out. 

Action  by  the  Council. — On  motion  of  Harris,  sec- 
onded by  Duffield,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  progress  report  of  Doctor 
Hamlin  be  accepted  and  that  the  Alameda  County 
Medical  Association  report  further  on  its  investi- 
gations. 

14.  Narcotic  Prescriptions. — Discussion  was  had  of 
the  present  situation  regarding  the  enforcement  of 
the  Narcotic  Law. 

Doctor  Kelly  presented  a letter  which  had  been 
prepared  in  accordance  with  the  resolution  of  the 
Executive  Committee,  which  was  to  go  to  all  mem- 
bers of  the  State  Association  advising  them  of  the 
law  regarding  written  narcotic  prescriptions. 

Action  by  the  Council. — On  motion  of  Hunter, 
seconded  by  Gibbons,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  letter  be  revised  by  Doctor 
Kelly  and  Mr.  Peart  and  that  it  be  sent  to  all  mem- 
bers of  the  State  Association  in  conformity  with  the 
resolution  of  the  Executive  Committee  and  that  copies 
be  sent  to  both  the  northern  and  southern  offices  of 
the  pharmaceutical  association. 

15.  Proposed  Amendment  to  the  Dental  Law. — 

Correspondence  from  Doctor  Pinkham  regarding  the 
proposed  amendment  to  the  dental  law  to  permit  the 
use  of  veronal,  barbital,  etc.,  by  dental  surgeons  under 
the  same  provisions  as  physicians  was  presented. 

Action  by  the  Council.- — On  motion  of  Catton,  sec- 
onded by  Kinney,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  correspondence  be  referred  to 
the  Committee  on  Public  Policy  and  Legislation  for 
study  and  report. 

16.  American  Medical  Association  Economics  Coun- 
cil.— Letter  from  Doctor  Kress  suggesting  that  the 
House  of  Delegates  of  the  California  Medical  As- 
sociation pass  a resolution  recommending  the  forma- 


tion of  a Council  on  Medical  Economics  of  the 
American  Medical  Association  was  presented. 

The  correspondence  was  referred  to  the  Executive 
Committee  for  report  at  the  first  meeting  of  the 
Council  at  Del  Monte. 

17.  Committee  on  Associated  Groups  and  Affiliated 
Societies.— -Resolution  of  the  Executive  Committee 
recommending  that  the  resignation  of  Dr.  T.  Hen- 
shaw  Kelly  be  accepted  from  the  Committee  on  As- 
sociated Societies  and  Technical  Groups  and  that 
Dr.  George  H.  Kress  be  appointed  to  fill  the  un- 
expired term  was  called  to  the  attention  of  the 
Council. 

Action  by  the  Council. — On  motion  duly  made,  sec- 
onded and  unanimously  carried,  the  following  resolu- 
tion was  adopted: 

Resolved,  That  the  resolution  of  the  Executive 
Committee  be  adopted  and  that  Doctor  Kress  serve 
as  a member  of  the  Committee  on  Associated  So- 
cieties and  Technical  Groups  for  the  unexpired  term 
of  Doctor  Kelly. 

18.  Radio  Broadcasting. — Dr.  T.  Henshaw  Kelly 
submitted  a progress  report  on  the  investigations 
being  carried  on  by  the  Committee  on  Radio  Broad- 
casting. Doctor  Kelly  stated  that  the  committee  was 
desirous  of  securing  a hook-up  with  one  of  the  larger 
stations,  KGO-KFI  or  KFRC-KCA.  Doctor  Kelly 
stated  that  the  National  Broadcasting  Corporation 
was  initiating  an  educational  program  and  he  had 
hoped  to  be  able  to  have  them  include  the  medical 
broadcasting  in  this  program,  but  this  did  not  seem 
possible  at  the  present  time.  Doctor  Kelly  stated  that 
unless  one  of  the  larger  stations  could  be  secured  it 
would  be  best  to  abandon  the  plan.  Doctor  Kelly 
stated  that  it  was  his  plan  at  present  to  appoint  his 
subcommittees  as  authorized  and  prepare  his  pro- 
gram, which  would  then  be  submitted  to  the  manager 
of  National  Broadcasting  Corporation. 

Action  by  the  Council. — On  motion  of  Duffield, 
seconded  by  Kinney,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  progress  report  of  Doctor  Kelly 
be  accepted. 

19.  Woman’s  Auxiliary. — Doctor  Kress  stated  that 
he  felt  that  the  formation  of  the  various  county  auxili- 
aries would  be  materially  benefited  if  a small  pam- 
phlet giving  the  purposes  of  the  auxiliary,  rules 
governing,  etc.,  was  published  for  distribution. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Pallette,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  Committee  on  Associated  So- 
cieties and  Technical  Groups  be  authorized  to  publish 
and  distribute  a pamphlet  containing  the  rules  and 
purposes  of  the  Woman’s  Auxiliary  in  such  number 
as  it  sees  fit. 

20.  Canvass  of  Votes  on  Incorporation. — The  secre- 
tary reported  on  the  formal  canvass  of  votes  on 
incorporation  stating  that  the  membership  as  of  De- 
cember 1,  1929  was  4809;  the  total  votes  cast,  3440; 
the  total  votes  cast  for  incorporation  3276  and  the 
total  votes  cast  against  incorporation  164;  giving  a 
surplus  of  33  votes  over  a two-thirds  vote. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Gibbons,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  canvass  of  votes  on  incorpora- 
tion by  the  Executive  Committee  be  accepted  and 
approved  and  that  the  Council  proceed  in  accordance 
with  the  resolution  passed  at  the  185th  meeting,  to 
form  the  corporation. 

Mr.  Peart  then  presented  a draft  of  Articles  of  In- 
corporation, and  it  was  the  sense  of  the  Council  that 
copies  be  sent  to  all  councilors.  Mr.  Peart  stated  that 
he  had  been  working  on  the  by-laws  but  as  yet  had 
no  written  draft  to  submit  for  want  of  information 
as  to  clauses  desired. 


446 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Duffield,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  the  president  of  the  Association, 
the  chairman  of  the  Executive  Committee,  and  the 
general  counsel  be  constituted  a committee  to  prepare 
the  by-laws  for  the  proposed  incorporation  and  report 
to  the  Executive  Committee  and  the  Council. 

It  was  stated  that  copies  of  the  by-laws  should  be 
sent  to  all  members  of  the  Council,  when  prepared. 

21.  Los  Angeles  Hospital. — Doctor  Kress  reported 
on  the  condition  of  the  Los  Angeles  Hospital  relating 
to  clinic  and  out-patient  departments. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Peers,  and  unanimously  carried,  the  follow- 
ing resolution  was  adopted: 

Resolved,  By  the  Council  of  the  California  Medical 
Association  that,  in  its  opinion,  public  hospitals  of 
California  supported  by  taxation  should  not  maintain 
certain  institutional  activities  in  the  care  of  the  indi- 
gent sick,  when  such  activities  might  ultimately  lead 
to  ill  results  to  the  public  health  and  to  medical 
science  standards;  and  be  it  further 

Resolved,  That  in  the  viewpoint  of  the  Council  of 
the  California  Medical  Association,  when  public  hos- 
pitals such  as  county  hospitals  maintain  out-patient 
or  dispensary  departments,  and  charge  admission  or 
treatment  fees  to  such  patients,  that  then  such  out- 
patient departments  of  public  hospitals  could  and  in 
nearly  all  instances  should  very  properly  refer  all 
out-patients,  with  the  exception  of  indigent  patients 
who  can  pay  nothing,  and  of  other  special  classes 
listed  below,  to  other  out-patient  dispensaries  of  in- 
stitutions of  good  reputation  in  the  same  communi- 
ties, when  such  exist.  The  exceptions  being:  (1) 
ambulant  patients  who  have  been  in-patients,  on 
whom  it  is  desirable  to  have  a follow-up  supervision; 
(2)  out-patients  suffering  from  conditions  liable  to 
shortly  make  them  possible  in-patients.  In  the  opin- 
ion of  the  California  Medical  Association,  California 
law  intends  county  hospitals  to  supply  professional 
services  and  hospitalization  only  to  the  indigent  sick 
and  injured,  and  county  hospitals  existing  under  the 
general  California  law  should  observe  this  funda- 
mental rule  and  law. 

22.  Editorials.— Doctor  Kress  stated  that  he  wished 
to  include  an  editorial  on  the  January  issue  of  the 
Survey  Graphic.  Doctor  Kress  stated  that  at  the  an- 
nual Conference  of  Secretaries  Dr.  Harry  M.  Hall 
presented  an  article  on  “Descartes  Was  Right,”  and  if 
there  were  no  objections  he  would  like  to  publish  the 
article  in  the  journal.  No  objection. 

23.  Medical  Service  Plan. — Doctor  Coffey  stated 
that  the  San  Joaquin  County  Society  was  desirous  of 
having  him  speak  to  the  members  at  Stockton  regard- 
ing the  medical  service  plan.  Doctor  Hunter  stated  that 
he  believed  this  plan  should  be  discussed  before  the 
different  societies  by  persons  competent  to  present 
the  plan. 

Action  by  the  Council. — On  motion  of  Hunter,  duly 
seconded,  and  unanimously  carried,  the  following 
resolution  was  adopted: 

Resolved,  That  the  Council  authorize  the  Executive 
Committee  to  delegate  certain  men  whom  it  feels  are 
qualified  by  reason  of  judgment  to  appear  before  the 
county  units  throughout  the  state  and  present  the 
plan  for  medical  service. 

The  letter  to  the  Medical  Economics  Publishing 
Company  was  referred  to  Doctor  Kelly  for  answer 
that  plans  were  not  definite  as  yet. 

24.  Pischel  Correspondence. — Correspondence  re- 
garding certain  optometry  matters  was  discussed  and 
it  was  decided  that  the  letters  be  not  published. 

25.  Board  of  Medical  Examiners. — As  chairman  of 
the  Committee  on  Public  Policy,  Dr.  Junius  B.  Harris 
reported  on  the  recent  changes  in  personnel  of  the 
Board  of  Medical  Examiners. 


It  was  the  sense  of  the  Council  that  Doctor  Harris 
be  authorized  to  express  the  appreciation  of  the  As- 
sociation to  the  Governor. 

26.  Basic  Science  Act  Committee. — Dr.  George  H. 
Kress,  chairman  of  the  Committee  on  the  Medical 
Practice  Act  and  possible  Basic  Science  Act,  pre- 
sented the  report  of  his  committee.  Dr.  Kress  stated 
that  a suggested  basic  science  act  had  been  prepared 
by  the  southern  members  of  the  committee  for  dis- 
tribution to  councilors  and  for  study  and  suggestions. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Duffield,  and  unanimously  carried,  it  was 

Resolved,  That  the  matter  of  a basic  science  act 
be  placed  on  the  docket  for  the  March  1 meeting  of 
the  Council. 

27.  Meeting  of  the  Council. — The  advisability  of 
holding  a special  Council  meeting  for  consideration 
of  the  medical  service  plan  was  discussed. 

Action  by  the  Council. — On  motion  duly  made, 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  a special  meeting  of  the  Council 
be  held  on  Saturday,  March  1,  at  the  home  of  Doctor 
Kress,  Los  Angeles. 

Action  by  the  Council. — On  motion  of  Kelly,  duly 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  the  docket  for  the  March  1 Council 
meeting  be  kept  clear  for  consideration  of  the  medical 
service  plan  and  the  basic  science  act. 

28.  Medical  Service  Plan. — The  general  counsel 
stated  that  he  had  made  further  investigations  of 
types  of  hospital  associations.  Mr.  Peart  then  pre- 
sented a written  memorandum  of  his  investigations  of 
the  possibilities  of  carrying  out  the  plan  under  a cor- 
poration formed  by  others  than  members  of  the  As- 
sociation under  the  Civil  Code,  Title  12. 

It  was  suggested  that  the  general  counsel  have  his 
plans  for  carrying  out  the  medical  service  plan  in 
more  or  less  definite  form  for  the  March  1 meeting. 

The  general  counsel  informed  the  Council  that,  in 
accordance  with  authorization  from  the  Executive 
Committee,  he  had  called  in  outside  counsel  on  the 
question.  It  was  stated  that  the  question  of  special 
fee  for  the  investigations  of  the  general  counsel  and 
his  outside  counsel  had  not  yet  been  discussed. 

29.  Adjournment. — There  being  no  further  business 
the  meeting  adjourned. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 

* * * 

Minutes  of  the  One  Hundred  and  Eighty-Eighth 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Eighty-Ninth 
Meeting  of  the  Council  of  the  California 
Medical  Association,  April  27,  1930 

Held  at  the  home  of  Dr.  George  H.  Kress,  Santa 
Monica  Canyon,  Los  Angeles,  Saturday,  March  1, 
1930,  at  11  a.  m. 

Present. — Drs.  Gibbons,  Kinney,  Pallette,  Hamlin, 
Arnold,  Duffield,  DeLappe,  Phillips,  Coffey,  Harris, 
Rogers,  Hunter,  Cushman,  Kress,  Catton,  Kelly, 
Peers,  Pope,  and  General  Counsel  Peart;  and  chair- 
man of  the  Medical  Economics  Committee,  John  H. 
Graves. 

Absent. — Doctor  Moseley. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Medical  Service  Plan.* — Dr.  John  H.  Graves, 
chairman  of  the  Medical  Economics  Committee,  sub- 


* Full  report  will  be  published  in  July  issue. 


June,  1930 


COUNCIL  MINUTES 


447 


mitted  a written  report  containing  medical  service 
costs  to  specified  groups  in  England;  and  also  in  the 
United  States.  It  was  suggested  that  a digest  of  the 
report  be  made  for  distribution  to  members  of  the 
House  of  Delegates  and  the  Council.  However, 
Doctor  Graves  stated  that  some  of  the  figures  con- 
tained in  the  report  were  confidential  and  had  been 
secured  under  the  agreement  that  they  would  not  be 
published  at  the  present  time. 

Action  by  the  Council. — On  motion  of  Kinney,  sec- 
onded by  Pallette,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  it  is  the  sense  of  the  Council  that 
Doctor  Graves  be  asked  to  present  to  the  Council  at 
Del  Monte  such  figures  as  can  be  released  and  his 
conclusions,  in  the  form  of  a digest  suitable  for  print- 
ing and  for  distribution  among  the  delegates. 

Doctor  Graves  stated  that  he  might  make  sug- 
gestions but  that  he  did  not  feel  that  he  would  want 
to  make  any  recommendations,  and  that  he  would 
endeavor  to  prepare  a digest  of  such  facts  as  could 
be  released. 

Doctor  Graves  then  stated  that  at  the  time  Doctor 
Ritter  had  been  invited  to  address  the  Council  on  his 
medical  service  plan  it  was  understood  that  one-half 
of  his  expenses  from  Los  Angeles  to  San  Francisco 
and  return  would  be  paid  by  the  Association. 

It  was  the  sense  of  the  Council  that  the  payment  of 
$34.17  be  authorized,  being  one-half  of  the  expense 
of  Doctor  Ritter’s  trip  from  Los  Angeles  to  San 
Francisco  and  return. 

3.  Noon  Adjournment. — On  motion  duly  made  and 
seconded,  adjournment  was  taken  for  luncheon. 

4.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin;  all  members  who 
attended  the  morning  session  being  present. 

5.  Medical  Service  Plans. — The  General  Counsel 
submitted  a written  opinion  on  the  possibilities  of 
furnishing  medical,  surgical,  and  hospital  services  to 
persons  whose  incomes  are  less  than  $2500  per  annum 
by  means  of  a medical  and  surgical  staff  composed  of 
those  members  of  the  Association  who  desire  to 
render  such  services  in  consideration  of  payment  of 
a monthly  assessment  by  the  prospective  patient. 

The  opinion  brought  out  the  fact  that,  although 
such  service  could  legally  be  given  under  a copartner- 
ship, it  would  be  unethical  and  illegal  to  solicit  busi- 
ness, directly  or  indirectly,  as  provided  in  Section  14, 
Subsection  12  of  the  Medical  Practice  Act.  Dis- 
cussion was  then  had. 

Dr.  Morton  R.  Gibbons  then  presented  a statement 
of  legal  costs  involved  in  the  investigations  of  the 
insurance,  medical  service  and  hospital  laws  and  dis- 
cussion in  connection  with  the  proposed  plan,  cover- 
ing fee  for  McCutchen,  Olney,  Mannon  & Greene, 
called  in  consultation,  and  fee  for  the  general  counsel 
of  the  Association,  as  authorized  by  the  Council  at  a 
previous  meeting. 

Action  by  the  Council. — On  motion  of  Kinney,  duly 
seconded  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  the  bill  as  submitted  be  approved. 

Doctor  Gibbons  then  stated  that  on  account  of  lack 
of  precedent,  difficulties  in  arriving  at  costs  and  other 
details;  obstacles  involved  in  administration  and  the 
seeming  departure  from  ethical  standards  to  meet 
difficulties  in  a limited  field  with  a resultant  breaking 
down  of  the  barriers  in  the  whole  field;  opposition 
from  cults  and  others  because  of  the  plan  being 
limited  to  members  of  the  California  Medical  Associa- 
tion and  a certain  class  of  beneficiary,  he  would  vote 
to  abandon  the  attempt  to  immediately  put  into  effect 
a health  insurance  plan  but  would  approve  of  a con- 


tinuance of  research  which  would  be  of  utmost  value 
for  future  reference. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Hunter,  the  following  resolution  was  sub- 
mitted for  discussion: 

Resolved,  That  Doctor  Gibbons’  opinion  be  the 
sense  of  this  Council. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Coffey,  it  was 

Resolved,  That  Doctor  Kelly’s  motion  be  laid  on 
the  table. 

Discussion  then  ensued  and  Doctor  Gibbons  stated 
that  he  would  withdraw  his  opinion. 

Doctor  Kress  suggested  that  a special  committee 
be  appointed  to  investigate  the  type  of  legislation 
necessary  to  amend  the  statutes  so  that  the  Associa- 
tion would  be  permitted  to  proceed  with  a plan. 

Doctor  Duffield  introduced  the  following  motion, 
which  was  duly  seconded: 

Resolved,  That  Doctor  Graves’  committee  be  in- 
structed to  continue  the  study  of  this  matter. 

With  the  consent  of  Doctor  Duffield  and  his  second, 
the  following  was  offered  by  Doctor  Kress  as  a sub- 
stitute motion: 

Resolved,  That  a special  committee,  consisting  of 
the  president  of  the  society,  Doctor  Gibbons;  the 
president-elect,  Doctor  Kinney,  the  chairman  of  the 
Council,  Doctor  Hamlin;  the  chairman  of  the  Execu- 
tive Committee,  Doctor  Kelly;  Doctor  Graves  and 
Doctor  Coffey,  with  Mr.  Peart  in  consultation,  be 
appointed  and  that  this  be  constituted  a committee 
of  this  Council  to  pursue  the  special  investigations. 

It  was  stated  that  Doctor  DeLappe,  who  spoke  of 
a plan  of  medical  care  through  county  hospitals, 
should  be  invited  to  meet  with  the  committee. 

Action  by  the  Council. — After  discussion,  the 
motion  of  Doctor  Kress  was  unanimously  carried. 

Doctor  Catton  then  suggested  that  the  two  ques- 
tions of  “liability”  and  “solicitation”  be  submitted  to 
a vote.  No  action  taken. 

Discussion  was  then  had  of  the  advisability  of  call- 
ing a special  meeting  of  the  Council  prior  to  the 
annual  meeting  for  discussion  of  the  medical  service 
plan. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Coffey,  it  was 

Resolved,  That  a special  meeting  of  the  Council  be 
called  on  April  12  for  consideration  of  the  medical 
service  plan  and  other  business  which  may  come  up. 

A vote  was  then  taken  on  the  motion.  Yeas,  5; 
noes,  6;  motion  defeated. 

Action  by  the  Council. — On  motion  of  Hunter,  sec- 
onded by  Kelly,  and  unanimously  carried,  it  was 

Resolved,  That  the  Council  meet  at  2 p.  m.  Sunday. 
April  27,  at  Del  Monte  at  which  meeting  the  medical 
service  plan  shall  be  considered  further. 

Discussion  was  then  had  as  to  the  advantage  of 
such  a medical  service  plan  over  other  types  of  health 
associations  and  medical  service  plans,  and  Doctor 
Hunter  was  asked  to  prepare  a statement  presenting 
his  viewpoints  and  basic  contentions. 

6.  Basic  Science  Act. — Dr.  George  H.  Kress,  chair- 
man of  the  Committee  on  the  Medical  Practice  Act 
and  the  Proposed  Basic  Science  Act.  called  the  atten- 
tion of  the  Council  to  the  report  of  his  committee, 
suggesting  that  the  report  be  studied  so  that  some 
conclusions  could  be  reached  at  the  next  Council 
meeting. 

7.  Adjournment. — There  being  no  further  business 
the  meeting  adjourned. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 


+48 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Minutes  of  the  One  Hundred  and  Eighty-ninth 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Ninetieth  Meeting 
of  the  Council  of  the  California  Medical 
Association,  April  28,  1930. 

Held  in  Room  723,  Hotel  Del  Monte,  Del  Monte, 
California,  Sunday,  April  27,  1930  at  2:30  p.  m. 

Present. — Doctors  Gibbons,  Kinney,  Pallette,  Arn- 
old, Duffield,  DeLappe,  Phillips,  Hamlin,  Harris, 
Rogers,  Hunter,  Cushman,  Kress,  Kelly,  Peers,  Pope, 
and  General  Counsel  Peart. 

Absent. — Doctors  Moseley,  Coffey,  and  Catton. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Minutes  of  the  Council. — The  chairman  stated 
that  the  minutes  of  the  187th  and  188th  meetings  of 
the  Council  had  been  mailed  to  all  councilors  and  if 
there  were  no  objections,  he  would  entertain  a mo- 
tion for  their  approval  without  further  reading. 

Action  by  the  Council. — On  motion  of  Kinney, 
seconded  by  Duffield,  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved.  That  the  minutes  of  the  187th  and  188th 
meetings  of  the  Council,  as  mailed  to  all  members, 
be  approved. 

3.  Minutes  of  the  Executive  Committee. — The 

chairman  stated  that  the  minutes  of  the  118th  and 
119th  meeting  of  the  Executive  Committee  had  been 
mailed  to  all  members  of  the  Council. 

Action  by  the  Council. — On  motion  duly  made  and 
seconded,  and  unanimously  carried,  the  following  reso- 
lution was  adopted: 

Resolved,  That  the  minutes  of  the  118th  and  119th 
meetings  of  the  Executive  Committee,  as  mailed  to 
all  councilors,  be  approved. 

4.  Medical  Service  Plan. — Doctor  Hunter  submitted 
a letter  on  medical  service,  which  was  referred  to 
the  Committee  on  Medical  Economics. 

Discussion  was  had  as  to  the  advisability  of  con- 
tinued study  of  the  problem  of  adequate  medical  care 
of  persons  of  limited  incomes.  Doctor  Hunter  stated 
that  without  any  thought  of  developing  any  particular 
plan,  the  Committee  on  Medical  Economics  should 
be  instructed  to  continue  its  study  of  the  various 
phases  of  this  subject  and  present  to  the  Council 
from  time  to  time  such  suggestions  and  plans  as  it 
may  evolve. 

Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Duffield,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  matter  of  the  medical  service 
plan  be  laid  on  the  table  for  consideration  at  a future 
meeting  of  the  Council  at  the  Del  Monte  session. 

5.  Correspondence  from  Doctor  Day. — Letter  ad- 
dressed to  the  chairman  of  the  Council  by  Dr.  Robert 
V.  Day  requesting  that  financial  statements  of  the 
Association  be  furnished  county  society  officers,  was 
read.  It  was  pointed  out  that  the  financial  records  of 
the  Association  were  open  to  inspection  of  all  mem- 
bers. After  discussion,  it  was  decided  that  distribu- 
tion throughout  the  state  was  inadvisable. 

Amendment  to  Section  11  of  Article  10  of  the  Con- 
stitution as  submitted  by  Doctor  Day  was  read. 

Action  by  the  Council. — On  motion  of  Pallette,  sec- 
onded by  Kelly  and  unanimously  carried,  the  follow- 
ing resolution  was  adopted: 

Resolved,  That  the  communication  be  received,  and 
that  action  there  on  be  deferred  until  the  meeting  of 
the  Council  on  Thursday. 

6.  Council  Docket. — Doctor  Kelly  stated  that  he 
was  in  favor  of  combining  the  first  and  second  meet- 
ings of  the  Council  and  dispensing  with  the  8 p.  m. 
session. 


Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Duffield,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  Council  combine  the  order  of 
business  of  the  first  and  second  meetings  of  the 
Council  and  dispense  with  the  evening  meeting. 

7.  Basic  Science  and  Medical  Practice  Acts. — Dis- 
cussion was  had  of  the  advisability  of  amending  the 
Medical  Practice  Act.  Doctor  Kress  stated  that 
amendment  of  the  act  seemed  impractical  at  this  time 
except  on  the  point  of  interneship  as  discussed  last 
year  by  the  deans  of  the  University  of  California, 
Stanford,  College  of  Medical  Evangelists  and  the 
Board  of  Medical  Examiners,  which  would  provide 
that  medical  students  from  other  states  must  serve 
the  equivalent  of  one  year’s  interneship  before  tak- 
ing examination  for  license  to  practice.  It  was  pointed 
out  that  it  was  desirable  to  study  the  legislative  pro- 
cedures necessary  for  such  amendment  of  the  act  and 
that  the  viewpoints  of  the  deans  of  the  universities 
and  the  Board  of  Medical  Examiners  should  be  ob- 
tained. 

Action  by  the  Council.— On  motion  of  Kress,  sec- 
onded by  Kelly  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  matter  of  the  amendment  of 
the  Medical  Practice  Act  be  referred  to  the  Com- 
mittee on  Public  Policy  and  Legislation  for  study 
and  report  at  the  fall  meeting  of  the  Council. 

8.  Basic  Science  Act. — Doctor  Kress,  chairman  of 
the  Special  Committee  on  the  Basic  Science  Act,  sub- 
mitted a progress  report  of  his  committee,  stating  that 
the  term  “Qualifying  Certificate”  would  probably  be 
a better  title  for  the  act  than  Basic  Science  Law. 
Doctor  Gibbons  then  presented  his  views  on  the  pro- 
posed law. 

Action  by  the  Council. — On  motion  of  Gibbons,  sec- 
onded by  Kelly,  and  carried,  the  following  resolution 
was  adopted: 

Resolved,  That  the  matter  of  a proposed  Basic 
Science  Law  be  dropped. 

Action  by  the  Council. — On  motion  duly  made  and 
seconded,  the  following  substitute  motion  was  then 
offered  and  unanimously  carried: 

Resolved,  That  the  proposed  Basic  Science  Act  be 
referred  back  to  the  committee  and  that  the  northern 
and  southern  groups  study  the  whole  question  and  re- 
port to  the  Council  at  a future  meeting. 

9.  Order  of  Business.— In  accordance  with  the  con- 
stitution’s provision,  the  Council  discussed  the  order 
of  business  for  the  first  two  meetings  of  the  House 
of  Delegates,  which  was  amended  as  follows: 

FIRST  MEETING 
ORDER  OF  BUSINESS 

1.  Call  to  order. 

2.  Report  of  the  speaker  on  personnel  of  Creden- 
tials Committee  and  two  Reference  Committees. 

3.  Report  of  the  Credentials  Committee  and  roll 
call. 

4.  Report  of  the  president,  Morton  R.  Gibbons. 

5.  Report  of  the  Council,  Oliver  D.  Hamlin,  Chair- 
man. 

6.  Report  of  the  Auditing  Committee,  T.  Henshaw 
Kelly,  Chairman. 

7.  Report  of  the  secretary,  Emma  W.  Pope. 

8.  Report  of  the  editors,  George  H.  Kress,  Emma 
W.  Pope. 

9.  Report  of  the  general  counsel,  Hartley  F.  Peart. 

10.  Unfinished  business. 

11.  New  business  (Introduction  of  resolutions). 

12.  Reading  and  adoption  of  minutes. 

Adjournment. 

SECOND  MEETING 
ORDER  OF  BUSINESS 

1.  Call  to  order. 

2.  Roll  call. 


June,  1930 


COUNCIL  MINUTES 


449 


3.  Announcement  of  place  of  session,  1931. 

4.  Election  of: 

(a)  President-elect. 

(b)  Speaker  of  the  House  of  Delegates. 

(c)  Vice-Speaker  of  House  of  Delegates. 

(d)  Councilors: 

Second  District,  Incumbent — William  Duf- 
field,  Los  Angeles  (1930). 

Fifth  District,  Incumbent — Alfred  Phillips, 
Santa  Cruz  (1930). 

Eighth  District,  Incumbent — Junius  B.  Har- 
ris, Sacramento  (1930). 

Councilors-at-large — Incumbents : 

Ruggles  A.  Cushman,  Santa  Ana  (1930). 

T.  Henshaw  Kelly,  San  Francisco  (1930). 

(e)  Delegates  and  alternates  to  the  American 

Medical  Association  for  sessions  of  1931- 

1932. 

Incumbents : 

Delegates — Victor  Vecki,  San  Francisco; 
Percy  T.  Magan,  Los  Angeles;  Junius  B. 
Harris,  Sacramento. 

Alternates — William  E.  Stevens,  San  Fran- 
cisco; Chas.  D.  Lockwood,  Pasadena; 
John  Hunt  Shephard,  San  Jose. 

5.  Report  of  Reference  Committee  on  reports  of 
officers  and  standing  committees. 

6.  Report  of  the  Reference  Committee  on  Resolu- 
tions and  new  business. 

7.  New  business. 

8.  Presentation  of  president. 

9.  Presentation  of  the  president-elect. 

10.  Reading  and  adoption  of  minutes. 

Adjournment. 

Action  by  the  Council:  On  motion  of  Kinney,  sec- 
onded by  Kelly,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  printed  order  of  business  for 
the  first  two  meetings  of  the  House  of  Delegates,  as 
amended,  be  accepted. 

10.  Death  of  Doctor  McArthur. — The  secretary 
read  a resolution  on  the  death  of  Dr.  William  T. 
McArthur  as  prepared  by  Doctor  Duffield. 

Action  by  the  Council. — On  motion  duly  made  and 
seconded,  and  unanimously  carried,  the  following 
resolution  was  adopted: 

Resolved,  That  the  resolution  on  the  death  of 
Doctor  William  Taylor  McArthur  be  presented  at 
the  first  meeting  of  the  House  of  Delegates. 

Doctor  Duffield  was  appointed  to  present  the  resolu- 
tion. 

11.  Budget. — Dr.  T.  Henshaw  Kelly,  Chairman  of 
the  Auditing  Committee  presented  a budget  of  re- 
ceipts and  expenses  for  1931.  Doctor  Kelly  stated 
that  in  the  past  it  had  been  the  custom  of  the  As- 
sociation to  allow  the  medical  society  of  the  county 
wherein  the  annual  meeting  was  held  to  stand  the 
expenses  of  the  meeting.  Because  of  this  only  the 
larger  societies  were  able  to  invite  the  Association 
to  hold  meetings  in  their  counties.  Since  the  financial 
status  of  the  Association  is  on  a sound  basis,  Doctor 
Kelly  suggested  the  expense  of  annual  meetings  be 
borne  by  the  Association.  It  was  the  sense  of  the 
Council  that  expenses  of  annual  meetings  be  paid 
by  the  Association  in  the  future. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Harris,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted. 

Resolved,  That  the  budget  as  amended  be  ac- 
cepted. 

12.  Incorporation. — The  General  Council  stated 
that  the  Articles  of  Incorporation  and  By-Laws  had 
been  mailed  to  all  officers  and  councilors.  Mr.  Peart 
then  read  the  articles  section  by  section.  The  matter 
of  cumulative  voting  was  discussed  and  it  was  de- 
cided that  provision  should  be  made  in  the  articles 


to  prohibit  cumulative  voting.  Discussion  was  then 
had  as  to  the  number  of  directors  for  the  corpora- 
tion. 

Action  by  the  Council. — On  motion  of  Peers,  sec- 
onded by  Kinney  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  number  of  directors  of  the  pro- 
posed corporation  be  limited  to  seven. 

13.  Report  of  the  Council. — The  report  of  the 
Council  as  prepared  by  the  chairman  was  read  sec- 
tion by  section  and  a few  additions  made. 

14.  Illness  of  Doctor  Moseley. — Telegram  from 
Doctor  Moseley  was  read  by  the  secretary.  The  Coun- 
cil expressed  its  regret  of  Doctor  Moseley’s  inability 
to  be  present  and  authorized  the  president  to  write  a 
letter  of  sympathy  to  Doctor  Moseley. 

15.  William  KcKim  Marriott. — Telegram  from  Doc- 
tor William  McKim  Marriott,  invited  guest,  was 
read.  The  Program  Committee  was  authorized  to 
secure  another  speaker  for  the  general  session  at 
which  Doctor  Marriott  was  to  speak.  It  was  sug- 
gested that  the  committee  attempt  to  secure  as 
speaker,  Doctor  Sommer,  Vice-President  of  the  Amer- 
ican Medical  Association,  who  was  present  at  the 
meeting. 

16.  Members  of  Standing  Committees. — Discus- 
sion was  had  of  the  advisability  of  inviting  members 
of  standing  committees  to  attend  the  meetings  of 
the  House  of  Delegates  and  enter  into  any  discussion 
had  on  reports  of  such  committees.  It  was  pointed 
out  that  the  meetings  of  the  House  of  Delegates  were 
open  to  all  members  of  the  Association  and  that  if 
any  reports  of  standing  committees  evoked  discus- 
sions, the  speaker  would  grant  the  members  of  the 
committees  the  courtesy  of  the  floor. 

17.  Adjournment. — There  being  no  further  busi- 
ness, the  meeting  adjourned  to  meet  in  the  same 
place  at  2:30  p.  m.,  Monday,  April  28,  1930. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 

* * * 

Minutes  of  the  One  Hundred  and  Ninetieth  Meeting 
of  the  Council  of  the  California  Medical 

Association 

Approved  at  the  One  Hundred  and  Ninety-third  Meeting 

of  the  Council  of  the  California  Medical  Association, 
May  1,  1930. 

Held  in  Room  723,  Hotel  Del  Monte,  Del  Monte, 
California,  Monday,  April  28,  1930,  at  2:30  p.  m. 

Present. — Doctors  Gibbons,  Kinney,  Pallette,  Arn- 
old, Duffield,  DeLappe,  Phillips,  Hamlin,  Harris,  Rog- 
ers, Hunter,  Cushman,  Kress,  Kelly,  Coffey,  Catton, 
Peers,  Pope  and  General  Counsel  Peart  and  Vice- 
Speaker  John  H.  Graves. 

Absent. — Doctor  Moseley. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Prize  Award. — Doctor  Emmet  Rixford,  mem- 
ber of  the  Committee  on  Clinical  and  Research  Prizes, 
submitted  the  following  report  for  the  committee: 

“On  behalf  of  the  Committee  on  Prize  Essays  I 
have  the  honor  to  make  the  following  report: 

“Five  papers  were  submitted  and  were  read  by  the 
three  members  of  the  committee  each  of  whom  voted 
independently  of  the  others.  Their  vote  coincided  in 
awarding  the  Clinical  Prize  to  the  paper  written  under 
the  pseudonym  ‘Philo,’  and  the  Research  Prize  under 
the  pseudonym  ‘Rose  Trendelenburg.’  It  is  only 
fair  to  state,  however,  the  two  papers,  viz.,  that 
under  the  name  ‘Carpe  Diem’  and  that  under  the 
name  ‘Ignotus,’  were  more  than  good  seconds.  We 
agree  that  they  should  receive  honorable  mention 
and  suggest  that  they  be  presented  to  the  meeting.” 

The  secretary  then  opened  the  sealed  envelopes 
containing  the  nom  de  plumes  and  stated  that  Emil 


450 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Bogen  of  Los  Angeles  wrote  the  paper  “Pulmonary 
Hemorrhage”  under  the  name  of  “Philo”;  H.  J.  Hara 
of  Los  Angeles  submitted  the  paper  on  “Comparative 
Merits  of  Posture  in  Tonsillectomy”  under  the  name 
“Rose  Trendelenburg”;  T.  L.  Althausen,  San  Fran- 
cisco, submitted  the  paper  entitled  “Functional  As- 
pects of  Regenerated  Hepatic  Tissue”  under  the  name 
“Carpe  Diem”;  Mary  Lawson  Neff  of  Los  Angeles 
wrote  “Clinical  Study  of  an  Unusual  Case  of  Tetanus” 
under  the  name  of  “Ignotus.” 

It  was  pointed  out  that  it  would  be  impossible  to 
read  the  papers  before  the  different  sections  as  pro- 
vided in  the  report,  since  all  programs  were  filled. 

Action  by  the  Council. — On  motion  of  Gibbons, 
seconded  by  Kress,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  report  of  the  Committee  on 
Clinical  and  Research  Prizes  be  accepted  and  the  rec- 
ommendations contained  therein  be  adopted,  except 
that  provision  which  states  that  papers  shall  be  read 
before  the  respective  sections;  and  that  in  addition 
to  the  $150  prize,  each  winner  be  given  a certificate 
of  award. 

3.  Council  on  Medical  Economics  of  the  A.  M.  A. — 

The  question  of  a Council  on  Medical  Economics  of 
the  American  Medical  Association  was  further  dis- 
cussed, and  on  motion  of  Kress,  seconded  by  Pallette, 
and  unanimously  carried,  the  following  resolution  was 
adopted : 

Resolved,  That  the  Council  recommend  that  the 
House  of  Delegates  of  the  California  Medical  Asso- 
ciation be  instructed  to  present  a resolution  asking 
the  House  of  Delegates  of  the  American  Medical 
Association  to  consider  the  advisability  of  forming 
a Council  on  Medical  Economics.  Also  that  our  dele- 
gates be  instructed  to  call  the  attention  of  the  House 
of  Delegates  of  the  American  Medical  Association  to 
certain  experiences  had  regarding  the  Porter  Narcotic 
Bills. 

4.  Report  of  the  Council. — Certain  data  which  had 
been  submitted  for  inclusion  in  the  report  of  the  Coun- 
cil was  approved  and  ordered  added  to  the  report  for 
presentation  to  the  House  of  Delegates  at  the  first 
meeting  thereof. 

5.  Minutes  of  the  Council. — Minutes  of  the  189th 
meeting  of  the  Council  were  read. 

Action  by  the  Council. — On  motion  of  Kelly,  sec- 
onded by  Harris,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  the  minutes  of  the  189th  meeting 
of  the  Council,  as  amended,  be  approved. 

6.  Tax  Exemption  on  Nonprofit  Hospitals. — Doc- 
tor Catton  read  the  resolution  passed  at  the  187th 
meeting  of  the  Council  wherein  the  California  Medi- 
cal Association  endorsed  the  proposed  legislation  on 
tax  exemption  for  nonprofit  hospitals.  Doctor  Cat- 
ton  stated  that  he  had  been  asked  by  those  interested 
in  the  legislation  if  it  would  be  possible  to  have  the 
House  of  Delegates  also  endorse  the  resolution. 

Action  by  the  Council. — On  motion  of  Catton,  sec- 
onded by  Duffield  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  a resolution  be  presented  at  the 
first  meeting  of  the  House  of  Delegates  recommend- 
ing endorsement  of  Amendment  No.  6,  which  will 
exempt  nonprofit  hospitals  from  taxation  in  Cali- 
fornia. 

Doctor  Catton  was  instructed  to  prepare  the  reso- 
lution for  presentation  to  the  House  of  Delegates. 

7.  Credentials  Committee. — Doctor  Edward  M.  Pal- 
lette, Speaker  of  the  House  of  Delegates,  informed 
the  Council  that  he  had  appointed  as  members  of  the 
Credentials  Committee,  Dr.  George  G.  Reinle  of  Oak- 
land, chairman;  Dr.  Percy  T.  Magan  of  Los  Angeles, 
and  Dr.  John  Homer  Woolsey  of  San  Francisco. 

Doctor  Kress  stated  that  some  type  of  form  should 
be  adopted  in  order  to  facilitate  the  work  of  the 
Reference  Committee. 


It  was  the  sense  of  the  Council  that  some  such 
form  blank  should  be  used  by  the  Reference  Com- 
mittee and  that  at  the  fall  meeting  of  the  Council  the 
question  should  be  again  discussed. 

8.  National  Millers’  Association. — Dr.  T.  Henshaw 
Kelly  stated  that  a representative  of  the  National 
Millers’  Association  had  requested  that  a resolution  be 
passed  by  the  Council  of  the  California  Medical  As- 
sociation similar  to  that  passed  by  other  State  Asso- 
ciations deploring  food  fads. 

On  authorization  of  the  Council  Doctor  Kelly 
formulated  and  presented  the  following  resolution, 
which  was  seconded  by  Catton  and  unanimously  car- 
ried: 

Whereas,  All  sorts  of  food  and  nutritional  fads,  sup- 
ported by  misinformation  and  exaggerated  claims  and 
involving  grossly  unbalanced  diets  are  being  advocated 
by  various  persons  and  agencies;  and 

Whereas,  Any  diet,  consisting  of  animal  protein, 
fruits,  vegetables,  especially  fresh  and  green  vege- 
tables, the  better  grades  of  bread,  made  from  flour 
which  contains  the  necessary  vitamins  and  mineral 
salts,  digestible  fats  such  as  butterfat,  and  other  eas- 
ily assimilable  carbohydrates  to  complete  the  energy 
requirements  of  the  individual,  is  a balanced  diet;  and 

Whereas,  The  statements  that  meat,  white  bread, 
sweets,  or  other  usual  foods  incorporated  in  a gen- 
eral diet  are  the  causes  of  serious  ailments  are  not 
based  on  scientific  facts;  and 

Whereas,  The  results  of  dietary  deficiencies  have 
been  grossly  misstated  by  faddists;  and 

Whereas,  Any  special  diet  should  be  adopted  only 
upon  the  prescription  of  a properly  trained  physician 
after  complete  study  of  the  dietary  necessities  of  the 
individual;  therefore  be  it 

Resolved,  That  the  Council  of  the  California  Med- 
ical Association  is  in  full  accord  with  the  statements 
made  above  and  strongly  disapproves  on  the  basis 
of  the  danger  to  the  public  and  individual  health,  of 
all  food  fads  and  special  unbalanced  diets. 

9.  Medical  Service. — Doctor  John  H.  Graves, 
chairman  of  the  Medical  Economics  Committee  stated 
that  he  had  received  some  figures  and  data  from 
other  sources  since  the  submission  of  his  last  report, 
particularly  the  Southern  Pacific  Company  and  some 
of  the  older  hospital  institutions,  but  as  yet  had  not 
had  time  to  incorporate  them  in  a report  for  sub- 
mission to  the  Council. 

Doctor  Walter  B.  Coffey  then  addressed  the  Coun- 
cil presenting  a chart  of  figures  which  had  been  pre- 
pared by  outstanding  expert  accountants,  based  on 
medical  service  to  be  furnished  by  the  Santa  Fe  and 
Southern  Pacific  Railroads.  Doctor  Coffey  stated  that 
he  would  furnish  Doctor  Graves’  Committee  with 
such  figures  as  he  had  obtained. 

Doctor  Duffield  then  brought  up  the  question  of 
having  a meeting  at  which  Doctors  Coffey  and  Graves 
could  discuss  the  medical  service  problem.  It  was 
pointed  out  that  Dr.  Rexwald  Brown  was  scheduled 
to  present  a paper  on  the  Business  of  Medicine  be- 
fore the  joint  section  meeting  of  General  Medicine 
and  Pediatrics. 

On  motion  of  Peers,  duly  seconded  and  unani- 
mously carried,  the  following  resolution  was  adopted: 

Resolved,  That  Dr.  Rexwald  Brown’s  paper  on  the 
Business  of  Medicine  be  presented  as  the  fourth 
paper  at  the  joint  section  meeting  of  General  Med- 
icine and  Pediatrics  and  that  Doctors  Coffey  and 
Graves  discuss  the  paper  at  the  close  of  its  presenta- 
tion. 

10.  Retired  Membership.  — Letter  from  the  San 
Joaquin  County  Society  requesting  that  retired  mem- 
bership be  granted  Dr.  Mary  C.  Taylor  was  read. 

Action  by  the  Council. — On  motion  of  Rogers,  sec- 
onded by  Peers,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  Mary  C.  Taylor,  former  member  of 
San  Joaquin  County  Society,  be  granted  retired  mem- 
bership in  the  California  Medical  Association. 


June,  1930 


COUNCIL  MINUTES 


451 


Letter  from  the  Tulare  County  Society  requesting 
that  Doctor  Thomas  O.  McSwain  be  granted  retired 
membership  was  read. 

Action  by  the  Council. — On  motion  of  DeLappe, 
seconded  by  Duffield  and  unanimously  carried,  the 
following  resolution  was  adopted: 

Resolved,  That  Thomas  O.  McSwain,  Visalia,  Tu- 
lare County,  be  granted  retired  membership  in  the 
California  Medical  Association. 

Letter  from  the  San  Bernardino  County  Society  re- 
questing that  Drs.  W.  H.  Stiles  be  granted  retired 
membership  was  read. 

On  motion  of  Harris,  duly  seconded  and  unani- 
mously carried,  the  following  resolution  was  adopted: 

Resolved,  That  W.  H.  Stiles,  San  Bernardino,  San 
Bernardino  County,  be  granted  retired  membership. 

The  advisability  of  adopting  a form  which  would 
contain  complete  information  on  all  doctors  request- 
ing retired  membership  was  discussed  and  the  fol- 
lowing form  was  presented  by  Doctor  Kress: 

(Note. — Information  here  requested  is  to  be  se- 
cured by  the  secretary  of  the  County  Society  making 
a retired  membership  recommendation.) 

Name  — 

Address  

Born  Where When 

Graduate  of  at  place  in  year  

In  practice  at  the  following  places  (approximate 

periods  sufficient)  

Came  to  California  to  reside  in  year  

Licensed  in  California  in  year  

First  joined  a county  medical  society  of  the  Cali- 
fornia Medical  Association  in  year  — ■ — 

Has  been  a member  of  a county  medical  society  of 
the  California  Medical  Association  for  the  last 
years. 

How  long  out  of  practice  (in  part)  ; (per- 

manently)— 

Remarks : 


Place  Date 

To  the  Council  of  the  County  Medical  Association: 

At  a meeting  of  the  (state  whether  executive  board, 
or  society  as  a whole  ) it  was  voted  to  recom- 

mend for  retired  membership  in  the  California  Med- 
ical Associatin  the  name  of  a member  in  good 

standing  of  this  county. 

Remarks: 

Respectfully  submitted, 


The County  Society. 

By President. 

..Secretary. 


Action  by  the  Council. — On  motion  of  Kress,  sec- 
onded by  Catton,  and  unanimously  carried,  the  fol- 
lowing resolution  was  adopted: 

Resolved,  That  a form  blank  as  submitted  be  used 
in  applications  for  retired  membership. 

List  of  names  of  members  of  the  San  Francisco 
County  Society  to  whom  it  was  desired  to  grant  re- 
tired membership  was  presented.  Doctor  Kelly,  Sec- 
retary of  the  San  Francisco  County  Society,  stated 
that  all  of  the  members  named  had  been  fully  in- 
vestigated and  that  they  met  the  requirements  of 
length  of  membership  and  age. 

On  motion  of  Duffield,  seconded  by  Pallette  and 
unanimously  carried,  the  following  resolution  was 
adopted: 

Resolved,  That  Drs.  David  Cohn,  Adolph  J.  Kahn, 
Arthur  F.  Sampson,  Howard  Somers,  Emanuel  Good- 
man, Henry  C.  McClenahan,  James  Franklin  Smith, 
Edith  W.  Hammond,  James  J.  Hogan,  and  Raymond 
Alexander,  all  members  of  the  San  Francisco  County 
Society  be  granted  retired  membership  in  the  Cali- 
fornia Medical  Association. 

12.  Constitutional  Convention. — The  General  Coun- 
sel stated  that  a committee  had  been  appointed  by 


the  Governor  to  investigate  the  desirability  of  call- 
ing a constitutional  convention  to  prepare  a model 
constitution  for  the  state,  and  suggested  that  at  hear- 
ings on  matters  of  public  health  the  Association  be 
represented. 

12.  Adjournment. — There  being  no  further  business 
the  meeting  adjourned  to  meet  in  the  same  place  at 
9 a.  m.,  Tuesday,  April  29,  1930. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 

* * * 

Minutes  of  the  One  Hundred  and  Ninety-first 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Ninety-third  Meeting 
of  the  Council  of  the  California  Medical 
Association,  May  1,  1930. 

Held  in  Room  723,  Hotel  Del  Monte,  Del  Monte, 
California,  April  29,  1930,  at  9 a.  m. 

Present. — Doctors  Gibbons,  Kinney,  Hamlin,  Pal- 
lette, Duffield,  Arnold,  Peers,  Rogers,  Cushman, 
Kelly,  Kress,  DeLappe  and  Pope  and  General  Coun- 
sel Peart. 

Absent. — Doctors  Phillips,  Moseley,  Catton,  Coffey, 
Flarris  and  Hunter. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Adjournment. — There  being  no  business  to  come 
before  the  Council,  the  meeting  adjourned  to  meet 
in  the  same  place  at  9 a.  m.,  Wednesday,  April  30, 
1930. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 

* * * 

Minutes  of  the  One  Hundred  and  Ninety-second 
Meeting  of  the  Council  of  the  California 
Medical  Association 

Approved  at  the  One  Hundred  and  Ninety-third  Meeting 
of  the  Council  of  the  California  Medical 
A ssociation,  May  1,  1930. 

Held  in  Room  723,  Hotel  Del  Monte,  Del  Monte, 
California,  Wednesday,  April  30,  1930,  at  9 a.  m. 

Present. — Doctors  Gibbons,  Kinney,  Hamlin,  Pal- 
lette, Arnold,  Duffield,  DeLappe,  Kress,  Phillips,  Har- 
ris, Rogers,  Hunter,  Cushman,  Catton,  Kelly,  Peers, 
Pope  and  General  Counsel  Peart. 

Absent. — Doctors  Moseley  and  Coffey. 

1.  Call  to  Order. — The  meeting  was  called  to  order 
by  the  chairman,  Oliver  D.  Hamlin. 

2.  Woman’s  Auxiliary. — The  request  of  the  Wom- 
an’s Auxiliary  that  during  the  organization  period 
financial  aid  be  granted  the  Auxiliary  by  the  Cali- 
fornia Medical  Association  was  discussed.  Doctor 
Kinney  stated  that  the  request  had  been  made  on 
account  of  expenses  incurred  in  organization  work. 
Doctor  Kress  pointed  out  that  dues  were  assessed 
by  the  Auxiliary  and  that  the  organization  should  be 
self-supporting.  It  was  decided  that  although  the 
Association  should  aid  the  Auxiliary  in  its  work  no 
definite  appropriation  for  the  time  being  should  be 
made. 

3.  Place  of  the  1931  Annual  Meeting. — Discussion 
was  had  of  the  place  of  the  next  annual  meeting.  It 
was  stated  that  invitations  had  been  received  from 
San  Francisco  and  other  cities. 

On  motion  duly  made  and  seconded,  and  unani- 
mously carried,  the  following  resolution  was  adopted. 

Resolved,  That  the  next  annual  meeting  of  the  Cali- 
fornia Medical  Association  be  held  at  San  Francisco. 

4.  Adjournment. — -There  being  no  further  business, 
the  meeting  adjourned  to  meet  in  the  same  place  at 
9 a.  m.,  Thursday,  May  1,  1930. 

Oliver  D.  Hamlin,  Chairman. 

Emma  W.  Pope,  Secretary. 


STATE  MEDICAL  ASSOCIATIONS 


CALIFORNIA  MEDICAL 
ASSOCIATION* 

LYELL  C.  KINNEY President 

JUNIUS  B.  HARRIS President-Elect 

EMMA  W.  POPE 'Secretary 


OFFICIAL  NOTICES 

Council  Meeting. — The  next  meeting  of  the  Council 
will  be  held  at  Los  Angeles,  September  27,  1930. 

* * * 

Minutes  of  House  of  Delegates  and  Council.— The 

attention  of  the  members  of  the  California  Medical 
Association  is  especially  called  to  the  minutes  of  the 
House  of  Delegates  and  to  the  Minutes  of  the  Coun- 
cil, to  be  found  on  pages  432  and  444,  this  issue. 

* * * 

Reports  of  Standing  Committees. — The  reports  of 
standing  committees  of  the  California  Medical  As- 
sociation are  published  on  page  425.  These  reports 
of  the  Committee  on  Medical  Economics,  and  also  of 
the  Subcommittee  on  Clinics  of  the  Standing  Com- 
mittee on  Hospitals,  Dispensaries  and  Clinics,  are  out- 
standing contributions  to  the  study  of  the  Cost  of 
Medical  Care,  and  will  be  printed  in  the  July  issue. 


COMPONENT  COUNTY  SOCIETIES 

ALAMEDA  COUNTY 

The  Baby  Hospital  acted  as  host  to  the  Alameda 
County  Medical  Association  at  its  regular  meeting 
in  April,  providing  not  only  the  place  of  meeting,  but 
an  exceptional  program  on  the  subject  of  “Convul- 
sions in  Childhood.”  Dean  Langley  Porter  of  the 
University  of  California  and  H.  C.  Naffziger,  also  of 
the  University,  spoke  on  the  subject  from  the  stand- 
point of  their  respective  specialties. 

Dr.  Joseph  Erlanger,  professor  of  physiology  of  the 
Washington  University,  gave  a series  of  five  lectures 
in  Wheeler  Hall,  University  of  California,  beginning 
April  21,  on  the  subject  of  “Nerve  Impulses.” 

Gertrude  Moore,  Secretary. 

*> 

CONTRA  COSTA  COUNTY 

The  regular  meeting  of  the  Contra  Costa  County 
Medical  Society  was  held  at  the  Carquinez  Hotel, 
Richmond,  on  May  13.  This  was  a joint  meeting  with 
the  Contra  Costa  County  Dental  Association. 

The  scientific  program  consisted  in  a dental  and 
medical  presentation  of  the  subject  of  focal  infec- 
tion, with  special  reference  to  the  oral  cavity.  Dr. 
Stewart  V.  Irwin  of  Oakland  spoke  on  the  relation- 
ship of  teeth  as  foci  of  infection  in  health  and  disease. 
The  speaker  discussed  the  various  factors  which  pre- 
dispose to  dental  infection  and  the  detrimental  influ- 
ence of  infected  teeth.  Experimental  studies  on  this 
subject  were  widely  quoted.  The  reliability  of  radio- 
graphs in  the  diagnosis  of  dental  infection  was  dis- 
cussed. The  speaker  advised  extraction  of  pulpless 
teeth  in  serious  systemic  disease  when  no  other  foci 


* For  a complete  list  of  general  officers,  of  standing 
committees,  of  section  officers,  and  of  executive  officers 
of  the  component  county  societies,  see  index  reference  on 
the  front  cover,  under  Miscellany. 


of  infection  are  found,  even  in  the  absence  of  positive 
x-ray  findings. 

The  dental  aspect  of  this  subject  was  ably  pre- 
sented by  Dr.  A.  C.  Rulofson  of  San  Francisco.  The 
speaker  concurred  in  Doctor  Irwin’s  opinion,  in  re- 
gard to  indication  for  extraction  of  infected  teeth,  but 
explained  that  differences  of  opinion  on  this  question 
are  usually  on  forms  of  treatment.  Cooperation  be- 
tween physician  and  dentist  was  held  to  be  the  solu- 
tion of  the  important  question  as  to  whether  or  not 
suspicious  or  infected  teeth  should  be  extracted  or 
simply  treated.  Both  papers  brought  out  interesting 
discussion. 

Dr.  U.  S.  Abbott  made  a detailed  report  on  the 
state  convention,  which  he  attended  as  delegate  of 
the  society. 

The  request  of  the  Parent-Teacher  Association  for 
medical  examiners  at  the  annual  medical  examination 
of  the  preschool  children  was  read.  A buffet  lunch 
followed  the  meeting.  Doctor  Bumgarner  presided 
over  a large  attendance. 

L.  H.  Fraser,  Secretary. 

* 

FRESNO  COUNTY 

A meeting  of  the  Fresno  County  Medical  Society 
was  held  May  6 at  8 p.  m.  in  Judge  Crichton’s 
chambers. 

Dr.  Gavin  J.  Tefer,  district  health  officer  of  Los 
Angeles,  spoke  on  “Reportable  Diseases,  From  the 
Standpoint  of  Physicians  and  Public  Health  Officers.” 

Meeting  adjourned. 

J.  M.  Frawley,  Secretary. 

NAPA  COUNTY 

The  regular  meeting  of  the  Napa  County  Medical 
Society  was  held  Wednesday,  May  7,  at  7 p.  m.,  at 
the  St.  Helena  Sanitarium.  Dr.  H.  W.  Vollmer,  super- 
intendent of  the  sanitarium,  acted  as  host  and  pro- 
vided a well-appointed  banquet  in  the  spacious  new 
dining-room,  which  was  tastefully  decorated  for  the 
occasion.  The  dinner  was  enjoyed  by  sixty  persons, 
including  wives  of  members  of  the  medical  society, 
members  of  the  St.  Helena  Sanitarium  staff,  Train- 
ing School  supervisors,  and  laboratory  technicians. 
During  the  dinner  a splendid  program  of  instrumental 
music  was  furnished.  Mrs.  Jean  Rogers  of  Petaluma, 
state  president  of  the  Woman’s  Auxiliary,  spoke 
briefly  concerning  the  Del  Monte  meeting.  Mrs. 
Walter  Blodgett  of  Calistoga,  president  of  the  Napa 
County  Woman’s  Auxiliary,  also  spoke  briefly  about 
the  organization.  The  ladies  then  adjourned  for  an 
informal  discussion  of  the  auxiliary  work. 

The  meeting  of  the  society  was  then  opened  by 
Dr.  George  I.  Dawson,  president,  who  called  upon 
Dr.  H.  Coleman  for  his  report  as  delegate  to  the  re- 
cent state  convention.  Same  was  accepted  by  the 
society.  The  minutes  of  the  previous  meeting  were 
read  and  approved.  Bills  for  printing  were  allowed. 

The  speaker  of  the  evening,  Dr.  Frank  Topping  of 
Sacramento,  was  then  introduced  and  he  read  a paper 
on  “Eclampsia,”  describing  older  ideas,  theories,  and 
treatments,  as  compared  with  present-day  methods, 
in  which  it  was  shown  that  so-called  radical  treatment 
had  been  almost  abandoned  in  favor  of  conservative 
methods,  such  as  diet,  sedation,  elimination,  reduction 


452 


June,  1930 


STATE  MEDICAL  ASSOCIATIONS 


453 


of  acidosis,  colonic  flushing,  intravenous  therapy,  and 
cesarian  section  when  indicated.  His  paper  was  then 
discussed  by  several  of  the  members,  and  Doctor 
lopping  then  answered  questions  asked  during  the 
discussion. 

The  meeting  then  adjourned. 

Ladies  present:  Mesdames  C.  H.  Bulson,  Walter 
Blodgett,  H.  R.  Coleman,  G.  I.  Dawson,  C.  A. 
Gregory,  C.  A.  Johnson,  C.  E.  Nelson,  R.  S.  Nor- 
throp, Jean  Rogers,  and  C.  E.  Sisson. 

Members:  M.  M.  Booth,  W.  L.  Blodgett,  I.  E. 
Charlesworth,  H.  R.  Coleman,  G.  I.  Dawson,  C.  A. 
Gregory,  C.  A.  Johnson,  D.  H.  Murray,  C.  E.  Nelson, 
R.  S.  Northrop,  Orville  Rockwell,  John  Robertson, 
C.  E.  Sisson,  H.  W.  Vollmer,  George  J.  Wood. 

Visitors:  Dr.  C.  E.  Nixon,  Imola;  Dr.  A.  W.  Mc- 
Leish,  Veterans’  Home;  Dr.  H.  S.  Rogers,  Petaluma; 
Dr.  R.  V.  Harr  and  Dr.  Hammerlick,  Sonoma  State 
Home;  Dr.  Ida  Nelson  and  Dr.  Ruth  Miller,  Saint 
Helena  Sanitarium. 

C.  A.  Johnson,  Secretary. 

* 

ORANGE  COUNTY 

The  regular  monthly  meeting  of  the  Orange  County 
Medical  Society  was  held  in  the  basement  of  the 
Tustin  Presbyterian  Church  Tuesday,  May  6,  at  6:45 
p.  m.  The  Woman’s  Auxiliary  and  Nurses’  Associa- 
tion were  invited  as  guests,  and  a country  dinner 
served  by  the  ladies  of  the  church,  preceding  the  pro- 
gram, was  most  appetizing.  Eighty  members  and 
guests  were  present  at  this  meeting,  and  the  speaker 
of  the  evening  was  Dr.  Rea  Proctor  McGee  of  Holly- 
wood, who  gave  a very  interesting  and  complete  dis- 
cussion on  “Facial  Reconstruction.”  This  was  illus- 
trated by  lantern  slides. 

Following  the  speaker,  a short  business  meeting  of 
the  association  was  held.  The  minutes  of  the  last 
meeting  were  read  and  approved.  By  unanimous  vote 
the  secretary  was  ordered  to  pay  all  expenses  incurred 
by  the  association  and  Woman’s  Auxiliary  for  the 
meeting  of  the  Southern  California  Medical  Society, 
and  to  send  Mrs.  F.  E.  Coulter,  president  of  the 
auxiliary,  a letter  expressing  the  sincere  thanks  and 
appreciation  of  the  society  for  the  part  the  auxiliary 
took  in  making  this  meeting  a success. 

The  report  of  the  Committee  on  the  Establishment 
of  a Cooperative  Collecting  Agency  was  made,  and 
by  unanimous  vote  of  the  society  it  was  decided  that 
it  would  not  be  advisable  at  present  to  proceed  with 
such  plans. 

Full  reports  by  our  delegates  to  the  state  meeting 
at  Del  Monte  were  made,  Dr.  Harry  Zaiser  and  Dr. 
Dexter  Ball  each  outlining  in  detail  what  took  place 
at  the  various  meetings.  Dr.  R.  A.  Cushman  was 
reelected  to  the  Council  for  a three-year  period,  and 
Mrs.  Dexter  Ball  was  elected  as  State  Auxiliary  sec- 
retary. Doctor  Cushman  also  gave  a very  accurate 
and  detailed  report  on  the  state  meeting,  explaining 
the  work  of  the  Committee  on  Medical  Economics 
of  which  he  is  a member.  He  also  reminded  us  of 
the  advisability  of  having  over  one  hundred  members 
in  this  association  in  order  to  have  three  state  dele- 
gates instead  of  two,  which  we  now  have  with  a 
membership  of  ninety-seven. 

There  being  no  more  business  the  meeting  ad- 
journed. 

Harry  G.  Huffman,  Secretary. 

■» 


Members:  Drs.  Dunievitz,  Durand,  L.  B.  Barnes, 
Paul  D.  Barnes,  William  Miller,  Peers,  Thoren] 
Myers,  Johnson,  Rood,  Russell,  Fay,  Carl  Jones] 
Monica  Stoy  Briner,  C.  C.  Briner,  Tickell,  and 
McArthur. 

Visitors:  Drs.  Orrin  S.  Cook,  F.  P.  Brendel,  Gun- 
drum,  Hale,  Charles  Jones,  Fanning,  Primasing  and 
Kanner  of  Sacramento;  Dr.  Miriam  Pool  Huff, 
Weimar;  Dr.  Ward,  Auburn;  Mr.  Thoren,  Weimar; 
Dr.  Pom  O’Connor,  Murphy;  Drs.  Craig  and  Stone, 
Lakeport;  Dr.  Werner,  Nevada  City;  and  Drs.  Lout- 
zenheiser,  Sooy,  Best,  Haas,  Searls,  Naffziger,  Taylor, 
and  Bost  of  San  Francisco. 

Dr.  Miriam  Pool  Huff,  now  of  Weimar,  formerly 
of  San  Diego,  having  made  application  for  transfer 
from  the  San  Diego  County  Medical  Society  to  the 
Placer  County  Medical  Society,  was  unanimously 
elected  to  membership. 

The  meeting,  the  first  in  several  years  held  in  Grass 
Valley,  was  intended  as  a homecoming  gathering  for 
former  residents  of  Nevada  County  now  practicing 
outside  the  confines  of  the  counties  comprising  the 
Placer  County  Medical  Society  district.  An  effort 
was  made  to  notify  all  former  Nevada  County  phy- 
sicians so  that  they  might  have  an  opportunity  to 
attend.  The  program,  which  was  prepared  under  the 
direction  of  Dr.  Howard  Naffziger,  formerly  of  Ne- 
vada City,  now  professor  of  surgery  at  the  University 
of  California  Medical  School,  was  featured  by  ad- 
dresses by  former  Nevada  County  boys.  Telegrams 
from  Dr.  W.  W.  Wymore  and  Dr.  John  Gallwey  of 
San  Francisco,  sending  regrets  at  being  unable  to 
attend  the  reunion,  were  read  by  the  secretary. 

The  following  most  excellent  program  was  then 
presented: 

Anomalies  of  the  Lumbar  Vertebrae  (illustrated  by 
lantern  slides),  Dr.  Loutzenheiser;  Pitfalls  of  Gastric 
Surgery,  Dr.  Sooy;  Movements  of  the  Intestines 
(illustrated  by  motion  pictures),  Dr.  Best;  Reduction 
of  Congenital  Dislocation  of  the  Hip  (illustrated  by 
motion  pictures),  Dr.  Haas;  Comments  on  Goiter 
(illustrated  by  lantern  slides),  Dr.  Searls;  Newer 
Methods  of  Diagnosis  in  Intracranial  Disease  (illus- 
trated by  lantern  slides),  Dr.  Naffziger. 

Following  the  program,  supper  was  served  at  the 
Bret  Harte  Inn. 


This  was  one  of  the  best  attended  and  most  satis- 
factory meetings  in  the  history  of  the  Placer  County 

Medical  Society.  . „ 

Robert  A.  Peers,  Secretary. 


* 


SAN  BERNARDINO  COUNTY 

The  April  meeting  of  the  San  Bernardino  County 
Medical  Society  was  held  at  the  County  Hospital  in 
San  Bernardino  on  Saturday,  April  19,  at  8:20  p.  m. 

In  the  absence  of  the  president  and  both  vice-presi- 
dents, the  meeting  was  called  to  order  by  Dr.  Gayle 
G.  Moseley  at  8:20  o’clock. 

Owing  to  the  lateness  of  the  hour,  the  minutes  of 
the  previous  meeting  were  omitted  and,  there  being 
no  business  to  be  attended  to,  the  program  of  the 
evening  was  started. 

Simple  Methods  for  the  Diagnosis  of  Endocrine 
Disorders- — Anthropometric  and  Roentgenographic. 
(Lantern  slide  demonstration.)  By  Dr.  William 
Engelbach  of  St.  Louis.  Discussion  opened  by  Dr. 
Charles  A.  Wylie  of  San  Bernardino. 

There  were  about  fifty  members  and  guests  present. 


* * * 


PLACER  COUNTY 

The  Placer  County  Medical  Society  held  its  April 
meeting  in  the  banquet  room  of  the  Bret  Harte  Inn, 
in  Grass  Valley,  April  19,  the  president,  Dr.  Max 
Dunievitz  presiding. 

There  were  present  the  following  members  and 
visitors: 


The  May  meeting  of  the  San  Bernardino  County 
Medical  Society  was  held  at  Loma  Linda  on  Tuesday, 
May  6.  Dinner  was  served  at  7 p.  m.  Between  fifty 
and  sixty  members  and  guests  were  present. 

Toward  the  end  of  the  dinner  a one-reel  motion  pic- 
ture was  shown  by  Mr.  Hoff  of  the  Petrolagar  Lab- 
oratory, “Demonstration  of  Gall-Bladder  Hormone.” 


454 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


Following  this,  our  delegate,  Dr.  Charles  Curtiss 
reported  on  his  trip  to  the  state  medical  convention 
at  Del  Monte. 

The  meeting  was  called  to  order  by  the  president 
at  8 o’clock. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

The  program  of  the  evening  was  then  given,  with 
some  changes. 

Dr.  Henry  Hoit  first  read  his  paper. 

Dr.  Thearle  of  Denver,  Colorado,  read  a paper  on 
“Thoracoplasty”  at  the  request  of  Dr.  S.  J.  Mattison, 
who  was  the  original  speaker. 

Many  interesting  slides  were  shown  by  Dr.  Thearle 
and  Dr.  Atkinson. 

A vote  of  thanks  was  extended  to  the  College  of 
Medical  Evangelists  and  to  the  three  speakers. 

* * * 

The  meeting  of  the  Board  of  Councilors  was  held 
at  the  Cafe  Madrid  in  San  Bernardino  on  Friday, 
May  2,  at  12:10  p.  m. 

Members  present  were:  Drs.  Savage,  Mock,  Gage, 
Moor,  Pritchard,  and  Eytinge. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

The  question  of  the  June  meeting  was  discussed 
and  left  open  for  the  present. 

The  applications  of  Doctors  Williams  and  Bacon 
were  favorably  passed  upon. 

A letter  was  read  from  Dr.  William  Engelbach 
extending  his  thanks  for  the  courtesy  extended  to  him 
at  the  last  meeting. 

It  was  moved  by  Dr.  Philip  Savage  and  seconded 
by  Dr.  D.  C.  Mock  that  a letter  of  appreciation  be 
written  to  Dr.  Granville  MacGowan  relative  to  his 
work  in  connection  with  corporations  practicing  medi- 
cine without  a license. 

The  applications  of  Drs.  Leslie  E.  Elliott,  James  J. 
Cecil,  and  Delbert  B.  Williams  were  voted  upon  and 
accepted. 

The  meeting  adjourned  at  1 :30  o’clock. 

E.  J.  Eytinge,  Secretary. 

* 

SAN  JOAQUIN  COUNTY 

The  stated  meeting  of  the  San  Joaquin  County 
Medical  Society  was  held  Thursday  evening  at  eight 
o’clock,  May  1,  in  the  Medico-Dental  Club,  242  North 
Sutter  Street,  Stockton. 

The  meeting  was  called  to  order  by  Vice-President 
G.  H.  Rohrbacher.  The  minutes  of  the  previous 
stated  meeting  were  read  and  approved. 

The  application  of  Dr.  Thomas  L.  Sutton  having 
been  approved  by  the  California  Medical  Society  and 
the  local  society,  the  doctor  was  declared  a member 
of  the  San  Joaquin  County  Medical  Society. 

The  scientific  program  was  opened  with  an  exhibi- 
tion of  moving  pictures  given  by  M.  J.  Cloyes  of  the 
Petrolagar  Laboratories.  He  showed  films  on  the 
“Movements  of  the  Alimentary  Tract  in  Experi- 
mental Animals,”  and  “The  Influences  of  Drugs  on 
Gastro-Intestinal  Motility.” 

The  principal  paper  of  the  evening  was  given  by 
Dr.  Robertson  Ward  on  “Acute  Dilatation  of  the 
Stomach.”  Doctor  Ward  stated  that  whereas  acute 
dilatation  of  the  stomach  is  rare  as  a primary  con- 
dition, it  is  quite  common  as  a complication  following 
laparotomy.  It  is  due  to  an  acute  paralysis  of  the 
gastric  walls  and  usually  affects  the  upper  intestinal 
tract  as  well.  The  atonic  organ  soon  fills  with  fluid 
either  secreted  or  regurgitated.  The  diagnosis  is  com- 
paratively easy,  based  upon  the  distended  abdomen 
with  a mass  in  the  left  side.  There  is  a constant  effort 
to  bring  up  gas  with  or  without  copious  eructations 
and  threatening  hiccough.  Even  without  such  symp- 
toms and  before  the  gastric  walls  become  completely 


atonic,  the  presence  of  recurrent  vomiting  of  fluid  is 
a warning,  and  treatment  at  once  will  ward  off  more 
pronounced  signs.  Symptoms  of  toxic  absorption  ap- 
pear rapidly  if  the  condition  is  not  relieved. 

Method  of  treatment  is  by  continuous  gastric  lav- 
age with  a Levin  type  duodenal  tube  passed  through 
the  nostril  into  the  stomach  and  the  flow  maintained 
by  continuous  mild  suction  arranged  as  in  the  illus- 
tration to  be  found  in  the  December  issue  of  Cali- 
fornia and  Western  Medicine  on  page  396.  Usually 
the  tube  is  lubricated  with  vaselin  or  glycerin  and 
passed  readily,  but  in  nervous  or  excitable  patients 
it  may  be  necessary  to  anesthetize  with  five  per  cent 
cocain  solution.  This  method  has  been  used  success- 
fully in  paralytic  ileus,  intestinal  obstruction,  acute 
gastric  dilatation,  and  even  in  persistent  postoperative 
vomiting.  The  advantages  are  as  follows:  (1)  Relief 
from  conditions  caused  by  gas  and  regurgitated  fluids 
is  obtained.  (2)  There  is  either  interrupted  or  con- 
tinuous lavage  of  the  stomach  and,  in  some  cases,  of 
the  duodenum.  (3)  Nausea  and  toxemia  are  relieved. 
(4)  The  patient  may  drink  water  freely,  relieving  that 
most  distressing  symptom,  thirst.  (5)  Transgastric 
feeding  and  medication  are  made  possible.  (6)  The 
patient  is  so  much  more  comfortable  that  he  often 
begs  for  the  return  of  the  duodenal  tube  after  having 
once  experienced  the  relief  afforded  by  its  use.  If  the 
treatment  is  prolonged  it  is  necessary  to  combat  alka- 
losis by  massive  subcutaneous  injections  of  normal 
saline  solution.  The  same  solution  should  be  used  for 
the  gastric  lavage.  If  it  is  impossible  to  retain  food, 
nourishment  is  sustained  by  intravenous  glucose. 

Doctor  Ward  summarized  by  saying:  “Acute  gas- 
tric dilatation,  formerly  considered  a serious  and  fre- 
quently fatal  complication,  should  no  longer  be  a 
possible  cause  of  death.  Suspicion  of  its  presence 
should  lead  to  a speedy  test  by  transnasal  insertion 
of  a duodenal  tube.  Treatment  by  the  apparatus  for 
continuous  gastric  drainage  herein  described  is  simple 
and  rapidly  efficacious.” 

The  paper  was  freely  discussed  by  Doctors  Dozier, 
Priestley,  Sanderson,  Vischi,  and  English. 

The  meeting  was  attended  by  Mr.  M.  J.  Cloyes, 
Doctors  Robertson  Ward  of  San  Francisco,  F.  B. 
Reardon  and  O.  S.  Cook  of  Sacramento,  E.  F.  Reamer 
and  Smith  of  Modesto,  and  Dozier,  Blinn,  Broaddus, 
English,  Blackmun,  McGurk,  Hull,  Priestley,  Vischi, 
Kaplan,  Holliger,  Sanderson,  Dewey  Powell,  and 
Rohrbacher  of  Stockton. 

There  being  no  further  business  the  meeting  was 
adjourned  and  refreshments  served. 

C.  A.  Broaddus,  Secretary. 

SAN  MATEO  COUNTY 

The  March  meeting  of  the  San  Mateo  County 
Medical  Society  was  attended  by  about  eighteen  mem- 
bers of  the  society,  following  dinner  at  Chartier’s 
Cafe.  The  meeting  was  presided  over  by  Dr.  Harper 
Peddicord  of  Redwood  City,  president  of  the  society. 

The  speaker  of  the  evening  was  Dr.  Otis  Allen 
Sharpe  of  San  Francisco,  who  gave  an  interesting 
talk  on  quacks  and  near-quacks  in  the  modern  art  of 
healing.  He  pointed  out  that  by  misleading  and  in- 
correct statements  some  of  the  professions  allied  to 
the  medical  profession  are  infringing  on  the  fields  of 
both  the  general  practitioner  and  the  specialist;  that 
this  advertising  works  to  the  detriment  of  both  the 
patient  and  the  physician;  and  that  it  is  the  duty  of 
the  physicians  to  right  this  condition. 

It  was  decided  to  investigate  this  matter  and  take 
whatever  steps  seem  advisable  at  a later  date. 

It  was  also  voted  to  approve  the  standing  orders 
of  the  Metropolitan  visiting  nurses  for  use  in  their 
routine  visits  to  clients  who  are  ill. 

Erma  B.  Macomber,  Social  Secretary. 


June,  1930 


STATE  MEDICAL  ASSOCIATIONS 


455 


SANTA  BARBARA  COUNTY 

The  regular  meeting  of  the  Santa  Barbara  County 
Medical  Society  was  held  on  Monday  evening,  May  12, 
at  the  University  Club,  Dr.  Hugh  Freidell  presiding. 

This  was  a dinner  meeting,  held  in  honor  of  Dr. 
Leo  Buerger  of  Los  Angeles. 

The  minutes  of  the  previous  meeting  were  read  and 
approved. 

The  applications  of  Drs.  Leonard  Brunie,  Yolande 
Brunie,  and  Charles  Warwick  were  read  and,  upon 
ballot,  these  applicants  were  unanimously  elected  to 
membership. 

An  invitation  from  the  California  State  Dietetic  As- 
sociation to  the  members  of  the  society  to  attend  their 
convention  May  13  to  16  was  read. 

Doctor  Freidell  then  spoke  of  the  death  of  Dr.  Alex 
C.  Soper,  and  upon  motion,  duly  seconded  and  carried, 
a committee  consisting  of  Doctors  Means,  Ullmann, 
and  Eaton  was  appointed  to  draw  up  proper  reso- 
lutions. 

Doctor  Evans  then  spoke  of  the  necessity  for  the 
Bissell  Library  to  be  further  equipped  with  magazines 
and  books,  and  it  was  moved,  seconded  and  carried, 
that  the  president  appoint  a committee  to  investigate 
means  of  financing  this  problem.  A committee  con- 
sisting of  Doctors  Evans  (chairman),  Markthaler, 
and  Bakewell  was  appointed. 

President  Freidell  then  called  upon  Doctor  Thorner 
to  introduce  the  speaker  of  the  evening,  and  he  paid 
Doctor  Buerger  a glowing  tribute  for  his  outstanding 
contributions  to  medical  science. 

The  membership  then  adjourned  to  the  lounging 
room  of  the  University  Club,  where  they  were  enter- 
tained by  a most  interesting  talk,  illustrated  with 
lantern  slides,  on  “Some  of  the  Clinical  and  Patho- 
logical Aspects  of  Renal  and  Ureteral  Lithiasis.” 

At  the  conclusion  of  Doctor  Buerger’s  talk,  dis- 
cussions were  entered  into  by  Doctors  Pierce,  Wills, 
and  Engelbach. 

There  being  no  further  business  the  meeting  ad- 
journed. 

William  H.  Eaton,  Secretary. 

% 

TULARE  COUNTY 

A grand  time  was  enjoyed  by  a joint  meeting  of 
the  Medical  and  Bar  associations  of  Tulare  County  at 
Motley’s  Cafe  in  Visalia  on  March  23.  The  invita- 
tions to  the  members  of  the  Bar  Association  were 
sent  out  in  the  form  and  legal  verbiage  of  subpoenas, 
with  very  few  alterations. 

The  guest  of  the  evening  was  Dr.  C.  D.  Leake, 
professor  of  pharmacology  at  the  University  of  Cali- 
fornia, who  addressed  the  members  on  “Cooperation 
Between  Medicine  and  Law  in  Poison  Cases.”  The 
address  was  interspersed  with  a few  anecdotes,  and 
was  highly  appreciated  by  those  present. 

Dinner  was  served  at  7 p.  m.,  followed  by  the  ad- 
dress, which  continued  to  9:45,  the  time  for  the  return 
train  of  the  speaker. 

The  following  members  of  the  medical  and  law 
associations  were  present:  Dr.  J.  H.  Banks,  Dr.  D. 
McFadzean,  J.  T.  Fuller,  Dr.  W.  W.  Tourtillot, 
F.  Lamberson,  Judge  of  the  Superior  Court;  Dr. 

A.  W.  Preston,  Dr.  E.  R.  Zumwalt,  Dr.  T.  Mooney, 

Dr.  E.  C.  Bond,  Dr.  Annie  L.  Bond,  Dr.  J.  T. 
Melvin,  Dr.  F.  R.  DeLappe,  Dr.  H.  A.  Campbell, 
Dr.  C.  D.  Leake,  D.  F.  Maddox,  Dr.  S.  S.  Ginsburg, 
Dr.  D.  Fowler,  Dr.  A.  Miller,  J.  Field,  Ph.  D.;  W.  G. 
Machetanz,  J.  P.  King,  J.  A.  Shishmanian,  H.  S.  Mills- 
paugh,  Walter  Haight,  E.  L.  Lindsay,  W.  R.  Bailey, 
H.  B.  McClure,  E.  C.  Farnsworth,  C.  L.  Bradley, 

M.  E.  Power,  J.  T.  Crowe,  Dr.  G.  B.  Furness, 

N.  F.  Bradley,  J.  R.  McBride,  Dr.  B.  H.  Gilbert, 

Dr.  F.  R.  Guido,  Dr.  K.  F.  Weiss,  D.  E.  Perkins, 

Dr.  I.  M.  Lipson,  Dr.  E.  Brigham,  Dr.  A.  N.  Loper, 
L.  A.  Cleary,  S.  Halbert,  and  J.  M.  Burke. 


CHANGES  IN  MEMBERSHIP 


New  Members 


Alameda  County — Marvin  E.  Kirk,  Charles  J.  Luns- 
ford, Oscar  P.  Stowe,  Theodore  W.  Weller. 

Contra  Costa  County — Earl  B.  Fitzpatrick. 

Los  Angeles  County — 

Forrest  N.  Anderson 
William  Gillspie  Attwood 
Irby  B.  Ballenger 
Clifford  Loomis  Bartlett 
George  D.  Brown 
Leo  Buerger 
Donald  Austin  Charnock 
G.  E.  Christensen 
John  C.  Cottrell 
William  A.  Dashiell 
J.  Dwight  Davis 
William  V.  Gale 
Fred  Gassmann 
Donald  W.  Cady 
Walter  Donald  Gilkey 
Daniel  G.  Golding 
William  H.  Grishaw 
Harold  H.  Hanlon 
Howard  R.  Harner 


George  E.  Judd 
George  B.  Kryder 
John  P.  Lordan 
Clyde  Ferdinand  Loy 
A.  T.  Martin 
George  Henry  Martin 
Will  L.  Miles 
Harold  A.  Mourer 
Thomas  Elwood  Noble 
Sverre  Oftedal 
Walter  R.  Pendleton 
Joseph  D.  Peluso 
William  Frederick  Reasner 
Marie  Margaret  Schiller 
Camilo  Servin 
Earl  Newell  Van  Ornum 
Cecil  B.  Van  Sciver 
William  F.  Wagner 
F.  M.  Wood 
John  P.  Isaac  Frank  W.  Young 

Placer  County — Louis  Ernest  Jones. 

San  Diego  County — Harold  S.  Sumerlin. 

San  Mateo  County — Paul  G.  Capps. 

Santa  Clara  County — Frank  B.  Hoover,  Charles  A. 
W ayland. 

Transferred  Members 


Eugene  S.  Maxson,  from  Alameda  to  Los  Angeles 
County. 

Mariam  Pool  Huff,  from  San  Diego  to  Placer 
County. 

Charles  R.  Caskey,  from  Humboldt  to  Los  Angeles 
County. 

Clayton  R.  Lane,  from  Orange  to  Los  Angeles 
County. 

Rollan  W.  Kraft,  from  Alameda  to  Los  Angeles 
County. 

Harry  J.  Wiley,  from  Tulare  to  Los  Angeles 
County. 

Amos  D.  Ellsworth,  from  Fresno  County  to  Texas 
Medical  Association. 

Jens  Molgaard,  from  San  Francisco  to  San  Mateo. 


Deaths 

Clark,  John  Baptist.  Died  May  3,  1930,  age  34  years. 
Graduate  of  the  University  of  California  Medical 
School,  San  Francisco,  1927.  Licensed  in  California, 
1927.  Doctor  Clark  was  a member  of  the  Los  Angeles 
County  Medical  Association,  the  California  Medical 
Association,  and  the  American  Medical  Association. 

Dunham,  Ora  Berton.  Died  April  21,  1930,  age  51 
years.  Graduate  of  University  of  Illinois  College  of 
Medicine,  Chicago,  1900.  Licensed  in  California,  1904. 
Doctor  Dunham  was  a member  of  the  Imperial 
County  Medical  Society,  the  California  Medical  As- 
sociation, and  was  a Fellow  of  the  American  Medical 
Association. 

Soboslay,  Julius.  Died  at  Madera,  April  21,  1930. 
age  70  years.  Graduate  of  the  University  of  California 
Medical  School,  San  Francisco,  1886.  Licensed  in 
California,  1886.  Doctor  Soboslay  was  a retired  mem- 
ber of  the  San  Francisco  County  Medical  Society, 
the  California  Medical  Association,  and  the  American 
Medical  Association. 

Soper,  Alexander  Coburn.  Died  May  10,  1930,  age 
58  years.  Graduate  of  Rush  Medical  College,  Illinois, 
1901.  Licensed  in  California,  1919.  Doctor  Soper  was 
an  honorary  member  of  the  Santa  Barbara  County 
Medical  Society,  the  California  Medical  Association, 
and  the  American  Medical  Association. 


456 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


THE  WOMAN’S  AUXILIARY  OF  THE 
CALIFORNIA  MEDICAL 
ASSOCIATION* 

PRESIDENT’S  MESSAGE 

To  the  Woman’s  Auxiliary  of  the  California  Medical 
Association: 

We  have  just  had  our  second  state  meeting.  What 
was  accomplished  at  the  Del  Monte  meeting  splen- 
didly compliments  the  first  one  at  Coronado  last  year. 

The  gratifying  response  to  the  efforts  made  by  the 
officers  of  the  various  county  units  already  organized 
and  the  splendid  attendance  at  the  state  meetings, 
considering  the  short  time  the  Auxiliary  has  been  in 
existence,  augur  well  for  the  future.  But  more  than 
this  was  the  deep  interest  shown  by  the  women  who 
were  fortunate  enough  to  attend,  in  order  to  lend  their 
influence  and  experience  for  the  building  of  a strong 
and  permanent  organization.  Mrs.  H.  S.  Rogers, 
president,  outlined  the  foundations  already  laid,  espe- 
cially recommending  concentration  upon  a wide  dis- 
tribution of  “Better  Health”  literature.  During  Mrs. 
Rogers’  presidency  eight  splendid  county  auxiliaries 
were  organized. 

Our  most  essential  primary  effort  from  now  on 
must  be  the  organization  of  the  counties  that  are  at 
present  without  auxiliaries.  And  we  shall  not  be  satis- 
fied so  long  as  one  county  remains  unorganized.  From 
the  enthusiasm  which  developed  following  the  Coro- 
nado meeting,  and  which  was  so  actively  manifest  at 
Del  Monte,  we  have  every  reason  to  anticipate  a 
tremendous  increase  in  our  membership.  Enough  has 
already  been  accomplished  to  show  in  a concrete  way 
the  need  for  the  auxiliary,  for  the  assistance  of  the 
women  who  are  interested,  because  they  are  wives 
and  relatives  of  physicians,  in  the  progress  of  medical 
science  and  in  the  practical  help  they  can  give  to  the 
physicians  of  the  state  in  their  endeavors  to  bring  the 
body  politic  to  a real  appreciation  of  the  possibilities 
of  such  an  organization. 

If  some  of  the  far-sighted  women  in  each  unorgan- 
ized county  will  take  it  upon  themselves  to  see  that 
the  president  of  their  county  medical  association  will 
appoint  those  who  are  willing  to  work  toward  this 
end,  your  state  officers  will  be  greatly  assisted  and 
happy  to  suggest,  if  needed,  the  methods  found  most 
successful  not  only  in  this  state  but  in  others. 

Your  new  officers  are  thoroughly  appreciative  of 
your  confidence  in  electing  them  to  the  state  offices, 
and  are  not  unmindful  of  their  responsibilities.  Never- 
theless, it  is  with  high  and  enthusiastic  hopes  that 
they  anticipate  a hearty  cooperation  from  everyone 
in  putting  California  over  this  year  100  per  cent. 

Mrs.  James  F.  Percy,  President. 

* 

Minutes  of  the  Second  Annual  Session  of  the 
Woman’s  Auxiliary  of  the  California 
Medical  Association 

The  first  meeting  of  the  second  annual  session  of 
the  Woman’s  Auxiliary  of  the  California  Medical  As- 
sociation was  held  in  the  lounge  of  Hotel  Del  Monte, 
Monterey  County,  California,  Tuesday  morning,  April 
29,  1930,  with  the  president,  Mrs.  Henry  S.  Rogers, 
in  the  chair,  and  the  secretary-treasurer,  Mrs.  R.  A. 
Cushman,  recording  the  proceedings. 

The  chairman  called  the  meeting  to  order  and  intro- 
duced Mrs.  Charles  R.  Lowell  of  Monterey  County, 
who  gave  the  address  of  welcome  on  behalf  of  Mon- 
terey County  to  auxiliary  members  and  visiting  ladies. 

The  minutes  of  the  session  held  in  Coronado  on 
May  7 and  8,  1929,  were  read.  On  motion  of  Mrs. 
Scott  D.  Gleeton  of  Los  Angeles  County,  seconded 
by  Mrs.  George  G.  Hunter  of  Los  Angeles  County, 

* As  county  auxiliaries  to  the  Woman’s  Auxiliary  of  the 
California  Medical  Association  are  formed,  the  names  of 
officers  should  be  forwarded  to  the  state  secretary-treas- 
urer, Mrs.  Dexter  R.  Ball,  2419  Bonnie  Brae,  Santa  Ana. 
and  to  the  California  Medical  Association  office.  Room 
2004,  450  Sutter  Street,  San  Francisco.  Brief  reports  of 
county  auxiliary  meetings  will  be  welcomed  for  publica- 
tion in  this  column. 


and  unanimously  carried,  the  minutes  were  approved 
as  read. 

The  chairman  announced  there  would  be  a report 
from  each  organized  county  and  asked  the  secretary 
to  call  the  roll  by  counties. 

The  secretary  requested  each  county  to  give  the 
names  of  officers,  of  delegates  or  alternates  elected 
and  number  of  members. 

Mrs.  H.  V.  Brown  of  Los  Angeles  County  inquired 
if  this  could  not  be  done  outside  of  the  meeting-. 

The  secretary  stated  this  was  not  possible,  as  she 
found  the  representation  at  the  meeting  did  not  check 
up  with  her  credential  report. 

The  chairman  announced  that  the  meeting  would 
proceed  with  the  hearing  of  county  reports.  Upon 
request  of  the  secretary,  Mrs.  George  G.  Hunter  of 
Los  Angeles  County  recorded  the  oral  report,  which 
record  is  filed  herewith  and  made  a part  of  these 
minutes. 

1 he  chairman  urged  that  each  county  send  in  dues 
to  the  state  secretary  at  the  earliest  possible  moment, 
in  compliance  with  the  request  of  Mrs.  George  H. 
Hoxie,  president  of  the  national  Woman’s  Auxiliary, 
and  stated  that  the  national  dues  are  25  cents  per 
member,  the  state  dues  the  past  year  75  cents  per 
member. 

Upon  the  chairman’s  request  the  secretary  pre- 
sented a budget  made  at  the  request  of  the  chairman 
and  for  the  purpose  of  assisting  in  ascertaining  the 
amount  of  dues  necessary  to  maintain  the  state  or- 
ganization during  the  ensuing  year.  The  secretary 
declared  such  budget  to  be  purely  tentative,  as  it  could 
not  be  based  upon  the  treasury  report  of  the  past 
year,  the  president,  Airs.  Rogers,  having  handed  in 
no  expense  account,  and  no  stationery  having  been 
printed.  The  budget  as  submitted  is  appended  to 
these  minutes,  marked  “Appendix  A.” 

The  chairman  called  for  the  treasurer’s  report, 
which  was  given  as  appended  to  these  minutes, 
marked  “Appendix  B.” 

I he  matter  of  state  dues  was  then  presented.  Upon 
motion  of  Mrs.  James  F.  Percy  of  Los  Angeles 
County,  seconded  by  Mrs.  Dexter  R.  Ball  of  Orange 
County,  and  unanimously  carried,  state  dues  for  the 
ensuing  year  were  tentatively  fixed  at  fifty  cents,  such 
sum  to  cover  national  dues  also  of  twenty-five  cents 
per  member. 

The  chairman  submitted  an  oral  report  covering  the 
work  accomplished  during  the  past  year,  explaining 
the  aims  of  the  organization,  and  touching  upon  the 
work  necessary  during  the  coming  year.  She  stated 
election  of  officers  for  the  coming  year  would  be  held 
Wednesday  night. 

Moved  by  Airs.  William  Duffield  of  Los  Angeles 
County,  seconded  by  Mrs.  H.  B.  Tebbetts  of  Los  An- 
geles County  that  the  meeting  adjourn. 

The  secretary  called  to  the  attention  of  the  mem- 
bers the  fact  that  only  one  business  meeting  had  been 
announced  for  the  session,  that  of  Tuesday  morning, 
that  the  Wednesday  morning  meeting  as  announced 
was  to  consist  of  a program  of  addresses.  She  sug- 
gested that  delegates  might  be  leaving  who  had  come 
prepared  to  vote  for  officers  at  this  meeting. 

The  chairman  requested  delegates  who  were  leaving 
after  the  meeting  to  signify  by  uplifted  hands.  A 
number  of  hands  being  raised,  the  chairman  asked 
Airs.  Duffield  if  she  would  withdraw  her  motion. 
Some  debate  took  place  as  to  the  proper  time  for  the 
election  of  officers,  but  no  action  taken,  a motion 
being  before  the  house  and  the  speakers  not  being 
recognized  by  the  chair.  The  motion  to  adjourn  was 
withdrawn  by  Airs.  Duffield. 

Aloved  by  Mrs.  Thomas  Stoddard,  charter  member 
of  San  Francisco  County,  seconded  by  Mrs.  Charles  S. 
Stevens  of  Santa  Barbara  County,  that  the  meeting 
proceed  and  officers  be  elected  for  the  ensuing  year. 

Mrs.  James  F.  Percy  offered  an  amendment  to  add 
the  words  “that  the  meeting  proceed  on  Wednesday 
afternoon  directly  after  luncheon.”  The  amendment 
was  not  entertained  by  the  chair.  The  question  of 
election  of  officers  was  further  discussed,  the  question 
put,  and  the  motion  unanimously  carried. 


June,  1930 


STATE  MEDICAL  ASSOCIATIONS 


457 


Moved  by  Mrs.  H.  V.  Brown  of  Los  Angeles 
County,  seconded  by  Mrs.  Dexter  R.  Ball  of  Orange 
County,  and  unanimously  carried,  that  a nominating 
committee  be  formed. 

The  chairman  appointed  Mrs.  Charles  S.  Stevens 
of  Santa  Barbara  County  and  Mrs.  George  G.  Reinle 
of  Alameda  County  to  serve  on  the  nominating  com- 
mittee and  called  for  nominations  of  two  more  mem- 
bers from  the  floor.  Mrs.  George  G.  Hunter  of  Los 
Angeles  County  and  Mrs.  Arthur  A.  Arehart  of  Mon- 
terey County  were  regularly  nominated,  and  unani- 
mously elected. 

The  question  of  the  time  when  new  officers  should 
be  installed  was  informally  discussed,  but  no  action 

taken. 

The  nominating  committee  having  retired,  upon 
return  was  called  upon  to  report.  Mrs.  Stevens,  chair- 
man of  the  Nominating  Committee,  in  submitting  her 
report  explained  the  action  of  the  committee  as  being 
influenced  by  the  practice  in  operation  with  the  Cali- 
fornia Medical  Association  in  choosing  their  state 
officers  alternately  from  different  sections  of  the  state. 
The  chairman  reported  as  follows: 

President — Mrs.  James  F.  Percy  of  Los  Angeles 
County. 

First  vice-president — Mrs.  J.  M.  McCullough  of 
Contra  Costa  County. 

Second  vice-president — Mrs.'  Thomas  A.  Stoddard, 
charter  member,  of  San  Francisco  County. 

Secretary-treasurer — Mrs.  Dexter  R.  Ball  of  Orange 
County. 

The  chairman  inquired  if  there  were  any  nomina- 
tions from  the  floor.  There  being  none,  upon  motion 
of  Mrs.  John  H.  Shephard,  charter  member  and  ex- 
officio  member,  of  Santa  Clara  County,  seconded  by 
Mrs.  H.  V.  Brown  of  Los  Angeles  County,  and  unani- 
mously carried,  the  report  of  the  Nominating  Com- 
mittee was  accepted.  Upon  motion  of  Mrs.  Brown, 
seconded  by  Mrs.  Irving  Bancroft  of  Los  Angeles 
County,  and  unanimously  carried,  the  vote  was  cast 
in  favor  of  the  nominees  and  they  were  declared 
elected. 

Upon  suggestion  of  Mrs.  Stevens,  chairman  of  the 
Nominating  Committee,  and  by  unanimous  consent,  a 
rising  vote  of  thanks  was  given  Mrs.  Rogers,  state 
president,  for  the  successful  manner  in  which  she 
had  launched  the  organization  and  for  having  so 
generously  contributed  her  services  in  the  pioneer 
work  necessary  to  achieve  success.  By  informal  con- 
sent the  secretary  was  also  commended. 

The  secretary  was  instructed  to  write  Doctor  Pope, 
secretary  of  the  Medical  Association,  and  Doctor 
Kress,  Auxiliary  adviser,  letters  of  appreciation  for 
their  valuable  assistance  during  the  past  year;  also  to 
send  flowers  to  Mrs.  Lyell  C.  Kinney,  wife  of  the 
president  of  the  California  Medical  Association,  and 
to  congratulate  her  in  the  name  of  the  auxiliary  on 
the  birth  of  a son. 

The  meeting  adjourned  to  Wednesday,  April  30, 

1930,  at  10  a.  m.  _ 

Clara  R.  Cushman,  Secretary. 

* * * 

The  second  meeting  of  the  second  annual  session 
of  the  Woman’s  Auxiliary  of  the  California  Medical 
Association  was  held  on  the  mezzanine  floor  of  Hotel 
Del  Monte,  Wednesday  morning,  April  30,  1930,  with 
the  retiring  president,  Mrs.  Henry  S.  Rogers,  calling 
the  meeting  to  order  at  10  o’clock. 

The  chairman  introduced  Dr.  Morton  R.  Gibbons, 
president  of  the  California  Medical  Association,  who 
made  a short  and  interesting  address  on  the  aims  and 
purposes  the  California  Medical  Association  had  in 
view  in  launching  a woman’s  auxiliary.  He  particu- 
larly emphasized  the  need  existing  for  a body  of 
women  educated  in  health  matters  to  promote  the 
public  health  through  organized  effort,  and  he  sug- 
gested and  advised  the  auxiliary  to  make  a study  of 
the  matter  of  health  insurance,  a subject  which  is  now 
of  great  moment  and  concern  to  the  California  Medi- 
cal Association. 


Dr.  Lyell  C.  Kinney,  president-elect  of  the  Cali- 
fornia Medical  Association,  was  then  introduced. 
Doctor  Kinney  enlarged  upon  two  lines  of  useful 
work  to  which  the  auxiliary  might  devote  itself  with 
benefit  for  the  coming  year.  First,  perfecting  the 
organization  by  enlarging  and  consolidating  the  units, 
i.  e.,  increasing  membership  and  cooperating  in  aims 
and  purposes;  second,  educating  the  public  in  health 
matters. 

The  third  speaker,  Dr.  William  Duffield,  father,  as 
he  stated,  of  the  Woman’s  Auxiliary  movement  in 
California,  went  into  detail,  after  being  introduced, 
as  to  what,  in  his  opinion,  are  the  chief  objects  of  the 
American  Medical  Association  and  California  Medical 
Association  in  encouraging  the  wives  and  near  rela-. 
tives  of  their  members  to  organize,  and  as  to  what 
the  duties  of  such  organizations  should  be.  In  broad 
terms  his  most  important  message  was  the  urgent 
need  of  an  organization  designed  to  combat  ignorance 
and  superstition  in  matters  of  biology,  physiology, 
and  medical  treatment.  He  stated  that  scientific  edu- 
cation in  medical  matters  is  the  biggest  business  of 
the  auxiliary.  He  cited  many  illustrations  to  prove 
that  such  ignorance  and  superstition  along  medical 
lines  exists  among  so-called  highly  educated  people, 
even  educators  in  our  highest  seats  of  learning  being 
ignorant  of  the  functions  and  constitution  of  the 
human  body;  and  he  advised  auxiliary  units  to  turn 
their  efforts  toward  changing  this  condition  for  the 
better.  With  such  end  in  view  he  gave  concrete  sug- 
gestions for  the  county  units  to  follow,  such  as: 

1.  Put  the  magazines  Better  Health  and  Hygeia  into 
local  circulation. 

2.  Read  regularly  all  material  in  California  and 
Western  Medicine  and  the  American  Medical  Journal, 
pertaining  to  auxiliary  work  and  of  interest  along  the 
line  of  public  health  education;  also  see  that  your 
husband  reads  them. 

3.  Make  a study  of  the  different  cults,  becoming 
informed  as  to  their  methods  of  propaganda,  not  tak- 
ing concerted  action  against  such  cults  which  would, 
the  speaker  stated,  be  inadvisable,  but  learning  what 
they  are  doing  in  order  better  to  direct  the  auxiliary’s 
work. 

4.  Making  a study  of  material  sent  out  by  the 
American  Medical  Association,  a bibliography  of 
which  was  furnished  by  the  speaker  to  those  present, 
and  which  may  be  secured  by  application  to  the 
American  Medical  Association. 

5.  A study  of  the  antivivisection  movement,  about 
which  there  is  so  much  mental  confusion  and  so  much 
false  propaganda. 

Doctor  Duffield  gave  an  interesting  account  of  the 
methods  of  a certain  cult  in  forcing  through  their  pro- 
grams through  economic  pressure,  with  many  con- 
crete cases  cited.  He  dwelt  upon  the  harm  religious 
cults  bring  about  through  appeal  to  superstition,  to 
the  injury  of  health,  and  gave  a number  of  case  his- 
tories of  so-called  cures  by  religious  healers,  which 
he  had  personally  investigated  and  found  to  be  no 
cures  at  all. 

He  suggested  that  the  beginning  of  this  work  in 
public  health  education  might  well  be  in  the  public 
schools,  where  health  matters  are  usually  taught  im- 
properly, falsely,  or  not  at  all,  and  advised  the  auxili- 
ary, through  the  Parent-Teacher  Associations  and 
through  advocating  certain  legislative  measures  as 
they  are  introduced,  to  promote  the  teaching  of  biol- 
ogy, physiology,  and  hygiene  in  the  public  schools. 

Also,  Doctor  Duffield  advised  the  county  units  to 
go  into  politics  to  see  that  they  supported  as  a whole 
the  proper  candidates,  those  having  an  understand- 
ing of  and  an  intelligent  outlook  on  scientific  health 
matters. 

He  advised  the  auxiliary  the  members  would  be 
performing  a fine  bit  of  work  if  they  should  compile 
a history  of  medicine,  one  which  is  not  technical  but 
for  the  benefit  of  the  average  reader. 

Finally  he  outlined  a course  of  medical  study  along 
the  line  of  the  old  Chatauqua  courses,  and  he  fur- 


♦58 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


nished  the  following  list  of  books,  which  he  recom- 
mended for  study  by  the  auxiliaries  and  for  private 
reading. 

Vallery-Radot — “Pasteur.” 

Logan  Clendening — “The  Human  Body.” 

Carl  Menninger — “The  Human  Mind.” 

Bobbs-Merrill  Pub.  House — “Medical  Leaders.” 

Morris  Fishbein — “Medical  Follies.” 

Walsh  Walsh — “Cures.” 

McLaren — “Postmortem.” 

Howard  W.  Haggard — “Devils,  Drugs,  and  Doc- 
tors.” 

Cushing — “Life  of  Osier.” 

At  the  conclusion  of  Doctor  Duffield’s  talk,  the 
questions  and  discussion  became  so  general  that  the 
adjournment  was  taken  informally,  and  no  oppor- 
tunity was  given  to  express  appreciation  to  the 
speakers,  although  this  was  manifested  by  the  en- 
thusiasm and  close  attention  the  audience  paid  to  each 
talk. 

Clara  R.  Cushman,  Secretary. 

* * * 

APPENDIX  “A” 

Minutes  Second  Annual  Session,  First  Meeting 
TENTATIVE  BUDGET 

Based  Upon  a Presumed  Membership  of  One  Thousand. 


Letterheads  and  envelopes $20.00 

Second  sheets 3.00 

Office  supplies  (carbon,  clips,  folders,  etc.) 3.50 

Stamps,  five  hundred 10.00 

Telegrams  and  telephone  calls 15.00 

Parcel  post  circulars  and  material,  forty  counties 

eight  months  at  5 cents 16.00 

Stenographic  services  ten  months  at  $10  100.00 

Entertainment  and  expense  state  meeting 50.00 


Total  tentative  amount $217.50 

Office  file— organizing  expense  may  be  necessary,  but  not 
listed. 

APPENDIX  “B” 


Minutes  Second  Annual  Session,  First  Meeting 
treasurer’s  report 
From  May  9,  1929,  to  April  28,  1930 

Treasurer  is  charged  as  follows: 

Forty-six  charter  membership  dues,  $1  each... $46.00 

National  dues  as  follows: 

San  Bernardino  County,  eleven  members  at 

25  cents  each $ 2.75 

Kern  County,  twelve  members  at  25  cents 

each  3.00 

Napa  County,  twelve  members  at  25  cents 

each  3.00 

Sonoma  County,  twenty-one  members  at 

25  cents  each 5.25 

Contra  Costa  County,  sixteen  members  at 
25  cents  each 4.00 


Total  national  dues.  18.00 


Total  charges $64.00 


Treasurer  is  credited  as  follows: 


Stamps  and  stationery $ 9.35 

Minute  book 1.60 

Office  supplies 75 


Total  credits 11.70 


Which,  when  deducted  from  total  charges, 

leaves  a balance  of 

Consisting  of: 

Cash  in  First  National  Bank  of  Santa  Ana $34.30 

Checks  for  national  dues  (uncashed) 18.00 


$52.30 


Total  cash  on  hand 


$52.30 


Clara  R.  Cushman, 

Secretary-  T reasurer. 

* 


LOS  ANGELES  COUNTY 

The  regular  meeting  of  the  Woman’s  Auxiliary  was 
held  Thursday,  April  17,  at  2:30  p.  m.  in  the  Assembly 
Hall  of  the  Friday  Morning  Club  building,  Los  An- 
geles, with  Mrs.  James  F.  Percy,  president,  presiding. 
There  was  a large  attendance. 

Mrs.  George  G.  Hunter  was  appointed  acting  secre- 
tary for  the  secretary,  Mrs.  Martin  G.  Carter,  who 
was  absent  on  account  of  illness.  After  the  reading 
of  the  minutes,  Mrs.  Percy  presented  the  speaker  of 
the  afternoon,  Dr.  George  H.  Kress. 

Doctor  Kress’  theme  was  the  object  of  the  organi- 
zation as  conceived  by  the  California  State  Medical 
Association — the  basic  purpose  of  the  organization. 


And  he  presented  his  subject  clearly  and  concisely  in 
a manner  that  was  not  only  entertaining,  but  most 
instructive. 

He  urged  the  members  of  the  auxiliary  to  focus 
their  attention  upon  the  fundamental  principles  on 
which  scientific  medicine  is  founded.  Only  in  this  way 
would  the  auxiliary  be  able  to  exert  its  full  power 
for  the  benefit  of  the  medical  profession  and  the 
community. 

Women’s  clubs,  Doctor  Kress  pointed  out,  are  hap- 
pily in  a position  to  demonstrate  to  the  intelligent  lay- 
men the  difference  between  faddism  and  scientific 
medicine.  As  an  example  of  what  scientific  medicine 
has  already  accomplished  for  community  welfare, 
Doctor  Kress  cited  the  “pure  milk”  situation. 

Keep  out  of  politics,  was  the  doctor’s  admonition. 
Unless  one  has  a special  flare  for  politics,  is  is  likely 
to  prove  disastrous  rather  than  helpful. 

Doctor  Kress  paid  a high  tribute  to  the  work  of 
Dr.  Mona  Bettin,  whose  work  in  applied  bacteriology 
for  the  welfare  of  this  community  is  beyond  praise. 

At  the  close  of  Doctor  Kress’  address,  Mrs.  Elliot 
Alden  proposed  a rising  vote  of  thanks  by  the 
Woman’s  Auxiliary  members,  which  was  given  with 
enthusiasm  and  appreciation. 

A delightful  musical  program  was  given  by  Mrs. 
William  A.  Clark,  violinist,  with  Mrs.  E.  D.  Kremers, 
accompanist,  two  gifted  members  from  Pasadena, 
who  have  won  fame  on  the  concert  stage. 

A delicious  tea  was  served,  with  the  Long  Beach 
members  as  hostesses,  Mrs.  B.  von  Wedelstaedt, 
chairman.  * * * 

The  brilliant  ball  and  frolic  given  on  Saturday  eve- 
ning, May  10,  by  the  Los  Angeles  County  Medical 
Association,  assisted  by  the  Woman’s  Auxiliary,  at 
the  Grand  Central  Airport  on  San  Fernando  Road, 
was  enjoyed  by  over  three  hundred  participants.  The 
ball  and  supper  rooms  were  elaborately  decorated  in 
exquisite  taste.  And  the  sumptuous  supper  was  some- 
thing to  be  remembered  by  the  most  discriminating 
epicure.  An  exceptionally  fine  dance  orchestra  played 
throughout  the  evening.  And  a big  thrill  was  con- 
tributed by  the  huge  tri-motored  plane  which  was 
provided  to  take  the  guests  for  fifteen-minute  rides 
into  the  perfect  moonlit  night.  Not  the  least  inter- 
esting incident  of  this  unusual  evening  was  the  trip 
into  the  hangars  with  a well-informed  guide  who 
explained  the  intricate  and  intriguing  details  of  the 
imposing  array  of  planes. 

The  outstanding  success  of  this  occasion  is  a tribute 
to  the  enthusiastic  work  of  Mrs.  James  Fulton  Percy, 
president  of  the  Los  Angeles  County  Auxiliary  and 
recently  elected  president  of  the  state  auxiliary;  Mrs. 
Philip  Schuyler  Doane,  general  chairman;  Mrs.  George 

G.  Hunter,  and  Mrs.  Martin  G.  Carter. 

Present  with  parties  of  guests  were  noticed:  Doctors 
and  Mesdames  Robert  V.  Day,  Philip  Schuyler  Doane, 
James  Fulton  Percy,  George  G.  Hunter,  Martin  G. 
Carter,  William  Duffield,  John  V.  Barrow,  Elliot 
Alden,  H.  V.  Brown,  E.  M.  Lazard,  LeRoy  Sherry, 
Walter  P.  Bliss,  B.  von  Wedelstaedt,  Edward  Hunt- 
ington Williams,  Theodore  Lyster,  Isaac  H.  Jones, 

H.  G.  Marxmiller,  Fitch  Mattison,  and  Edward 

Pallette.  * * * 

The  next  meeting  of  the  Woman’s  Auxiliary  will 
be  on  Thursday,  June  19,  at  2:30  p.  m.  in  the  Assem- 
bly Hall  of  the  Friday  Morning  Club  building,  Los 
Angeles.  This  will  be  the  last  regular  meeting  until 
autumn,  although  in  the  interim  the  Executive  Com- 
mittee are  planning  to  call  round-table  gatherings  to 
discuss  any  issues  that  may  arise. 

Mrs.  Percy  announces  that  the  Western  Surgical 
Supply  Company  are  sending,  complimentary  to  all 
members  of  the  auxiliary,  the  monthly  magazine, 
Medical  Economics.  This  is  a business  magazine  and 
contains  innumerable  suggestions  and  ideas  which  the 
members  of  the  auxiliary  will  find  practical  and  useful. 

Cora  Young  Williams, 

Publicity  Chairman. 


June,  1930 


STATE  MEDICAL  ASSOCIATIONS 


459 


NEVADA  STATE  MEDICAL 
ASSOCIATION 

W.  A.  SHAW President 

R.  P.  ROANTREE,  Elko President-Elect 

H.  W.  SAWYER,  Fallon First  Vice-President 

E.  E.  HAMER,  Carson  City Second  Vice-President 

HORACE  J.  BROWN Secretary-Treasurer 

R.  P.  ROANTREE,  D.  A.  TURNER, 

S.  K.  MORRISON Trustees 


COMPONENT  COUNTY  SOCIETIES 

WASHOE  COUNTY 

The  Washoe  County  Medical  Society  met  in  the 
Washoe  County  Library  building,  Reno,  on  May  13, 
at  8 p.  m. 

In  the  absence  of  Doctor  Hamer,  president,  the 
vice-president,  Doctor  Creveling,  occupied  the  chair. 

No  clinical  cases  to  report.  The  president  intro- 
duced Doctor  Samuels  of  Reno,  who  responded  with 
a paper  on  the  “Treatment  of  Neisserian  Infections 
in  the  Male.”  While  Doctor  Samuels  gave  enough 
citations  from  standard  authorities,  he  went  more 
fully  into  the  matter  of  his  own  personal  experience 
in  handling  and  treating  this  type  of  case. 

Especially  so  in  the  social  management  of  patients. 
Doctor  Samuels  gave  a number  of  practical  hints 
which  dwelt  with  this  troublesome  side  of  the  case. 

The  usual  routine  for  medical  treatment  can  be 
found  in  standard  text  works,  modified  by  actual  ex- 
perience of  the  practitioner.  In  a disease  for  whose 
cure  most  of  the  traveling  pharmaceutical  salesmen 
have  the  last  word  for  absolute  cures  and  100  per  cent 
records,  the  man  of  experience  listens  to  these  con- 
fidential tips  as  he  would  listen  were  he  playing  the 
races,  and  takes  them  just  for  what  they  are  worth. 
Given  time  enough  and  an  obedient  patient,  this  class 
of  patients  will  respond  to  a well-directed  rational 
therapy. 

Next  followed  a paper  by  one  of  Reno’s  attorneys 
on  the  subject  of  “Insanity  and  the  Law.”  This  paper 
formerly  appeared  in  the  April  1930  number  of  Ameri- 
can Mercury.  The  paper  was  scholarly.  Many  of 
the  physicians  of  Reno  who  had  already  read  the 
paper  were  there  to  hear  it  from  the  author  himself. 
The  paper  called  out  a number  of  commendations,  and 
it  was  the  opinion  of  all  present  that  this  paper 
should  be  in  the  library  of  every  physician. 

There  being  no  further  business  the  meeting  ad- 
journed. Thomas  W.  Bath,  Secretary. 


UTAH  STATE  MEDICAL 
ASSOCIATION 


H.  P.  KIRTLEY,  Salt  Lake  City President 

WILLIAM  L.  RICH,  Salt  Lake  City President-Elect 


M.  M.  CRITCHLOW,  Salt  Lake  City Secretary 

J.  U.  GIESY,  701  Medical  Arts  Building, 

Salt  Lake  City Associate  Editor  for  Utah 


COMPONENT  COUNTY  SOCIETIES 
SALT  LAKE  COUNTY 

A joint  meeting  of  the  Salt  Lake  County  Medical 
Society  and  the  Utah  Ophthalmological  Society  was 
held  at  the  Newhouse  Hotel  on  Monday,  April  14. 

The  meeting  was  called  to  order  at  8:05  p.  m.  by 
President  M.  M.  Nielson.  Forty-seven  members  and 
three  visitors  were  present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted  without  correction. 


The  scientific  program  was  as  follows : “Strabismus” 
by  D.  W.  Henderson.  This  paper  was  discussed  by 
E.  M.  Neher,  W.  D.  Donoher,  F.  Stauffer,  L.  W. 
Snow,  and  H.  Van  Cott.  “The  Accessory  Nasal 
Sinuses”  (lantern  slides)  by  F.  M.  McHugh.  This 
paper  was  discussed  by  F.  Stauffer. 

A letter  from  the  American  Medical  Association 
was  read  urging  that  this  society  use  its  efforts  to 
amend  the  Porter  Federal  Narcotic  Service  Reorgani- 
zation Bill,  as  suggested  in  the  April  12  issue  of  The 
Journal  of  the  American  Medical  Association. 

* * * 

The  following  report  of  the  Necrology  Committee, 
J.  U.  Giesy,  chairman,  was  read: 

IN  MEMORIAM GEORGE  F.  ROBERTS 

Whereas,  An  inscrutable  Providence  in  the  pursu- 
ance of  its,  to  us  unknown,  purposes,  has  seen  fit  to 
remove  from  his  mundane  field  of  activities  our  ad- 
mired and  respected  confrere,  Dr.  George  F.  Roberts; 
and 

Whereas,  We,  who  have  known  and  labored  with 
him  in  a common  pursuit  for  years,  feel  deeply  the 
loss  to  us  and  to  his  friends  and  loved  ones  as  well 
as  to  the  community  at  large;  therefore  be  it 

Resolved,  By  the  members  of  the  Salt  Lake  County 
Medical  Society  that  we  take  this  formal  action  to 
express  our  regret;  that  this  resolution  be  inscribed 
on  the  minutes  of  the  society  as  a permanent  record 
and  tribute  to  our  departed  member,  and  that  a copy 
be  forwarded  to  the  family  of  the  deceased  as  a mark 
of  that  personal  tribute  which  we  pay  him  in  our 
hearts,  and  of  the  appreciation  of  his  worth  which  we 
carry  forward  with  us  in  our  thoughts. 

W.  F.  Beer  moved  that  the  report  be  accepted  and 
filed.  Seconded  and  carried. 

* * * 

The  application  of  L.  H.  O.  Stobbe  was  read  and 
turned  over  to  the  board  of  censors. 

A.  C.  Callister  read  a communication  from  the 
chief  of  police  relative  to  the  present  Caduceus  tax. 
This  was  heatedly  discussed  by  M.  M.  Nielson  and 
W.  F.  Beer.  President  M.  M.  Nielson  appointed  a 
special  committee  to  consider  this  communication. 

J.  P.  Kerby  gave  a lengthy  report  of  the  Fee  Sched- 
ule Committee.  This  was  ably  discussed  by  most  of 
the  members  present,  and  following  several  motions 
which  were  later  rescinded,  J.  Z.  Brown’s  motion  to 
the  effect  that  action  on  this  report  be  deferred  until 
the  meeting  of  June  9 was  seconded  and  carried.  J.  P. 
Kerby  moved  that  the  following  amendment  to  the 
by-laws  of  the  Salt  Lake  County  Society  be  voted 
upon  at  the  business  meeting  in  June.  The  fee  bill 
adopted  at  this  meeting  is  intended  to  represent  the 
average  fee  under  ordinary  circumstances  (both  col- 
umns referred  to  minimum  fees),  the  difference  be- 
tween them  indicating  common  differences,  depending 
upon  the  responsibility  and  judgment  involved  in  treat- 
ing different  cases,  and  the  ability  of  patients  to  pay. 
This  fee  schedule  does  not  attempt  to  indicate  proper 
compensation  in  those  cases  requiring  special  skill, 
extraordinary  responsibility,  or  unusual  character  of 
service.  This  society  recognizes  the  right  of  every 
member  to  charge  what  he  believes  to  be  a fair  and 
adequate  fee  for  services  rendered,  or  to  give  the 
whole  or  any  part  of  his  services  in  charity.  But  it 
will  be  considered  his  duty  to  abide  by  the  fee  sched- 
ule herein  mentioned  whenever  the  circumstances  of 
the  patient  do  not  clearly  forbid.  Any  violation  of  the 
provisions  of  said  fee  schedule  solely  for  the  purpose 
of  securing  a patient  shall  be  considered  ipso  facto 
cause  for  loss  of  membership.  The  usual  procedure 
of  this  society  in  the  matter  of  filing  a complaint 
against  a member  shall  be  followed;  and  a written 


460 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


notice  of  this  proposed  amendment  be  furnished  each 
member  not  less  than  ten  days  before  the  regular 
business  meeting  in  June.  Motion  seconded  and 
carried. 

Meeting  adjourned  at  10:30  o'clock. 

* * * 

The  regular  meeting  of  the  Salt  Lake  County  Medi- 
cal Society  was  held  at  the  Holy  Cross  Hospital  on 
Monday,  April  28. 

The  meeting  was  called  to  order  by  President  M.  M. 
Nielson  at  8:15  p.  m.  Forty  members  and  two  visitors 
were  present. 

The  minutes  of  the  previous  meeting  were  read  and 
accepted  after  a slight  correction. 

The  application  of  M.  F.  Poulson  was  read  and 
turned  over  to  the  board  of  censors. 

L.  H.  O.  Stobbe  was  unanimously  elected  a mem- 
ber of  the  society. 

The  clinical  program  was  as  follows:  A Burn  Case, 
S.  H.  Besley.  The  Use  of  Mercurials  in  Cardiac  De- 
compensation, Claude  Shields  and  R.  Friel.  Surgical 
Shock,  Douglas  Hansen.  Orthoplasty  of  the  Knee, 
S.  C.  Baldwin  and  D.  Hansen;  this  subject  was  dis- 
cussed by  L.  N.  Ossman  and  L.  C.  Snow.  Sacroiliac 
Fusion,  L.  N.  Ossman;  discussed  by  C.  M.  Benedict 
and  G.  H.  Pace. 

Meeting  adjourned  at  9:25  o’clock. 

Barnet  E.  Bonar,  Secretary. 

& 

UTAH  COUNTY 

The  Utah  County  Medical  Society  held  a meeting 
on  April  9,  at  Provo.  The  topic,  discussed  generally 
by  the  members  of  the  society,  was  “Medical  Eco- 
nomics and  the  High  Cost  of  Medicine.” 

Several  current  articles  from  recent  medical  jour- 
nals and  lay  magazines  were  reviewed  by  the  County 
Medical  Society. 

The  second  meeting  of  the  society  was  held  April 
23.  Dr.  L.  A.  Smith,  pediatrician  of  Ogden,  gave  an 
interesting  talk  on  infant  feedings. 

J.  L.  Aird,  Secretary. 


UTAH  NEWS 

One  of  the  outstanding  events  of  the  past  month 
was  the  testimonial  banquet  tendered  by  the  state 
association  to  Dr.  Emerson  F.  Root  in  recognition 
of  the  completion  of  his  fiftieth  year  in  the  practice 
of  medicine. 

On  the  night  of  April  17  a representative  gathering 
of  the  members  of  the  state  association  was  held  at 
the  Alta  Club,  Salt  Lake  City,  to  do  honor  to  this 
veteran  and  well-beloved  member  of  their  profession. 

The  occasion  was  brilliant.  In  the  main  dining 
room  of  the  Club  long  tables,  stretched  from  head 
to  foot  and  adorned  with  flowers,  seated  some  one 
hundred  and  fifty  of  the  members  from  all  parts  of 
the  state. 

Dr.  William  Donoher  officiated  in  his  own  inimi- 
table style  as  toastmaster  for  the  evening.  Responses 
were  made  by  Doctors  H.  P.  Kirtlqy,  J-  W.  Aird, 
Samuel  Baldwin,  Ezra  Rich,  and  F.  S.  Bascom.  A 
beautiful  memento  of  the  occasion  was  presented  to 
Doctor  Root  by  the  last-named  speaker,  after  which 
Doctor  Root  himself  responded  to  both  the  bouquets 
and  brickbats  which  had  been  hurled  so  generously. 

The  committee  in  charge  consisted  of  Doctors  H.  P. 
Kirtley,  J.  C.  Landenberger,  W.  D.  Donoher,  R.  R. 
Hampton,  L.  N.  Ossman,  M.  M.  Critchlow,  and  Sol 
G.  Kahn.  The  affair  proved  a splendid  occasion  of 
good  fellowship. 


Meetings  of  the  Academy  of  Medicine  were  held 
during  April  as  follows; 

April  10 — Round  Table  Discussion  of  Physical 
Therapy,  Dr.  J.  U.  Giesy.  Physical  Examination  of 
the  Chest  (slides),  Dr.  Van  Scoyoc.  Recent  Litera- 
ture on  Endocrines,  Dr.  Tyndale. 

April  17 — Meeting  canceled  on  account  of  the  ban- 
quet to  Dr.  E.  F.  Root. 


An  Indianapolis  general  physician  who  is  reputed 
to  be  very  busy  as  well  as  prosperous  says  that  he 
quite  agrees  with  us  in  the  statement  that  the  majority 
of  the  physicians  are  cutting  their  own  throats  by 
recommending  or  even  approving  the  frills  with  which 
the  ordinary  sick  person  surrounds  himself.  He  says 
that  he  tells  women  patients  in  moderate  circum- 
stances that  thej'  can  have  their  babies  at  home,  and 
even  with  a practical  nurse  which  he  finds  sufficient, 
and  that  the  expense  is  far  less  than  at  a hospital. 
A confinement  case  at  home  permits  the  attending 
physician  to  obtain  a decent  fee  that  he  otherwise 
might  lose.  He  also  says  that  he  doesn’t  keep  surgical 
cases  in  the  hospital  merely  as  a convenience  to  him- 
self, but  sends  them  home  as  soon  as  it  is  safe  for 
them  to  be  moved,  which  practice  permits  the  patient 
to  pay  the  physician  for  his  visit  at  the  home  instead 
of  paying  twice  as  much  for  the  hospital  care  and 
have  nothing  left  for  the  physician.  In  short,  it  is 
his  idea  that  nowadays  the  average  sick  person  ex- 
pects and  receives  not  only  a good  deal  of  superfluous 
attention,  but  more  expensive  attention  than  is  re- 
quired in  order  to  secure  equally  good  results.  In 
consequence  the  sick  person  pays  out  more  money 
than  he  should,  and  the  attending  physician  often- 
times gets  little  or  nothing,  whereas  if  the  extra  and 
unnecessary  attention  is  cut  out  the  physician  could 
be  paid.  He  claims  that  his  income  has  doubled  since 
he  adopted  the  plan  of  rendering  more  service  at  the 
home  of  the  patient,  and  that  his  patients  have  been 
saved  money  without  the  slightest  loss  of  efficiency 
and  service. — Editorial,  The  Journal  of  the  Indiana 
State  Medical  Association,  February  15,  1930. 


Battling  With  Locusts.— An  editorial  in  the  New 
York  Times  of  April  17  calls  attention  to  the  battle 
of  El  Arish  on  the  shore  of  Sinai  peninsula,  where 
the  British  defeated  the  Turks  in  1917,  and  continues: 

“It  is  another  enemy  that  has  threatened  Egypt 
during  the  past  week,  and  the  defenders  have  gone 
out  to  meet  the  invading  hordes  in  the  same  desert 
area  in  which  the  Turks  were  met  and  driven  back. 
The  dispatch  says  that  ‘the  heaviest  fighting  occurred 
around  El  Arish.’  But  in  this  battle  it  was  man  fight- 
ing his  ancient  and  inveterate  enemy,  the  locust.  The 
Inspector-General  of  the  Egyptian  Army  was  in  com- 
mand, and  was  accompanied  by  soldiers  and  men  of 
the  camel  corps,  but  his  chief  of  staff  was  an  ento- 
mologist and  their  weapons  were  ‘flame  guns.’  The 
trenches  in  this  campaign  were  not  for  their  own  pro- 
tection but  for  trapping  the  locust  enemies,  who  were 
destroyed  by  millions  as  they  advanced  in  serried 
bands  and  fell  into  the  ditches. 

“The  scene  as  described  in  Monday’s  Times  was 
with  none  of  the  horrors  of  war  but  with  all  its  dra- 
matic incidents:  the  blazing  miles-long  trenches,  the 
flanking  gunners  shooting  flames,  the  phalanxes  of 
men  in  gasoline-tin  armor,  the  square  miles  of  charred 
locusts  left  on  the  battlefield.  And  all  in  the  midst 
of  terrific  sandstorms  and  in  the  oppressive  heat  of 
the  desert.  It  is  a warfare  which  suggests  some  of 
the  battles  that  civilization  will  have  to  continue  to 
wage  even  after  wars  cease  between  man  and  man. 
Egypt  has  again  been  saved  by  a victory  over  the 
invaders  at  El  Arish,  or  so  it  is  hoped;  but  this  time 
by  an  army  under  the  leadership  of  an  official  pro- 
tector of  nlants.” — New  York  State  Journal  of  Medicine, 
May  1,  1930. 


MISCELLANY 

Items  for  the  News  column  must  be  furnished  by  the  twentieth  of  the  preceding  month.  Under  this  department  are 
grouped:  News;  Medical  Economics;  Correspondence;  Department  of  Public  Health;  California  Board  of  Medical 
Examiners;  and  Twenty-Five  Years  Ago.  For  Book  Reviews,  see  index  on  the  front  cover,  under  Miscellany. 

. - • ------  ...  — . .. 

NEWS 


Graduate  Summer  Course. — The  Stanford  Univer- 
sity School  of  Medicine  offers  a special  summer 
course  of  lectures  and  demonstrations  for  graduates 
of  medicine  to  be  given  between  Monday,  June  16, 
and  Saturday,  June  28,  1930. 

A detailed  program  will  be  sent  on  request  to  any- 
one interested  on  application  to  the  Dean,  Stanford 
University  School  of  Medicine,  2398  Sacramento 
Street,  San  Francisco. 


The  Thirty-first  Annual  Session  of  the  American 
Proctologic  Society  will  meet  at  Buffalo  on  Sunday, 
Monday,  Tuesday,  June  22,  23,  24,  1930.  The  society’s 
headquarters  are  the  Statler  Hotel,  Buffalo. 


Woman’s  Auxiliary,  American  Medical  Association. 

The  eighth  annual  session  of  the  Woman's  Auxiliary 
of  the  American  Medical  Association  will  convene  at 
Detroit,  Michigan,  on  June  23  to  26.  Headquarters 
will  be  in  the  Hotel  Tuller.  General  sessions  will 
begin  on  Tuesday,  June  24,  at  9 a.  m.  in  the  Arabian 
Room,  at  which  time  reports  of  officers  will  be  made. 
Other  meetings  will  follow  in  regular  sequence. 


Awards  Made  in  Del  Monte  Golf  Tournament. — 

The  Entertainment  Committee  on  Golf  has  an- 
nounced the  names  of  the  winners  in  the  various 
entries : 

Low  net — President’s  Cup,  Dr.  R.  W.  Langley,  Los 
Angeles,  88-24-64. 

Low  gross— Dr.  Robert  O’Conner,  Oakland,  78. 
Class  A,  0-17 — Low  net,  Dr.  S.  V.  Christeerson, 
San  Francisco,  80-10-70;  second  low  net,  Dr.  Frank 
Sheehy,  San  Francisco,  88-72. 

Class  B,  18-24 — Low  gross,  Dr.  W.  If.  Brownfield, 
Los  Angeles,  93;  low  net,  Dr.  J.  E.  Hughes,  Vallejo, 

93- 24-69;  second  low  net,  Dr.  R.  Scudder,  Fort  Bragg, 

94- 24-70. 

April  30,  1930,  Pebble  Beach  Course: 

Low  net — Dr.  O.  R.  Meyers,  Eureka,  98-24-74. 

Low  gross — Dr.  Roderick  O’Conner,  San  Fran- 
cisco, 88. 

Blind  Bogey: 

Class  A — Dr.  T.  F.  Wier,  San  Diego. 

Class  B — Dr.  W.  S.  Clark,  Ventura. 


The  American  Association  for  the  Study  of  Goiter 

will  hold  its  annual  meeting  on  July  10  and  11,  at 
Seattle,  Washington,  and  on  July  12  at  Tacoma, 
Washington,  and  Mount  Rainier.  The  following 
speakers  will  address  the  meeting:  E.  R.  Arn,  Day- 
ton,  Ohio,  President’s  address;  Willard  Batlett,  Jr., 
St.  Louis;  Leo  P.  Bell,  Woodland,  Calif.;  Addison  G. 
Brenizer,  Charlotte,  N.  C.;  Harold  Brunn,  San  Fran- 
cisco; Thomas  O.  Burger,  San  Diego;  Warren  H. 
Cole,  St.  Louis;  J.  Earle  Else,  Portland,  Ore.;  Wil- 
liam Engelbach,  Santa  Barbara,  Calif.;  Gordon  S. 
Fahrni,  Winnipeg;  N.  W.  Gillett,  Toledo,  Ohio;  Allen 
Graham,  Cleveland;  Samuel  F.  Haines,  Rochester, 
Minn.;  John  S.  Helms,  Tampa,  Florida;  Lewis  M. 
Hurxthal,  Boston;  Arnold  Jackson,  Madison,  Wis.; 
Thomas  M.  Joyce,  Portland,  Ore.;  E.  Starr  Judd, 
Rochester,  Minn.;  William  J.  Kerr,  San  Francisco; 


O.  P.  Kimball,  Cleveland;  Le  Roy  Long,  Oklahoma 
City;  E.  P.  McCullagh,  Cleveland;  K.  F.  Meyer,  San 
Francisco;  R.  J.  Millzner,  San  Francisco;  Henry  F. 
Plummer,  Rochester,  Minn.;  H.  W.  Riggs,  Vancou- 
ver, B.  C.;  C.  A.  Roeder,  Omaha,  Nebr. ; Linden  Seed, 
Chicago;  J.  R.  E.  Sievers,  Butte,  Mont.;  E.  P.  Sloan, 
Bloomington,  111.;  Martin  B.  Tinker,  Ithaca,  N.  Y.; 
Robertson  Ward,  San  Francisco;  Clarence  G.  Toland, 
Los  Angeles;  John  M.  Askey,  Los  Angeles,  and  Ralph 
R.  Wilson,  Kansas  City. 


San  Francisco  Pathological  Society. — The  regular 
meeting  of  the  San  Francisco  Pathological  Society 
was  held  on  Monday,  May  5,  1930,  in  the  Clinic 
Building  of  St.  Luke’s  Hospital,  Twenty-sixth  and 
Valencia  streets,  San  Francisco. 

The  following  program  was  provided:  Review  of 
the  Chicago  and  New  York  meetings  of  several  na- 
tional Pathological  Societies,  C.  L.  Connor;  Osteo- 
chondroma of  the  Ileum,  A.  Weeks  and  G.  D.  Delprat; 
Mediastinal  Tumor,  Leo  Eloesser;  An  Omental 
Tumor,  A.  H.  Roseberg;  A New  Concept  of  Endo- 
thelium, James  F.  Rinehart,  and  Parathyroid  Aden- 
oma, J.  Carr.  


Propedeutic  Medical  Clinic  will  be  held  at  Hopital 
de  la  Charite,  37  rue  Jacob,  Paris,  under  Professor 
Sergent  from  October  20-25,  1930. 

Ten  lectures  on  the  diseases  of  the  lung  with  x-ray 
projections  and  anatomical  specimens,  each  lecture 
being  followed  by  practical  demonstrations  by  MM. 
Bordet,  Turpin,  Kourilsky  and  Benda,  occupying  the 
positions  of  former  clinical  chiefs  and  clinical  chiefs 
of  the  clinic. 

In  the  morning  practical  demonstrations  will  be 
held  in  the  wards  under  the  guidance  of  Professor 
Sergent. 

The  afternoon  will  be  devoted  to  theoretical  lectures 
(from  2:30  p.  m.  to  3:30  p.  m.  and  from  4 p.  m.  to 
5 p.  m.)  by  Lipiodol  in  the  diagnosis  of  the  diseases 
of  the  respiratory  tract — F.  Bordet.  Bronchiectasis 
(one  lecture) — F.  Bordet.  Abscess  of  the  lung — 
Kourilsky.  Gangrene  of  the  lung — Kourilsky.  Car- 
cinoma of  the  lung  (primary) — Turpin.  Carcinoma  of 
the  lung  (secondary) — Turpin.  Syphilis  of  the  lung — - 
Benda.  Syphilis  and  tuberculosis — Benda.  Mechanism 
of  the  tuberculous  infection  af  the  lung — Turpin. 
Tuberculosis  of  the  lung  and  the  new  data  on  the 
tubercle  bacillus — Kourilsky. 

For  further  information  and  registration,  apply  to 
the  “Association  pour  le  Developpement  des  Re'ations 
Medicales”  Salle  Beclard,  Faculte  de  Medecine, 
Paris  6s. 


Library  Needs  of  the  Medical  School  of  the  Univer- 
sity of  Southern  California. — The  reinstituted  School 
of  Medicine  of  the  University  of  Southern  California 
is  engaged  in  laying  the  foundation  of  a medical 
library.  Any  members  of  the  profession  who  have 
files  of  medical  journals  or  of  text  or  other  books  in 
medicine,  who  would  wish  to  donate  or  otherwise  dis- 
pose of  the  same  to  a medical  institution,  will  confer 
a favor  by  writing  to  the  Dean  of  the  University  of 
Southern  California  Medical  School,  Dr.  W.  D.  Cutter, 
3551  University  Place,  Los  Angeles,  who  will  be  glad 
to  take  up  the  matter  further. 


The  John  Phillips  Memorial  Prize. — The  American 
College  of  Physicians  announces  the  John  Phillips 
Memorial  Prize  of  $1500,  to  be  awarded  for  the  most 

461 


+62 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


meritorious  contribution  in  Internal  Medicine  and 
sciences  contributing  thereto,  under  the  following 

conditions:  . . , 

1.  The  contribution  must  be  submitted  in  the  torm 
of  a thesis  or  dissertation  based  upon  published  or 
unpublished  original  work. 

2.  It  must  be  mailed  to  the  Executive  Secretary  ot 

the  American  College  of  Physicians,  E.  R.  Loveland, 
133-135  S.  Thirty-sixth  Street,  Philadelphia,  Pa.,  on  or 
before  August  31,  1930.  , . , , 

3.  The  thesis  or  dissertation  must  be  in  the  English 
language,  in  triplicate,  in  typewritten  or  printed  form, 
and  the  work  upon  which  it  is  based  must  have  been 
done  in  whole  or  in  part  in  the  United  States  or 

Canada.  . 

4.  The  recipient  of  the  prize  would  be  expected  to 
read  the  essay  at  the  next  Annual  Meeting  of  the 
College,  after  which  he  would  be  officially  presented 
with  the  prize  by  the  President. 

5.  The  College  reserves  the  right  to  make  no  award 
of  the  prize  if  a sufficiently  meritorious  piece  of  work 
has  not  been  received. 

6.  The  announcement  of  the  prize  winner  will  be 

made  not  later  than  two  months  before  the  Annual 
Meeting.  __ 

MEDICAL  ECONOMICS 


At  the  Del  Monte  session  of  the  California  Medical 
Association  (April  28-May  1,  1930)  the  Council  of  the 
California  Medical  Association  recommended  to  the 
House  of  Delegates  that  the  California  delegates  to 
the  Detroit  session  of  the  American  Medical  Asso- 
ciation (June  23-27,  1930)  be  instructed  to  present 
resolutions  and  proposed  amendments  to  the  By-laws 
of  the  American  Medical  Association  in  favor  of  and 
for  an  American  Medical  Association  “Council  of 
Medical  Economics.” 

At  the  meeting  of  the  Executive  Committee  held  on 
May  17,  the  president-elect  of  the  California  Medical 
Association,  Dr.  Junius  B.  Harris  of  Sacramento,  who 
is  one  of  the  California  Medical  Association  delegates, 
was  instructed,  with  his  fellow  delegates,  to  sponsor 
these  resolutions  and  amendments. 

Reference  thereto  is  made  in  one  of  the  editorials 
in  this  issue,  and  also  in  the  minutes  of  the  California 
Medical  Association  Council  and  of  the  House  of 
Delegates,  which  are  printed  in  the  California  Medical 
Association  column.  For  the  information  of  members, 
the  resolutions  and  proposed  amendments  are  as 
follows.  * * * 

Whereas,  The  proper  solution  of  problems  in  Med- 
ical Economics  is  one  of  major  importance  if  modern 
day  standards  of  medical  practice  and  public  health 
are  to  be  properly  maintained  and  safeguarded;  now 
therefore  be  it 

Resolved,  By  the  House  of  Delegates  of  the  Cal- 
ifornia Medical  Association  that  its  delegates  to  the 
1930  annual  meeting  of  the  American  Medical  Asso- 
ciation be  instructed  to  request  the  consideration  by 
the  House  of  Delegates  of  the  American  Medical 
Association  of  the  desirability  of  forming  a Council 
on  Medical  Economics  of  the  American  Medical  Asso- 
ciation; and  be  it  further 

Resolved,  That  the  House  of  Delegates  of  the 
American  Medical  Association  be  informed  that  the 
House  of  Delegates  of  the  California  Medical  Asso- 
ciation recommends  the  formation  of  such  a Council 
by  the  American  Medical  Association. 

* * * 

Whereas,  The  members  of  the  House  of  Delegates 
of  the  California  Medical  Association  at  the  1930 
Del  Monte  annual  session  unanimously  voted  that  the 
California  Medical  Association  delegates  “to  the 
American  Medical  Association  be  instructed  to  attempt 
to  secure  the  formation  of  a Council  on  Medical  Eco- 
nomics of  the  American  Medical  Association”;  now 
therefore  be  it 

Resolved,  By  the  Executive  Committee  of  the 
California  Medical  Association  in  pursuance  of  the 


said  instructions  from  the  California  House  of  Dele- 
gates that  there  be  submitted  to  the  House  of  Dele- 
gates of  the  American  Medical  Association  the 
attached  proposed  amendments  to  the  By-laws  of  the 
American  Medical  Association;  and  be  it  further 

Resolved,  By  the  California  Medical  Association 
delegates  be  instructed  to  use  their  best  endeavors  to 
secure  the  approval  of  the  House  of  Delegates  of  the 
American  Medical  Association  to  the  end  that  an 
amendment  to  the  By-laws  of  the  American  Medical 
Association  may  be  adopted  which  would  provide  for 
a Council  on  Medical  Economics. 

* * ^ 

Proposed  Amendments  to  the  By-Laws  of  the 
American  Medical  Association 

Submitted  by  the  California  Medical  Association 
through  its  own  House  of  Delegates  and  its  delegates 
to  the  American  Medical  Association. 

Amendment  to  Chapter  VII. — Committees: 

Sec.  3.  to  be  amended  by  the  addition  beneath 
the  words: 

(c)  “Council  on  Scientific  Assembly.” 
of  the  clause 

(d)  “Council  on  Medical  Economics.” 

# 

CHAPTER  VIII.  ORGANIZATION  OF  STANDING  COMMITTEES 
OR  COUNCILS 

To  be  amended  by  the  addition  of  the  words  “The 
Council  on  Medical  Economics  shall  consist  of  seven 
members,  each  elected  for  seven  years.”  This  sen- 
tence to  be  inserted  in  Sec.  1.  immediately  after  the 
sentence  which  reads:  “The  Council  on  Medical  Edu- 
cation and  Hospitals  shall  consist  of  seven  members, 
each  elected  for  seven  years.” 

Sec.  2.  Officers.  To  be  amended  by  the  addition 
after  the  phrase  “The  Board  of  Trustees  shall  elect 
annually,  to  serve  one  year,  a secretary  of  the  Council 
on  Medical  Education  and  Hospitals”  of  the  words 
“and  a secretary  of  the  Council  on  Medical  Economics, 
and  shall  fix  their  salaries.” 

CHAPTER  IX.  DUTIES  OF  STANDING  COMMITTEES  OR 
COUNCILS 

To  be  amended  by  the  addition  of  a new  Sec.  4.  to 
read : 

Sec.  4.  Council  on  Medical  Economics.  The  func- 
tions of  the  Council  on  Medical  Education  shall  be: 
(1)  To  investigate  conditions  of  medical  economics 
and  to  suggest  means  and  methods  by  which  the  same 
may  be  improved.  (2)  To  endeavor  to  further  the 
realization  of  such  suggestions  as  may  be  approved  by 
the  House  of  Delegates. 


TWENTY-FIVE  YEARS  AGO  * 


EXCERPTS  FROM  OUR  STATE  MEDICAL 
JOURNAL 

Vol.  Ill,  No.  6,  June  1905 

From  some  editorial  notes: 

. . . Wasting  Material. — Doctor  Osier,  at  a farewell 
dinner  given  him  by  some  five  hundred  physicians 
of  this  country  and  Canada  on  May  2,  called  atten- 
tion to  a general  condition  which  has  been  pointed 
out,  so  far  as  its  local  application  to  San  Francisco 
is  concerned,  in  the  pages  of  the  journal.  He  referred 
to  the  tremendous  waste  of  clinical  material  in  this 
country.  . . . 

. . . Honest  Medicines.  — Sufficient  time  has  now 
elapsed  to  permit  one  to  judge  of  the  reception  by 
the  medical  press  of  this  country  of  the  Council  on 
Pharmacy  and  Chemistry  of  the  American  Medical 
Association.  Remember,  this  Council  stands  for  the 
principle  that  secrecy  has  no  place  in  legitimate,  decent, 

* This  column  strives  to  mirror  the  work  and  aims  of 
colleagues  who  bore  the  brunt  of  state  society  work  some 
twenty-five  years  ago.  It  is  hoped  that  such  presentation 
will  be  of  interest  to  both  old  and  recent  members. 


June,  1930 


MISCELLANY 


463 


Professional  medicine.  . . . The  “root  of  the  proprie- 
tary principle”  is  composed  of  two  branches,  secrecy 
and  fraud.  Should  it  not  be  struck  at,  and  hard?  . . . 


From  an  article  on  “ Medical  Inspection  of  Schools"  by 
Ed<ward  Von  Adelung,  M.D.,  Oakland: 

■ . . An  efficient  system  can  be  found  in  Egypt 
which  dates  back  twenty-two  years,  in  Belgium  for 
over  twenty-six  years,  in  France  for  twenty  years.  It 
has  been  in  vogue  for  a long  time  in  Switzerland, 
England,  Germany,  Russia,  and  Scotland.  It  was  in- 
augurated in  Japan  in  1893.  In  the  United  States  it 
was  first  adopted  in  Boston  in  1894  and  Brookline 
soon  followed  Boston’s  example.  . . . 


From  “Reports  Presented  at  the  Thirty-Fifth  Annual 
Meeting  of  the  California  State  Medical  Society”: 

Report  of  the  Editor  and  the  Publication  Committee. — 
. . . In  view  of  these  facts,  it  is  a pleasure  to  report 
to  you  that  the  just  criticisms  which  have  been  voiced 
in  the  pages  of  your  journal  have  been  very  largely 
instrumental  in  the  organization,  by  the  trustees  of 
the  American  Medical  Association,  of  a “Council  on 
Pharmacy  and  Chemistry.”  . . . 

...  We  consider  the  stimulation  of  county  societies 
the  most  important  function  of  your  journal.  . . . 

Report  of  the  Council. — . . . Two  publications  of  this 
society,  the  Journal  and  the  Register,  speak  for  them- 
selves. The  stand  taken  by  our  journal  in  the  inter- 
ests of  legitimate  and  standard  pharmaceutical  prepa- 
rations has  made  it  unique  in  journalism  in  the  United 
States.  This  work  has  been  ably  conducted  by  the 
editor,  with  the  assistance  of  the  Publication  Com- 
mittee, and  has  had  a tendency  to  bring  about  great 
and  lasting  results.  . . . 

. . . During  the  session  of  the  legislature  the  secre- 
tary mailed  to  each  officer  of  the  state  society  and 
to  the  president  and  secretary  of  every  component 
society,  from  time  to  time,  a circular  letter  giving, 
briefly,  information  relative  to  measures  pending 
before  the  legislature.  . . . 

. . . Santa  Clara  County  Society  has  made  formal 
request  that  your  honorable  body  rule  upon  the  eligi- 
bility of  homeopathic  or  eclectic  physicians  who  may 
be  members  of  homeopathic  or  eclectic  medical  socie- 
ties to  become  members  of  component  societies  of 
the  Medical  Society  of  the  State  of  California.  . . . 

Membership  in  1905  and  1906: 


Last 

This 

Year 

Year 

Gain 

Alameda  County 

113 

125 

12 

Los  Angeles  County 

278 

315 

37 

Sacramento  County 

45 

48 

3 

San  Francisco  County  . 

464 

521 

57 

An  excerpt  from  the  “ California  Medical  and  Surgi- 
cal Reporter,”  entitled  “Some  Personal  Impressions” : 

There  was  an  excellent  opportunity  to  study  some 
strong  medical  personalities  at  the  Riverside  meeting 
of  the  Medical  Society  of  the  State  of  California 
(California  Medical  Association): 

President  Adams,  frank,  open-faced  and  genial,  even 
when  corrected  on  points  of  law  by  his  right  bower, 
the  state  secretary;  Dr.  Philip  Mills  Jones,  a paradox 
of  alertness  in  a somewhat  attenuated  and  languid 
physical  frame  who,  like  President  Adams,  was  genial 
even  in  his  positive  interpretations  of  the  Constitution 
and  By-Laws  of  the  society;  Dr.  Dudley  Tait,  pol- 
ished expounder  of  the  state  medical  laws,  a popular- 
unpopular  member,  whose  comings  and  goings  were 
of  interest  to  all;  Dr.  Rooney,  president-elect  for 
1906,  pleasant  in  manner  and  feature,  and  reconteur 
of  an  inexhaustible  fund  of  stories;  Dr.  Norman 
Bridge,  like  Dr.  Tait,  positive  and  outspoken  in  his 
conceptions  of  things;  Dr.  H.  Bert.  Ellis,  leisurely 
alert  and  smilingly  aggressive;  Dr.  Walter  Lindley, 
moving  here  and  there,  but  leaving,  no  doubt,  the 
impress  of  his  presence;  the  venerable  Dr.  Orme,  a 
faithful  member  and  officer  of  the  state  society 
through  many  past  years;  and  so  on  through  a whole 
host  of  workers  in  our  noble  guild,  to  mention  all  of 
whom  with  proper  words  would  require  much  more 
space  than  is  at  our  disposal. 


DEPARTMENT  OF  PUBLIC 
HEALTH 

By  W.  M.  Dickie,  Director 

Prevalence  of  Trichinosis  Is  Exceptional. — The  past 
five  months  have  brought  to  California  a larger  num- 
ber of  cases  of  trichinosis  than  have  ever  occurred 
within  the  state  during  a like  period  of  time.  A total 
of  132  cases  were  reported  during  the  period  Decem- 
ber 1,  1929,  to  April  5,  1930.  During  the  calendar  year 
1929,  there  were  but  thirty-three  cases  of  trichinosis 
reported,  and  during  the  first  fourteen  weeks  of  this 
year,  105  cases  have  been  reported. 

While  it  is  true  that  most  cases,  this  season,  found 
their  sources  of  infection  in  sausages,  both  home- 
made and  commercially  prepared,  a considerable  num- 
ber of  cases  were  traced  to  the  use  of  pork  meat 
which  was  improperly  cooked.  No  less  than  twenty- 
one  of  the  132  cases  that  have  been  reported  during 
the  past  winter  season,  were  due  to  the  use  of  under- 
cooked pork  meat.  A very  few  cases  were  due  to  the 
use  of  commercially  packed  sausages,  which  were  not 
thoroughly  cooked  before  eating,  and  most  of  them 
were  due  to  the  use  of  home-prepared  salami,  mett- 
wurst  and  to  other  types  of  sausages  which  were  not 
thoroughly  cooked  before  being  eaten.  Complete  death 
records  are  not  available  at  this  time,  but,  in  so  far 
as  they  are  available,  it  would  appear  there  have  been 
two  deaths  from  trichinosis  in  Trinity  County,  one  in 
San  Francisco  and  five  in  El  Dorado  County.  The 
group  of  cases  which  occurred  in  Trinity  County  are 
particularly  interesting  for  the  reason  that  they  were 
due  to  the  use  of  smoked  bear  meat.  This  is  the  first 
instance  on  record  in  which  infected  bear  meat  has 
caused  trichinosis  in  California. 

It  is  the  consensus  of  opinion  among  public  health 
authorities  that  no  method  of  inspection  has  yet  been 
devised  by  which  the  presence  or  absence  of  trichinae 
in  pork  can  be  determined  with  certainty.  There  is 
but  one  way  to  absolutely  avoid  the  contraction  of 
trichinosis  and  that  is  to  cook  all  pork  products  to  a 
temperature  of  160  degrees  Fahrenheit  before  serving. 
Fresh  pork  should  be  cooked  until  it  becomes  entirely 
white  and  there  is  no  longer  any  red  color  left. 
Pickled  pork,  smoked  pork  and  similar  methods  of 
curing  pork  products  may  render  them  safe  in  so  far 
as  trichinosis  is  concerned,  but  since  the  thoroughness 
of  the  curing  process  is  not  always  a certainty,  it  is 
safer  to  thoroughly  cook  all  pork  meat,  at  all  times, 
before  eating  it. 

At  the  meeting  of  the  State  Board  of  Public  Health 
held  in  San  Francisco,  April  12,  1930,  trichinosis  was 
made  a reportable  disease.  The  attention  of  health 
officers  is  drawn  to  this  fact.  All  practitioners  of 
medicine  should  be  advised  of  this  fact,  in  order  that 
cases  of  trichinosis,  or  cases  which  may  be  suspected 
as  cases  of  trichinosis,  may  be  reported  properly. 


Many  Deaths  from  Heart  Disease. — Diseases  of  the 
heart  and  circulatory  system  caused  23.9  per  cent  of 
all  deaths  in  California  last  year.  In  1920,  diseases  of 
the  heart  and  circulatory  system  caused  17  per  cent 
of  all  deaths  in  California.  There  were  8013  deaths 
from  this  cause  out  of  a total  of  47,124  deaths  from 
all  causes  in  the  year  1920.  In  1929,  there  were  15,620 
deaths  from  heart  disease  out  of  a total  of  65,363 
deaths  from  all  causes.  The  increase  in  the  numbers 
and  percentages  of  deaths  from  heart  disease  in 
California  during  the  past  ten  years  has  been  gradual, 
but  persistent.  The  increase,  however,  casts  no  reflec- 
tion upon  the  health  resources  of  California,  particu- 
larly when  it  is  noted  that  more  than  60  per  cent  of 
all  deaths  from  heart  disease  in  this  state  last  year 
were  in  persons  more  than  65  years  of  age,  and  almost 
20  per  cent  of  such  deaths  were  in  persons  who  were 
between  55  and  64  years  of  age.  Men  must,  of  neces- 
sity, die  of  some  condition. 


464 


CALIFORNIA  AND  WESTERN  MEDICINE 


Vol.  XXXII,  No.  6 


CALIFORNIA  BOARD  OF 
MEDICAL  EXAMINERS 


By  C.  B.  Pinkham,  M.  D. 

Secretary  of  the  Board 

News  Items,  June  1930 

A corporation  cannot  practice  medicine,  Superior 
Judge  Samuel  Blake  ruled  yesterday  in  a precedent 
decision  of  widespread  importance.  The  decision  was 
in  the  case  of  People  vs.  Medical  Service  Corpora- 
tion, in  which  Attorney-General  Webb  brought  quo 
warranto  proceedings  to  cancel  the  franchise  of  the 
concern  on  the  ground  it  was  engaging  in  business  in 
which  the  law  forbids  a corporation  to  participate.  . . . 
Judge  Blake  said  in  part:  “A  corporation  cannot,  of 
course,  as  a corporation,  pass  the  medical  board  ex- 
amination and  can  only  act  through  its  agents.  The 
right  to  practice  medicine  attaches  to  the  individual 
and  dies  with  him,  and  it  cannot  be  made  the  subject 
of  business  sheltered  under  the  cloak  of  corporations 
having  marketable  shares  descendable  under  the  rules 
of  inheritance.  All  the  directors  of  this  corporation 
or  stockholders  may  be  licensed  practitioners,  but  at 
any  time  these  directors  or  officers,  by  death  or  other- 
wise, may  transfer  their  shares  and  it  might  be  suc- 
ceeded by  laymen,  none  of  whom  possess  the  right 
to  practice  medicine.”  . . . “Unprofessional  conduct 
on  behalf  of  the  corporation  could  not  be  reached, 
such  as  aiding  or  betraying  a professional  secret, 
advertising  or  offenses  involving  moral  turpitude,  and 
many  others  too  numerous  to  mention.  ...”  Judge 
Blake  pointed  out  in  his  memorandum  that  his  de- 
cision does  not  affect  hospitals  and  charitable  institu- 
tions now  in  existence  which  are  corporations  (Los 
Angeles  News,  May  1,  1930). 


According  to  reports,  the  National  Health  Founda- 
tion, Ltd.,  alleged  to  be  incorporated  in  Nevada,  has 
established  headquarters  in  the  Beaux  Arts  Building, 
Los  Angeles,  offering  a comprehensive  medical  ser- 
vice to  members  at  a cost  of  $2  per  month  each,  which 
includes  physical  examination,  doctor’s  prescriptions, 
hospitalization,  accidents,  ambulance,  x-ray,  eye,  ear, 
nose  and  throat,  physiotherapy,  clinico-biological  lab- 
oratory tests,  etc. 

“Dr.”  Arthur  Benson,  the  asserted  head  of  the 
Thayer  Health  Foundation,  was  sought  for  again  to- 
day as  the  city  prosecutor’s  office  continued  a probe 
of  charges  that  operations  of  the  institution  have  con- 
stituted a huge  medical  fraud.  The  charges  were 
made  at  an  indignation  meeting  in  the  office  of  Prose- 
cutor Lloyd  Nix  when  two  hundred  former  patients 
of  the  Foundation  gathered  to  tell  of  paying  $100  to 
$1000  for  a course  of  treatments  for  various  diseases, 
some  of  which  were  actual  and  others  apparently  in- 
vented by  the  Foundation’s  attaches  . . . (Los  Angeles 
Express,  April  23,  1930).  The  records  of  the  Board  of 
Medical  Examiners  relate  that  Benson  pleaded  guilty 
in  the  courts  of  Los  Angeles  on  January  6,  1928,  to 
a charge  of  violation  of  the  Medical  Practice  Act 
and  paid  a fine  of  $250,  following  which  he  is  said  to 
have  employed  licensed  chiropractors,  osteopaths,  and 
medical  doctors  to  give  all  treatments,  his  place  being 
operated  since  his  arrest  under  the  name  of  the 
“Golden  Rule  Health  Institute,”  assertedly  by  Clara 
Brown,  a chiropractor.  (Previous  entry,  February, 
1928.)  

I 

Following  the  death  of  Miss  Evelyn  Winifred 
Hughes,  age  twenty-seven,  in  Yuba  City  last  Friday, 
Dr.  Fred  B.  Tapley  of  Marysville  was  placed  under 
arrest  and  he  has  been  indicted  by  the  Yuba  County 
Grand  Jury  and  charged  with  murder  in  the  second 
degree  for  performing  an  illegal  operation  on  Miss 
Hughes  which  caused  her  death.  This  is  the  second 
time  a criminal  charge  of  this  kind  has  been  made 
against  Doctor  Tapley.  He  was  tried  by  a jury  in 
the  Superior  Court  of  Yuba  County  in  February  of 


last  year  on  the  charge  of  murder  and  performing  an 
illegal  operation  on  Mrs.  Eva  Griffith  of  Encinal, 
Sutter  County,  who  had  died  May  21,  1928.  The  trial 
ended  with  the  jury  acquitting  Doctor  Tapley  of  both 
charges  after  it  had  deliberated  for  only  ten  minutes. 
At  that  time  the  State  Board  of  Medical  Examiners 
revoked  his  license  to  practice  medicine  or  surgery. 
He  brought  an  action  in  the  Superior  Court  of  San 
Francisco,  but  that  court  upheld  the  decision  of  the 
board  and  he  then  appealed  to  the  Appellate  Court, 
and  his  appeal  is  pending  at  present.  In  the  mean- 
time he  wTas  allowed  to  continue  his  practice  (Yuba 
City  Farmer,  April  18,  1930). 


A scar  on  her  arm  damaged  her  to  the  extent  of 
$25,000,  according  to  a suit  filed  in  Superior  Court 
here  yesterday  by  Miss  Hazel  Quinn,  1049  Santa  Bar- 
bara Court,  a radio  artist.  The  suit  names  as  defend- 
ants, Miss  Minnie  Belle  Barnett  and  the  Tricho  Insti- 
tute, a beauty  parlor  . . . (Sacramento  Union,  May  1, 
1930).  The  records  of  the  Board  of  Medical  Ex- 
aminers show  a large  number  of  reported  permanent 
disfigurements  following  treatment  by  Tricho  and 
other  x-ray  machines  in  attempted  removal  of  super- 
fluous hair.  It  is  reported  that  three  suits  for  dam- 
ages are  now  pending  in  the  courts  of  San  Francisco. 


According  to  report  of  our  Investigation  Depart- 
ment, Magnetic  Darius  of  Boston,  Massachusetts, 
who  recently  burst  into  print  by  advertising  a course 
of  lectures  in  San  Francisco,  is  alleged  to  have  been 
formerly  known  as  Terrence  Hogan,  assertedly  a 
“soap-box  lecturer”  on  Mission  Street.  The  advertis- 
ing relates  that  “Darius  is  destined  to  startle  and  in- 
tellectually delight  the  nation,  a throwback  to  the 
ancient,  classic  Greeks.  In  physical  mold — Godlike. 
A new  voice  in  the  wilderness.” 


Dun  Chun,  alias  Kung  Tao,  Chinese  herbalist,  1053 
Stockton  Street,  San  Francisco,  at  the  time  of  his 
arrest  on  a charge  of  violation  of  the  Medical  Prac- 
tice Act,  produced  the  first  Anglo-Oriental  medical 
Correspondence  School  diploma  that  we  have  seen. 
This  interesting  document,  partially  in  Chinese  and 
partially  in  English,  is  dated  Shanghai,  December 
1925,  and  signed  Dr.  Wainyard,  M.  D.,  purporting  to 
have  been  issued  by  the  Shanghai  Oriental  Medical 
Correspondence  School,  whatever  that  may  be. 


Dr.  Raymond  C.  Howe,  2576  Florence  Avenue, 
Huntington  Park,  yesterday  was  ordered  held  for  trial 
in  Superior  Court,  charged  with  performing  an  illegal 
operation  . . . (Los  Angeles  Illustrated  Daily  News, 
April  17,  1930).  The  records  show  Raymond  C.  Howe 
is  a licensed  chiropractor. 


According  to  reports,  Maurice  LeBelle  was  on 
April  15  sentenced  in  Los  Angeles  to  pay  a fine  of 
$100  on  a charge  of  violation  of  the  Medical  Practice 
Act.  Fifty  dollars  of  said  fine  was  suspended  for  six 
months  and  $50  paid,  although  Section  24  of  the 
Medical  Practice  Act  provides  that  the  minimum  fine 
shall  be  $100.  

Arthur  G.  Loye  was  reported  to  have  pleaded  guilty 
in  Los  Angeles  on  April  14  to  a charge  of  violation 
of  the  Medical  Practice  Act  and  was  sentenced  to 
pay  a fine  of  $500  or  serve  fifty  days  in  jail,  sentence 
being  suspended  on  condition  that  he  change  his 
advertising  as  soon  as  possible. 


Charged  with  violation  of  the  Harrison  Act,  Dr. 
S.  M.  Mann,  740  National  Avenue,  National  City,  was 
bound  over  for  trial  in  Federal  Court  after  a hearing 
yesterday  before  United  States  Commissioner  Henry 
Ryan.  . . . The  charge  against  Doctor  Mann  alleged 
the  unlawful  issuing  of  narcotic  prescriptions  in  viola- 
tion of  the  federal  law,  according  to  arresting  officers 
(San  Diego  Union,  April  30,  1930). 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


33 


The  American  Surgical  Sales  Co.,  Ltd. 

Better  Service 

SAN  FRANCISCO  OAKLAND  SAN  JOSE  FRESNO  SEATTLE  PORTLAND 


No.  0561  Tassco  Economy  Six-Piece  Set 

Only  $165.00 — Terms 

Or  Liberal  Cash  Discount 


The  American  Surgical  Sales  Co.,  Ltd.,  owns  and  operates 
the  following  stores: 

THE  TRAVERS  SURGICAL  COMPANY,  Inc. 

429  Sutter  Street,  San  Francisco 

THE  BISCHOFF  SURGICAL  HOUSE 

427  20th  Street,  Oakland,  Calif.  Medico-Dental  Bldg.,  San  Jose,  Calif. 

THE  AMERICAN  SURGICAL  SALES  CO. 

Elks  Bldg.,  Fresno 

REID  BROS.,  Inc. 

91  Drumm  Street,  San  Francisco,  Calif. 

1417  4th  Avenue,  Seattle,  Wash.  416  Taylor  Street,  Portland,  Oregon 

The  Largest  Physicians,  Hospital  and  Sick  Room  Supplies  Company  in  the  West 
We  Manufacture  and  Fit  Trusses,  Supporters,  Elastic  Stockings,  Corsets,  etc. 

RICHARD  H.  TRAVERS  FRED  J.  BISCHOFF 

President  Secretary  and  General  Manager 


34 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


This  retractor  is  provided  with  a quick -lock 
screw  adjustment.  This  device  holds  the  re- 
tractor open  at  any  point,  and  maintains  an 
even  pressure  at  the  blades.  50 

Price  ■ .........  ■ 


Jo  Help  - 

Sharp  Si  Smith  have  as  their  abiding 
purpose — "Service”  to  the  thousands  of 
patrons  whose  confidence  has  made  SandS 
the  leading  source  of  Hospital  Supplies 
and  Surgical  Instruments. 

You  will  continue  to  read,  therefore, 
(as  you  have  in  the  past)  Sharp  & Smith 
announcements  of  new  instruments  and 
supplies — introduced  to  help  make  your 
work  easier,  to  help  you  maintain  the  high 
calibre  of  service  that  engenders  respect 
for  your  profession. 


General  Surgical  and  Hospital  Supplies 
65  East  Lake  Street  Chicago,  Illinois 

Western  Branch:  1203  W.  Sixth  Street 
Los  Angeles,  Calif. 


PHYSIOTHERAPY  AND  X-RAY  COURSES— CHILDREN’S  HOSPITAL 

4616  Sunset  Blvd.,  Los  Angeles,  California 

Physiotherapy  Courses  Given  by  the  Doctors  on  the  Hospital  Stall  and  the  Director  of  Physiotherapy. 

X-Ray  Course  Given  by  the  Supervisor  of  X-Ray  Department  and  Under  the  Supervision  of  the  Director  of  X-Ray. 

COURSE  No.  1:  For  Graduate  Nurses  and  Physical  Education  Students.  Sept.  12,  1930— Sept.  12,  1931.  Fee  $85.00. 

COURSE  No.  2:  For  those  with  no  previous  training  but  holding  a High  School  diploma  or  its  equivalent.  Sept.  12,  1930  to  March  12,  1932. 
Fee  $125.00. 

COURSE  No.  3:  An  elective  Course  in  X-ray  for  students  of  Courses  1 and  2,  requiring  an  additional  three  months.  Fee  $5  0.00. 

Training  given  in  the  treatment  of  all  Orthopedic  Cases. 

Apply  to:  MISS  LILY  H.  GRAHAM 

Director,  Physiotherapy  Dept.,  Children’s  Hospital,  Los  Angeles,  California 


For  Your  Own  Surgery 

NON-TOXIC  used  in  leading  NON-CAUSTIC 


PACIFIC  COAST  HOSPITALS 

Write  for  Sample 

HEXOL,  INC.,  1040  Larkin  Street,  San  Francisco,  California 

FRANKLIN  1012 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  31) 

Van  Ard  Sanatorium. — The  Van  Ard  Sanatorium, 
Inc.,  does  a quack  rheumatism-cure  business  from  an 
old  brick  residence  on  the  south  side  of  Chicago.  It 
is  an  Illinois  corporation  with  an  authorized  capital 
of  $10,000.  Its  officers  are  listed  as  J.  B.  Creevy, 
president;  H.  L.  Cassel,  secretary.  They  are  the  same 
individuals  who  are,  or  were,  connected  with  the 
“Cass  Treatment  for  Rheumatism.”  The  impression 
is  given  in  the  Van  Ard  advertising  that  Charles  J. 
Cahill,  who  is  connected  with  the  business  of  the 


firm,  has  special  knowledge  of  the  treatment  of  rheu- 
matism. Needless  to  say,  Cahill’s  name  is  unknown 
to  scientific  medicine.  Just  as  in  the  Cass  Labora- 
tories’ fake  the  letters  were  signed  “Harvey  L.  Cass” 
(a  person  who  didn’t  exist),  so  in  the  Van  Ard  Sana- 
torium quackery  most  of  the  letters  are  signed  ,‘J.  B. 
Crenon,  Secretary.”  And  just  as  “Harvey  L.  Cass” 
was  really  Harvey  L.  Cassel,  so,  doubtless,  “J.  B. 
Crenon”  is  Joseph  B.  Creevy!  Reports  were  received 
from  California  of  three  deaths  in  which  the  principal 
autopsy  finding  was  an  extreme  degree  of  atrophy  of 
the  liver.  The  reports  brought  out  that  two  of  the 
women  had  been  taking  the  Van  Ard  “treatment,” 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


35 


Dairy  Delivery  Company 

Successors  in  San  Francisco  to 

Millbrae  Dairy 

The  Milk  With  More  Cream 


We  deliver  daily  from 
San  Francisco 
to 

Menlo  Park 

PHONE  VALENCIA  TEN  THOUSAND 
and  BURLINGAME  3076 


while  the  third  had  been  taking  the  Cass  “treatment.” 
From  the  results  of  chemical  analyses  carried  out  in 
the  American  Medical  Association  Chemical  Labora- 
tory it  may  be  stated  that  the  Van  Ard  treatment 
consists  essentially  of  acetylsalicylic  acid  (aspirin), 
cinchophen,  sodium  bicarbonate  (baking  soda),  and  a 
laxative.  It  is  obvious  that  the  Van  Ard  and  Cass 
“treatments”  are  for  all  practical  purposes  identical. 
In  the  Cass  treatment  it  was  Epsom  salt,  flavored, 
while  in  the  Van  Ard  treatment  it  seems  to  be  phenol- 
phthalein  and  aloes. — Jour,  A.  M.  A.,  April  19,  1930, 
p.  1255. 

“S.  C.  A.”  Soluble  Antigen,  “S.  C.  A.”  Serum 
Equine  (Concentrated),  and  “S.  C.  A.”  Serum  Bovine 

(Unconcentrated).— The  Council  on  Pharmacy  and 
Chemistry  issues  a preliminary  report  reviewing  the 
available  evidence  published  by  J.  C.  Small  concern- 
ing preparations  stated  to  represent  products  obtained 
from  the  bacterium  claimed  to  be  the  cause  of  rheu- 
matic fever.  Preparations  of  this  organism  were  pre- 
sented to  the  Council  by  theH.  K.  Mulford  Company 
as  S.  C.  A.  Soluble  Antigen,  S.  C.  A.  Serum  Equine 
(Concentrated)  and  S.  C.  A.  Serum  Bovine  (Uncon- 
centrated). The  Council  decided  that  the  published 
work  of  Small  does  not  offer  sufficient  evidence  to 
warrant  the  acceptance  of  the  Mulford  products.  Fur- 
ther doubt  has  been  cast  on  the  value  of  this  therapy 
by  the  paper  of  Dr.  May  G.  Wilson,  in  which  it  is 
reported  that  the  administration  of  Streptococcus  cardio- 
arthritidis  antiserum  and  of  the  soluble  antigen  of 
Streptococcus  cardioarthritidis  did  not  seem  to  influence 
the  usual  clinical  course  of  the  disease  or  prevent  the 
occurrence  of  relapses.  The  Council  holds  that,  while 
the  products  are  suitable  for  controlled  clinical  in- 
vestigation by  experimental  workers,  propaganda 
which  invites  their  general  use  is  not  warranted  at 
this  time. — Jour.  A.  M.  A.,  April  26,  1930,  p.  1303. 

Undulant  Fever  Bacterial  Vaccine. — The  Council 
on  Pharmacy  and  Chemistry  reports  that  the  Jensen- 
(Continued  on  Next  Page) 


Suggest  this 
Pure  Fruit  Juice , 
so  rich  in 
Food  Values 

Young  and  old  relish  the  delicious  mel- 
low taste  of  ’49  Brand  California  Grape 
Juice.  For  general  diet  and  hospital  use  ’49 
Grape  Juice  is  unsurpassed  because  of  its 
high  percentage  of  natural  invert  sugar, 
valuable  mineral  salts,  and  stimulating  laxa- 
tive properties. 

An  exclusively  controlled  process  is  respon- 
sible for  the  fresh,  lasting  purity  of  ’49  Brand. 

All  the  natural  goodness  of  selected,  mature 
grapes  is  brought  to  you  in  ’49.  Nothing — 
not  even  sugar — is  added  to  the  pure  juice. 


Physicians,  dietitians 
or  hospitals  interested 
in  learning  more  about 
’49  Brand  California 
Grape  Juice,  either 
Red  or  White,  may 
write  to 


VITA-FRUIT  PRODUCTS  INC. 

RUSS  BLDG.,  SAN  FRANCISCO 

GRAPE  JUICE  PLANT  AT  LODI 

PARROTT  & CO. 

SALES  REPRESENTATIVES 

SAN  FRANCISCO  LOS  ANGELES  PORTLAND 

SEATTLE  TACOMA  SPOKANE 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3 '6 


Rainier  Pure  Grain  Alcohol 

USP 

The  only  pure  alcohol  manufactured  on  the 
Pacific  Coast  from  GRAIN  ONLY 


RAINIER  PURE  GRAIN  ALCOHOL  IS  DOUBLE  DISTILLED  AND  IS 

ABSOLUTELY  ODORLESS 

RAINIER  BREWING  COMPANY 

1500  BRYANT  STREET 

Telephone  MArket  0530  San  Francisco,  Calif. 


Mercurochrome  - 220  Soluble 

( Dibrom-oxymercuri-  fluorescein.) 


The  Stain  Provides  for  Penetration 

and 

Fixes  the  Germicide  in  the  Tissues 


Mercurochrome  is  bacteriostatic  in  ex- 
ceedingly high  dilutions  and  as  long  as 
the  stain  is  visible  bacteriostasis  is  pres- 
ent. Reinfection  or  contamination  are 
prevented  and  natural  body  defenses 
are  permitted  to  hasten  prompt  and 
clean  healing,  as  Mercurochrome  does 
not  interfere  with  immunological  proc- 
esses. This  germicide  is  non-irritating 
and  non-in jurious  when  applied 
to  wounds. 

HYNSON,  WESTCOTT  & DUNNING,  INC. 

Baltimore,  Maryland 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 

Salsbery  Laboratories,  Inc.,  have  presented  Undulant 
Fever  Bacterial  Vaccine  (Jensen-Salsbery)  for  con- 
sideration by  the  Council.  This  product  is  stated  to 
be  a physiologic  saline  suspension  of  Brucella  meli- 
tensis  (var.  abortus  75  per  cent,  and  suis  25  per  cent). 
From  an  examination  of  the  published  reports  the 
Council’s  referee  came  to  the  conclusion  that  this 
material  does  not  offer  adequate  evidence  for  the  use- 
fulness of  the  product  and  that  this  form  of  treatment 
should  be  subjected  to  further  controlled  clinical  trial. 
The  Council  voted  to  publish  its  preliminary  report 
and  to  postpone  definite  action  on  the  question  of 
accepting  Undulant  Fever  Bacterial  Vaccine  (Jensen- 
Salsbery)  while  awaiting  the  development  of  further 
evidence  of  its  therapeutic  value. — Jour.  A.  M.  A., 
April  26,  1930,  p.  1304. 

Incorrect  Labeling  of  Upsher  Smith  Digitalis  Prepa- 
rations.— Tablets  Folia-Digitalis  (Upsher  Smith)  one 
grain,  Tincture  Digitalis  (Upsher  Smith)  and  Cap- 
sules Folia-Digitalis  (Upsher  Smith)  one  grain,  were 
exempted  by  the  Council  on  Pharmacy  and  Chemis- 
try as  having  the  status  of  official  substances.  The 
Council  reports  that  a committee  for  the  study  of  the 
actions  of  digitalis  in  patients  suffering  with  pneu- 
monia used  tablets  of  digitalis  (Upsher  Smith)  and 
tablets  of  digitalis  of  another  firm,  and  directed  that 
patients  receive  these  in  uniform  doses  calculated  to 
induce  a moderate  degree  of  digitalization,  assuming 
that  both  specimens  of  tablets  were  correctly  labeled; 
that  after  a total  of  258  patients  had  been  treated  it 
was  discovered  that  the  tablets  of  digitalis  (Upsher 
Smith)  induced  both  severe  and  minor  toxic  symp- 
toms far  more  frequently  than  those  of  the  other 
firm,  and  that  an  examination  of  the  records  brought 
out  that  minor  toxic  symptoms  were  more  than  ten 
times  as  great  in  those  who  received  the  Upsher 
Smith  tablets  as  in  those  who  received  the  other 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


37 


For  use  in  the  Prevention  and  Treatment 
of  the  Acid-Ash  Type  of 

ACIDOSIS 

California  Lima  Bean  FLOUR! 

Alkalinity,  of  course,  neutralizes  acidity.  And 
Limas  are  one  of  the  most  alkaline  foods 
known — 41.65  per  100  grams! 

To  meet  a definite  demand  from  the  medical 
profession,  we  have  developed,  to  a high  degree 
of  fineness,  a Lima  Bean  FLOUR — for  making 
non-acid  breads,  muffins,  pancakes  and  waffles 
for  Basic  Diet  menus! 

Lima  FLOUR  is  available  in  10-lb.  bags  at 
$1.20,  and  in  100-lb.  bags  at  $10.00.  Upon 
receipt  of  price  and  delivery  instructions  your 
order  will  be  shipped  parcel  post  or  express  col- 
lect. Send  orders,  and  make  check  or  money 
order  payable  to — 

CALIFORNIA  LIMA  BEAN 
GROWERS  ASSOCIATION 

Oxnard,  California 


firm’s  tablets  and  that  the  mortality  was  49  per  cent 
of  all  cases  of  pneumonia  treated  with  the  first,  as 
compared  with  38  per  cent  in  all  those  treated  with 
the  other  tablets.  The  Council  further  reports  that 
both  brands  of  tablets  were  then  assayed;  that  the 
tablets  of  the  other  firm  were  found  to  be  of  activity 
stated  on  the  label,  and  those  of  Upsher  Smith  to  be 
twice  the  activity  stated.  Upsher  Smith  has  assured 
the  Council  that  any  of  his  misbranded  preparations 
on  the  market  will  be  called  in,  and  that  in  the  future 
the  greatest  care  will  be  taken  to  insure  that  the 
potency  of  these  will  be  stated  correctly. — Jour. 
A.  M.  A.,  April  26,  1930,  p.  1305. 

Therapeutic  Claims  for  Theobromin  and  Theophyl- 
lin  Preparations. — The  Council  on  Pharmacy  and 
Chemistry  reports  that,  questions  having  arisen  in 
regard  to  the  advertising  claims  that  might  be  per- 
mitted for  the  xanthin  derivative  preparations  ac- 
cepted for  New  and  Nonofficial  Remedies,  the  Coun- 
cil’s referee  for  these  products  presented  a review  of 
the  important  literature,  with  special  reference  to  the 
value  of  xanthin  derivatives  in  vascular  hypertension 
and  arteriosclerotic  conditions.  In  the  light  of  this 
review,  the  Council  decided  that  the  following  claims 
could  be  permitted  for  both  theobromin  and  theophyl- 
lin:  ( a ) diuretic  action;  ( b ) myocardial  stimulation; 
(c)  occasionally  (and  more  often  with  theophyllin) 
relief  of  pain  in  angina  and  similar  lancinating  pains. 
It  does  not  seem  permissible  to  claim  lowering  of 
hypertension. — Jour.  A.  M.  A.,  April  26,  1930,  p.  1306. 

The  Cutaneous  Absorption  of  Mercury. — It  requires 
little  imagination  to  appreciate  the  uncertainties  that 
must  attend  the  problem  of  dosage  when  such  a rela- 
tively insoluble  substance  as  mercury  is  applied  to  the 
skin.  The  size  of  the  particles,  the  nature  of  the 
adjuvant,  the  place  of  application  and  its  conditions, 
and  the  vigor  with  whicfi  inunction  is  practiced  are 
some  of  the  complicating  features.  The  assumption 
that  only  the  mercury  globules  rubbed  into  the  folli- 
(Continued  on  Next  Page) 


Tycos  Pocket  Type 
Sphygmomanometer 

TWENTY-TWO  years  ago  the  first  Tycos 
Sphygmomanometer  was  placed  on  the 
market.  Although  modifications  have  been  made 
whenever  desirable,  fundamentally  the  instru- 
ment remains  the  same  today. 

Every  Tycos  Sphygmomanometer  has  adhered 
to  an  indisputable  principle  — that  only  a dia- 
phragm-type instrument  is  competent  for  the 
determination  of  blood  pressure.  To  faithfully 
record  the  correct  systolic  pressure,  an  indi- 
cator’s accuracy  must  not  be  affected  by  the 
speed  at  which  the  armlet  pressure  is  released, 
only  a diaphragm  instrument  can  guarantee  this. 
To  honestly  give  the  true  diastolic  pressure,  a 
sphygmomanometer  must  respond  precisely  to 
the  actual  movements  of  the  arterial  wall,  again, 
only  a diaphragm  instrument  can  do  this. 

Portable,  the  entire  apparatus  in  its  handsome 
leather  case  is  carried  in  coat  pocket.  Durable, 
its  reliability  in  constant  use  has  been  proved 
by  many  thousands  of  instruments,  during,  the 
past  twenty-two  years.  Accurate,  its  precision 
is  assured  by  relation  of  the  hand  to  the  oval 
zero. 

Further  information  relative  to  the  Tycos 
Pocket  Type  Sphygmomanometer  will  be  fur- 
nished upon  request. 

Write  for  new  1930  edition  of  Tycos  Bulletin  #6 
“Blood  Pressure-Selected  Abstracts.”  A great 
aid  to  the  doctor  who  wishes  to  keep  abreast 
of  blood  pressure  diagnosis  and  technique. 

Taylor  Instrument  Companies 

ROCHESTER,  N.  Y.,  U.  S.  A. 

CANADIAN  PLANT  MANUFACTURING  DISTRIBUTORS 
TYCOS  BUILDING  I N G REAT  BRITAIN 

TORONTO  SHORT  & MASON,  LTD.,  LONDON-E  17 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


3* 


Analyzed  and  Certified  Products 

NITROUS  OXIDE 
MEDICAL  OXYGEN 
CARBON  DIOXIDE,  ETHYLENE 
INTRAVENOUS  AND 
INTRAMUSCULAR  MEDICATIONS 
PHARMACEUTICALS 

We  maintain  fully  equipped  commercial  and  research  laboratories  with  facilities  for  all 
classes  of  analytical  determinations.  These  additions  to  our  plants  have  made  it  possible 
to  conduct  routine  quantitative  tests  on  all  of  our  products,  thus  insuring  you  against 
fatalities  due  to  haphazard  production. 

In  addition  to  medical  gases  we  also  manufacture  a full  line  of  intravenous  and  intra- 
muscular medications  and  are  prepared  to  make  up  special  formulas. 

We  solicit  your  cooperation  in  the  ethical  advancement  of  intravenous  medications 
as  well  as  anesthesia. 

CERTIFIED  LABORATORY  PRODUCTS 

1503  Gardena  Avenue,  Glendale,  California 
1379  Folsom  Street,  San  Francisco,  California 

Staff  Memberships  Include 

American  Chemical  Society,  American  Medical  Association,  American  Hospital  Association,  American 
Association  of  Engineers,  National  Anesthesia  Research  Association. 


LtferiFiCD 


Four  Fifty 
I Sutter 


San  Francisco’s  largest 
medical-dental  build- 
ing designed  and  built 
exclusively  for  physi- 
cians, dentists  and  af- 
filiated activities. 

The  8-floor  garage  for 
tenants  and  the  public 
is  the  West’s  largest — 
holding  1000  cars. 


Four-Fifty  Sutter  St.  San  Francisco 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 
cles  are  gradually  absorbed  had  led  to  the  clean  inunc- 
tion method  proposed  by  Cole  and  his  collaborators. 
Some  indication  of  the  efficacy  of  inunction  pro- 
cedures can  be  secured  by  estimation  of  the  substance 
that  is  eliminated.  This  has  been  done,  and  it  was 
found  that  the  amount  of  mercury  which  is  absorbed 
had  excreted  after  inunction  is  dependent  directly  on 
the  concentration  of  the  metal  in  the  base — that  is, 
5,  25,  and  50  per  cent  preparations  show  that  the 
excretion  is  about  in  proportion  to  the  concentration 
in  the  ointment  used.  Again,  contrary  to  what  many 
have  assumed,  colloidal  mercury  ointments  showed 
no  greater  excretion  of  mercury  than  official  old- 
fashioned  mercury  ointments  of  equal  concentration 
in  benzoinated  lard.  Furthermore,  massive  or  inten- 
sive weekly  inunctions  of  a 30  per  cent  mercurial 
ointment  may  lead  to  an  equal  or  higher  mercury 
excretion  than  the  simple  daily  use  of  50  per  cent 
ointment  or  even  certain  types  of  intramuscular  injec- 
tion.— Jour.  A.  M.  A.,  April  26,  1930,  p.  1322. 

John  R.  Brinkley,  Quack. — John  R.  Brinkley  of 
Milford,  Kansas,  has  for  years  been  quacking  it  but, 
having  his  own  so-called  hospital,  it  has  been  possible 
for  him  to  keep  his  own  records,  so  that  only  by 
accident  do  the  results  of  his  work  become  public. 
The  newspaper  publicity  that  has  recently  been  given 
to  Brinkley  is  beginning  to  bring  to  light  some  of  the 
crudities  of  his  work.  Brinkley’s  “specialty”  is  the 
alleged  sexual  rejuvenation  of  the  male  by  the  (also 
alleged)  implantation  of  goats’  testicles  into  the 
human  scrotum.  Naturally,  the  deluded  individuals 
who  go  in  for  this  particular  line  of  medical  humbug 
are  not  going  to  complain  after  they  have  found  that 
they  have  been  swindled.  If  Brinkley  had  been 
shrewder,  he  would  have  confined  his  quackery  to 
this  particular  field.  More  recently,  however,  he  has 
been  going  into  the  treatment  (still,  alleged)  of  pros- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


J<) 


CHARLES  B.  TOWNS 
HOSPITAL 

293  Central  Park  West 
NEW  YORK,  NEW  YORK 

FOR 

Alcoholism  and  Drug  Addiction 

Provides  a definite  eliminative  treatment  which 
obliterates  craving  for  alcohol  and  drugs,  in- 
cluding the  various  groups  of  hypnotics  and 
sedatives. 

Complete  department  of  physical  therapy.  Well 
equipped  gymnasium.  Located  directly  across 
from  Central  Park  in  one  of  New  York’s  best 
residential  sections. 

Any  physician  haring  an  addict  problem  is 
invited  to  write  for  "Hospital  Treatment  for 
Alcohol  and  Drug  Addiction ." 


SURGICAL  SUPPLY  CENTER 
First  Floor,  Medical  Building 
Opposite  St.  Francis  Hospital 
BUSH  AND  HYDE  STREETS 

Telephone  GRaystone  9210 

Main  Store  and  Fitting  Rooms 
2004-06  SUTTER  STREET  WEST  6322 

Corsets  . . Surgical  Appliances  . . Storm  Binders 
Orthopedic  Appliances  . . Elastic  Hosiery  . . Trusses 
California  Manufacturing  Agents  for 

The  "Storm  Binder”  and  Abdominal  Supporter 

(Patented ) 


FRANK  F.  WEDEKIND  CO. 


state  trouble  and,  naturally,  men  do  not  have  the  same 
hesitancy  about  discussing  operations  for  the  relief 
of  pathologic  conditions  of  the  prostate  that  they  do 
in  talking  about  sexual  rejuvenation.  The  Kansas 
City  Star,  which  has  been  giving  its  readers  a great 
deal  of  information  about  Brinkley’s  methods,  has 
now  published  some  interesting  material  from  Brink- 
ley  victims  who  throw  light  on  the  way  in  which  he 
uses  his  radio  station  to  get  in  touch  with  persons 
and  how  he  treats  them  at  his  hospital. — Jour.  A.  M.  A,. 
April  26,  1930,  p.  1339. 

The  Baker  Ballyhoo. — Norman  Baker,  the  high- 
pressure  gentleman  at  Muscatine,  Iowa,  who  has  re- 
cently invaded  the  medical  field  with  two  quack 
cancer  cures — those  of  Ozias  and  Hoxsey — continues 
to  get  publicity.  This  in  addition  to  the  very  good 
job  that  he  does  over  his  own  radio  station,  KTNT. 
Recently  newspaper  accounts  have  appeared  stating 
that  Baker  had  claimed  that  an  attempt  had  been 
made  on  his  life  and  that  an  attempt  has  been  made 
to  blow  up  his  radio  station.  These  reports  were  not 
confirmed.  The  only  other  newspaper  items  that  have 
been  noted  regarding  Baker  are  the  reports  of  cancer 
victims  who  have  died  following  the  Baker  Institute 
“treatments.” — Jour.  A.  M.  A.,  April  26,  1930,  p.  1340. 

Tobacco  Advertising  Gone  Mad. — The  modern  tend- 
ency for  advertisers  of  all  kinds  of  merchandise  to 
drag  the  health  angle  into  their  advertisements  is  one 
of  the  most  disturbing  features  in  the  modern  adver- 
tising field.  The  medal  for  the  most  horrible  example 
would  seem  to  go  to  the  American  Tobacco  Company 
in  the  exploitation  of  Lucky  Strike  cigarets  and 
Cremo  cigars.  The  exploiters  of  Lucky  Strike  cigarets 
have  claimed  that  eighteen  thousand  physicians  have 
testified  that  “the  heat  treatment,  or  toasting  process, 
applied  to  tobacco  previously  aged  and  cured”  is  likely 
to  free  the  cigaret  “from  irritation  to  the  throat.” 
There  was  also  started  a campaign,  “Reach  for  a 
(Continued  on  Next  Page) 


New  York  Post-Graduate  Medical  School  and  Hospital 

offers  courses  of  interest 

to  the  medical  practitioner  and  the  medical  specialist 

INTERNAL  MEDICINE — Courses  of  one  to  three  months’ 
duration,  continuous  throughout  the  year. 

CARDIOLOGY,  GASTROENTEROLOGY,  ALLERGY 
(ASTHMA,  HAY  FEVER,  etc.) — Intensive  courses  of 
one  month’s  duration  by  arrangement. 

PEDIATRICS Courses  of  one  to  six  months’  duration, 

continuous  throughout  the  year. 

DERMATOLOGY — Courses  of  six  weeks  to  six  months, 
continuous  throughout  the  year. 

ROENTGENOLOGY — Courses  of  six  weeks  to  three 
months,  by  arrangement. 

LABORATORY — Courses  in  Bacteriology,  Bio-chemistry, 
and  Pathology — one  to  six  months. 

NEUROPSYCHIATRY — Courses  of  one  to  three  months, 
by  arrangement. 

Physicians  from  approved  medical  schools  are  admitted  to 
these  courses. 

For  descriptive  booklet  and  further  information , address 

THE  DEAN  313  East  Twentieth  Street  New  York  City 

Actinotherapy  and 
Allied  Physical 
Therapy 

T.  HOWARD  PLANK,  M.  D. 

Price  $5.00 

BROWN  PRESS 

Room  212,  490  Post  Street,  San  Francisco,  Calif. 


40 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


FINANCING  THE  DOCTOR’S  PATIENTS 

A Definite  Payment  Plan 

CASH  for  the  Doctor  CREDIT  for  the  Patient 

HUNDREDS  OF  SATISFIED  DOCTORS 
THOUSANDS  OF  SATISFIED  PATIENTS 

We  Collect  Annually  Over  $200,000 

No  Investment  No  Entrance  Fee 

Medico-Dental  Finance  Corporation 

Suite  410 — 450  Sutter  Street  San  Francisco,  Calif. 

Medico-Dental  Finance  Corporation  of  Oakland 


909  Financial  Center  Building  Oakland,  Calif. 


Post  Graduate  School  of  Surgical  Technique 

INC. 

2512  Prairie  Avenue  (opposite  Mercy  Hospital) 

CHICAGO,  ILLINOIS 

A School  of  Surgical  Technique  Conducted  by  Experienced  Practicing  Surgeons 

1.  General  Surgery:  100  hours  (2  weeks)  course  of  intensive  instruction  and  practice  in  surgical  technique  combined  with 
clinical  demonstrations  (for  practicing  surgeons). 

2.  General  Surgery  and  Specialties:  Three  months*  course  comprising:  (a)  review  in  anatomy  and  pathology;  (b)  demon- 

stration and  practice  in  surgical  technique;  (c)  clinical  instruction  by  faculty  members  in  various  hospitals,  stressing 
diagnosis,  operative  technique  and  surgical  pathology. 

3.  Special  Courses:  Orthopedic  and  traumatic  surgery;  gynecology  and  radiation  therapy;  eye,  ear,  nose  and  throat,  thoracic, 
genito-urinary  and  goiter  surgery;  bronchoscopy,  etc. 

All  courses  continuous  throughout  the  year.  Detailed  information  furnished  on  request 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Preceding  Page) 

Lucky  instead  of  a Sweet,”  in  which — either  directly 
or  by  implication — young  women  were  urged  to 
smoke  Lucky  Strike  cigarets  when  they  had  a desire 
to  eat  candy  or  pastry.  Another  branch  of  the  Ameri- 
can Tobacco  Company’s  business  has  been  carrying 
on  an  advertising  campaign  for  “Cremo”  cigars  in 
which  the  public  is  led  to  believe  that  most  cigars  are 
hand-made  and  have  their  tips  finished  ofif  with  the 
saliva  of  the  individual  workman.  Physicians  will 
readily  admit  that  many  young  women  eat  more 
candy  than  is  good  for  them,  but  they  will  certainly 
not  agree  that  the  substitution  of  cigarets  in  such 
cases  is  in  the  interest  of  public  health.  Physicians 
may  also  admit  that,  theoretically,  it  is  possible  for 
disease  to  be  transmitted  by  means  of  cigars.  But 
when  one  considers  the  millions  of  cigars  that  are 


consumed  annually  and  that  it  is  extremely  difficult 
to  find  in  medical  literature  any  real  evidence  of  the 
transmission  of  pathologic  bacteria  by  means  of 
cigars,  the  campaign  of  the  Cremo  concern  stands 
condemned.— Jour.  A.  M.  A.,  March  15,  1930,  p.  810. 

More  Misbranded  Nostrums. — The  following  prod- 
ucts have  been  the  subject  of  prosecution  by  the  Food, 
Drug,  and  Insecticide  Administration  of  the  United 
States  Department  of  Agriculture  which  enforces  the 
Federal  Food  and  Drugs  Act:  Kroy  Wen  All  Heal- 
ing Ointment  (The  Manhattan  Drug  Company),  con- 
sisting essentially  of  carbolic  acid,  zinc  oxid,  boric 
acid,  sulphur,  and  a volatile  oil  in  a mixture  of  wax 
and  wool-fat.  Wag’s  Salve  (Wag’s  Chemical  Com- 
pany, Inc.),  a petrolatum  product  with  oil  of  winter- 
green  and  menthol.  Winter  Cerate  (The  Irvine 
Chemical  Company),  an  ointment  having  a petro- 
latum base  and  containing  the  usual  volatile  oils. 
Amex  (The  Craig-Grandell  Manufacturing  Company, 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


4i 


CALSO  WATER 

PALATABLE  ALKALINE  SPARKLING 

Not  a Laxative 

Galso  Water:  An  efficient  method  of  supplying  the  normal  ALKALINE  SALTS 

for  counteracting  ACIDOSIS. 

Calso  Water:  Made  of  distilled  water  and  the  ALKALINE  SALTS  (C.  P.) 

normally  present  in  the  healthy  body. 

Calso  Water:  Counteracts  and  prevents  ACIDOSIS,  maintains  the  ALKALINE 

RESERVE. 


THE  CALSO  COMPANY 


524  Gough  Street 
San  Francisco 


316  Commercial  Street 
Los  Angeles 


Inc.),  an  ointment  having  a petrolatum  base  and  con- 
taining oil  of  wintergreen,  oil  of  peppermint,  menthol, 
and  myrrh.  Quin-Lax  (James  Bailey  and  Son),  con- 
taining acetanilid,  cinchonin,  aloin,  and  cornstarch. 
Neuro-Nerve  Powders  (The  Neuro  Chemical  Com- 
pany) containing  aspirin,  phenacetin,  and  caffein. 
Laxative  Phospho  Quinin  (Brewer  & Company,  Inc.), 
containing  acetanilid,  cinchona  alkaloids,  phenolphtha- 
lein,  red  pepper,  gamboge,  and  some  other  materials. 
Glycero-Terpin  Compound  (Boss  and  Seiffert  Com- 
pany, Inc.),  containing  a codein  salt,  chloroform, 
terpin  hydrate,  ammonium  chlorid,  tolu,  glycerin,  and 
alcohol.  Salicon  (K.  A.  Hughes  Company),  contain- 
ing 3.8  grains  of  aspirin,  with  phenolphthalein  and 
calcium  and  magnesium  carbonates.  Capsi-Quin  (Boss 
and  Seiffert  Company,  Inc.),  containing  about  1 grain 
of  quinin  sulphate,  1%  grains  of  acetanilid,  and  a 
small  amount  of  red  pepper  in  each  tablet. — Jour. 
A.  M.  A.,  March  15,  1930,  p.  811. 

Annual  Meeting  of  the  Council  on  Pharmacy  and 
Chemistry. — The  Council  on  Pharmacy  and  Chemis- 
try held  its  annual  meeting  at  the  association  head- 
quarters March  7 and  8.  Extended  consideration  was 
given  to  the  work  of  the  newly  established  Com- 
mittee on  Foods  and  the  proposed  publication  of  the 
book  “Accepted  Foods.”  The  progress  made  appeared 
satisfactory  and  the  work  appears  to  be  appreciated 
by  the  profession,  the  public,  and  manufacturers.  The 
Council  discussed  the  status  of  the  streptococcus 
preparations  for  the  treatment  of  rheumatic  fever 
made  in  accordance  with  the  method  of  J.  C.  Small: 
it  was  the  consensus  that,  while  these  products  are 
suitable  for  controlled  investigation  by  qualified  ex- 
perimental workers,  propaganda  which  invites  their 
general  use  is  not  justified  at  this  time.  The  Council 
decided  that  the  available  evidence  does  not  demon- 
strate the  usefulness  of  puerperal  fever  streptococcus 
serum.  The  Council  decided  to  continue  the  accept- 
(Continued  on  Page  43) 


^OJF...  A World  Mart 
of  Surgical  Su  pplies 
Brought  to  You  ..  . 


...IN  LOS  ANGELES 


For  your  convenience,  Doctor,  a complete  stock 
of  surgical  equipment,  instruments  and  supplies 
from  the  dominant  foreign  and  domestic  quality 
markets  of  the  world  has  been  concentrated  in 
Los  Angeles.  Take  advantage  of  this  convenient 
source  of  supply. 


Send  for  this  FREE 
book  of 

BARGAINS 

Save  money  on  your  purchases. 
Greatly  reduced  prices  are 
quoted  in  this  book  of  Bargains 
on  hundreds  of  items.  Mail  a 
postal  for  your  copy  TODAY. 


KENISTON-ROOT  DIVISION 

A.  S.  ALOE  CO. 

932  South  Hill  Street 

LOS  ANGELES,  CAL. 


42 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


KLIM  (powdered  whole  milk)  is  of  indispensable  value  when  babies  travel.  ([  Whether 
incorporated  into  infant  feeding  formulae,  or  used  alone  as  fluid  whole  milk,  Klim 
has  proved  its  worth.  It  is  simply  pure,  fresh,  full  cream  milk  to  which  nothing  has  been 
added  and  from  which  only  the  water  has  been  removed.  ([  All  the  vitamins  of  fluid  milk 
are  retained  in  Klim.  The  bacterial  count  is  below  3000  per  c.c.  There  are  no  pathogens. 
Klim  is  wholly  soluble.  Its  curd  is  as  fine  as  that  of  boiled  milk  yet  it  is  not  boiled 
milk.  Its  butter  fat  is  completely  homogenized  and  does  not  rise.  It  is  frequently  tol- 
erated when  an  allergy  to  fluid  cow’s  milk  exists.  £ The  above  characteristics  as  well  as  its 
uniformity  and  absolute  dependability  make  Klim  indispensable  for  “traveling  babies.” 
C Literature  and  samples,  including  inf  ant  feeding  calculator , will  be  sent  on  request. 
Merrell-Soule  Co.,  Inc.,  350  Madison  Ave.,  New  York 


Merrell-Soule  Powdered  Milk  Products,  in- 
cluding Klim,  Whole  Lactic  Acid  Milk  and 
Protein  Milk,  are  packed  to  keep  indefinite- 
ly. Trade  packages  need  no  expiration  date. 


(Recognizing 
the  importance 
of  scientific 
control,  all  con- 
tact with  the 
laity  is  predi- 
cated on  the 
policy  that 
KLIM  and  its 
allied  products 
be  used  in  in- 
fant feeding 
only  according 
to  a physician's 
formula.) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


43 


FRANKLIN  HOSPITAL  14th  and  Noe  Streets 


B EAUTIFULLY  located  in  a 
scenic  park — Rooms  large  and  sunny 
— Fine  Cuisine — Unsurpassed  Oper- 
ating, X-Ray  and  Maternity  Depart- 
ments. 


Training  School  for 
Nurses 


8 


For  further  information 
Address 

FRANKLIN  HOSPITAL 

San  Francisco 


THE  MONROVIA  CLINIC 

Geo.  B.  Kalb,  M.  D.  H.  A.  Putnam,  M.  D.  Scott  D.  Gleeten,  M.  D. 

R.  E.  Crusan,  M.  D. 

The  Clinic  deals  with  the  diagnosis  and  treatment  of  all  forms  of  tuberculosis  as  well  as  with 
asthma,  bronchiectasis,  chronic  bronchitis  and  other  diseases  of  the  chest,  and  is  equipped  with 
complete  laboratory  and  X-Ray,  also  Alpine  and  Kromayer  lamps  and  physiotherapy  equipment. 

Special  attention  is  given  to  artificial  pneumothorax,  oxyperitoneum,  thoracoplasty,  heliotherapy 
and  treatment  of  laryngeal  tuberculosis. 

Patients  may  be  cared  for  in  Sanatoria,  in  nursing  homes  or  with  their  families  in  private  bungalows. 
Rates  $15  to  $35  per  week.  Medical  fees  extra. 

137  North  Myrtle  Street  Monrovia,  California 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  41) 

ance  of  Type  I antipneumococcic  serum  for  New  and 
Nonofficial  Remedies;  that  Type  II  serum  is  still  in 
the  experimental  stage;  and  that  pneumococcic  serum 
preparations  representing  a mixture  of  Type  I and  II 
pneumococci  be  considered  unacceptable.  It  was  de- 
cided that,  while  adequate  clinical  evidence  for  the 
potency  of  a liver  extract  must  be  required  before 
acceptance,  further  clinical  testing  will  not  be  re- 
quired after  a product  has  been  shown  to  be  active 
and  the  method  of  preparation  shown  to  be  satisfac- 
tory. The  Council  considered  the  rules  that  are  to 
govern  the  use  of  the  seal  to  be  used  by  manufac- 
turers to  identify  products  accepted  for  New  and  Non- 
official Remedies  or  for  Accepted  Foods.  The  Council 
approved  a proposed  study  of  commercial  allergic 
protein  preparations  and  offered  cooperation.  The 
Council  considered  a proposed  manual  for  the  guid- 
(Continued  on  Next  Page) 


Creating  Joy 

Qreate  joy  jor  yourself  and  others 
by  sending  flowers 


Telephone:  SUtter  6200 
SAN  FRANCISCO 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


u 


Banning  Sanatorium  FoarJu^^sis 


Ideal  all  the  year  climate,  combining  the  best 
elements  of  the  climates  of  mountain  and 
desert,  particularly  adapted  to  those  suffering 
with  lung  and  throat  diseases,  as  shown  by 
long  experience. 


Altitude  2450 

Reasonable  Rates 

Efficient  Individual 
Treatment 
Medical  or  Surgical 

Bungalow  Plan 

Send  for  circular 


Orchards  in  bloom.  Banning  and  mountains  to  north. 


A.  L.  Bramkamp,  M.  D. 

Medical  Director 
Banning,  Calif. 


6 Definite  Indications 

1.  Atrophic  Rhinitis 

2.  Sinusitis 

3.  Catarrh 

4.  Influenza 

5.  Hay  Fever 

6.  Ethmoiditis 

Write  today  for  comprehensive  booklet  and 
trial  proposition 

Nichols  Nasal  Syphon,  Inc. 
159  E.  34TH  ST.  NEW  YORK 


N I C H O I_i  X 

NATAL  T YPHON 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Preceding  Page) 
ance  of  hospitals  to  be  prepared  by  a committee  ap- 
pointed by  the  Council  on  Medical  Education  and 
Hospitals  with  the  cooperation  of  the  Council  on 
Pharmacy  and  Chemistry.  Plans  for  the  consolida- 
tion of  various  committees  concerned  with  anesthesia 
were  discussed. — Jour.  A.  M.  A.,  March  22,  1930, 
p.  874. 

Ethylhydrocuprein. — Clinicians  of  large  experience 
have  grown  skeptical  about  the  use  of  ethylhydro- 
cuprein (optochin)  in  the  treatment  of  pneumonia, 
whereas  they  were  once  enthusiastic,  and  hopeful 
about  its  possibilities.  In  a review  of  this  subject, 
Cahn-Bronner  cites  an  extensive  literature  and  con- 
cludes from  his  own  experience  and  a review  of 
numerous  authors  that  ethylhydrocuprein  is  not  su- 
perior to  quinin  and  that  neither  drug  is  a specific 


Health  First 

SPRING  WATER 

Delivered 

to  Offices  and  Homes 
Entire  Bay  District 

Purity  Spring  Water  Co. 

2050  Kearny  Street 
San  Francisco 
Phone  DAvenport  2197 


in  the  treatment  of  pneumococcus  pneumonia.  The 
following,  with  reference  to  ethylhydrocuprein,  ap- 
pears in  New  and  Nonofficial  Remedies:  “Clinical 
investigation  indicates  that  the  drug  may  be  of  value 
in  the  treatment  of  lobar  pneumonia,  if  a sufficient 
amount  can  be  administered  sufficiently  early  without 
untoward  effect.  To  avoid  such  effect  it  is  proposed 
to  secure  low  absorption  through  the  administration 
of  the  free  base  by  mouth.  The  hydrochlorid  may 
be  administered  intramuscularly,  but  is  liable  to  be 
irritant.  Intravenous  administration  seems  to  be  con- 
traindicated. The  drug  has  a definite  value  in  the 
treatment  of  pneumococcic  infections  of  the  eye  (ulcus 
corneal  serpens).” — Jour.  A.  M.  A.,  March  22,  1930, 

p.  888. 

Collosol  Calcium  Not  Acceptable  for  New  and 
Nonofficial  Remedies.— The  Council  on  Pharmacy 
and  Chemistry  reports  that  Collosol  Calcium  was 
(Continued  on  Page  46) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


45 


OJ/hen  is  (Diathermy  of  Oatue 
in  HJour  Practice  ? 


YOUR  decision  to  use  diathermy 
in  the  treatment  of  any  condition 
will,  of  course,  be  based  on  recognized 
medical  authority.  Many  physicians 
have  become  interested  as  a result  of 
observing  the  many  references  to  dia- 
thermy in  current  medical  literature, 
and  no  doubt  intend  to  investigate 
for  themselves  when  opportunity  pre- 
sents. But  a busy  practice  affords 
little  of  the  time  required  in  search- 
ing the  files  of  the  medical  library, 
and  it  is  put  off  indefinitely. 

A preliminary  survey  of  the  articles 
on  diathermy,  published  during  the 
past  year  or  so,  is  available  to  you  in 


the  form  of  a 64'page  booklet  entitled  “In* 
dications  for  Diathermy.”  In  this  booklet 
you  will  find  over  250  abstracts  and  ex- 
tracts  from  articles  by  American  and  foreign 
authorities,  including  references  to  more 
than  a hundred  conditions,  in  the  treatment 
of  which  the  use  of  diathermy  is  discussed. 

If  you  number  yourself  among  the  phy 
sicians  who  have  not  adopted  diathermy-^- 
in  practice,  and  desire  to  investigate  this 
form  of  therapy  in  view  of  reaching  your 
own  conclusion  as  to  its  value  in  your 
practice,  you  will  find  this  booklet  a conve' 

nient  reference.  

A copy  will  be 
sent  on  request. 


SAN  FRANCISCO:  FourFifty  Sutter 
LOS  ANGELES:  Medico-Dental  Bldg. 

GENERAL  A ELECTRIC 


Chicago,  UL,  U.  S.  A. 


X-RAY  CORPORATION 


2012  Jackson  Boulevard 

FORMERLY  VICTOR  ffjfejj! 

Join  us  in  the  General  Electric  Hour  broadcast  every  Saturday  night 
on  a nationwide  N.  B.  C.  network . 


General  Electric  X-Ray  Corporation 
2012  Jackson  Blvd.,  Chicago. 

Not  being  a user  of  diathermy  in  my  prac- 
tice, please  send  your  64-page  booklet  “ Indi- 
cations for  Diathermy.” 


Dr 

Address . 
City 


State . 


46 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


DIATHERMY 


GALVANIC 


SINE  WAVE 


X-RAY 


Dewar  & Hare  Electric  Co* 


386  Seventeenth  Street 


Oakland,  California 


THE  "THERMOTAX” 

A High  frequency  apparatus  of  unusual  merit  for  the  correct  administration 

of  true  Diathermy 


THE  "ELECTROTAX” 


A Galvanic  and  Sine  Wave  Generator  unsurpassed  for  the  successful  application  of  Galvanic 
and  Sine  Wave  Currents.  First  in  the  field  to  use  the  modern  tube  rectifier  and  filter  for  the 

production  of  smooth  Galvanic  Current. 


Distributors  of 

X-RAY  EQUIPMENT  DIATHERMY  APPARATUS  SINE  WAVE  APPARATUS 

QUARTZ  ULTRA  VIOLET  LAMPS  "BRITESUN”  APPARATUS 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  44) 

presented  by  the  Crookes  Laboratories,  Inc.,  as  a 
colloidal  suspension  of  calcium  oleate,  containing  ap- 
proximately 0.85  per  cent  of  calcium  oleate  and  0.05 
per  cent  of  calcium.  The  preparation  is  stated  to  con- 
tain 1 per  cent  gelatin  as  a protective  colloid  and 
0.5  per  cent  of  phenol  and  0.1  per  cent  of  chlorbu- 
tanol  as  preservatives  and  to  be  intended  for  hypo- 
dermic and  intramuscular  injection.  A similar  prepa- 
ration, Collosol  Calcium  Oral,  containing  the  same 
amount  of  calcium  oleate,  is  intended  for  oral  ad- 
ministration. The  Council  reports  that  the  label  of 
the  submitted  specimens  and  the  advertising  makes 
no  mention  of  gelatin,  phenol,  or  chlorobutanol.  After 
examination  of  the  available  evidence  the  Council 
declared  Collosol  Calcium  unacceptable  for  New  and 
Nonofficial  Remedies  because  it  is  an  unscientific 
preparation  of  no  proved  value  and  marketed  under 
unwarranted  therapeutic  claims.  When  the  Council’s 
report  was  sent  to  the  Crookes  Laboratories,  Inc., 
the  firm  expressed  willingness  to  mention  on  the  label 
the  presence  of  gelatin,  chlorbutanol,  and  phenol.  It 
submitted  a new  advertising  booklet  and  offered  to 
submit  further  evidence.  Since  there  appeared  to  be 
no  possibility  of  the  product  being  made  acceptable, 
the  Council  authorized  publication  of  its  report. — 
Jour.  A.  M.  A.,  March  29,  1930,  p.  920. 

FC-100. — Recently  Pittsburgh  papers  reported  that 
two  officers  and  two  employees  of  a Pittsburgh  bank 
had  been  poisoned  following  the  taking  of  a “remedy 
for  a cold.”  Investigation  disclosed  that  the  nostrum 
these  four  men  took  was  known  as  “FC-100,”  put  on 
the  market  by  the  Food  Chemistry  Corporation  of 
Pittsburgh,  which  has  for  its  president  P.  S.  Cham- 
bers. Presumably,  this  is  the  same  P.  S.  Chambers 
who  was  connected  with  the  American  Chemical 
Company  of  Pittsburgh  and  the  Research  Laboratories 


of  Pittsburgh,  exploiters  of  AL-14,  another  nostrum 
exploited  for  the  cure  of  colds.  The  Food  Chemistry 
Corporation  is  today  circularizing  bank  presidents 
and  suggesting,  by  implication,  that  these  bank  execu- 
tives purchase  FC-100  for  themselves  and  their  em- 
ployees. From  an  examination  made  by  the  American 
Medical  Association  Chemical  Laboratory  it  may  be 
concluded  that  the  specimens  of  FC-100  examined 
consisted  essentially  of  an  effervescent  mixture  con- 
sisting of  citric  acid,  potassium  and  sodium  bicarbo- 
nates, along  with  traces  of  calcium  and  magnesium, 
and  an  overdose  of  an  arsenic  compound.  Here,  as  in 
the  case  of  AL-14,  $2  was  charged  for  twelve  tubes 
containing  a few  cents’  worth  of  citric  acid  and  bak- 
ing soda,  put  out  under  the  claim  that  the  preparation 
is  "not  a drug”  and  that  it  is  quickly  effective  in 
curing  90  per  cent  of  common  colds! — Jour.  A.  M.  A., 
March  29,  1930,  p.  1010. 

Modilac  Not  Acceptable  for  New  and  Nonofficial 
Remedies. — The  Council  on  Pharmacy  and  Chemis- 
try reports  that  Modilac  is  the  proprietary  name 
under  which  the  William  S.  Merrell  Company  mar- 
kets a compressed  tablet  containing  milk  sugar  and 
some  salts,  recommended  for  the  "humanizing”  of 
cow’s  milk  to  render  it  suitable  for  infant  feeding.  In 
1925  the  Council  held  Modilac  not  to  be  within  the 
scope  of  New  and  Nonofficial  Remedies  because  no 
medicinal  claims  were  made  for  it,  and  included  the 
product  in  the  list  of  exempted  articles.  From  an 
examination  of  the  present  advertising  it  appears  that 
medicinal  claims  are  now  being  made  for  the  product, 
thus  bringing  it  within  the  scope  of  New  and  Non- 
official Remedies.  These  claims  were  found  to  be  un- 
acceptable and,  therefore,  the  Council  voted  that  the 
exemption  of  Modilac  be  rescinded  and  that  it  be 
considered  unacceptable  for  New  and  Nonofficial 
Remedies  because  it  is  an  unscientific  mixture  of  offi- 
cial articles  marketed  under  a nondescriptive  proprie- 
( Continued  on  Page  48) 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


47 


Why  Dryco? 


A glass  of  DRYCO  is  free  from  all  pathogenic  bacteria 
more  effective  and  less  costly  than  vitamins  taken  in  any  other 


ia  and  is  1 
ther  way.  \ 


Because: 


It  Was  Perfected: 

To  meet  the  demands  of  both  pediatricians  and 
general  practitioners  for  an  easily  digestible,  pre- 
pared and  modified  milk  which  would  be  well 
tolerated  by  the  most  delicate  infant’s  stomach! 

It  Has  an  Enviable  Clinical  History: 

Thousands  of  physicians  for  many  years  have 
found  DRYCO  the  best  milk  for  bottle-fed  babies. 
It  is  stable  and  unvarying  in  its  constituents;  con- 
tains the  vitamins  unimpaired  and  is  free  from 
all  pathogens. 

It  Conquered: 

The  danger  of  milk-borne  infection;  the  necessity 
for  refrigeration;  indigestibility  and  intolerance 
in  the  most  difficult  feeding  cases  and  the  danger 
of  frozen  milk  troubles — vomiting,  loose  stools 
and  diarrhea! 


Prescribe  Dryco  the  Safe  Milk 


Let  us  send  clinical  data  and  samples  of  this  milk 
Pin  this  to  your  Rx  blank  or  letterhead  and  mail 


THE  DRY  MILK  COMPANY,  INC. 


205  E.  42nd  Street,  New  York,  N.  Y. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


4» 


The  California  Sanatorium 

Belmont  (San  Mateo  County),  California 

FOR  THE  TREATMENT  OF  TUBERCULOSIS 

Completely  Equipped  i Excellent  Cuisine 

DR.  MAX  ROTHSCHILD  DR.  HARRY  C.  WARREN 

Medical  Director  Asst.  Medical  Director 


Rates  and  Prospectus  on  Request 


San  Francisco  Office 
384  Post  Street 
Phone  DAVENPORT  4466 


Address:  BELMONT,  CALIF. 
Phone  BELMONT  100 
(3  Trunk  Lines) 


Johnston -Wickett 
Clinic 

ANAHEIM,  CALIFORNIA 

Departments — Diagnosis, 
Surgery,  Internal  Medicine, 
Gynecology,  Urology,  Eye, 

Ear,  Nose,  Throat,  Pediat- 
rics, Obstetrics,  Orthopedics, 
Radiology  and  Pharmacy. 

Laboratories  fully  equipped 
for  basal  metabolism  deter- 
minations, Wassermann  re- 
action and  blood  chemistry, 
Roentgen  and  radium  therapy. 


TRUTH  ABOUT  MEDICINES 


(Continued  from  Page  46) 

tary  name  and  with  unwarranted  therapeutic  claims. — 
Jour.  A.  M.  A.,  March  8,  1930,  p.  716. 

Jean  Jacques  Laboratories. — For  some  time  one 
I.  Francis  Purdy  has  been  exploiting  a piece  of  aphro- 
disiac quackery  through  the  United  States  mails.  Re- 
cently the  postal  authorities  called  a halt  on  the 
matter  and,  after  a hearing  debarred  Purdy’s  business 
from  the  mails.  Purdy’s  trade  style  was  “Jean 
Jacques  Laboratories,”  operating  from  3104  Michigan 
Avenue,  Chicago.  Purdy  was  selling  through  the 
mails  a medicinal  preparation  that  he  called  “Oxcen- 
tric” which  was  supposed  to  be  a cure  for  lost  sexual 
vigor  and  prostatic  trouble  in  men  of  all  ages.  The 
preparation  was  put  up  for  him  by  the  Bierstedt 
Suppository  Company  of  Chicago.- — Jour.  A.  M.  A., 
March  8,  1930,  p.  735. 

Misbranded  Pharmaceuticals. — During  1929  Notices 
of  Judgment  were  issued  by  the  Food,  Drug  and 
Insecticide  Administration  of  the  United  States  De- 
partment of  Agriculture  against  the  following  phar- 
maceutical products  that  were  found  adulterated  or 
misbranded — or  both — under  the  Food  and  Drugs 
Act:  Blaud’s  Modified  Tablets  (Pharmacal  Products 
Co.,  Inc.,  Easton,  Md.) ; Chloramine-T  Tablets 
(Smith  Dorsey  Co.,  Lincoln,  Neb.);  Creosote  Com- 
pound Mixture  (Charles  Killgore,  New  York  City); 
Sirup  of  Ipecac  (William  R.  Warner  & Co.,  Inc., 
New  York  City);  Tincture  of  Belladonna  Leaves 
(Frank  G.  Scott,  Detroit,  Mich.);  Hyoscyamus  (Hen- 
bane Leaves)  (Mcllvaine  Bros.,  Inc.,  New  York 
City);  Calomel  Tablets  (Frank  G.  Scott,  Detroit, 
Mich.);  Calomel  and  Phenolphthalein  Tablets  (Phar- 
macal Products  Co.,  Inc.,  Easton,  Md.);  Sodium 
Bicarbonate  (James  Good,  Inc.,  Philadelphia;  Mor- 
phin  Sulphate  Tablets  (Frank  G.  Scott,  Detroit, 
Mich.);  Morphin  and  Atropin  Tablets  (Smith- 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


49 


Announcing 

The  new 

AUDIPHONE 

This  hearing  device  is  equipped  with  a small 
inconspicuous  earpiece  and  a powerful  light- 
weight battery  which  can  be  easily  concealed. 

The  Audiphone  was  developed  in  the  Bell 
Telephone  Laboratories,  and  is  manufactured 
by  the  Western  Electric  Company — a strong 
guarantee  of  its  reliability. 

Full  details  or  demonstration  upon  request 


W.  D.  FENNIMORE  A.  R.  FENNIMORE 


ESTABLISHED  - 1888  , 


177-181  Post  Street  San  Francisco 


Dorsey  Company,  Lincoln,  Neb.);  Codein  Sulphate 
Tablets  (Frank  G.  Scott,  Detroit,  Mich.);  Aletris 
(Unicorn  Root)  (Sig.  Wallace,  Statesville,  N.  C.) ; 
Rheumatism  Tablets  (P.  H.  Mallen  Co.,  Chicago); 
Spigelia  (Pink  Root)  (R.  Hillier’s  Son  Co.,  Inc., 
Jersey  City,  N.  J.);  Cinchophen  Tablets  (Pharmacal 
Products  Co.,  Inc.,  Easton,  Md.) ; Citrated  Magnesia 
(New  England  Magnesia  Company,  Boston,  Mass.); 
Acetphenetidin  Tablets  (Pharmacal  Products  Co., 
Inc.,  Easton,  Md.);  Tincture  of  Aconite  (Pharmacal 
Products  Co.,  Inc.,  Easton,  Md.);  Tincture  of  Iodin 
(George  A.  Breon  & Co.,  Kansas  City,  Mo.);  Cit- 
rated Magnesia  (Philadelphia  Magnesia  Co.,  Phila- 
delphia).— Jour.  A.  M.  A.,  February  15,  1930,  p.  501. 

The  Hazard  of  Using  Nonaccepted  Drugs. — Re- 
cently the  American  Medical  Association  Chemical 
Laboratory  published  a report  on  Bichloridol  collap- 
sules  indicating  that  only  from  one-tenth  to  one- 
fifth  of  the  amount  of  mercuric  chlorid  claimed  to  be 
present  was  actually  discovered.  The  results  of  the 
American  Medical  Chemical  Laboratory  have  received 
independent  confirmation.  Apparently  most  of  the 
mercuric  chlorid  had  reacted  with  the  lining  of  the 
collapsule  and  was  not  in  the  medicament  itself.  This 
product  has  been  administered  to  patients  by  phy- 
sicians who  thought  that  they  were  giving  a certain 
dosage  of  mercuric  chlorid,  whereas  the  patient  re- 
ceived only  from  one-tenth  to  one-fifth  of  the  dose  he 
should  have  had.  In  1925  the  Council  on  Pharmacy 
and  Chemistry  declared  Bichloridol  unacceptable  for 
New  and  Nonofficial  Remedies.  It  is  safer  to  follow 
the  Council. — Jour.  A.  M.  A.,  February  22,  1930,  p.  563. 

Misbranded  Pharmaceuticals. — During  1929  Notices 
of  Judgment  were  issued  by  the  Food,  Drug  and 
Insecticide  Administration  of  the  United  States  De- 
partment of  Agriculture  against  the  following  pharma- 
ceutical products  that  were  found  adulterated  or  mis- 
branded— or  both — under  the  Food  and  Drugs  Act: 

(Continued  on  Page  53) 


THE  MEDICAL 
PROFESSION 

is  urged  to 
investigate 


the  coverage  of  our 
Professional  Liability 
contracts,  the  Organ- 
ization and  Service 
behind  them  and  our 
reasonable  Premium 
Rates  before  choosing 
other  insurance  which 
may  lack  one  or  more 
of  these  essentials. 


ASK  OUR  LOCAL  AGENT 
OR  WRITE  TO  OUR 
BRANCH  OFFICE 


Over  $68,000,000 
in  Resources 


W e insure  only 
ethical  practitioners 


UNITED  STATES 
FIDELITY  and  GUARANTY 
COMPANY 

Baltimore,  Maryland 


Branch  Offices 


340  Pine  Street 
San  Francisco,  Calif. 

1404  Franklin  Street 
Oakland,  Calif. 

724  South  Spring  Street, 
Los  Angeles,  Calif. 


602  San  Diego  Trust 
& Savings  Building 
San  Diego,  Calif. 

Continental  National 
Bank  Building 
Salt  Lake  City,  Utah 


50 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


A PRIMER 

FOR  THE  TUBERCULOUS 
AND  OTHER  ESSAYS  ON 
TUBERCULOSIS 

By  ROBERT  A.  PEERS 


M.D.,  C.D.,  C.M., 


Authoritative,  instructive 
. and  intensely  interesting, 
this  book  is  a notable  contribu- 
tion to  medical  science  in  that  it 
reviews  the  researches  of  a suc- 
cessful physician  whose  study  of 
tuberculosis  has  been  his  life’s 
work,  and  who  possesses  the 
happy  faculty  of  telling  about 
it  in  an  absorbingly  interesting 
fashion. 

Together  with  some  thirty- 
three  essays  and  addresses,  this 
book  contains  also  Dr.  Peers’ 
well  known  Primer  for  the  Tu- 
berculous, which  is  used  by  his 
patients  as  a guide  book  on  the 
road  to  cure;  also  his  Tubercu- 
losis Primer  for  School  Chil- 
dren, which  has  had  wide  cir- 
culation among  school  children, 
not  only  in  California  but  in 
other  states. 


F.T.M.C.,  F.A.C.P. 


While  the  book  is  couched  in 
the  language  of  the  layman  and 
designed  primarily  as  a guide 
to  the  patient  and  homes  touched 
by  tuberculosis,  it  is  by  no  means 
out  of  place  in  the  doctor’s  li- 
brary. Once  perused,  it  will  be 
deemed  indispensable  to  nurses, 
teachers,  social  workers  and  in 
the  sanatorium. 

336  pages,  printed  on  Antique 
Book  paper.  Half  bound  vol- 
ume with  square  art  canvas  back, 
paper  sides  and  pasted  labels. 

I 

I 

| The  James  H.  Barry  Company, 

1122  Mission  Street, 

I San  Francisco,  California. 

Please  send  me copies  of  “A  Primer 

for  the  Tuberculous  and  Other  Essays  on 
i Tuberculosis,”  for  which  I herewith  enclose 
I $3.50  per  copy. 

I 

i Name 

Address. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


5' 


HOSPITAL  FOR  CHILDREN  AND 
TRAINING  SCHOOL  FOR  NURSES 

A general  hospital  of  27S  beds  for  women  and  children. 

Thirty  beds  for  maternity  patients  in  a separate  building,  newly  equipped. 

Complete  services  of  all  kinds  for  women  and  children. 

Infant  feeding  a specialty. 

House  staff  consists  of  three  resident  physicians  and  eight  interns. 

Accredited  by  the  Council  on  Medical  Education  and  Hospitals  of  the 
American  Medical  Association. 

Institutional  member  of  League  for  the  Conservation  of  Public  Health. 
The  oldest  school  of  nursing  in  the  West. 


Director  of  Hospital 
Dr.  J.  B.  Cutter 

Assistant  Superintendent 
Mrs.  Hulda  N.  Fleming 

Superintendent  of  Nurses 
Miss  Ada  Boye,  R.N. 

3700  California  Street 
San  Francisco 


Ongisa 

A REMARKABLE  SURGICAL  STOCKING  WITHOUT  RUBBER 
Looks  like  a dress  silk  stocking.  Gives  compression 
when  drawn  up  at  the  top.  Tightness  regulated  in 
direct  relation  to  vertical  pull. 

Superior  to  elastic  hosiery  or  bandages  for  treat- 
ment of  varicose  veins  and  swollen  limbs.  Neat  and 
comfortable. 


Appeals  to  the  fastidious  woman  as  well  as  to  the  physician. 

Doctors  who  have  ordered  this  stocking  for  their  patients  are  sending  for 
more  of  them.  Order  one  today  on  open  account.  If  you  do  not  like  it, 


send  it  back. 

PRICES 

Length  as  illustrated $ 7.00  In  ordering  give  patient’s 

Half  thigh  length 9.00  calf  measurement. 

Full  length  10.00 

SOLD  AND  FITTED  BY 

<&J<»  ® 

323  W.  6TH  STREET  LOS  ANGELES,  CALIF. 


Phone  MUtual  8081 


52 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


Experienced  Technicians  in  Clinical  Laboratory  and 
Physiotherapy  Departments.  Electrocardiographic  and 
Basal  Metabolic  determinations  made. 


The 

Santa  Barbara  Clinic 

SANTA  BARBARA,  CALIFORNIA 

General  Surgery 

REXWALD  BROWN,  M.  D. 

IRVING  WILLS,  M.  D. 

Internal  Medicine 

HILMAR  O.  KOEFOD,  M.  D. 

H.  E.  HENDERSON,  M.  D. 

WM.  M.  MOFFAT,  M.  D. 

NEVILLE  T.  USSHER,  M.  D. 

Obstetrics  and  Gynecology 

BENJAMIN  BAKEWELL,  M.  D. 
LAWRENCE  F.  EDER,  M.  D. 

Diseases  of  Children 

HOWARD  L.  EDER,  M.  D. 

Ear,  Nose  and  Throat 

H.  J.  PROFANT,  M.  D. 

WM.  R.  HUNT,  M.  D. 

U rology 

IRVING  WILLS,  M.  D. 

Orthopedics 

RODNEY  F.  ATSATT,  M.  D. 

Eye 

F.  J.  HOMBACH,  M.  D. 
Roentgenology 

M.  J.  GEYMAN,  M.  D.,  Consultant 


ST.  JOSEPH’S  HOSPITAL 


SAN  FRANCISCO, 
CALIFORNIA 


Buena  Vista  and  Park  Hill  Avenues 

A limited  general  hospital  conducted  by 
the  Franciscan  Sisters  of  the  Sacred  Heart. 

Accredited  by  the  American  Medical  As- 
sociation and  American  College  of  Sur- 
geons; accredited  School  of  Nursing. 

Open  to  all  members  of  the  California 
Medical  Association. 


Take  a close  up  of  your  ledger 

"WE  GET  THE  COIN”  "WE  PAY” 

BITTLESTON  COLLECTION  AGENCY,  Inc. 

1211  Citizens  National  Bank  Bldg.  LOS  ANGELES  TRinity  6861 


Science  of  Medicine. — Medicine  until  modern  times 
was  a species  of  dramatic  play  upon  emotions  rather 
than  a science  made  useful  through  technology.  It 
combined  centuries  of  experience  in  trial  and  error  in 
reactions  from  many  drugs,  with  a maximum  of  skill 
on  the  part  of  the  practitioner  in  a kindly  art  of  mak- 
ing the  patient  feel  as  hopeful  and  comfortable  as 


possible  while  he  was  dying  of  the  disease,  the  origin 
and  treatment  of  which  were  as  yet  undiscovered. 
Providence  was  made  responsible  for  his  fate  rather 
than  the  bacillus  which  should  never  have  been 
allowed  to  infect  him. — From  Address  by  President 
Hoover  in  Commemoration  of  the  Eightieth  Birthday 
of  Dr.  William  Henry  Welch. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


53 


POTTENGER  SANATORIUM  AND  CLINIC 

FOR  DISEASES  OF  THE  CHEST  Monrovia,  California 


Twenty-five  years’  experience  in  meeting  the  problems  of  the  tuberculous  patient. 

Located  in  the  foothills  of  the  Sierra  Madre  mountains,  at  an  elevation  of  1000  feet.  Sixteen  miles  east  of  Los  Angeles, 
on  the  main  line  of  the  Santa  Fe.  Reached  also  by  the  Pacific  Electric.  Equipped  for  the  scientific  treatment  of  tuberculosis 
and  other  diseases  of  the  chest.  Beautiful  surroundings.  Close  personal  attention.  Excellent  food. 

A clinic  for  the  study  and  diagnosis  of  all  diseases  of  the  chest,  including  asthma,  lung  abscess  and  bronchiectasis  is 
maintained  in  connection  with  the  institution. 

Los  A ngeles  Office  For  particulars  address: 

WILSHIRE  MEDICAL  BLDG.  POTTENGER  SANATORIUM 

1930  Wilshire  Blvd.  Monrovia,  California 


TRUTH  ABOUT  MEDICINES 

(Continued  from  Page  49) 

Marjoram  (R.  T.  Randall  & Co.,  Philadelphia);  Ergot 
(King  and  Howe,  New  York  City);  Sodium  Sali- 
cylate Tablets  (William  R.  Warner  & Co.,  Inc.,  New 
York  City);  Strychnin  Sulphate  Tablets  (William  R. 
Warner  & Co.,  Inc.,  New  York  City);  Sodium  Sali- 
cylate Tablets  (Shores-Mueller  Co.,  Cedar  Rapids, 
Iowa);  Strychnin  Sulphate  Tablets  (P.  H.  Mallen 
Co.,  Chicago);  Tincture  of  Nux  Vomica  (William  R. 
Warner  & Co.,  Inc.,  New  York  City);  Strychnin 
Sulphate  Tablets  (Frank  G.  Scott,  Detroit,  Mich.); 
Atropin  Sulphate  Tablets  (Pharmacal  Products  Co., 
Inc.,  Easton,  Md.);  Nitroglycerin  Tablets  (Frank 
G.  Scott,  Detroit,  Mich.);  Nitroglycerin  Tablets 
(Pharmacal  Products  Company,  Inc.,  Easton,  Md.); 
Bacillus  Bulgaricus  Tablets  (Fairchild  Bros,  and 
Foster,  New  York  City);  Bacillus  Bulgaricus  Liquid 
Culture  and  Tablets  (Parke,  Davis  & Co.,  Detroit, 
Mich.);  Phenacetine  Tablets  (P.  H.  Mallen  Co.,  Chi- 
cago); Cocain  Hydrochloric!  Tablets  (Pharmacal 
Products  Co.,  Inc.,  Easton,  Md.);  Arsenous  Acid 
Tablets  (Pharmacal  Products  Co.,  Inc.,  Easton,  Md.) ; 
Quinin  Sulphate  Tablets  (Pharmacal  Products  Co., 
Inc.,  Easton,  Md.);  Tincture  of  Cinchona  Compound 
(Pharmacal  Products  Co.,  Inc.,  Easton,  Md.);  Cal- 
cium Lactate  Tablets  (Smith-Dorsey  Co.,  Lincoln, 
Neb.);  Heart  Sedative  Tablets  (P.  H.  Mallen  Co., 
Chicago);  Potassium  Bromid  Tablets  (Smith-Dorsey 
Co.,  Lincoln,  Neb.).- — Jour.  A.  M.  A.,  February  22, 
1930,  p.  577. 

Association  of  Hawaiian  Pineapple  Canners. — On 

the  basis  of  an  average  of  representative  samples  of 
Hawaiian  pineapples  there  is  obtained  a value  of 
eighty-eight  calories  per  hundred  grams  of  canned 
pineapple.  There  are  better  sources  of  a single  vita- 
min, but  as  an  all  around  source  of  vitamins  the 
pineapple  takes  unusually  high  rank.  Canned  pine- 
apple is  an  article  of  diet  of  substantial  food  value. — 
Jour.  A.  M.  A.,  March  8,  1930,  p.  716. 


Doctor l 

We  want  you  to  know  that  we 

SPECIALIZE 

in  the  BUYING  of  USED  EQUIPMENT 
and  the 

SELLING  of  RENEWED  EQUIPMENT 

Exchange  what  you  don’t  want 
for  something  that  you  do  want 

also 

Authorized  agents  and  distributors  for 
standard  makes  of  NEW  goods 

SIDNEY  J.  WALLACE  CO. 

Second  Floor,  Galen  Building 

391  SUTTER  STREET 

SAN  FRANCISCO 

Telephone:  SUTTER  5314 


54 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


ST.  MARY’S  HOSPITAL  San  Francisco 


Conducted  by  Sisters  of  Mercy 


Accredited  by  the  American  Medical  Association.  Open  to  all  members  of  the  California 
Medical  Association.  Accredited  School  of  Nursing  and  Out-Patient  Department 


PROFESSIONAL  STAFF 


Surgery 

T.  Edward  Bailly,  Ph.  D. 

F.  A.  C.  S.,  M.  D. 

Guido  Caglieri,  B.  Sc., 

F.  R.  C.  S.,  F.  A.  C.  S.,  M.  D. 
Edward  Topham,  M.  D.,  F.A.C.S. 
Jas.  Eaves,  M.  D. 

F.  F.  Knorp,  M.  D. 

Hubert  Arnold,  M.  D. 

Edmund  Butler,  M.  D.,  F.  A.  C.  S. 
Rodney  A.  Yoell,  M.  D. 

Eye,  Ear,  Nose  and  Throat 
F.  J.  S.  Conlan,  F.  A.  C.  S.,  M.  D. 
L.  A.  Smith,  M.  D. 

J.  J.  Kingwell,  M.  D. 

T.  Stanley  Burns,  M.  D. 


Obstetrics 
Philip  H.  Arnot,  M.  D. 
Charles  C.  Mohun,  M.  D. 

Medicine 

Chas.  D.  McGettigan,  M.  D. 
J.  Haderle,  M.  D. 

H.  V.  Hoffman,  M.  D. 
Stephen  Cleary,  M.  D. 

T.  T.  Shea,  M.  D. 

A.  Diepenbrock,  M.  D. 

J.  H.  Roger,  M.  D. 

Thomas  J.  Lennon,  M.  D. 
James  M.  Sullivan,  M.  D. 


Orthopedics 
Thos.  J.  Nolan,  M.  D. 

J.  J.  Loutzenheiser,  M.  D. 
Urology 

Chas.  P.  Mathe,  F.  A.  C.  S.,  M.  D. 
George  F.  Oviedo,  M.  D. 

Thomas  E.  Gibson,  M.  D. 
Pediatrics 

Randolph  G.  Flood,  M.  D. 

Heart 

Harry  Spiro,  M.  D. 

Gastroenterology 
Edward  Hanlon,  M.  D. 

Frank  A.  Kinslow,  M.  D. 


Pathology 
Elmer  Smith,  M.  D. 

Radium  Therapy 
Monica  Donovan,  M.  D. 

Dermatology 
H.  Morrow,  M.  D. 

Harry  E.  Alderson,  M.  D. 

Neurology 
Milton  Lennon,  M.  D. 

Neurological  Surgery 
Edmund  J.  Morrissey,  M.  D. 

Dentistry 
Thos.  Morris,  D.  D.  S. 

Francis  L.  Meagher,  D.  D.  S. 


Trademark  UC'T'/YTI  H/V99  Trademark 
Registered  \ vJlvlVl  Registered 

Binder  and  Abdominal  Supporter 


"Type  A”  "Type  N” 


The  Storm  Supporter  is  in  a “class”  entirely  apart 
from  others.  A doctor’s  work  for  doctors.  No  ready- 
made belts.  Every  belt  designed  for  the  patient. 
Several  “types”  and  many  variations  of  each,  afford 
adequate  support  in  Ptosis,  Hernia,  Pregnancy, 
Obesity,  Relaxed  Sacro-Iliac  Articulations,  Floating 
Kidney,  High  and  Low  Operations,  etc. 

Mail  orders  filled  Please  ask  for 

in  24  hours  literature 

Katherine  L.  Storm,  M.  D. 

Originator , Owner  and  Maker 
1701  Diamond  Street,  Philadelphia,  Pa.,  U.  S.  A. 


Education  by  Discussion. — The  N eve  England  Journal 
of  Medicine,  in  a recent  number,  commented  upon  a 
statement  by  Muirhead  to  the  effect  that  in  the  United 
States  discussion  as  a method  of  promoting  knowl- 
edge did  not  exist.  By  discussion  is  understood  a 
calm,  dispassionate  exchange  of  ideas  with  the  object 
of  arriving  at  truth,  or  as  near  truth  as  possible. 
Concerning  most  questions  the  American,  according 
to  this  writer,  either  knows  it  all,  or  is  not  at  all  in- 
terested. In  either  case  discussion  is  out  of  the  ques- 
tion. It  is  not  that  we  do  not  talk.  Take,  for  instance, 
the  perennial  subject  prohibition — enough  is  said,  but 
there  is  practically  no  modification  of  our  attitude 
regarding  it,  whichever  side  we  happen  to  favor. 

The  editorial  in  the  New  England  Journal  of  Medicine 
relates  that  a proposed  meeting  of  physicians  to  dis- 
cuss birth  control  had  to  be  given  up  because  it  was 
thought  that  such  discussion  would  divide  the  pro- 
fession and  wreck  a certain  county  medical  society. 
Medical  education  is  another  topic  that  evidently  is 
not  amenable  to  discussion  in  the  East. 

Probably  the  lack  of  disposition  to  indulge  in  calm 
deliberation  is  a national  characteristic.  It  may  be 
due  to  climate  or  what  not.  More  than  one  European 
observer  has  commented  upon  the  spirit  of  intoler- 
ance that  is  apt  to  be  accorded  any  vital  subject  in 
this  country.  A subject  that  is  purely  academic  is 
apt  to  be  met  with  lack  of  interest  or  indifference. 

And  yet  we  look  forward  to  conferences,  Leagues 
of  Nations,  world  courts,  as  a means  of  preventing 
future  conflicts.  It  would  seem  that  the  remedy  would 
be  in  a greater  use  of  debate,  especially  in  the  dis- 
cussion of  such  subjects  as  admit  of  difference  of 
opinion.  This  would  include,  so  far  as  medical  socie- 
ties are  concerned,  all  topics  of  a medico-social  nature. 
Debate  properly  conducted  demands  a sort  of  in- 
tellectual sportsmanship  that  should  prevent  cleavage 
in  any  group  of  intelligent  people. — Editorial,  The 
Journal  of  the  Michigan  State  Medical  Society,  April, 
1930. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


55 


Telephone  Belmont  40  P.  O.  Box  27 

Alexander  Sanitarium 

Incorporated 

Belmont,  California 

Hydro-Electro  and  Physiotherapy  Treatments. 
Specializing  in  Recuperative  and  Nervous 
Cases.  Homelike  Atmosphere.  Absolutely 
Modern  in  Every  Respect.  Inspection  Invited. 


This  is  our  Hydro-Electro  and  Physiotherapy  Building 

22  Miles  From  San  Francisco — Situated  in  the  beautiful  foothills  of  Belmont,  on 
Half  Moon  Bay  Boulevard.  The  grounds  consist  of  seven  acres  studded  with  live 
oaks  and  blooming  shrubbery. 

Rooms  with  or  without  baths,  suite,  sleeping  porches  and  other  home  comforts, 
as  well  as  individual  attention  and  good  nursing. 

Fine  Climate  the  Year  Around — Best  of  food,  most  of  which  is  grown  in  our 
garden,  combined  with  a fine  dairy  and  poultry  plant.  Excellent  opportunity  for 
outdoor  recreation — wooded  hillsides,  trees  and  flowers  the  year  around. 

Just  the  place  for  the  overworked,  nervous,  and  convalescent.  Number  of 
patients  limited.  Physician  in  attendance. 

Address  ALEXANDER  SANITARIUM 

Phone  Belmont  40  Box  27,  BELMONT,  CALIF. 


‘‘TRADE  IN  SACRAMENTO” 

WITH 

EUGENE  JAY  B. 

Benjamin  & Rackerby 

917  and  919  Tenth  Street  SACRAMENTO  Phone  MAIN  3644 


Surgeons * Instruments  * Physicians * and  Hospital  Supplies 


HAVE  YOU  SEEN  THE  NEW  No.  24  BLADE? 

Orthopedic  Appliances,  Elastic  Hosiery,  Abdominal,  Ptosis,  _____ — 

Sacro-IIiac  and  Maternity  Supports,  Crutches,  ■=7?^  '( 

Wheel-Chairs,  Invalid  Supplies. 

SEND  US  YOUR  ORDERS  FOR  PROMPT  DELIVERY  Agents  for  Bard-Parker  Company 


56 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


THE  KOMPAK  Model  is  the  smallest,  lightest  and  most  com- 
pact MASTER  blood  pressure  instrument  ever  made  . . . only 
30  oz.  in  weight  . . • and  because  it  is  a scientifically  accurate 
instrument,  it  removes  every  reason  or  excuse  for  using  inaccurate 
or  clumsy  blood  pressure  apparatus. 

The  KOMPAK  Model  fits  easily  into  any  physician’s  bag  . . . 
it  can  actually  be  carried  in  the  hip  pocket. 

Compactly  encased  in  Duralumin  inlaid  with  Morocco  grained 
genuine  leather,  the  KOMPAK  Model  is  a Finished  Product  . . . 
the  Handiest  of  all  types  and  the  most  permanent. 


NEW! 


KOMPAK  MODEL 


STANDARD  FOR  BLOODPRESSURE 


Demonstration,  or  Sent  for  Inspection  Upon  Request 


RICHTER  & DRUHE 

641  Mission  Street  San  Francisco 

Telephone  SUTTER  1026 


OFFICE  AND  HOSPITAL  SUPPLIES 

We  Have  a Complete  Stock  of  All  the  Latest  Designs  in  INSTRUMENTS  and  FURNITURE 

Also  a Complete  Line  of  Dressings — Sutures — Enamelware — GLASSWARE,  etc. 

ABDOMINAL  BELTS — ELASTIC  HOSIERY— TRUSSES — FOOT  SUPPORTS 
FITTED  BY  EXPERIENCED  FITTERS 

NEW  FEATURES — Kompak  Baumanometer,  weighing  only  32 
ozs.  Bard-Parker  New  Blade  No.  24,  as  illustrated.  Jones 
Intravenous  Syringe  in  5 cc.,  10  cc.  and  20  cc.  Tip  of  Syringe 
is  angled,  small  channel  in  tip,  to  make  sure  of  blood  flow 
before  drawing  piston. 

WALTERS  SURGICAL  GO. 

521  SUTTER  STREET  Surgical  Instruments  SAN  FRANCISCO 

Telephone  GARFIELD  7795 


NEW  No.  24  BARD-PARKER  BLADE 


Relative  Values. — Inasmuch  as  we  sympathize  with 
the  county  medical  society  secretary,  who  generally. is 
not  appreciated  and  whose  task  is  entirely  thankless, 
we  wish  to  say  a good  word  for  him,  and  particu- 
larly when  he  is  active,  enterprising,  and  courteous. 
Give  him  your  cordial  cooperation  and  assistance  in 
his  effort  to  make  your  society  amount  to  something. 
Don’t  kick  on  the  character  of  the  program  furnished 
when  there  is  no  valid  reason  for  registering  a kick, 
and  don’t  object  to  a few  dollars  of  extra  expense  as 
a tax  when  it  means  so  much  toward  building  up  the 
social  and  scientific  interests  in  your  society.  You 
pay  the  golf  club  or  the  bootlegger  extravagantly  as 
well  as  cheerfully,  but  most  of  you  kick  like  a bay 
steer  when  it  comes  to  paying  anything  that  will  help 
you  in  the  practice  of  medicine  or  make  you  a more 
wholesome  and  agreeable  fellow  among  your  con- 
freres. You  will  “cut  your  belt”  for  almost  anything 


but  your  county  medical  society,  and  it  is  high  time 
that  you  learned  to  “cut  your  belt”  for  the  latter  and 
do  it  willingly  and  cheerfully  without  being  clubbed 
to  it. — Editorial,  Journal  of  Indiana  State  Medical  As- 
sociation, January  15,  1930. 


Vienna’s  “Mutterschulen.”  — The  city  of  Vienna, 
Austria,  has  started  schools  for  mothers  in  which  they 
are  taught  about  nutrition  and  nutritional  disturb- 
ances, infectious  diseases  and  protective  inoculation, 
care  of  the  new-born  and  of  well  and  sick  children, 
mental  hygiene  of  children,  and  the  hygiene  of  sleep. 
Lessons  on  children’s  songs  and  games  and  the  mak- 
ing of  children’s  clothing  may  be  added.  The  courses 
are  under  the  direction  of  a woman  physician  and  a 
woman  welfare  worker. — United  States  Department  of 
Labor,  Children’s  Bureau. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


57 


APPROVED  CLINICAL  LABORATORIES 

Excerpts  from  American  Medical  Association  Essentials  for  an  Approved 

Clinical  Laboratory 

DEFINITION 

"*  * * /I  clinical  pathologic  laboratory  is  an  institution  organized  for  the  practical  application  of 
one  or  more  of  the  fundamental  sciences  by  the  use  of  specialized  apparatus,  equipment  and  methods,  for 
for  the  purpose  of  ascertaining  the  presence,  nature,  source  and  progress  of  disease  in  the  human  body.” 

" Only  those  clinical  laboratories  in  which  the  space,  equipment,  finances,  management,  personnel  and 
records  are  such  as  will  insure  honest,  efficient  and  accurate  work  may  expect  to  be  listed  as  approved.” 

" The  housing  and  equipment  should  be  sufficient  to  permit  all  essential  technical  procedures  to  be 
properly  carried  out.” 

THE  DIRECTOR 

" The  director  of  an  approved  clinical  laboratory  should  be  a graduate  of  an  acceptable  college  or 
university  of  recognized  standing,  indicating  proper  educational  attainments.  He  shall  have  specialized  in 
clinical  pathology,  bacteriology,  pathology,  chemistry  or  other  allied  subjects,  for  at  least  three  years. 
He  must  be  a man  of  good  standing  in  his  profession.” 

" The  director  shall  be  on  full  time,  or  have  definite  hours  of  attendance,  devoting  the  major  part  of 
his  time  to  the  supervision  of  the  laboratory  work.” 

” The  director  may  make  diagnoses  only  when  he  is  a licensed  graduate  of  medicine,  has  specialized 
in  clinical  pathology  for  at  least  three  years,  is  reasonably  familiar  with  the  manifestation  of  disease  in  the 
patient,  and  knows  laboratory  work  sufficiently  well  to  direct  and  supervise  reports.” 

” The  director  may  have  assistants,  responsible  to  him.  All  their  reports,  bacteriologic,  hematologic, 
biochemical,  serologic  and  pathologic  should  be  made  to  the  director.” 

RECORDS 

" Indexed  records  of  all  examinations  should  be  kept.  Every  specimen  submitted  to  the  laboratory 
should  have  appended  pertinent  clinical  data.” 

PUBLICITY 

" Publicity  of  an  approved  laboratory  should  be  directed  only  to  physicians  either  through  bulletins 
or  through  recognized  technical  journals,  and  should  be  limited  to  statements  of  fact,  as  the  name,  address, 
telephone  number,  names  and  titles  of  the  director,  and  other  responsible  personnel,  fields  of  work  covered, 
office  hours,  directions  for  sending  specimens,  etc.,  and  should  not  contain  misleading  statements.  Only 
the  names  of  those  rendering  regular  service  to  the  laboratory  should  appear  on  letterheads  or  other  form 
of  publicity.” 

FEES 

"*  * * There  should  be  no  dividing  of  fees  or  rebating  between  the  laboratory  or  its  director  and 
any  physician,  corporate  body  or  group.  * * *” 


The  following  laboratories  in  California  are  among  those  approved  by 
the  Council  on  Medical  Education  and  Hospitals  of  the  American  Medical 
Association: 

Clinical  Laboratory  of  Drs.  W.  V.  Brem,  A.  H.  Zeiler  and  R.  W.  Hammack, 
Pacific  Mutual  Building,  Los  Angeles,  California. 

Dr.  Marion  H.  Lippman’s  Laboratory,  Butler  Building,  135  Stockton  Street, 
San  Francisco. 

The  Western  Laboratories,  2404  Broadway,  Oakland. 


These  laboratories  use  only  standard  methods  and  are  fully  equipped  with  the  most  modern 
apparatus  to  make  all  clinical  examinations  of  value  in:  Pathology  (frozen  sections  when  ordered), 

Bacteriology,  Chemistry,  Hematology,  Serology,  Medico-legal,  Basal  metabolism,  Blood  chemistry, 
Autogenous  vaccines  and  all  other  laboratory  aids  in  diagnosis. 

Tubes  and  mailing  containers  sent  on  request. 

Use  special  delivery  postage  for  prompt  service. 


5$ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


7 

Annual  Meeting 

of  the 


American  Association 
for  the  Study  of  Qoiter 


SEATTLE,  WASHINGTON 


July  10,  11,  12,  1930 


Addresses  or  Demonstrations 

will  be  made  by  the  following  ( partial  list) : 

WM.  J.  KERR,  San  Francisco 
J.  EARLE  ELSE,  Portland,  Oregon 
LEWIS  M.  HURXTHAL,  Boston 
THOMAS  M.  JOYCE,  Portland,  Oregon 
LEO  P.  BELL,  Woodland,  California 
MARTIN  B.  TINKER,  Ithaca 
THOMAS  O.  BURGER,  San  Diego 
C.  A.  ROEDER,  Omaha 
LeROY  LONG,  Oklahoma  City 
ROBERTSON  WARD,  San  Francisco 
RAYMOND  J.  MILLZNER,  San  Francisco 
E.  R.  ARN,  Dayton,  Ohio 
E.  STARR  JUDD,  Rochester,  Minn. 
ADDISON  G.  BRENIZER,  Charlotte,  N.  C. 
ALLEN  GRAHAM,  Cleveland 
LINDON  SEED,  Chicago 
JOSEPH  L.  DeCOURCY,  Cincinnati 
H.  W.  RIGGS,  Vancouver 
GORDON  S.  FAHRNI,  Winnipeg 
W.  O.  THOMPSON,  Chicago 
EARLE  DRENNEN,  Birmingham,  Ala. 
WILLARD  BARTLETT,  Jr.,  St.  Louis 
KARL  F.  MEYER,  San  Francisco 


All  Physicians  Interested  in  Recent  Advances  in 
Knowledge  of  Diseases  of  the  Thyroid  Gland 
Are  Cordially  Invited  to  Attend  This  Meeting. 

Special  Pullman  Cars  will  be  attached  to  the 
C.  and  N.  W.  Canadian  National  Train  leaving 
Chicago,  5:40  P.  M.,  Wednesday,  July  2.  Stop- 
over Thursday  night  and  Friday  at  Winnipeg 
for  Special  Clinics.  Stopover  Sunday  and  Mon- 
day in  Jasper  National  Park.  Travel  through 
the  Canadian  Rockies  Tuesday.  Arrive  in  Seattle, 

July  9. 


Headquarters:  OLYMPIC  HOTEL 

Communications  relative  to  this  meeting  should  be 
addressed  to: 


J.  TATE  MASON 

Chairman,  Committee  on  Arrangements 

Mason  Clinic,  Seattle,  Washington 


LA  VIDA 

Mineral  Water 

LA  VIDA  MINERAL  WATER  is  a natural, 
palatable,  alkaline,  diuretic  water,  indicated  in 
all  conditions  in  which  increased  alkalinity  is 
desired.  It  flows  hot  from  an  estimated  depth  of 
9,000  feet  at  Carbon  Canyon,  Orange  County, 
30  miles  from  Los  Angeles. 

The  salts  in  LA  VIDA  form  a part  of  "the 
infinitely  lesser  chemicals”  of  which  the  human 
body  contains  only  an  exceedingly  small  amount, 
but  which  play  a vital  part  in  maintaining  good 
health. 

An  outstanding  American  medical  authority 
states:  "You  have  the  nearest  approach  of  any 
water  in  the  United  States  (or  perhaps  in  the 
world)  to  the  celebrated  Celestins  Vichy  of 
France*  . . . there  is  no  water  in  this  country 
like  La  Vida.”  (Name  on  request.) 

The  cost  of  LA  VIDA  is  well  within  the  reach 
of  the  average  patient. 

IONIZATION 

There  is  an  important  difference  between  nat- 
ural and  manufactured  waters.  Only  in  natural 
waters  does  complete  ionization  of  mineral 
salts  take  place. 

PRICES 

Plain:  $ 2.00  per  case  (4  gal.) 
Carbonated:  $2.00  per  dozen 
(12  oz.)  bottles 

Tonic  Ginger  Ale:  $2.25  per  doz. 

(12  oz.)  bottles 


^CHEMICAL  ANALYSIS 

GRIFFIN-HASSON 

LABORATORIES 

Celestins 

LA 

VICHY 

Grains  per  gallon 

VIDA 

of  France 

Calcium  Bicarbonate  

3.74 

43.28 

Magnesium  Bicarbonate  ... 

0.98 

5.00 

Sodium  Bicarbonate  

252.6 

205.53 

Sodium  Chloride  

94.0 

21.94 

Iron  Oxide  

0.07 

Trace 

0.13 

Silica  ..  

6.42 

2.63 

0.001 

Sodium  Sulphate  

14.97 

TOTAL  

357.941 

293.35 

FREE  to  Physicians  in  Hospitals  in 
Southern  California 

We  will  gladly  send  you  without  cost  or  obliga- 
tion, a full  case  (4  gallons)  of  LA  VIDA  MIN- 
ERAL WATER,  six  bottles  of  LA  VIDA  CAR- 
BONATED WATER,  and  six  bottles  of  LA 
VIDA  TONIC  GINGER  ALE. 

LA  VIDA 

Mineral  Water  Company 

MUtual  9154 
927  West  Second  Street 
LOS  ANGELES,  CALIFORNIA 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


59 


TWIN  PINES 

BELMONT,  CALIFORNIA 

A Sanatorium  for  Nervous 
and  Convalescent  Patients 

RESIDENT  PHYSICIAN 
Consultants: 

Walter  F.  Schaller,  M.  D. 

Walter  B.  Coffey,  M.  D. 

Charles  Miner  Cooper,  M D. 

Walter  W.  Boardman,  M.  D 
Harry  R.  Oliver,  M.  D. 

Telephone:  Belmont  111 


The  New  FFS-8  Physician’s  Microscope 

with  Rack  and  Pinion  Substage  and  Divisible  Abbe  Condenser 
with  16  mm.,  4 mm.  and  1.9  mm.  Oil  Immersion  Objectives, 
2 Eyepieces  and  triple  revolving  Nosepiece.  Complete  in 
hardwood  carrying  case 

$120.00 

BAUSGH  & LOME  OPTICAL  CO. 

OF  CALIFORNIA 

28  GEARY  STREET  SAN  FRANCISCO,  CALIF. 


J.  M.  ANDERSON,  Owner  and  Manager 

The  Anderson  Sanatorium 

For  Mental  and  Nervous  Diseases 

Hydrotherapy  Equipment 

Open  to  any  member  of  the  State 
Medical  Society 

2535  Twenty- fourth  Avenue  Oakland,  Calif. 

Telephone  Fruitvale  488 


Cancer  Attacks  All  Parts  of  the  Body. — No  organ 
or  tissue  of  the  body  is  exempt  from  cancer,  though 
its  occurrence  is  much  more  common  in  some  parts 
than  in  others.  The  most  frequent  sites  of  fatal  cancer 
are  the  stomach  and  the  liver.  For  instance,  in  1927, 
in  the  United  States  death  registration  area,  cancer 
of  these  organs  caused  20,119  deaths  among  males 
and  16,755  among  females,  a total  of  36,874,  amount- 
ing to  35.6  per  cent  of  the  total  mortality  from  this 
disease,  while  cancer  of  the  brain  caused  only  528 
deaths  (0.5  per  cent)  among  both  sexes.  Cancer  of 
the  peritoneum,  intestines,  and  rectum  caused  15,164 
(14.6  per  cent)  deaths  in  both  sexes;  cancer  of  the 
female  genital  organs  caused  15,001  (14.4  per  cent) 
and  of  the  male  genital  organs  4079  (4.9  per  cent). 
Cancer  of  the  buccal  cavity,  including  cancer  of  the 
lip,  tongue,  mouth  and  jaw,  caused  2599  deaths  among 
men  (2.5  per  cent)  and  only  585  among  women 


(0.56  per  cent) — probably  because  women  are  more 
observant  of  the  principles  of  dental  hygiene.  Cancer 
of  the  kidney  and  bladder  is  also  more  common 
among  men,  causing  2899  deaths  (2.8  per  cent),  and 
only  1685  among  women  (1.6  per  cent).— Health  News. 


Cost  of  Medical  Care. — Seventy  dollars  per  family 
was  the  average  cost  of  medical  care  during  a recent 
six-months  period  of  over  three  thousand  working- 
men’s families  selected  for  study  from  the  insured 
list  of  the  Metropolitan  Life  Insurance  Company. 
The  total  expenditure  for  these  families  during  this 
period  was  $230,907.  The  expenditures  for  the  larger 
families  averaged  less  per  capita  than  for  the  smaller 
families,  and  one-fifth  of  the  families  expended  nearly 
two-thirds  of  the  total. — United  States  Department  of 
Labor,  Children’s  Bureau. 


6o 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


► 

► 


► 


> 


H 


► 
► 
► 
► 
► 
► 
► 
► 
► 
► 
► 
► 
► 
► 
► 


HAY  FEVER 

An  Advertising  Statement 

AY  FEVER,  as  it  occurs  throughout  the  United  States,  is  actually  peren- 
nial rather  than  seasonal,  in  character. 

Because  in  the  Southwest — Bermuda  grass,  for  instance,  continues  to  flower 
until  December  when  the  mountain  cedar,  of  many  victims,  starts  to  shed  its 
pollen  in  Northern  Texas  and  so  continues  into  February.  At  that  time,  else- 
where in  the  South,  the  oak,  birch,  pecan,  hickory  and  other  trees  begin  to 
contribute  their  respective  quotas  of  atmospheric  pollen. 

But,  nevertheless,  hay  fever  in  the  Northern  States  at  least,  is  in  fact  seasonal 
in  character  and  of  three  types,  viz.: 

TREE  HAY  FEVER  —March,  April  and  May 
GRASS  HAY  FEVER — May,  June  and  July 
WEED  HAY  FEVER  — August  to  Frost 

And  this  last,  the  late  summer  type,  is  usually  the  most  serious  and  difficult 
to  treat  as  partly  due  to  the  greater  diversity  of  late  summer  pollens  as  re- 
gionally dispersed. 

With  the  above  before  us,  as  to  the  several  types  of  regional  and  seasonal 
hay  fever,  it  is  important  to  emphasize  that  Arlco-Pollen  Extracts  jor  diagnosis 
and  treatment  cover  adequately  and  accurately  all  sections  and  all  seasons — 
North,  East,  South  and  West. 

FOR  DIAGNOSIS  each  pollen  is  supplied  in  individual  extract  only . 

FOR  TREATMENT  each  pollen  is  supplied  in  individual  treat- 
ment set. 

ALSO  FOR  TREATMENT  wre  have  a few  logically  conceived  and  scientifi- 
cally justified  mixtures  of  biologically  related  and  simultaneously  pollinating 
plants.  Hence,  in  these  mixtures  the  several  pollens  are  mutually  helpful  in  build- 
ing the  desired  group  tolerance. 

IF  UNAVAILABLE  LOCALLY  THESE  EXTRACTS 
WILL  BE  DELIVERED  DIRECT  POST  PAID 
SPECIAL  DELIVERY 

List  and  prices  oj  jood,  epidermal,  incidental  and  pollen 
proteins  sent  on  request 

The  Arlington  Chemical  Company 

YONKERS,  N.Y. 


◄ 

◄ 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 

4 


3 


◄ 

◄ 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


versus 


Hole 


I was  sued  by  a woman  patient  who  claimed  damages  of 
$50,000  as  the  result  of  alleged  negligence  on  my  part.  Her 
husband  also  sued  me  for  an  additional  $10,000  for  the  loss  of 
services  and  companionship  of  his  wife.  (A  ‘property  damage’ 
suit.)  The  jury  brought  in  a verdict  of  $10,000  for  the  wife  and 
$3,000  for  the  husband.  My  insuring  company  accepted  lia- 
bility for  the  first  action  but  denied  liability  for  the  second,  as 
they  claimed  they  do  not  cover  ‘property  damage’  suits  under 
their  malpractice  liability  form  of  policy.” 

Whole — The  Medical  Protective  Contract  covers  ‘property  damage’ 
suits  resulting  from  professional  services,  as  well  as  ‘breach  of 
contract’  suits  and  many  other  liabilities  not  covered  elsewhere. 


You  can’t  have  a hole  in  your  protection 
and  still  have  whole  protection. 


Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Boulevard  i Chicago,  Illinois 


MEDICAL  PROTECTIVE  CO. 
360  North  Michigan  Blvd. 
Chicago,  111. 

Address 

Kindly  send  details  on  your  plan  of 
Complete  Professional  Protection 

Pi ry 

5-30 

62 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


When  Steers  Had 
Long  Horns 

The  medicinal  value  of  the 
glands  of  internal  secretion 
was  not  recognized. 

But  times  have  changed,  as  well 
as  cattle.  Now,  the  therapeutic 
value  of  certain  gland  products 
is  definitely  established  and 
each  year  adds  to  our  knowl- 
edge in  this  important  field  of 
therapeutics. 

To  the  physician  prescribing 
gland  products  we  urge  specifi- 
cation of  “Wilson,”  because  it 
connotes  a product  made  at  the 
source  of  supply  from  fresh 
glands,  processed  promptly,  with 
the  aim  of  conserving  maximum 
hormone  activity,  in  a labora- 
tory devoted  exclusively  to  the 
endocrine  field. 


“Jhib  manX 


y\  r\  n 


THE  WILSON  LABORATORIES 


yy  \y 


yow  gtuwa/nW 


4221  S.  Western  Boulevard 
CHICAGO,  ILL. 


Manufacturers  of 

STANDARDIZED  ANIMAL  DERIVATIVES, 
LIGATURES  and  DIGESTIVE  FERMENTS 


“Air  Doctors” — The  Development  of  Medical  Avi- 
ation.— The  air  ambulance  with  silent  engines  which, 
it  was  announced  during  the  week,  is  being  made  for 
use  in  remote  parts  of  the  Empire,  will  probably  be 
the  beginning  of  a new  and  interesting  Empire  service. 

France  has  already  formed  a branch  of  what  is 
called  medical  aviation  for  her  African  colonies,  and 
during  1928,  the  year  of  its  formation,  it  was  respon- 
sible for  the  transport  of  239  patients  from  outlandish 
parts  of  Algeria,  Morocco,  and  the  Levant  to  centers 
where  they  could  be  properly  treated.  The  planes  are 
Farmans,  one  type  of  which  carries,  in  addition  to 
doctor  and  nurse,  six  patients  on  stretchers,  and  the 
other  type  twelve  persons  sitting  or  ten  on  stretchers. 
The  United  States  Department  of  Commerce  has  also 
secured  air  ambulances  for  use  in  the  Great  Lakes 
district,  where  sick  persons  in  isolated  settlements  are 
often  carried  with  speed  to  hospital  or  clinic.  The 
planes  in  use  here  are  fitted  with  wheeled  cots,  hot 
and  cold  running  water,  electric  fans,  etc. 

It  is  for  grappling  quickly  with  an  epidemic,  how- 
ever, that  medical  aviation  is  expected  to  prove  itself 
most  useful.  Of  this  there  was  an  illustration  in 
Canada  last  year.  Diphtheria  broke  out  in  a trading 
post  along  the  banks  of  the  Peace  River,  Alberta,  and 
the  only  doctor  available,  sent  for  by  dog  sled  from 
Fort  Vermilion,  soon  found  himself  handicapped  by 
lack  of  serum.  He  sent  word  of  his  need,  by  the 
means  of  a dog  team,  to  the  nearest  town,  and  within 
a few  hours  two  airmen  were  soaring  northward  with 
supplies  of  serum  that  saved  many  lives — though  this 
was  an  ordinary  open  plane,  and  not  a medical  one. 

Organized  medical  aviation  was  first  employed  in 
Siam,  a country  in  which  epidemics  have  hitherto 
spread  with  dread  rapidity.  In  the  winter  of  1927  an 
epidemic  broke  out  in  the  Ubol  province,  and,  with 
the  quick  exhaustion  of  medicines,  cases  multiplied  to 
an  alarming  extent.  The  Governor  telegraphed  to 
Bangkok,  and  the  health  director  there  telephoned  to 
the  air  commandant  at  Don  Muang,  a special  train, 
with  doctors  and  nurses,  being  prepared  at  the  same 
time  to  leave  for  the  flying  ground. 

Within  a few  hours  of  taking-off  in  six  aeroplanes 
the  doctors  and  nurses  were  coping  successfully  with 
the  epidemic,  and  the  King  was  so  impressed  that 
he  headed  a public  subscription  to  buy  a number  of 
planes,  filled  with  medical  equipment  and  ready  to 
go  at  a moment’s  notice  to  any  part  of  the  country. 

Used  in  cooperation  with  wireless,  with  which  the 
world’s  lonely  outposts  are  being  gradually  equipped, 
medical  aviation  is  probably  destined  to  nip  in  the  bud 
many  a terrible  plague. — The  Observer. 


White  and  Whole-Wheat  Breads  Both  Wholesome, 
Say  Scientists. — White  and  whole-wheat  breads  both 
are  wholesome  foods.  They  are  among  the  most 
important  and  cheapest  sources  of  energy  and  pro- 
tein in  the  diet.  The  composition  and  value  in  the 
diet  of  whole-wheat  and  white  bread  vary  not  only 
with  the  differences  in  the  flour  used,  but  also  with 
the  amount  and  character  of  other  added  constituents. 

Whole-wheat  or  graham  flours,  which  contain  the 
bran  and  germ  portion  of  the  grain,  have  lower  bread- 
making capacity  and  are  more  susceptible  to  spoilage, 
so  cannot  be  handled  as  readily  commercially.  In 
general  they  contain  more  essential  minerals  and  vita- 
mins and  more  roughage  than  white  flour. 

No  person  subsists  on  one  food.  Each  food  should 
be  chosen  in  relation  to  the  other  constituents  of  the 
diet.  Bread,  either  white  or  whole-wheat,  is  always 
an  economical  source  of  energy  and  protein  in  any 
diet.  The  form  may  be  left  to  the  choice  of  the  indi- 
vidual when  the  remainder  of  the  diet  is  so  consti- 
tuted as  to  contribute  the  necessary  minerals,  vita- 
mins, and  any  necessary  roughage. — United  States  De- 
partment of  Agriculture. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


63 


to* 


* 

to* 


a* 


s* 


*A 


H 


Colfax  School  for  the 
Tuberculous 

Qolfax , Qalijornia 

(Altitude  2400  feet) 


This  institution  is  for  the  treatment  of  medical  tuber- 
culosis and  of  selected  cases  of  extrapulmonary  (so- 
called  surgical)  tuberculosis. 

The  Colfax  School  for  the  Tuberculous  consists  of  five 
Hospital  Units  with  beds  for  patients  who  come  unat- 
tended and  a Housekeeping  Cottage  Colony  for  patients 
and  their  families. 

The  Colfax  School  for  the  Tuberculous  offers  the  fol- 
lowing advantages: 


i Patients  are  given  individ- 

ual  care  by  experienced 
tuberculosis  specialists.  The  pa- 
tient is  treated  according  to  his 

individual  needs. 

O Patients  are  taught  how  to 

secure  an  arrest  of  their 
disease,  how  to  remain  well  when 
once  the  disease  is  arrested,  and 
how  to  prevent  the  spread  of  the 
disease. 

3 Patients  have  the  advan- 

• tage  of  modern  laboratory 
aids  to  diagnosis  and  of  all  modern 
therapeutic  agencies. 


4  The  climate  of  Colfax  en- 
• ables  the  patient  to  take  the 
cure  without  discomfort  twelve 
months  in  the  year.  We  believe 
climate  is  secondary  to  medical 
supervision  and  rest,  but  the  fact 
remains  that  it  is  easier  to  “cure” 
under  good  climatic  conditions 
than  where  these  climatic  condi- 
tions are  absent. 

5  Colfax  is  accessible.  It  is 
• on  the  main  line  of  the 
Ogden  Route  of  the  Southern  Pa- 
cific R.  R.  and  has  excellent  train 
service.  It  can  be  reached  by 
paved  highway,  being  on  the  Vic- 
tory Highway,  with  paved  roads 
all  the  way  to  Colfax. 


For  further  information  address 


ROBERT  A.  PEERS,  M.  D.,  Medical  Director 

Colfax , California 


ft 

iv 

ft 

V 

ft 

v 

ft 

v* 

ft 


v 

ft 

iv 

ft 

ft 

v 

ft 


ft 

VI 

ft 


ft 

V 
ft 

V 


V 


ft 

V 

ft 


CJ  01  it?  Ql 


64. 


CALIFORNIA  AND  WESTERN  MEDICINE  ADVERTISER 


For  Local  and  General  Anesthesia 


KELENE 

PURE  ETHYL  CHLORIDE 


Sole  Distributors  for  the  United  States  and  Canada: 

MERCK  & CO.  Inc. 

Main  Office:  Rahway,  N.  J. 


Investigation  of  the  Etiology  of  Rheumatism. — 

A generation  ago  Painter  and  Payner  announced  the 
cause  of  rheumatic  fever  to  be  a streptococcus  and 
indeed  bacteriologists  for  some  time  have  accepted  the 
idea  that  this  fever  was  due  to  one  of  the  streptococci, 
but  this  particular  one  belongs  to  a group  of  strepto- 
cocci that  has  been  somewhat  overlooked. 

Recently  an  article  was  published  by  Dr.  Konrad  E. 
Birkhang  on  “Bacteriologic  Study  in  Acute  Rheu- 
matic Fever,  with  Reference  to  Soluble  Toxin  Pro- 
duction” in  Proceedings  of  the  Society  of  Experi- 
mental Biology  and  Medicine,  1927,  Vol.  24,  in  which 
he  reports  practically  the  same  results  obtained  with 
a streptococcus  isolated  from  the  blood  of  persons 
suffering  with  acute  rheumatic  fever  as  published  by 
Doctor  Small.  He  states  that  the  organism  named 
streptococcus  cardio-artritidis  by  Doctor  Small  is 
probably  identical  with  that  isolated  by  him,  as  well 
as  by  several  other  workers,  and  called  by  other 
names. 

There  is  at  least  a good  chance  that  a solution  of 
the  acute  rheumatism  problem  may  soon  be  found. 
This  is  doubly  important,  as  the  solution  of  this  prob- 
lem carries  with  it  the  solution  of  the  heart  disease 
problem.  Doctor  Small  is  able  to  grow  this  coccus 
and  use  it  on  laboratory  animals  to  make  an  antitoxin, 
which  is  more  than  a simple  antitoxin  in  that  it  kills 
the  coccus  as  well  as  neutralizes  the  toxin.  He  has 
used  this  antitoxin  on  a small  series  of  cases  of  acute 
rheumatic  fever  in  human  beings  and  thereby  cured 
them  in  a way  that  has  every  resemblance  to  the  way 
diphtheria  antitoxin  cures  diphtheria. 

Therefore  it  would  seem  from  the  knowledge  we 
have  at  the  present  time  that  acute  rheumatic  fever 
is  caused  by  a particular  variety  of  streptococcus, 
which  will  produce  a soluble  toxin.  The  fact  that  this 
particular  variety  of  streptococcus  can  be  isolated 
from  the  throat  of  these  persons  would  indicate  that 
the  mode  of  entry  into  the  system  is  through  the 


respiratory  tract.  This  is  probably  the  same  kind  of 
streptococcus  that  was  isolated  by  Poynton  and  Paine 
in  1900.  Recently  we  have  been  better  able  to  classify 
the  streptococcus  into  definite  groups  such  as  those 
that  cause  scarlet  fever,  erysipelas,  acute  rheumatic 
fever,  etc. 

When  the  particular  coccus  was  taken  from  the 
throat  and  grown  on  culture  media  and  then  injected 
into  rabbits,  it  caused  a disease  that  had  the  earmarks 
of  rheumatism.  When  the  sick  rabbits  were  killed 
and  their  hearts  examined,  Aschoff’s  bodies  were 
found.  These  bodies  are  characteristic  of  acute  rheu- 
matic fever.  The  cocci  persist  in  those  subacute 
rheumatic  joint  conditions  which  so  frequently  follow 
acute  rheumatic  fever.  In  certain  cases  the  symptoms 
were  those  of  St.  Vitus’  dance,  which  is  a full  brother 
to  acute  rheumatic  fever. — Charles  Rudolph,  M.  D., 
Western  Medical  Times,  October  1929. 


Control  of  Disease. — Because  of  unusual  sanitary 
problems  resulting  from  location  and  topography, 
unique  and  original  engineering  designs  in  the  Na- 
tional Parks  are  not  infrequently  employed  by  the 
Public  Health  Service.  At  Grand  Canyon  National 
Park,  for  example,  water  for  all  purposes  must  be 
hauled  in  railroad  tank  cars  for  many  miles.  This 
water  is  used  for  domestic  purposes  and  discharged 
into  the  sewers  in  the  usual  manner.  Almost  90  per 
cent  of  this  sewage  is  then  reclaimed  by  various  in- 
genious methods  of  treatment  and  filtration  and  is 
used  over  again  for  supplying  water  to  boilers  at  the 
power  plant  at  Grand  Canyon  and  to  the  boilers  of 
the  passenger  and  freight  locomotives  which  run 
between  Williams  and  the  Canyon.  The  reclaimed 
water  has  practically  the  same  degree  of  bacteriologi- 
cal purity  as  that  required  by  drinking  water. — Public 
Health. 


California  and  Western  Medicine 

OFFICIAL  PUBLICATION  OF  THE 

California  Medical  Association 

ACCREDITED  REPRESENTATIVE  OF  THE 

Nevada  State  Medical  Association 

ACCREDITED  REPRESENTATIVE  OF  THE 

Utah  State  Medical  Association 

PRINTED  AND  EDITED 

FOR  THE 

California  Medical  Association 

Under  the  direction  of  the  House  of  Delegates  and  Council 

George  H.  Kress,  M.  D. 

Emma  W.  Pope,  M.  D. 

Editors 


VOLUME  XXXII 

JANUARY  TO  JUNE,  1930 


California  Medical  Association,  Four-Fifty  Sutter,  San  Francisco 


OFFICERS 

of  the 

CALIFORNIA  MEDICAL  ASSOCIATION 

1930-193 1 


i i i 

GENERAL  OFFICERS 

Lyell  C.  Kinney President 

510  Medico-Dental  Building,  233  A Street,  San  Diego 

Junius  B.  Harris . President-Elect 

Medico-Dental  Building,  1127  11th  Street,  Sacramento 

Edward  M.  Pallette Speaker  of  the  House  of  Delegates 

Wilshire  Medical  Building,  1930  Wilshire  Boulevard,  Los  Angeles 

John  H.  Graves . Vice-Speaker  of  the  House  of  Delegates 

977  Valencia  Street,  San  Francisco 

Oliver  D.  Hamlin Chairman  of  Council 

Federal  Realty  Building,  Oakland 

r.  Henshaw  Kelly Chairman  of  Executive  Committee 

830  Medico-Dental  Building,  490  Post  Street,  San  Francisco 

Emma  W.  Pope Secretary-Treasurer 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 

George  H.  Kress Editor 

245  Bradbury  Building,  304  South  Broadway,  Los  Angeles 

Emma  W.  Pope Associate  Editor 

Four-Fifty  Sutter,  Room  2004,  San  Francisco 


Hartley  F.  Peart General  Counsel 

1800  Hunter-Dulin  Building,  111  Sutter  Street,  San  Francisco 

Hubert  T.  Morrow .Assistant  General  Counsel 

Van  Nuys  Building,  210  West  Seventh  Street,  Los  Angeles 


COUNCILORS 


Mott  H.  Arnold  (1932),  1220  First  National  Bank 

Building,  1007  5th  Street,  San  Diego First  District 

William  Duffield  (193  3),  516  Auditorium  Building, 

427  West  Fifth  Street,  Los  Angeles Second  District 

Gayle  G.  Moseley  (1931),  Medical  Arts  Building, 

Redlands Third  District 

Frfd  R.  DeLappe  ( 1932),  218  Beaty  Building,  1024 
J Street,  Modesto Fourth  District 


Alfred  L.  Phillips  ( 193  3 ),  Farmers  and  Merchants  Bank 

Building,  Santa  Cruz Fifth  District 

Walter  B.  Coffey  ( 193  1 ),  501  Medical  Building,  909 

Hyde  Street,  San  Francisco Sixth  District 

Oliver  D.  Hamlin  ( 1932)  Chairman,  Federal  Realty 

Building,  Oakland Seventh  District 

Robert  A.  Peers  ( 1933  ),  Colfax  -Eighth  District 

Henry  S.  Rogers  (1931),  Petaluma Ninth  District 


COUNCILORS-AT-LARGE 


George  G.  Hunter  ( 1932),  910  Pacific  Mutual  Building, 
523  West  6th  Street,  Los  Angeles. 

Ruggles  A.  Cushman  ( 193  3 ),  632  North  Broadway, 
Santa  Ana. 

George  H.  Kress  ( 193  1 ),  245  Bradbury  Building,  304 
South  Broadway,  Los  Angeles. 


Joseph  Catton  ( 1932),  825  Medico-Dental  Building, 
490  Post  Street,  San  Francisco. 

T.  Henshaw  Kelly  ( 193  3 ),  8 30  Medico-Dental  Build- 
ing, 490  Post  Street,  San  Francisco. 

Edward  N.  Ewer  ( 193  1 ),  25  1 Moss  Avenue,  Oakland. 


STANDING  COMMITTEES 


Executive  Committee 

The  President,  the  President-Elect,  the  Speaker 
of  the  House  of  Delegates,  the  Secretary-Treasurer, 
the  Editor,  and  the  Chairman  of  the  Auditing  Com- 
mittee. 

Committee  on  Associated  Societies  and 


Technical  Groups 

George  H.  Kress,  Los  Angeles 1933 

Harold  A.  Thompson,  San  Diego 1932 

William  Bowman,  Los  Angeles 1931 

Committee  on  Extension  Lectures 

Robert  A.  Peers,  Colfax 1933 

James  F.  Churchill,  San  Diego 1932 

Robert  T.  Legge,  Berkeley 1931 

The  Secretary  Ex-officio 

Committee  on  Health  and  Public  Instruction 

Henry  S.  Rogers,  Petaluma 1933 

Fred  B.  Clarke  (Chairman),  Long  Beach 1932 

Gertrude  Moore,  Oakland 1931 

Committee  on  Hospitals,  Dispensaries  and  Clinics 

Gayle  G.  Moseley,  Redlands 1933 

John  C.  Ruddock,  Los  Angeles 1932 

Walter  B.  Coffey,  San  Francisco 1931 

Committee  on  Industrial  Practice 

Mott  H.  Arnold,  San  Diego 1933 

Packard  Thurber,  Los  Angeles 1932 

Ross  W.  Harbaugh,  San  Francisco 1931 

Committee  on  Medical  Economics 

Ruggles  A.  Cushman,  Santa  Ana 1933 

John  H.  Graves  (Chairman),  San  Francisco 1932 

Joseph  M.  King,  Los  Angeles 1931 

Committee  on  Medical  Education  and  Medical 
Institutions 

George  G.  Hunter,  Los  Angeles 1933 

George  Dock,  Pasadena 1932 

H.  A.  L.  Ryfkogel,  San  Francisco 1931 


Committee  on  Medical  Defense 


Fred  R.  DeLappe,  Modesto 1933 

George  G.  Reinle,  Oakland 1932 

J.  L.  Maupin,  Sr.,  Fresno 1931 

Jesse  W.  Barnes,  Stockton 1933 

Harlan  Shoemaker,  Los  Angeles 1932 

LeRoy  Brooks,  San  Francisco 1931 

The  Secretary  Ex-officio 

Committee  on  Membership  and  Organization 

Committee  on  History  and  Obituaries 

Emmet  Rixford,  San  Francisco 1933 

Charles  D.  Ball,  Santa  Ana 1932 

Percy  T.  Phillips,  Santa  Cruz 1931 

The  Secretary  Ex-officio 

The  Editor  Ex-officio 


Committee  on  Publications 

Frederick  F.  Gundrum,  Sacramento 1933 

Morton  R.  Gibbons,  San  Francisco 1932 

Percy  T.  Magan,  Los  Angeles 1931 

The  Secretary  Ex-officio 

The  Editor Ex-officio 

Committee  on  Public  Policy  and  Legislation 

Joseph  Catton,  San  Francisco 1933 

Junius  B.  Harris  (Chairman),  Sacramento 1932 

William  Duffield,  Los  Angeles 1931 

The  President  Ex-officio 

The  President-Elect  Ex-officio 

Committee  on  Scientific  Work 

Emma  W.  Pope  (Chairman),  San  Francisco 

Francis  M.  Pottenger,  Monrovia 1933 

Karl  Schaupp,  San  Francisco 1932 

Lemuel  P.  Adams,  Oakland 1931 


Verne  R.  Mason,  Sec’y  Sect.  Med.,  Los  Angeles....  1931 
Clarence  E.  Rees,  Sec’y  Sect.  Surg.,  San  Diego.. 1931 


Index — California  and  Western  Medicine,  Volume  XXXII 

January  to  June,  1929 


California  and  Western  Medicine  is 
annually  issued  in  two  volumes:  the 
first  from  January  to  June,  inclusive; 
and  the  second  from  July  to  December, 
inclusive. 

Arrangement  of  Index 

This  index  is  arranged  under  the 
following  heads: 

I.  Key  to  Abbreviations. 

II.  Authors. 

III.  Subject  Index. 

IV.  Lure  of  Medical  History. 

V.  Editorials. 

VI.  Bedside  Medicine. 

VII.  California  Medical  Association, 
(a)  Component  County  Societies. 

VIII.  Nevada  State  Medical  Associa- 
tion. 

(a)  Component  County  Societies. 

IX.  Utah  State  Medical  Association, 
(a)  Component  County  Societies. 

X.  Deaths. 

XI.  Miscellany. 

XII.  Book  Reviews. 

XIII.  Index  to  Board  of  Medical  Ex- 
aminers’ News  Items. 

American  Medical  Association 
Quarterly  Cumulative  Index 

Note:  Members  who  wish  to  consult 
a general  medical  index  are  referred 
to  the  Quarterly  Cumulative  Index  of 
the  American  Medical  Association. 


I.  KEY  TO  ABBREVIATIONS 

Add. — Address. 

Or. — Original  Article. 

C.  R.— Case  Report. 

B.  M. — Bedside  Medicine. 

Ed. — Editorial. 

M.  T. — Medicine  Today. 

C.  N.- — Clinical  Notes. 

L.  M.  H. — Lure  of  Medical  History. 


* * * 


II.  AUTHORS 
A 

Althausen,  T.  L. — Present  Status  of 
Liver  Extract  Tests  (M.  T.),  54. 

Askey,  E.  Vincent — Intravenous  In- 
fusion of  Glucose  With  Report  of 
Anaphylactoid  Reaction  (Or.),  394. 

Askey,  John  Martin  — The  Specific 
Gravity  of  the  Blood  (C.  N.),  184; 
Bacillus  Pyocyaneus  Septicemia  (C. 
R.),  352. 

Ayres,  Samuel,  Jr. — Eczema  — Some 
Recent  Contributions  to  Its  Study 
(Or.),  153. 


B 

Babington,  Suren  H. — Phenobarbital — 
Rash  and  Other  Toxic  Effects 
(C.  R.),  114. 

Ball,  Howard  A. — Human  Torula  In- 
fection— A Review  (Or.),  338. 

Baltimore,  Louis  — Neurocirculatory 
Asthenia  (M.  T.),  196. 

Bartlett,  Edwin  I. — The  Lump  in  the 
Breast  (B.  M.),  115. 

Baxter,  Donald  E. — Anesthetic  Gases 
(Or.),  349. 

Blevins,  W.  J. — Rupture  of  Uterus 
(C.  R.),  111. 

Braddock,  William  R.  — “Biter  Bit” 
(Or.),  140. 

Brooks,  LeRoy. — Postoperative  Treat- 
ment Following  Abdominal  Opera- 
tions (B.  M.),  354. 

Burger,  Thomas  O.  — Postoperative 
Treatment  Following  Abdominal 
Operations  (B.  M.),  355. 

Burrows,  M.  T. — The  Lump  in  the 
Breast  (B.  M.),  115. 

Butler,  Edmund — Treatment  of  An- 
aerobic Toxemia  in  Bowel  Obstruc- 
tion and  Peritonitis  (M.  T.),  196;  In- 
fection of  Abdominal  Wall  with  B. 
Welchii  Following  Enterostomy  for 
Bowel  Obstruction  (Or.),  248. 


C 

Campbell,  H.  Sutherland  — - Indirect 
Treatment  of  a Presumably  Syphi- 
litic Child  by  Maternal  Therapy 
During  Lactation  (Or.),  231. 

Cheney,  Garnett — Stramonium  Treat- 
ment of  Chronic  Encephalitis  (M.  T.), 
54. 

Christian,  Henry  A. — Chronic  Non- 
valvular  Heart  Disease — Its  Causes, 
Diagnosis,  and  Treatment  (Or.), 
320. 

Clark,  Thomas  J. — Scabies  and  Its 
Complications  (Or.),  26. 

Clarke,  R.  Manning — Ectopic  Ventricu- 
lar Tachycardia  (C.  R.),  252. 

Clary,  Lloyd  A.— Rectovaginal  Fistula 
in  Infancy  (C.  R.),  413. 

Codellas,  Pan  S. — The  Evolution  of 
Melotherapy,  Music  in  the  Cure  of 
Disease  (L.  M.  H.),  411. 

Coffey,  Robert  C. — Treatment  of  Can- 
cer— Present-Day  Rationale  (Or.), 
313. 

Cook,  E.  P. — Bronchopneumonia  in 
Early  Childhood  (Or.),  170. 

Cooke,  A.  B. — The  Cost  of  Medical 
Care  and  Hospitalization  (Or.),  73; 
Sodium  Amytal  in  Thyroid  Surgery 
(M.  T.),  362. 

Cooper,  Charles  Minor — The  Future  of 
Medical  Practice — Medical  Service 
Organizations  (Or.),  148. 

Costolow,  William  E. — Carcinoma  of 
the  Uterus — Its  Treatment  by  Radi- 
ation (Or.),  95. 

Courville,  Cyril  B. — Pituitary  Tumors 
and  Diabetes  Insipidus  (M.  T.),  420. 

Craig,  Robert  Glenn — Bladder  Care 
After  Abdominal  Operations  (Or.), 
162. 


Creveling,  Earle  L.— Toxic  Amblyopia 
(C.  R.),  110. 

D 


Desjardins,  Arthur  U.— The  Value  of 
Radiotherapy  in  Mediastinal  Tumors 
(Or.),  377. 

Dickey,  Lloyd  B.— A Tuberculosis 
Clinic  for  Children  (Or.),  90;  The 
Treatment  of  Juvenile  Tuberculosis 
(B.  M.),  414. 

Dock,  William— The  Causes  of  Angina 
Pectoris  (B.  M.),  45. 

Dolley,  Frank  S. — The  Diagnosis  and 
Treatment  of  Lung  Abscess  (Or.), 
28;  Local  Compression  Therapy  in 
the  Treatment  of  Pulmonary  Tuber- 
culosis (B.  M.),  256. 


Du  Puy,  Clarence  A. — Pelvic  Inflam- 
matory Disease  (B.  M.),  187. 


E 


Ebright,  George  E. — Clam  and  Mussel 
Poisoning  (Or.),  382. 


Evans,  Herbert  M.— Aschheim-Zondek 
lest  for  Pregnancy  (Or.),  145. 


Evans,  Newton — Kahn  Precipitation 
Test  for  Syphilis  (Or.),  24. 


Ewer,  Edward  N.— Pelvic  Inflamma- 
tory Disease  (B.  M.),  187. 


F 

Faulkner,  William  B.— Local  Com- 
pression Therapy  in  the  Treatment 
of  Pulmonary  Tuberculosis  (B.  M.), 


Fist,  Harry  S.— Obstetrical  Analgesia 
(Or.),  331. 

Frost,  Kendal — Indirect  Treatment  of 
a Presumably  Syphilitic  Child  by 
Maternal  Therapy  During  Lactation 
(Or.),  231. 


G 

Geiger,  J.  C. — Epidemic  Cerebrospinal 
Fever  on  the  Pacific  Coa^st  (Or.), 


Gibbons,  Morton  R. — Problems  Con- 
fronting the  Medical  Profession 
(Add.),  305. 

Glaser,  Mark  Albert— Surgical  and 
Nonsurgical  Facial  Neuralgia  (Or.), 
174. 

Godwin,  Dean  E.— Sphenoiditis.  Its 
Diagnosis  and  Treatment  (Or.),  402. 

Gundrum,  F.  F.— Mercury  “Rubs”  (M. 
T.),  422. 


H 

Haas,  S.  L. — Free  Fascial  Grafts — 
Their  Union  With  Muscle  (Or.),  387. 

Haggard,  R.  E. — Fractures  of  the 
Spine  (Or.),  325. 

Hall,  Ernest  M. — Intravenous  Infusion 
of  Glucose — With  Report  of  Anaphy- 
lactoid Reaction  (Or.),  394. 

Happ,  William  M. — The  Treatment  of 
Juvenile  Tuberculosis  (C.  R.),  415. 

Harbaugh,  R.  W. — Fractures  of  the 
Spine  (Or.),  325. 


Harbridge,  Delamere  F. — Capsulotomy 
Method  of  Lens  Extraction  (Or.), 
158. 

Hartman,  Howard  R. — Medical  Care 
of  Peptic  Ulcer,  5. 

Hayes,  E.  W.— Tuberculosis  in  School 
Children  (Or.),  178. 

Herzikoff,  Sam — Apparatus  Used  in 
Treatment  of  Fractures  of  the  Pelvis 
(C.  N.),  252. 

Hinman,  Frank — The  Teaching  of 
Perineal  Prostatectomy  (Or.),  13; 

Experimental  Perfusion  of  the  Frog’s 
Kidney  (M.  T.),  420. 


I-J 


Iannfe,  Charles  L.— Childhood  Tuber- 
culosis— Its  Treatment  (Or.),  334. 

Jacobs,  S.  Nicholas — Extensive  Frac- 
ture of  the  Skull  (C.  R.),  40. 

* 

K 


Katz,  Benjamin — New  Theories  About 
Common  Colds  (M.  T.),  198. 

Kilgore,  Alson — The  Lump  in  the 
Breast  (B.  M.),  115. 

King,  Joseph  M. — The  Causes  of  An- 
gina Pectoris  (B.  M.),  43. 


L 


Langley,  Robert  William — The  Causes 
of  Angina  Pectoris  (B.  M.),  43. 

Lanphere,  Grant  H. — Peptic  Ulcer — Its 
Management  (Or.),  237. 

Larson,  E.  Eric — A Rare  Sequel  to 
Gastro -Enterostomy  (C.  N.),  183. 

Leake,  Chauncey  D. — A Note  on  the 
Medical  Books  of  Famous  Printers, 
36. 

M 


Maner,  George  D. — Systemic  Blasto- 
mycosis (Or.),  87. 

Manwaring,  W.  M. — Synthetic  Diph- 
theria Antitoxin  (M.  T.),  124;  Para- 
doxical Culture  Media  (M.  T.),  362. 

Martin,  James  Raymond — Anesthesia 
for  Children  (Or.),  93. 

Mason,  V.  R. — Intestinal  Obstruction 
(Or.),  1. 

Matzger,  Edward — Diseases  of  Human 
Hypersensitiveness  (Or.),  409. 

Mentzer,  Stanley  H. — Surgical  Catas- 
trophes Following  Overlooked  Stone 
(C.  R. ),  42;  Acute  Cholecystitis — Its 
Surgical  Treatment  (Or.),  224. 

Mills,  Lloyd — Intracapsular  Cataract 
Operations  (Or.),  405. 


N 


Neile,  Olga  — Self  - Retaining  Intra- 
uterine Pessary  (C.  R.),  41. 

Newman,  William  W. — Quinidin — Some 
Toxic  Effects  (Or.),  398. 


O 


Ostroff,  Robert  A. — Duodenal  Ulcer — 
Its  Surgical  Treatment  (Or.),  346. 


P 


Parker,  Wilbur  B. — Urology  — Some 
General  Observations  (Or.),  165. 

Pierson,  Philip  H. — Local  Compression 
Therapy  in  the  Treatment  of  Pulmo- 
nary Tuberculosis  (B.  M.),  257. 

Pitkin,  Horace  C. — Stenosing  Tendo- 
vaginitis of  De  Quervain  (Or.),  101. 


Porter,  Langley — Hippocratic  Medicine 
(L.  M.  H.),  Part  I,  181;  Part  II,  249; 
Part  III,  350. 

Pottenger,  F.  M. — Pulmonary  Tuber- 
culosis (Or.),  9;  Acute  Articular 

Rheumatism  as  Allergic  Manifesta- 
tion (M.  T.),  125;  Local  Compression 
Therapy  in  the  Treatment  of  Pulmo- 
nary Tuberculosis  (B.  M.),  257. 

Potts,  John  E. — Servicitis  (M.  T.),  422. 


R 


Read,  J.  Marion — The  Causes  of  An- 
gina Pectoris  (B.  M.),  45. 

Rhodes,  George  H. — Infection  of  Ab- 
dominal Wall  with  B.  Welchii  Fol- 
lowing Enterostomy  for  Bowel  Ob- 
struction (Or.),  248. 

Riach,  May  Turner — Glaucoma — Some 
Surgical  Considerations  (Or.),  242. 

Rothman,  Phillip  E. — Parenteral  In- 
fections and  Infantile  Diarrhea 
(M.  T.),  123. 


S 


Sanderson,  George  H. — Postoperative 
Treatment  Following  Abdominal 
Operations  (B.  M.),  356. 

Schaupp,  Karl  L. — Pelvic  Inflamma- 
tory Disease  (B.  M.),  187. 

Schiffbauer,  H.  E. — Indications  for 
Surgery  in  Pulmonary  Tuberculosis 
(Or.),  245. 

Scholtz,  Moses — Blood  Chemistry  in 
Diseases  of  the  Skin  (M.  T.),  421. 

Sciaroni,  George  H. — Surgical  Treat- 
ment of  Staphylococcus  Meningitis 
(C.  R.),  186. 

Shaw,  H.  N. — Pelvic  Inflammatory  Dis- 
ease (B.  M.),  187. 

Simpson,  Miriam  E. — Aschheim-Zon- 
dek  Test  for  Pregnancy  (Or.),  145. 

Smith,  Wilburn — Superior  Mesenteric 
Thrombosis  (Or.),  308. 

Soiland,  Albert  — - Carcinoma  of  the 
Uterus — Its  Treatment  by  Radiation 
(Or.),  95. 

Spiro,  Harry — The  Causes  of  Angina 
Pectoris  (B.  M.),  44;  Quinidin — Some 
Toxic  Effects  (Or.),  398. 

Stafford,  Henry  E. — The  Child  Who 
Will  Not  Eat  (Or.),  18. 

Stevens,  William  E. — Foreign  Bodies 
in  the  Ureter  (Or.),  104. 

Stibbens,  Frank  H. — Scabies  and  Its 
Complications  (Or.),  26. 

Sweet,  Clifford — Acute  Upper  Respira- 
tory Tract  Infection  (Or.),  74;  The 
Treatment  of  Juvenile  Tuberculosis 
(B.  M.),  414. 


T 

Taussig,  Lawrence  R. — Long  X-Rays 
in  Dermatology  (Or.),  166. 

Tedstrom,  Milo  K. — Hemochromatosis 
(Or.),  102. 

Templeton,  H.  J. — Modern  Advances 
in  the  Therapy  of  Syphilis  (M.  T.), 
361. 

Thayer,  W.  S. — Thoughts  on  Angina 
Pectoris  (Or.),  217. 

Thomas,  Roy  E. — The  Immunobiologic 
Reaction  in  Tuberculosis  (Or.),  385. 

Tollefson,  Donald  E. — Blood  Sedimen- 
tation Test  (Or.),  20. 

Trauner,  Lawrence  M. — Extensive 
Fracture  of  the  Skull  (C.  R.),  40. 


V 

Viko,  L.  E. — Heart  Disease — Its  Mod- 
ern Diagnosis  (Or.),  78. 

Von  Geldern,  Hans — Carcinoma  of  the 
Cervix  (Or.),  32. 


W 

Waitzfelder,  Frederic — I ncreasing 
Weight  in  the  Nondiabetic  by  Means 
of  Insulin  (M.  T.),  197. 

Watkins,  James  T. — Stenosing  Tendo- 
vaginitis of  De  Quervain  (Or.),  101. 

Weymann,  M.  F. — Chronic  Dacryocys- 
titis (M.  T.),  53. 

White,  Lawrence  F. — Incomplete  In- 
version of  Uterus  with  Subsequent 
Pregnancies  (C.  R.),  254. 

Woods,  Donald  K. — The  Treatment  of 
Juvenile  Tuberculosis  (B.  M.),  415. 

Wright,  Burnett  W. — Injuries  of  the 
Urogenital  Tract  (Or.),  240. 


III.  SUBJECT  INDEX 


A 

Acute  Articular  Rheumatism  as  Aller- 
gic Manifestation— F.  H.  Pottenger 
(M.  T.),  125. 

Acute  Cholecystitis  — Its  Surgical 
Treatment  — Stanley  H.  Mentzer 
(Or.),  224. 

Acute  Upper  Respiratory  Tract  Infec- 
tion— Clifford  Sweet  (Or.),  74. 

Analgesia,  Obstetrical — Harry  S.  Fist, 
(Or.),  331. 

Anesthesia  for  Children — James  Ray- 
mond Martin  (Or.),  93. 

Anesthetic  Gases — -Donald  E.  Baxter 
(Or.),  349. 

Angina  Pectoris,  Thoughts  on — W.  S. 
Thayer  (Or.),  217. 

Apparatus  Used  in  Treatment  of  Frac- 
tures of  the  Pelvis — Samuel  Herzi- 
koff (C.  N.).  252. 

A Rare  Sequel  to  Gastro-Enteros- 
tomy — E.  Eric  Larson  (C.  N.),  183. 

Aschheim-Zondek  Test  for  Pregnancy 
— Herbert  M.  Evans  and  Miriam  E. 
Simpson  (Or.),  145. 


B 

Bacillus  Pyocyaneus  Septicemia — John 
Martin  Askey  (C.  R.),  352. 

“Biter  Bit’’ — William  R.  Braddock 
(Or.),  140. 

Bladder  Care  After  Abdominal  Opera- 
tions— Robert  Glenn  Craig  (Or.),  162. 

Blood  Picture  in  Hodgkin’s  Disease — 
Ernest  H.  Falconer  (Or.),  83. 

Blood  Sedimentation  Test — Donald  G. 
Tollefson  (Or.),  20. 

Bronchopneumonia  in  Early  Childhood 
— Its  Treatment — E.  P.  Cook  (Or.), 
170. 


C 

Cancer,  Treatment  of — Present-Day 
Rationale — Robert  C.  Coffey  (Or.), 
313. 

Capsulotomy  Method  of  Lens  Extrac- 
tion— Delamere  F.  Harbridge  (Or.), 
158. 

Carcinoma  of  the  Cervix — Its  Surgical 
Treatment — Hans  von  Geldern  (Or.), 
32. 

Carcinoma  of  the  Uterus — Its  Treat- 
ment by  Radiation — Albert  Soiland 
and  William  E.  Costolow  (Or.),  95. 


Cerebrospinal  Fever,  Epidemic,  on  the 
Pacific  Coast — J.  C.  Geiger  (Or.), 
322. 

Cervix  Carcinoma — Its  Surgical  Treat- 
ment— Hans  von  Geldern  (Or.),  32. 

Childhood  Bronchopneumonia— Its 
Treatment — E.  P.  Cook  (Or.),  170. 

Childhood  Tuberculosis — Its  Treatment 
Charles  L.  IannS  (Or.),  334. 

Cholecystitis,  Acute  — Its  Surgical 

Treatment  — Stanley  H.  Mentzer 

(Or.),  224. 

Chronic  Dacryocystitis — M.  F.  Wey- 
mann  (M.  T.),  53. 

Chronic  Nonvalvular  Heart  Disease — 
Its  Causes,  Diagnosis,  and  Manage- 
ment— -Henry  A.  Christian  (Or.),  320. 

Clam  and  Mussel  Poisoning — George 
E.  Ebright  (Or.),  382. 

Cost  of  Medical  Care  and  Hospitali- 
zation— A.  B.  Cooke  (Or.),  73. 


D 


Dermatology,  Long  X-Rays  in— Law- 
rence R.  Taussig  (Or.),  166. 

Descartes  Was  Right.  Part  1.  Reprint 
from  A.  M.  A.  Bulletin — Harry  M. 
Hall,  135,  210. 

Diagnosis  and  Treatment  of  Lung  Ab- 
scess— Frank  S.  Dolley  (Or.),  28. 

Diseases  of  Human  Hypersensitive- 
ness— Edward  Matzger  (Or.),  409. 

Duodenal  Ulcer — Its  Surgical  Treat- 
ment— Robert  A.  Ostroff  (Or.),  346. 


E 


Ectopic  Ventricular  Tachycardia — R. 
Manning  Clarke  (C.  R.),  252. 

Eczema — Some  Recent  Contributions 
to  Its  Study— Samuel  Ayres,  Jr. 
(Or.),  153. 

Epidemic  Cerebrospinal  Fever  on  the 
Pacific  Coast — J.  C.  Geiger  (Or.), 
322. 

Extensive  Fracture  of  the  Skull — S. 
Nicholas  Jacobs  and  Lawrence  M. 
Trauner  (C.  R.),  40. 


F 

Facial  Neuralgia — Surgical  and  Non- 
surgical — Mark  Albert  Glaser  (Or.), 
174. 

Foreign  Bodies  in  the  LTreter — William 
E.  Stevens  (Or.),  104. 

Fractures  of  the  Spine — R.  W.  Har- 
baugh  and  R.  E.  Haggard  (Or.),  325. 

Free  Fascial  Grafts — Their  Union  With 
Muscle— S.  L.  Haas  (Or.),  387. 

Future  of  Medical  Practice — Medical 
Service  Organizations — C.  M.  Cooper 
(Or.),  148. 


G 


Glaucoma — Some  Surgical  Considera- 
tions— May  Turner  Riach  (Or.),  242. 

Godwin,  Dean  E. — Sphenoiditis — Its 
Diagnosis  and  Treatment  (Or.),  102. 


H 

Heart  Disease,  Chronic  Nonvalvular — 
Its  Causes,  Diagnosis,  and  Treat- 
ment— Henry  A.  Christian  (Or.),  320. 

Heart  Disease — Its  Modern  Diagnosis 
— L.  E.  Viko  (Or.),  78. 


Hemochromatosis — Milo  K.  Tedstrom 

(Or.),  102. 

Hippocratic  Medicine — Langley  Porter 
(L.  M.  H.),  Part  I,  181;  Part  II,  249; 
Part  III,  350. 

Hodgkin’s  Disease — The  Blo.od  Picture 
in — Ernest  H.  Falconer  (Or.),  83. 

Human  Torula  Infection — A Review — 
Howard  A.  Ball  (Or.),  338. 


I 

Immunobiologic  Reaction  in  Tubercu- 
losis— Roy  E.  Thomas  (Or.),  385. 

Incomplete  Inversion  of  Uterus  with 
Subsequent  Pregnancy — Lawrence  F. 
White  (C.  R.),  254. 

Increasing  Weight  in  the  Nondiabetic 
by  Means  of  Insulin — Frederic  Waitz- 
felder  (M.  T.),  197. 

Indications  for  Surgery  in  Pulmonary 
Tuberculosis  — H.  E.  Schiffbauer 
(Or.),  245. 

Indirect  Treatment  of  a Presumably 
Syphilitic  Child — By  Maternal  Ther- 
apy During  Lactation — H.  Suther- 
land Campbell  and  Kendal  Frost 
(Or.),  231. 

Infection  of  Abdominal  Wall  with 
B.  Welchii  Following  Enterostomy 
for  Bowel  Obstruction  — Edmund 
Butler  and  George  H.  Rhodes  (Or.), 

248. 

Injuries  of  the  Urogenital  Tract — Bur- 
nett W.  Wright  (Or.),  240. 

Intestinal  Obstruction- — V.  R.  Mason 
(Or.),  1. 

Intracapsular  Cataract  Operations — 
Lloyd  Mills  (Or.),  405. 

Intravenous  Infusion  of  Glucose — With 
Report  of  Anaphylactoid  Reaction — 
E.  Vincent  Askey  and  Ernest  M. 
Hall  (Or.),  394. 

Intra-Uterine  Pessary,  Self-Retain- 
ing— Olga  Neile  (C.  R.),  41. 


K 

Kahn  Precipitation  Test  for  Syphilis — 
Newton  Evans  (Or.),  24, 


L 

Lens  Extraction — Capsulotoniy  Method 
— Delamere  F.  Harbridge  (Or.),  158. 

Long  X-Rays  in  Dermatology— Law- 
rence R.  Taussig  (Or.),  166. 

Lung  Abscess,  Diagnosis  and  Treat- 
ment— Frank  S.  Dolley  (Or.),  28. 


M 

Mediastinal  Tumors — Value  of  Radio- 
therapv  in — Arthur  U.  Desjardins 
(Or.),  377. 

Medical  Books  of  Famous  Printers— 
Chauncey  D.  Leake  (L.  M.  H.),  Part 
I,  36;  Part  II,  106. 

Medical  Care  of  Peptic  Ulcer — Howard 
R.  Hartman  (Or.),  5. 

Medical  Service  Organizations — The 
Future  of  Medical  Practice — C.  M. 
Cooper  (Or.),  148. 

Modern  Advances  in  the  Therapy  of 
Syphilis — H.  J.  Templeton  (M.  T.), 
361. 


N 

Neurocirculatory  Asthenia  — Louis 
Baltimore  (M.  T.),  196. 


New  Theories  About  Common  Colds — 
Benjamin  Katz  (M.  T.),  198. 


O 


Obstetrical  Analgesia — Harry  S.  Fist 
(Or.),  331. 


P 


Paradoxical  Culture  Media — -W.  H. 
Man  waring  (M.  T.),  362. 

Parenteral  Infections  and  Infantile 
Diarrhea — Philip  E.  Rothman  (M. 
T.),  123. 

Peptic  Ulcer — Its  Management — Grant 
H.  Lanphere  (Or.),  237. 

Peptic  Ulcer — -Medical  Care  of— How- 
ard R.  Hartman  (Or.),  5. 

Perineal  Prostatectomy  The  Teaching 
of — Frank  Hinman  (Or.),  13. 

Phenobarbital — Rash  and  Other  Toxic 
Effects — Suren  H.  Babington  (C.  R.), 
114. 

Pregnancy  Test,  Aschheim-Zondek — 
Herbert  M.  Evans  and  Miriam  E. 
Simpson  (Or.),  145. 

Present  Status  of  Liver  Function 
Tests — T.  L.  Althausen  (M.  T.), 

Part  I,  54;  Part  II,  124. 

Problems  Confronting  the  Medical  Pro- 
fession— Morton  R.  Gibbons  (Add.), 
305. 

Prostatectomy,  Perineal — The  Teach- 
ing of — Frank  Hinman  (Or.),  13. 

Pulmonary  Tuberculosis — F.  M.  Pot- 
tenger  (Or.),  9. 

Pulmonary  Tuberculosis — Indications 
for  Surgery — H.  E.  Schiffbauer  (Or.), 
245. 


Q 


Quinidin — Some  Toxic  Effects — Harry 
Spiro  and  William  W.  Newman 
(Or.),  398. 


R 


Radon  in  Cancer  of  the  Esophagus — 
H.  J.  Hara  (M.  T.),  362. 

Rectovaginal  Fistula  in  Infancy — Lloyd 
A.  Clary  (C.  R.),  413. 

Respiratory  Tract  Infection  — Acute 
Upper  — Clifford  Sweet  (Or.),  74. 

Rupture  of  Uterus — W.  J.  Blevins 
(C.  R.),  111. 


S 


Scabies  and  Its  Complications— 
Thomas  J.  Clark  and  Frank  H. 
Stibbens  (Or.),  26. 

Sedimentation  Test,  Blood — Donald  E. 
Tollefson  (Or.),  20. 

Sodium  Amytal  in  Thyroid  Surgery — 
A.  B.  Cooke  (M.  T.),  362. 

Specific  Gravity  of  the  Blood— John 
Martin  Askey  (C.  N.),  184. 

Sphenoiditis — Its  Diagnosis  and  Treat- 
ment— Dean  E.  Godwin  (Or.),  402. 

Stenosing  Tendovaginitis  of  De  Quer- 
vain — James  T.  Watkins  and  Horace 
C.  Pitkin  (Or.),  101. 

Stramonium  Treatment  of  Chronic  En- 
cephalitis— Garnett  Cheney  (M.  T.), 
54. 

Superior  Mesenteric  Thrombosis — Wil- 
burn Smith  (Or.),  308. 


Surgical  and  Nonsurgical  Facial  Neu- 
ralgia— Mark  Albert  Glaser  (Or.), 
174. 

Surgical  Catastrophes  Following  Over- 
looked Stone — Stanley  H.  Mentzer 
(C.  R.),  42. 

Surgical  Treatment  of  Duodenal  Ulcer 
— Robert  A.  Ostroff  (Or.),  346. 

Surgical  Treatment  of  Staphylococcus 
Meningitis — George  H.  Sciaroni  (C. 
R.),  186. 

Synthetic  Diphtheria  Antitoxin — W.  H. 
Manwaring  (M.  T.),  124. 

Syphilitic  Child  — Maternal  Therapy 
During  Lactation  — H.  Sutherland 
Campbell  and  Kendal  Frost  (Or.), 
231. 

Systemic  Blastomycosis  — • George  D. 
Maner  and  Roy  W.  Hammack  (Or.), 
87. 


T 


Teaching  of  Perineal  Prostatectomy- 
Frank  Hinman  (Or.),  13. 

Test  for  Syphilis — Kahn  Precipitation 
— Newton  Evans  (Or.),  24. 

The  Child  Who  Will  Not  Eat— Henry 
E.  Stafford  (Or.),  IS. 

Thoughts  on  Angina  Pectoris — W.  S. 
Thayer  (Or.),  217. 

Thrombosis,  Superior  Mesenteric — 
Wilburn  Smith  (Or.),  308. 

Torula  Infection,  Human — A Review — 
Howard  A.  Ball  (Or.),  338. 

Toxic  Amblyopia — Earle  L.  Creveling 
(C.  R.),  110. 

Treatment  of  Anaerobic  Toxemia  in 
Bowel  Obstruction  and  Peritonitis— 
Edmund  Butler  (M.  T.),  196. 

Treatment  of  Cancer — Present-Day 
Rationale— Robert  C.  Coffey  (Or.), 
313. 

Tuberculosis,  Childhood — Its  Treat- 
ment— Charles  L.  Ianne  (Or.),  334. 

I . 

Tuberculosis  Clinic  for  Children — Lloyd 
B,  Dickey  (Or.),  90. 

Tuberculosis  in  School  Children — E.  W. 

r Hayes  (Or.),  178. 


U 


Ulcer,  Peptic — Medical  Care  of — How- 
ard R.  Hartman  (Or.),  5. 

Urology — Some  General  Observations — 
Wilbur  B.  Parker  (Or.),  165. 


V 

Value  of  Radiotherapy  in  Mediastinal 
Tumors — Arthur  U.  Desjardins  (Or.), 
377. 


IV.  LURE  OF  MEDICAL  HISTORY 

A Note  on  the  Medical  Books  of  Fa- 
mous Printers — Chauncey  D.  Leake, 
Part  I,  36;  Part  II,  106. 

Hippocratic  Medicine — Langley  Porter, 
Part  I,  181;  Part  II,  249;  Part  III, 
350. 

The  Evolution  of  Melotherapy,  Music 
in  the  Cure  of  Disease — Pan  S.  Co- 
dellas,  411. 


V.  EDITORIALS 

Back  to  Nature  for  Discoveries  in  Sci- 
ence, (Ed.),  359. 


California  Acquires  Two  Foundations 
for  Cancer  Research — The  First  at 
Los  Angeles  and  the  Second  at  San 
Francisco  (Ed.),  360. 

Comments  on  Some  Work  Phases  of 
the  1930  Del  Monte  Fifty-ninth  An- 
nual Session  of  the  C.  M.  A.  (Ed.), 
417. 

Construction  and  Maintenance  Costs 
in  the  New  Unit  of  the  Los  Angeles 
County  General  Hospital — What  of 
Ultimate  Results  (Ed.),  193. 

Difficulties  Met  with  in  Trying  to  Edu- 
cate Citizens  Concerning  Quackery 
(Ed.),  119. 

Dr.  Holman  of  Stanford  Is  Awarded 
the  Samuel  D.  Gross  Prize  (Ed.), 
419. 

Does  Los  Angeles  County  Hospital 
Extension  Into  Private  Hospitals 
Constitute  a Menace  to  Medical 
Practice  (Ed.),  117. 

Epidemic  Cerebrospinal  Fever  (Ed.), 
359. 

Individualism  and  the  Group  Spirit  in 
the  Practice  of  Medicine  (Ed.),  51. 

Influence  of  “Pre-Convention  Bulletin" 
at  Del  Monte  Session  (Ed.),  416. 

Mary  Baker  Eddy — A Letter  and  a 
Book  Review  (Ed.),  52. 

Narcotic  Prescriptions — California  Nar- 
cotic Laws — Federal  Narcotic  Act — 
Proposed  Porter  Narcotic  Act  (Ed.), 
192. 

New  County  Society  Officers — Some  of 
Their  Problems  (Ed.),  49. 

The  C.  M.  A.  and  the  Years  1929  and 
1930  (Ed.),  47. 

The  “Cost  of  Medical  Care,”  as  Dis- 
cussed in  Some  Recent  Lay  Journals 
(Ed.),  121. 

The  Del  Monte  “Pre-Convention  Bul- 
letin”— Comments  on  Some  of  Its 
Suggestions  (Ed.),  357. 

Two  Recent  California  Researches — 
The  Aschheim- Zondek  Pregnancy 
Test  and  the  Coffey-Humber  Cancer 
Experiments  (Ed.),  190. 

William  Henry  Welch  (Ed.),  359. 


VI.  BEDSIDE  MEDICINE 

Local  Compression  Therapy  in  the 
Treatment  of  Pulmonary  Tubercu- 
losis, 257. 

Pelvic  Inflammatory  Disease,  187. 

Postoperative  Treatment  Following 
Abdominal  Operations,  354. 

The  Causes  of  Angina  Pectoris,  43. 

The  Lump  in  the  Breast,  115. 

Treatment  of  Juvenile  Tuberculosis, 
414. 

VII.  CALIFORNIA  MEDICAL 
ASSOCIATION 

California  Medical  Association,  56,  126, 
199,  284,  363,  452. 

Council  Minutes,  284,  444. 

Minutes  of  the  House  of  Delegates,  432. 

Pre-Convention  Bulletin,  423. 

Program  Annual  Meeting,  Del  Monte, 
267. 

Reports  of  Standing  Committees,  425. 

(a)  Component  County  Societies 

Alameda  County,  56,  126,  199,  363,  452. 


Contra  Costa  County,  57,  127,  200,  288, 
363,  452. 

Fresno  County,  127,  200,  289,  363,  452. 

Kern  County,  57,  200. 

Los  Angeles  County,  363. 

Marin  County,  364. 

Monterey  County,  364. 

Napa  County,  127,  289,  364,  452. 

Orange  County,  127,  201,  364,  453. 

Placer  County,  289,  453. 

Sacramento  County,  57,  290. 

San  Bernardino  County,  57,  128,  201, 
290,  453. 

San  Diego  County,  365. 

San  Joaquin  County,  57,  128,  201,  290, 
365,  454. 

San  Luis  Obispo  County,  366. 

San  Mateo  County,  58,  128,  454. 

Santa  Barbara  County,  58,  202,  366,  455 
Santa  Cruz  County,  58,  203. 

Sonoma  County,  58. 

Stanislaus  County,  129,  203. 

Tulare  County,  58,  291,  455. 

Ventura  County,  129,  203,  291,  366. 
Yolo-Colusa  Couuty,  291. 

Yuba-Sutter  County,  292. 

Woman’s  Auxiliary 

Abstract  of  A.  M.  A.  Leaflet,  60. 

Contra  Costa  County  Auxiliary,  294, 

368. 

Kern  County  Auxiliary,  62. 

Los  Angeles  County  Auxiliary,  62,  204, 

294,  368,  458. 

Minutes  of  Second  Annual  Session,  456. 
Monterey  County  Auxiliary,  368. 

Orange  County  Auxiliary,  131,  295,  368. 

San  Bernardino  County  Auxiliary,  62, 

295. 

Woman’s  Auxiliary,  60,  131,  204,  294, 
367,  456. 

VIII.  NEVADA  STATE  MEDICAL 
ASSOCIATION 

Nevada  Medical  Association,  63,  205, 

369,  459. 

(a)  Component  County  Societies 

Elko,  205. 

Washoe,  63,  205,  369,  459. 

IX.  UTAH  STATE  MEDICAL 
ASSOCIATION 

Utah  Medical  Association,  64,  131,  206, 
295,  369,  459. 

(a)  Component  County  Societies 
Carbon,  295. 

Salt  Lake,  64,  206,  296,  369,  459. 

Utah,  65,  296,  370,  460. 

Weber,  65,  296,  370. 


X.  DEATHS 

Aikin,  Ilo  Rafenel,  60. 

Barsotti,  Camillo,  203. 

Beckwith,  Ward  M.,  292. 

Berndt,  Richard  M.  H.,  60. 

Breneman,  Joseph  Truesdale,  293. 
Browning',  Frederick  William,  129. 
Bullock,  Newell  Harris,  60. 

Clark,  John  Baptist,  455. 

Davis,  Walter  Watkins,  204. 

De  Loss,  Herbert,  292. 

Draper,  Alfred  Lawrence,  129. 
Dunham,  Ora  Berton,  455. 

Edie,  Guy  Lewis,  367. 

Franklin,  James  William,  367. 

Gatchell,  Ella  Frances,  367. 

Guy,  Walter  Perry,  367. 

Hai'binson,  James  Edward,  367. 
Henrikson,  Gustav,  367. 

Jacobs,  Edward  H.,  129. 

Leavitt,  Edgar  Irving,  292. 

McArthur,  William  Taylor,  293. 
McClish,  Clark  Loring,  292. 

McDowell,  Anderson  Eddie,  367. 
McKinnon,  Wilfred  Charles,  129. 

Miller,  Allan  Percy,  292. 

Miller,  Ulysses  Grant,  60. 

Mott,  George  Hervey,  60. 

Muchnic,  Adolph  Maurice,  367. 

Munroe,  Harrington  Bennett,  129. 
Owens,  William  Dunlop,  293. 

Read,  William  Parsons,  367. 

Reynolds,  Clyde  G.,  60. 

Scholl,  Margarite  Julia,  203. 

Shiels,  John  Wilson,  129. 

Simpson,  Frank  William,  60. 

Soboslay,  Julius,  455. 

Soper,  Alexander  Coburn,  455. 
Sweeney,  George  J.,  129. 

Tate,  C.  Francis,  129. 

Thompson,  Roy  Oliver,  130. 

Zbinden,  David  Burdett,  60. 

XI.  MISCELLANY 

California  Board  of  Medical  Exam- 
iners, 71,  144,  216,  302,  375,  464. 

Correspondence,  68,  134,  209,  298. 

Department  of  Public  Health,  70,  143, 
215,  301,  374,  463. 

Medical  Economics,  67,  133,  462. 

News,  66,  132,  208,  297,  371,  461. 

Public  Policy  and  Legislation,  213. 

Twenty-Five  Years  Ago,  69,  142,  214, 
300,  373,  462. 

XII.  BOOK  REVIEWS 

A Diabetic  Manual  for  the  Mutual  Use 
of  Doctor  and  Patient,  March,  18. 

An  Introduction  to  the  Nervous  Sys- 
tem, E.  E.  Hewer  and  G.  M.  Sandes, 
January,  12;  May,  28. 


An  Introduction  to  the  Study  of 
Physic,  William  Heberden,  March,  18. 

Applied  Electrocardiography — An  In- 
troduction to  Electrocardiography 
for  Physicians  and  Students,  Aaron 
E.  Parsonnet  and  Albert  S.  Hyman, 
February,  11. 

A Practical  Treatise  on  Disorders  of 
the  Sexual  Function  in  the  Male  and 
Female,  Max  Huhner,  May,  12. 

A Primer  for  the  Tuberculous  and 
Other  Essays  on  Tuberculosis,  Robert 
A.  Peers,  May,  11. 

A Surgical  Diagnosis,  J.  Lewi  Don- 
hauser,  March,  12. 

Bodily  Changes  in  Pain,  Hunger,  Fear, 
and  Rage — An  Account  of  Recent 
Researches  Into  the  Function  of 
Emotional  Excitement,  Walter  B. 
Cannon,  March,  19. 

Clinical  Medicine  for  Nurses,  Paul  H. 
Ringer,  March,  16. 

Clinical  Obstetrics,  Paul  T.  Harper, 
January,  14;  May,  12. 

Diseases  of  the  Chest  and  the  Princi- 
ples of  Physical  Diagnosis,  George 
William  Norris  and  Henry  R.  M. 
Landis,  May,  29. 

Diseases  of  the  Thyroid  Gland,  Arthur 
E.  Hertzler,  January,  12. 

Diseases  Transmitted  From  Animal  to 
Man,  Thomas  G.  Hull,  May,  29. 

Essentials  of  Medical  Electricity,  Elkin 
P.  Cumberbatch,  May,  30. 

Gall-Bladder  Disease,  Roentgen  Inter- 
pretation and  Diagnosis,  David  S. 
Beilin,  May,  26. 

Getting  Well  and  Staying  Well — A 
Book  for  Tuberculous  Patients,  Pub- 
lic Health  Nurses  and  Doctors,  John 
Potts,  June,  12. 

Hemorrhoids:  The  Injection  Treatment 
and  Pruritus  Ani,  Lawrence  Gold- 
bacher,  January,  12;  May,  23. 

Hookworm  Disease;  Its  Distribution, 
Biology,  Epidemiology,  Diagnosis, 
Treatment  and  Control,  Asa  C. 
Chandler,  April,  18. 

Hypertension  and  Nephritis,  Arthur 
M.  Fishberg,  June,  16. 

Imperative  Traumatic  Surgery,  with 
Special  Reference  to  After-Care  and 
Prognosis,  C.  R.  G.  Forrester,  March, 
16. 

Krankheiten  und  Hygiene  der  War- 
men  Lander,  von  Prof.  Dr.  Reingold 
Ruge,  January,  14. 

Laboratory  Methods  in  the  United 
States  Army,  Charles  F.  Craig,  May, 

19. 

Materia  Medica  and  Therapeutics,  In- 
cluding Pharmacy  and  Pharmacol- 
ogy, Reynold  Webb  Wilcox,  April,  14. 

Minor  Surgery,  Frederick  Christopher, 
June,  18. 

Modern  Methods  of  Treatment,  Logan 
Clendenning,  April,  16. 

Mrs.  Eddy — The  Biography  of  a Vir- 
ginal Mind,  Edwin  Frauden  Dakin, 
January,  11. 

Outline  of  Preventive  Medicine  for 
Medical  Practitioners  and  Students, 
February,  11. 

Pathogenic  Microorganisms — A Practi- 
cal Manual  for  Students,  Physicians, 
and  Health  Officers,  William  Hal- 
lock  Park  and  Anna  Wessels  Wil- 
liams, March,  23. 


Pettibone’s  Textbook  of  Physiological 
Chemistry,  J.  F.  McClendon,  Janu- 
ary, 12;  April,  16. 

Posture  and  Hygiene  of  the  Feet, 
Philip  Lewin,  April,  18. 

Practical  Local  Anesthesia  and  Its 
Surgical  Technic,  Robert  Emmett 
Farr,  May,  19. 

Roentgenographic  Technique — A Man- 
ual for  Physicians,  Students  and 
Technicians,  Darmon  Artelle  Rhine- 
hart,  June,  12. 

Practical  Massage  and  Corrective  Ex- 
ercises with  Applied  Anatomy,  Hart- 
Vig  Nissen,  May,  14. 

Practical  Materia  Medica — An  Intro- 
ductory Text  to  the  Study  of  Phar- 
macology and  Therapeutics,  De- 
signed for  Students  of  Medicine, 
Clayton  S.  Smith  and  Helen  L. 
Wikoff,  May,  26. 

Rickets,  Including  Osteomalacia  and 
Tetany,  Alfred  F.  Hess,  February,  11. 

Selected  Readings  in  Pathology  from 
Hippocrates  to  Virchow,  Esmond  R. 
Long,  June,  16. 

Sterilization  for  Human  Betterment — - 
A Summary  of  Results  of -Six  Thou- 
sand Operations  in  California,  E.  S. 
Gosnay  and  Paul  Popenoe,  April,  11. 

Stone  and  Calculus  Disease  of  the 
Urinary  Organs,  J.  Swift  Joly,  Janu- 
ary, 12;  June,  15. 

Surgical  Diseases  of  the  Thyroid  Gland, 
E.  M.  Eberts,  June,  15. 

Surgical  and  Medical  Gynecologic 
Technic,  Thomas  H.  Cherry,  Janu- 
ary, 11. 

The  Blood  Picture  and  Its  Clinical  Sig- 
nificance (Including  Tropical  Dis- 
eases)— A Guide  Book  on  the  Micros- 
copy of  Blood,  Victor  Schilling,  June, 
11. 

The  Challenge  of  Chronic  Disease, 
Ernst  P.  Boas  and  Nicholas  Michel- 
son,  April,  12. 

The  History  of  Nursing,  James  J. 
Walsh,  March,  12. 

The  Nose,  Throat  and  Ear,  John  F. 
Barnhill,  April,  12. 

The  Nose,  Throat  and  Ear,  and  Their 
Diseases  by  American  and  European 
authors,  March,  16. 

The  Nutrition  of  Healthy  and  Sick  In- 
fants and  Children  for  Physicians 
and  Students,  E.  Nobel,  C.  Pirquet 
and  R.  Wagner,  February,  11. 


The  Pathology  of  the  Eye,  Jonas  S. 
Friedenwald,  June,  16. 

The  Science  of  Nutrition  Simplified, 
D.  D.  Rosewarne,  January,  12;  June, 
14. 

The  Treatment  of  Diabetes  Mellitus 
With  Higher  Carbohydrate  Diets, 
William  David  Sansum,  Percival 
Allen  Gray  and  Ruth  Bowden,  Feb- 
ruary, 11. 

The  Treatment  of  Varicose  Veins  in 
the  Lower  Extremities,  T.  Henry 
Treves-Barber,  May,  12. 

The  Volume  of  the  Blood  and  Plasma 
in  Health  and  Disease,  Leonard  G. 
Rowntree  and  George  E.  Brown, 
May,  14. 

William  Harvey,  Archibald  Malloch, 
March,  16. 

Your  Nose,  Throat,  and  Ears — Their 
Health  and  Care,  L W.  Oaks  and 
H.  G.  Merrill,  January,  12 


—the  pre-proxed  product 


* 

Pediatrists 

see  the  current 
number  of  youT 
Pediatric  Journals 
for  complete  an- 
nouncement and 
information  con- 
cerning the  new 

$flQ£Cg 
S e r y i c e © ~ 


In  1910,  the  idea  was  conceived  to  adapt  the  fat  of 
modified  milk  to  that  of  human  milk.  In  1913,  actual 
laboratory  work  was  begun  to  produce  a closer 
adaptation  to  breast  milk  than  had  hitherto  been 
accomplished.  The  formula  was  developed  in  1914. 
A preliminary  report  was  made  in  1915  and  a more 
extensive  and  elaborate  one  appeared  in  I9I6.  This 
was  based  on  practical  evidence  obtained  during 
an  extended  feeding  observation  with  311  cases. 
Th  is  latter  report  showed  conclusively  that  S.  M.  A. 
presented  a decided  step  forward  in  infant  feeding. 
In  November,  1 921,  S.  M.  A.  was  made  available  to 
the  medical  profession. 

S.M.A.  was,  therefore,  a pre-proved  product,  having 
eight  years  of  experimental  research  work  and  six 
years  of  clinical  observation  as  a background  before 
being  offered  to  physicians  generally  as  a diet  for 

infants  deprived  of  breast 
milk,  a a a We  invite  you 
to  try  S.  M.  A.  in  your  own 
infant  feeding  work  and  prove 
to  yourself  that  results  are  ob- 
tained more  simply  and  more 
quickly  with  S.  M.  A. 

Write  to  our  nearest  office  for 
samples  and  our  Questions 
and  Answers  Booklet  No.  A-20. 

\ 

The  Laboratory  Products  Company 
Cleveland,  Ohio 

West  of  Rockies: 

437-0-9  Phelan  Building,  San  Francisco,  Cal. 

In  Canada: 

64  Gerrard  Street,  East,  Toronto,  Ontario 
In  England: 

Adelaide  House,  King  William  St.,  London,  E.  C.  4. 


POLLEN  EXTRACTS  [CUTTER] 


CUTTER 
Regional 
Test  Sets 
are 

Accurate ! 
Convenient ! 
Safe ! 


I 


Treatment 

Sets 

containing 
60,000 
Pollen  Units 

i -t 

No  minimum 
Spoonfed 
Dosage 
✓ / 

30  or  more 
Doses 

if  necessary 


THE  CUTTER  LABORATORY,  P-2 

Berkeley,  California. 

Gentlemen: 

Please  send  me 

Free  booklet  containing  Pollen  Chart. 

Spring  Test  Sets  for  my  region,  for  which 

find  enclosed  my  check  at  $1.00  each. 

Dr.  

Street 

City State  


PRODUCED  for  physicians  who  desire  max- 
imum results.  Cutter  regional  test  sets  and 
flexible-dosage,  high-unitage  treatment  sets,  are 
based  on  no  questionable  short-cuts  such  as 
group  testing,  stock  mixed  treatment  sets, 
spoonfed  dosage,  etc. 

Send  for  Free  Literature  with 
Geographical  Pollen  Chart 

The  Cutter  Laboratory  Berkeley 

/ CALIFORNIA 

Established  1897 


DANTE  SANATORIUM 

BROADWAY  AND  VAN  NESS  AVENUE 

SAN  FRANCISCO  CALIFORNIA 


Known  for  the  High  Standard  of  Cuisine  and  Service 

E.  A.  TRENKLE,  Manager 


Phone  GRAYSTONE  1200